Comparison of the tube thoracostomy techniques on treatment in COVID-19 patients with pneumothorax (original) (raw)
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Background: Patients with COVID-19 are at risk of developing acute respiratory distress syndrome requiring invasive mechanical ventilation. Barotrauma in these patients often leads to clinically significant pneumothorax, which necessitates chest tube thoracostomy. However, given the mode of transmission of the severe acute respiratory syndrome coronavirus 2 virus and the aerosolizing nature of the procedure, special considerations and care must be taken to mitigate the exposure risks to health care personnel. This article discusses the risk mitigation strategies proposed and under review at the authors’ institution. Objective To identify and diagnosis Tube thoracostomy of COVID-19 positive patients during COVID-19 pandemic under thoracic surgery unit of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. Methods and materials A retrospective study was conducted in thoracic surgery unit of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. Seventeen patients included in our study. We included all COVID-19 cases admitted to ICU in the period between July 2020 to August 2021, requiring thoracic surgery consultation and management. Non-COVID-19 critical cases and iatrogenic pneumothorax were excluded. Results Total 17 patients required thoracic surgery consultation and management. Causes were pneumothorax: 05 cases (29.41%), traumatic hemothorax: 01 cases (5.88%), hydropneumothorax: 01 case (5.88%) and massive pleural effusion: 10 cases (58.82%). No complication after tube thoracostomy. 15 patient’s condition were improved in relation to oxygen demand and left hospital in good health and two patient died 3 days after tube thoracostomy who were in artificial ventilation and both patients had more than 81% lung involvement (fibrosis) diagnosed by CT scan of chest. The survival analysis showed improvement in patients who had thoracostomy tube insertion as a management than the group who were treated conservatively. Conclusion Non-iatrogenic pneumothorax, subcutaneous emphysema, and mediastinal emphysema are well-known thoracic entities, but their presence in the context of COVID-19 disease is a harbinger for worse prognosis and outcomes. The presence of pneumothorax may be associated with better prognosis and outcome compared to surgical and mediastinal emphysema.
Protective measures undertaken during chest tube thoracostomy in COVID-19 outbreak
Indian Journal of Thoracic and Cardiovascular Surgery, 2020
Background Coronavirus disease 2019 (COVID-19) is a newly emerging infectious disease that was first reported in China and has become a worldwide pandemic. Many surgical procedures are continuing to be performed during this state of pandemic as is thoracic surgery. We present six cases of tube thoracostomy in COVID-19 patients and the modifications to the routine surgical technique. Methods We serially attached two closed underwater drainage systems (CUDS) together and added a high-efficiency particulate air (HEPA) filter to the port of the second CUDS, because the intrapleural air, which passes through the CUDS into the air in intensive care unit (ICU), may contain high concentrations of 2019 novel coronavirus (2019-nCoV). Second, we attached the chest drain to the first CUDS in order to prevent the spread of virus during the placement of drain into the pleural cavity. Third, just before opening the parietal pleura, ventilation was put on standby mode and the endotracheal tube was clamped to prevent viral dissemination to the environment. Fourth, we covered the incision with a gauze sponge soaked with sterile saline solution during pleural entry, to prevent viral dissemination into the environment. Results There were a total of six patients enrolled in our study. All these patients were diagnosed with COVID-19. The surgical indication for the chest tube thoracostomy was tension pneumothorax in all six patents. All patients had lung expansion defects and subcutaneous emphysema after intervention. Unfortunately, all of them succumbed to COVID-19, despite best available treatment. There was no COVID-19 infection reported in the healthcare professionals during this study. Conclusions Thoracic surgical procedures may cause dissemination of high amounts of 2019-nCoV in the environment and thus are perhaps the most dangerous surgeries to perform. Variations in the thoracic surgical techniques are necessary in order to protect the healthcare providers from COVID-19.
Tube Thoracostomy Surgery among COVID-19 Positive Patients in a Tertiary Care Hospital in Bangladesh
Annals of International Medical and Dental Research, 2022
Background: Acute respiratory distress syndrome requiring invasive mechanical ventilation may occur in COVID-19 patients. Barotrauma causes clinically severe pneumothorax, necessitating a chest tube thoracostomy. Acute respiratory syndrome coronavirus 2 is aerosolized during the process, hence specific precautions must be taken to minimize exposure risks to health care workers. Objectives: The objective of the study to diagnosis of Tube thoracostomy during the COVID-19 pandemic to detect and diagnose patients who are positive with the virus.Material & Methods:In Bangladesh, researchers from a tertiary care hospital’s thoracic surgery section did a retrospective analysis. In total, we had 34 participants. All COVID-19 cases requiring thoracic surgery consultation and management that were admitted to the ICU between July 2020 and January 2022 were included in this study. Iatrogenic pneumothorax and other critical cases not associated with COVID-19 were also eliminated.Results:Thirty-f...
Cardiology and Cardiovascular Medicine, 2021
Background: Patients with COVID-19 are at risk of developing acute respiratory distress syndrome requiring invasive mechanical ventilation. Barotrauma in these patients often leads to clinically significant pneumothorax, which necessitates chest tube thoracostomy. However, given the mode of transmission of the severe acute respiratory syndrome coronavirus 2 virus and the aerosolizing nature of the procedure, special considerations and care must be taken to mitigate the exposure risks to health care personnel. This article discusses the risk mitigation strategies proposed and under review at the authors' institution. Objective To identify and diagnosis Tube thoracostomy of COVID-19 positive patients during COVID-19 pandemic under thoracic surgery unit of
Turkish journal of emergency medicine, 2018
Traumatic iatrogenic pneumothorax occurs most often after a transthoracic needle biopsy. Since this procedure has become a common outpatient intervention, emergency department admissions of post-biopsy pneumothorax patients have increased. The aim of this study was to determine the factors that predict the need for tube thoracostomy in patients with post-biopsy pneumothorax in the emergency department. A retrospective cross-sectional study was conducted on 191 patients with post-biopsy pneumothorax who were admitted to the emergency department between 2010 and 2017. Patient characteristics, clinical findings at the emergency department presentation, and procedural and radiological features were reviewed. A multivariate logistic regression model was constructed using the variables from univariate comparisons to determine the need for tube thoracostomy in patients with iatrogenic pneumothorax, and the effect sizes were demonstrated with odds ratios. Tube thoracostomies were performed ...
Recurrent pneumothorax in a COVID-19 patient: A case report
Respiratory Medicine Case Reports, 2020
An 88-year-old woman diagnosed with COVID-19 in Brazil presented with recurrent pneumothorax. She was under mechanical ventilation for 20 days because of acute respiratory distress syndrome (ARDS). Chest x-ray revealed right lung pneumothorax, which was treated with a pigtail chest tube leading to successful lung reexpansion. After 48 hours the patient developed an ipsilateral pneumothorax and a new tube thoracostomy under conventional chest tube under suction was performed and kept in place for 14 days. This brief report highlights that the conventional chest tube under suction procedures might be a good choice in Covid-19 patients.
Analysis of Tube Thoracostomy Performed by Pulmonologists at a Teaching Hospital
Chest, 1997
To evaluate all tube thoracostomies (TTs) done by pulmonary/critical care fellows and attending physicians in the Medical University of South Carolina's health-care system documenting patient demographics, indication for placement, size and characteristics of the tube, and associated problems. Design: Prospective. Setting: University health-care system, including a university hospital, a Veterans Affairs hospital, and a county hospital. Patients: All adult patients requiring consultation by a member of the pulmonary/critical care staff for a tube thoracostomy. Results: One hundred twenty-six tube thoracostomies were performed over a 24-month period in 91 patients. The most common initial indication for a TT was pneumothorax (69/103, 67%). Overall mortality in the patient population was 35% (32/91). Early problems (<24 hours following placement) occurred in 3% (4/126); late problems (>24 h after placement) occurred in 8% (10/126). Problems occurred in 36% (4/ll) of small-bore tube placements vs 9% (10/ll5) of standard TT placements (p=0.02). Conclusions: Tube thoracostomy can be safely performed by pulmonologists with relatively few associated problems.
Management of spontaneous pneumothorax in patients with COVID-19
Interactive CardioVascular and Thoracic Surgery, 2021
OBJECTIVES The coronavirus disease 2019 (COVID-19) pneumonia may cause cystic features of lung parenchyma which can resolve or progress to larger blebs. Pneumothorax was more likely in patients with neutrophilia, severe lung injury and a prolonged clinical course. The timely diagnosis and management will reduce COVID-19-associated morbidity and mortality. METHODS We present 11 cases of spontaneous pneumothorax managed with chest tube thoracostomy or high-dose oxygen therapy. Isolated spontaneous pneumothorax was detected in all cases. RESULTS Eight cases were male and 3 cases were female. There were bilateral ground-glass opacities or pulmonary infiltrates in the parenchyma of the 10 cases. We detected neutrophilia, lymphopaenia and increased C-reactive protein, Ferritin, lactate dehydrogenase, D-Dimer, interleukin-6 levels in almost all cases. Chest tube thoracostomy was sufficient to treat pneumothorax in our 9 of case. In 2 cases, pneumothorax healed with high-dose oxygen therapy...
Indonesian Journal of Anesthesiology and Reanimation, 2022
Introduction: Coronavirus disease-19 (COVID-19) has become a pandemic that is still ongoing today. This is a new challenge for health workers in handling emergency cases. Several COVID-19 patients arrived at the hospital with severe respiratory problems. Meanwhile, other pathological conditions causing respiratory failure must also be considered, such as pneumothorax. Objective: This study aimed to examine the effective emergency procedures to treat COVID-19 cases with tension pneumothorax. Case report: A 45-year-old male patient arrived with a referral letter from a pulmonologist with a diagnosis of simple pneumothorax and pneumonia. The patient also presented a positive SARS COV-2 PCR test result. The patient complained about a worsening of shortness of breath. A symptom of dry cough for 14 days was also reported. Chest radiograph examination subsequently indicated right tension pneumothorax. In the emergency ward, needle decompression procedure connected to the vial containing st...
A Comparative Evaluation of Pneumothorax in Ventilated Patients of COVID-19
SSRN Electronic Journal, 2021
Background: Coronavirus disease 2019 can complicate into pneumothorax and need hospitalization. We aimed to discuss the presence of pneumothorax and its possible causality in vulnerable patients of COVID-19 to set up an effective preventive and therapeutic strategy for this fatal complication. Methods: This retrospective observational case-control study included a total of 90 admitted patients of COVID-19 supported with NIV ventilation. 45 patients had a pneumothorax and another 45 had without pneumothorax as a control group. The patient's data concerning demography, clinical profile, point of onset of pneumothorax, required FiO2, PEEP, radiological imaging, and outcome were extracted from their medical records. All collected data were tabulated, compiled, and analyzed to establish the possible causality of pneumothorax. Results: Patients of both groups had matched demographic and clinical symptoms. Patients with pneumothorax had late hospitalization (10.04 v/s 7.11 days), require high PEEP (10.46 v/s 8.71 cmH2O), had raised inflammatory markers (NLR 7.46 v/s 6.23; CRP 44.04 v/s 32.73; D-dimer 2311 v/s 1801 µg/mL), high mortality (26.67% v/s 8.89%) and longer hospital stay (50.66 v/s 37.88) as compared to control group of without pneumothorax with p-value < 0.05. In our study pneumothorax developed 3rd week onwards after symptoms onset with a mean time of pneumothorax was found to be 22.04 days. Conclusion: Pneumothorax in COVID-19 infected patients of intensive care unit can be precipitated by severe COVID-19 pneumonia of longer duration with late hospitalization with high PEEP and raised inflammatory markers going to rapid worsening of symptoms.