Management of Persistent Pneumothorax With Thoracoscopy and Bleb Resection in COVID-19 Patients

Aiolfi, Alberto; Biraghi, T; Montisci, Andrea; Bonitta, Gianluca; Micheletto, Giancarlo; Donatelli, Francesco; Cirri, Silvia; Bona, Davide

doi:10.1016/j.athoracsur.2020.04.011

Cited by 77 publications

(81 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Nevertheless, for the management of pneumothorax or pneumomediastinum, some patients (40%; 8/20) required a chest tube drainage, 8,16,[19][20][21][22][23][24] others (5%; 1/20) also required needle aspiration, 24 and thoracoscopy and bleb resection were required in two (10%) cases of persistent or recurrent pneumothorax. 25 The remaining patients were either managed conservatively or not reported.…”

Section: Discussionmentioning

confidence: 99%

Case Report: Pneumothorax and Pneumomediastinum as Uncommon Complications of COVID-19 Pneumonia—Literature Review

Quincho-Lopez

Hurtado-Medina

2020

The American Journal of Tropical Medicine and Hygiene

View full text Add to dashboard Cite

As the COVID-19 pandemic progresses, awareness of uncommon presentations of the disease increases. Such is the case with pneumothorax and pneumomediastinum. Recent evidence suggested that these can occur in the context of COVID-19 pneumonia, even in the absence of mechanical ventilation-related barotrauma. We present two patients with COVID-19 pneumonia complicated by pneumomediastinum. The first patient was a 55-year-old woman who developed COVID-19 pneumonia. Her clinical course was complicated by pneumothorax and pneumomediastinum, and, unfortunately, she died 2 days following the admission. The second patient was a 31-year-old man who developed a small pneumomediastinum and was managed conservatively. He had a spontaneous resolution of the pneumomediastinum and was discharged 19 days later. None of our patients required invasive or noninvasive positive pressure ventilation. We performed a literature review of COVID-19 pneumonia cases that developed pneumothorax, pneumomediastinum, or both. The analysis showed that the latter had high mortality (60%). Thus, it is necessary to pay attention to these complications as early identification and management can reduce the associated morbidity and mortality.

show abstract

Section: Discussionmentioning

confidence: 99%

Case Report: Pneumothorax and Pneumomediastinum as Uncommon Complications of COVID-19 Pneumonia—Literature Review

Quincho-Lopez

Hurtado-Medina

2020

The American Journal of Tropical Medicine and Hygiene

View full text Add to dashboard Cite

show abstract

“…Two pneumothorax cases were managed by lung rest strategy using ECMO. In refractory cases of pneumothorax, surgical intervention with thoracoscopy may be considered if conservative treatment fails [36].…”

Section: Treatments and Clinical Outcomesmentioning

confidence: 99%

Characteristics, laboratories, and prognosis of severe COVID-19 in the Tokyo metropolitan area: A retrospective case series

Mori

Otomo

2020

PLoS ONE

View full text Add to dashboard Cite

The impact of the COVID-19 pandemic has been immense, while the epidemiology and pathophysiology remain unclear. Despite many casualties in many countries, there have been less than 1,000 deaths in Japan as of end of June, 2020. In this study, we analyzed the cases of COVID-19 patients admitted to our institution located in the Tokyo metropolitan area where the survival rate is higher than those in other cities in the world. Medical records of COVID-19 patients that were admitted to a single Japanese tertiary university hospital in the Tokyo metropolitan area between March 10th and June 2nd, 2020 were retrospectively reviewed. The identified COVID-19 cases were subdivided into two groups (severe and mild) depending on the need for mechanical ventilation. Those in the severe group required mechanical ventilation as opposed to those in the mild group. The data were analyzed using nonparametric tests expressed by median [interquartile range (IQR)]. A total of 45 COVID-19 patients were included, consisting of 22 severe cases (Group S) and 23 mild cases (Group M). Male sex (Group S, 95.5% vs. Group M, 56.5%, p<0.01), high body mass index (Group S, 24.89 [22.44-27.15] vs. Group M, 21.43 [19.05-23.75], p<0.01), and hyperlipidemia (Group S, 36.4% vs. Group M, 0%, p<0.01) were more seen in Group S. Five (22.7%) cases in Group S underwent extracorporeal membranous oxygenation (ECMO). On admission, lymphopenia, decreased albumin, and elevated fibrinogen, lactate dehydrogenase, transaminases, creatine kinase, C-reactive protein, and procalcitonin were observed in Group S. The median ICU and hospital stay were 13.5 [10.3-22.3] days and 23.0 [16.3-30.5] days, respectively, in Group S. As of June 28th, 2020, in Group S, 19 (86.4%) patients have survived, of which 17 (77.3%) were discharged, and 2 are still in treatments. Three died of multiple organ failure. All 23 patients in Group M have recovered. Male sex, high body mass index, and hyperlipidemia can be risk factors for severe COVID-19 pneumonia, and its overall short-term survival rate was between 77.3% and 86.4% in this study.

show abstract

“…Consent was not needed to be obtained as no identifying data were used and this study was made IRB exempt under 45 CFR 46.01(b) [4].…”

Section: Ethics Approval and Consent To Participatementioning

confidence: 99%

“…Due to limited knowledge of lung histopathology with COVID-19, it is unknown how well the diseased lung tissue will spontaneously heal and reexpand without intervention. For moderate to large pneumothorax and prolonged air leak, there have been reports of successful treatment with video-assisted thoracoscopic surgery and wedge resection [4]. There have also been explanations on how to contain viral dissemination by using bespoke viral filtration systems to limit contamination [5].…”

Section: Introductionmentioning

confidence: 99%

Expectant management of pneumothorax in intubated COVID-19 positive patients: a case series

Elder

Bawa

Anderson

et al. 2020

J Cardiothorac Surg

View full text Add to dashboard Cite

Background There is an increasing amount of literature describing the pathogenesis of coronavirus disease 2019 (COVID-19) pneumonia and its associated complications. Historically, a small pneumothorax has been shown to be successfully treated without chest tube insertion, but this management has yet to be proven in COVID-19 pneumonia patients. In addition, pneumothorax in an intubated patient with high positive end-expiratory pressure (PEEP) provides additional uncertainty with pursuing non-operative management. Case presentation In this series we report four cases of patients with respiratory distress who tested positive for COVID-19 via nasopharyngeal swab and developed ventilator-induced pneumothoraces which were successfully managed with observation alone. Conclusions Management of patients with COVID-19 pneumonia on positive pressure ventilation who develop small stable pneumothoraces can be safely observed without chest tube insertion.

show abstract

Management of Persistent Pneumothorax With Thoracoscopy and Bleb Resection in COVID-19 Patients

Cited by 77 publications

References 9 publications

Case Report: Pneumothorax and Pneumomediastinum as Uncommon Complications of COVID-19 Pneumonia—Literature Review

Case Report: Pneumothorax and Pneumomediastinum as Uncommon Complications of COVID-19 Pneumonia—Literature Review

Characteristics, laboratories, and prognosis of severe COVID-19 in the Tokyo metropolitan area: A retrospective case series

Expectant management of pneumothorax in intubated COVID-19 positive patients: a case series

Contact Info

Product

Resources

About