Surgical treatment of pleural empyema in Coronavirus disease 19 patients: the Southern Switzerland experience

Abstract

We report the first surgical series of patients developing pleural empyema after severe bilateral interstitial lung disease in confirmed severe acute respiratory syndrome coronavirus 2 infection. The empyema results in a complex medical challenge that requires combination of medical therapies, mechanical ventilation and surgery. The chest drainage approach was not successful to relieve the symptomatology and to drain the excess fluid. After multidisciplinary discussion, a surgical approach was recommended. Even though decortication and pleurectomy are high-risk procedures, they must be considered as an option for pleural effusion in Coronavirus disease-positive patients. This is a life-treating condition, which can worsen the coronavirus disease manifestation and should be treated immediately to improve patient’s status and chance of recovery.

Post COVID-19 pulmonary complications; a single center experience

“…Patients may be asymptomatic at the time of presentation due to the slow respiratory compensation of this process [ 15 ]. Bacterial super infection and subsequent development of pleural empyema may have been promoted by the combination of acute inflammatory state with the onset of reactive pleural effusion [ 16 ].…”

“…However, because of the small number of cases and the procedure's risk grade, surgical treatment of pleural empyema in COVID-19 patients is still to be described in the literature. Pleural empyema is a rare but possible complication, it is a life-treating disease, which can worsen the COVID-19 disease manifestations, and it should be treated immediately to improve patient's status and chance of recovery [ 16 ]. Most of the patients in the current study with empyema were managed through decortication, except for one case who underwent lobectomy.…”

Successful endobronchial occlusion in empyema with broncho‐pleural fistula secondary to COVID‐19 pneumonia: a case report and literature review

“…Bilateral multiple pneumonia is a common clinical presentation in COVID‐19 cases [5,6] and some cases with complex respiratory pathophysiology, such as pneumothorax, pneumomediastinum, and empyema, have been reported [7,8]. To our knowledge, five cases of empyema secondary to COVID‐19 have been reported to date, including two cases of pleural fistula (Table 1) [1–3]. All five patients were treated with surgical intervention, such as decortication, and four of these cases resulted in a good clinical course.…”

“…More recently, the complex respiratory pathophysiology of COVID‐19 pneumonia has been increasingly reported, and it is accompanied by pneumothorax, pneumomediastinum, and empyema. A few cases of surgical interventions for empyema secondary to COVID‐19 pneumonia have been reported [1–3]. However, the appropriate management of air leaks in COVID‐19 has not yet been established.…”

Anesthetic Management for Thoracic Surgery During the COVID-19 Pandemic

“…Persistent air leak management may require surgical management if initial treatments fail. Surgical management of pleural empyema as a complication of severe COVID-19 has also been reported [10], and, rarely, lung transplantation as salvage therapy for irreversible lung damage in carefully selected COVID-19 patients [11].…”