Surgical treatment of pneumothorax in patients with COVID-19 – results and management

Abstract

Introduction: The new coronavirus, SARS-CoV-2, provokes infection with different clinical presentation. It involves an asymptomatic condition, mild variants with fever and dry cough to severe pneumonia, adynamia and respiratory failure with lethal outcome. The fibrotic lung tissue after the inflammatory process is a background for development of a secondary pneumothorax. Although it rarely causes lethal outcomes in COVID-19 patients, pneumothorax requires early diagnosis and adequate treatment to prevent any complications and decrease mortality rate. Aim: The aim of this study was to analyse the results of surgical treatment of hospitalized COVID-19 patients with pneumothorax in terms of demographic data, concomitant diseases, complications, and outcome. Materials and methods: Longitudinal prospective study was carried out with 26 patients with pneumothorax as a result of SARS-CoV-2 infection. They were treated at the Intensive Care Unit of the Infectious Disease Clinic and at the Second Clinic of Surgery, St George University Hospital in Plovdiv over a 6-month period from September 2020 to February 2021. Results: Seventeen of the patients were men and nine – women. Twenty-four of all patients underwent thoracentesis and two of them had a video-assisted thoracoscopy. The mean age of the studied patients with pneumothorax and COVID-19 was 66.77±12.61 years, which shows that it is the patients of advanced age with concomitant diseases that are at a higher risk of serious complications and adverse outcome. Of the hospitalized 1245 patients with COVID-19, 385 (30.92%) passed away. Of all hospitalized patients with SARS-CoV-2, 26 (2.08%) developed pneumothorax. Sixteen of them (62%) passed away. The possibility of a lethal outcome for intubated patients increased more than twice. Conclusions: The pneumothorax as a complication of COVID-19 carries high mortality and severely worsens the prognosis for these patients.

The Biological Processes of Ferroptosis Involved in Pathogenesis of COVID-19 and Core Ferroptoic Genes Related With the Occurrence and Severity of This Disease

“… 25 There are limited medical intervention strategies to prevent the COVID-19. 26 Therefore, the deeper we clarify the pathogenic mechanisms of this disease, the better treatment efficacy will be. Emerging evidence indicated that the multi-organ failures rapidly happened in severe COVID-19 cases may due to the hemoglobin damage which could lead to iron overload.…”

Uso de colangiopancreatografía retrógrada endoscópica en pacientes con fístula biliopleural

“…The clinical manifestations are described as acute or chronic: the acute event the patient begins with respiratory stress, febrile syndrome, pleuritic pain in the lower portion of the right hemithorax, irritative cough, yellowish sputum in cases of BBPF, and right pleural effusion. The chronic condition is characterized by chronic cough, occasional yellow sputum, intermittent fever, and pneumonia-like conditions 8,9 .…”