Thoracic Surgery Consultations in COVID-19 Critically Ill Patients: Beyond Conservative Approach

Abstract

Introduction. Iatrogenic pneumothoracis, barotraumas, and tracheoesophageal fistulae, especially after prolonged intubation, and tracheal stenosis are all entities involving thoracic surgeons’ consultation and management. With the surge of COVID-19 cases particularly in the critical care settings, various types of complications have been observed that require intervention from thoracic surgeons. Methods and Materials. A retrospective study was conducted in an academic healthcare institute in the Eastern Province of Saudi Arabia. We included all COVID-19 cases admitted to ICU in the period between March 15, 2020, and August 15, 2020, requiring thoracic surgery consultation and management. Non-COVID-19 critical cases and iatrogenic pneumothorax were excluded. Results. Of 122 patients who were admitted to ICU with COVID-19, 18 patients (14.75%) required thoracic surgery consultation and management. We discovered a significant association between the outcomes and reintubation rates and the rate of pneumothorax occurrence. The survival analysis showed improvement in patients who had thoracostomy tube insertion as a management than the group who were treated conservatively. On the other hand, there was a significant difference between the COVID ICU group who had thoracic complication and those who did not regarding the length of hospital stay. Conclusion. Noniatrogenic 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.

Pneumomediastinum and pneumothorax in coronavirus disease-2019: Description of a case series and a matched cohort study

“…However, most patients with isolated PM or accompanying PM were followed up without an intervention. Although some studies showed a survival benefit for interventions in patients with PTX in COVID-19 patients, a study comparing COVID-19 patients with PTX and pleural effusion to non-COVID-19 patients showed that the benefit of tube thoracostomy was more limited in the former [ [68] , [69] , [70] ]. There is no consensus regarding the treatment of PTX/PM in COVID-19 patients yet.…”

Incidence, clinical associations and outcomes of intrathoracic complications with and without ARDS in COVID-19 pneumonia

“…patients or small sample size. 5,36 The ability to predict who may need a higher level of care may aid in clinical decision-making such as degree of patient monitoring (i.e. remote home monitoring versus admission).…”

Lessons learned by thoracic surgeons during the COVID-19 pandemic

“…There are many potential roles for thoracic surgeons during a respiratory-symptom predominant viral pandemic. Certain complications of COVID-19 may require thoracic surgical intervention, including pneumothorax, pneumatocele, empyema, hemothorax, and end stage lung disease (5)(6)(7)(8). Given their clinical familiarity with the airway, thoracic surgeons may be called on to perform tracheostomies.…”