Tube thoracostomy during the COVID-19 pandemic: guidance and recommendations from the AAST Acute Care Surgery and Critical Care Committees

Pieracci, Fredric M.; Burlew, Clay Cothren; Spain, David A.; Livingston, David H.; Bulger, Eileen M.; Davis, Kimberly A.; Michetti, Christopher P.

doi:10.1136/tsaco-2020-000498

Cited by 55 publications

(74 citation statements)

References 6 publications

(5 reference statements)

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“…Pneumothorax should be managed following standard guidelines, wearing personal protective equipment for chest tube placement and considering strategies to minimise droplet exposure via the chest drain circuit ( e.g. , connecting anti-viral filters on suction ports or adding bleach to the water seal chamber) [ 33 ].…”

mentioning

confidence: 99%

Pleural diseases and COVID-19: ubi fumus, ibi ignis

Porcel

2020

Eur Respir J

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More than 45 000 articles in the PubMed database and around 3200 studies registered in ClinicalTrials.gov, of which greater than half are clinical trials, is the result of ongoing and relentless research into the global pandemic nature of an acute respiratory disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which made its initial appearance in December 2019 in China. As of August 28, the total confirmed cases of coronavirus disease 2019 (COVID-19) surpass 24.5 million people, with over 830 000 global deaths [1]. An estimated 40% to 45% of persons infected with SARS-CoV-2 will remain asymptomatic, but they can transmit the virus to others for an extended period, perhaps longer than 14 days [2]. The primary presentation of symptomatic infection is that of an influenza-like illness or viral pneumonia, with about 20% of these patients developing severe or critical manifestations [3].

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confidence: 99%

Pleural diseases and COVID-19: ubi fumus, ibi ignis

Porcel

2020

Eur Respir J

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“… 8 These data support risk mitigation in patients with suspected or proven COVID-19, as recommended by the BTS 6 and the AAST. 7 However, the absolute risk involved remains uncertain and the experimental set-up used cannot be considered exactly equivalent to a bubbling drain in a clinical setting. Pleural effusion and pneumothorax appear uncommon complications of COVID-19 (occurring in ~5% and ~1% of cases, respectively 6 8 ) and an aerosol-generating chest drain can clearly only be an infection risk if SARS-CoV-2 is (a) present in any effusion drained (which may be of minimal volume in patients with pneumothorax and major air-leaks) and (b) remains viable long enough to be aerosolised.…”

Section: Discussionmentioning

confidence: 99%

“…The latter includes a cohort of 25 Chinese patients (including 12 HCWs) infected from a single index case who underwent elective lobectomy with undetected SARS-CoV-2 infection. 5 This has prompted expert bodies, including the British Thoracic Society (BTS) 6 and the American Association for the Surgery of Trauma (AAST) 7 to recommend risk mitigation of some form until the level of risk involved is more clearly understood. Risk mitigation options include connection of all patients to wall suction, use of a digital chest drain system or use of a bespoke anti-viral filter attached to a standard chest drain bottle.…”

Section: Introductionmentioning

confidence: 99%

Chest drain aerosol generation in COVID-19 and emission reduction using a simple anti-viral filter

et al. 2020

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IntroductionThe COVID-19 pandemic has been characterised by significant in-hospital virus transmission and deaths among healthcare workers. Sources of in-hospital transmission are not fully understood, with special precautions currently reserved for procedures previously shown to generate aerosols (particles <5 μm). Pleural procedures are not currently considered AGPs (Aerosol Generating Procedures), reflecting a lack of data in this area.MethodsAn underwater seal chest drain bottle (R54500, Rocket Medical UK) was set up inside a 60-litre plastic box and connected via an airtight conduit to a medical air supply. A multichannel particle counter (TSI Aerotrak 9310 Aerosol Monitor) was placed inside the box, allowing measurement of particle count/cubic foot (pc/ft3) within six channel sizes: 0.3–0.5, 0.5–1, 1–3, 3–5, 5–10 and >10 μm. Stabilised particle counts at 1, 3 and 5 L/min were compared by Wilcoxon signed rank test; p values were Bonferroni-adjusted. Measurements were repeated with a simple anti-viral filter, designed using repurposed materials by the study team, attached to the drain bottle. The pressure within the bottle was measured to assess any effect of the filter on bottle function.ResultsAerosol emissions increased with increasing air flow, with the largest increase observed in smaller particles (0.3–3 μm). Concentration of the smallest particles (0.3–0.5 μm) increased from background levels by 700, 1400 and 2500 pc/ft3 at 1, 3 and 5 L/min, respectively. However, dispersion of particles of all sizes was effectively prevented by use of the viral filter at all flow rates. Use of the filter was associated with a maximum pressure rise of 0.3 cm H2O after 24 hours of flow at 5 L/min, suggesting minimal impact on drain function.ConclusionA bubbling chest drain is a source of aerosolised particles, but emission can be prevented using a simple anti-viral filter. These data should be considered when designing measures to reduce in-hospital spread of SARS-CoV-2.

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“…During the patient's convalescence, whether in the ICU or in the wards, all care is necessary during the exchange of the water seals; it is advisable to reinforce the connections with adhesive tape or even with plastic clamps 13,14 .…”

Section: Discussionmentioning

confidence: 99%

Chest tubes in COVID-19 times: a safe way to protect the team

Medeiros

Westphal

2020

Rev. Assoc. Med. Bras.

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INTRODUCTION: What has been published so far regarding safe methods to deal with chest tube insertion during COVID-19. METHODS: A descriptive study of the literature available in the Medline/PubMed, Lilacs, Scopus databases and specialized books. The search was carried out using the terms "infectious diseases"; "COVID-19"; "Chest tubes". RESULTS: This paper aggregates and consolidates some old concepts to new tactics to minimize the contamination of teams who deal with chest tubes, before, during, and after the procedure. CONCLUSIONS: Health officials are under increasing pressure to control the spread of COVID-19, which is a very virulent disease. Our analysis brought together old rules against contamination along with new tactics for professionals who deal with chest drains in order to minimize the contamination of teams during the Pandemic.

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Tube thoracostomy during the COVID-19 pandemic: guidance and recommendations from the AAST Acute Care Surgery and Critical Care Committees

Abstract: This document provides guidance for trauma and acute care surgeons surrounding the placement, management and removal of chest tubes during the COVID-19 pandemic.

Cited by 55 publications

References 6 publications

Pleural diseases and COVID-19: ubi fumus, ibi ignis

Pleural diseases and COVID-19: ubi fumus, ibi ignis

Chest drain aerosol generation in COVID-19 and emission reduction using a simple anti-viral filter

Chest tubes in COVID-19 times: a safe way to protect the team

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