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SESSION TITLE: Chest Infections Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: The radiological changes in the lungs of patients infected with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) have not been fully characterized, but different radiological patterns have been observed at different times throughout the disease course. Pleural effusions range between 5% and 9.7% of the patients with confirmed COVID-19 pneumonia. In this study we aimed to calculate the prevalence of pleural effusions in COVID-19 hospitalized patients and to objectively describe the pleural fluid characteristics in this subgroup of patients. METHOD(S): Retrospective medical records review of patients diagnosed with pleural effusions and SARS-CoV-2 between January 1, 2020 and May 20, 2020 at Beth Israel Deaconess Medical Center, Boston, MA. Patients were identified from our institutional database. Demographics, baseline comorbidities, mortality, intensive care unit (ICU) stay, interventions and pleural fluid analysis (PFA) were recorded. RESULT(S): A total of 587 patients were admitted with SARS-CoV-2 infection (Age 65.29 years [SD 16.9];49.9% males). Nineteen (3.2%) developed pleural effusions during hospitalization course. There was no statistical difference between the baseline characteristics of both groups. Patients who developed pleural effusions had a prolonged ICU stay (7 vs 2 days, p=0.01). There was no statistically significant increased mortality rate in the pleural effusions group. Six (31.6%) of patients with pleural effusions required fluid drainage with tube thoracostomy. All PFA of the six patients were non complicated neutrophilic exudates. CONCLUSION(S): Pleural effusions are an infrequent finding in patients with COVID-19. Most effusions are small and don't require drainage. Pleural effusions may not be associated with an increased mortality in COVID-19 patients, but further prospective large cohort studies are needed. CLINICAL IMPLICATIONS: Characterization of pleural effusions in COVID-19. DISCLOSURES: No relevant relationships by Ramsy Abdelghani, source=Web Response No relevant relationships by Alvaro Ayala, source=Web Response No relevant relationships by Alex Chee, source=Web Response No relevant relationships by Fayez Kheir, source=Web Response Consultant relationship with Boston Scientific Please note: $1001 - $5000 by Adnan Majid, source=Web Response, value=Consulting fee Consultant relationship with olympus Please note: $5001 - $20000 by Adnan Majid, source=Web Response, value=Consulting fee Consultant relationship with pinacle biologics Please note: $1001 - $5000 by Adnan Majid, source=Web Response, value=Consulting fee Consultant relationship with cook medical Please note: $1001 - $5000 by Adnan Majid, source=Web Response, value=Consulting fee No relevant relationships by Rachel Martinez, source=Web Response No relevant relationships by Mihir Parikh, source=Web Response No relevant relationships by Priya Patel, source=Web Response No relevant relationships by Alichia Paton, source=Web Response No relevant relationships by Juan Pablo Uribe, source=Web ResponseCopyright © 2020 American College of Chest Physicians
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SESSION TITLE: Chest Infections Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Approximately 1% of patients admitted for SARS-CoV-2 may develop pneumothorax (PTX) during the hospitalization. Currently there is no literature available regarding the development of pneumothorax during SARS-CoV-2 infection neither the characteristics nor clinical outcomes of these patients. We present a single center review of 11 subjects who developed PTX during the course of hospitalization for SARS-CoV-2. METHOD(S): Retrospective medical records review of patients diagnosed with PTX and SARS-CoV-2 between January 1, 2020 and May 8, 2020 at Beth Israel Deaconess Medical Center in Boston, MA. Patients were identified from our institutional database (Clinical Query 2). Demographics, baseline comorbidities, hospital stay, ICU stay, interventions and crude mortality are presented. RESULT(S): A total of 11 inpatients with SARS-CoV-2 and PTX were included (mean age 66.45 years [SD 13.28];81.82% [n=9] males;72.73% PTX on the right side). The mean hospital stay until discharge or death was 25.91 days (SD 11.61), with a mean time from admission to PTX of 13.81 days (SD 12.27). Nine (81.82%) of PTX were secondary spontaneous and 2 (18.18%) iatrogenic. The most common comorbid conditions found were hypertension (54.55%) followed by hyperlipidemia (45.45%), malignancy (27.27%) and congestive heart failure (27.27%). Nine (81.81%) subjects were on the ICU when the event occurred with a mean ICU stay of 15.11 days (SD 8.89). Seven (63.64%) patients were under mechanical ventilation with a mean intubation time of 19.86 days (SD 10.17). Ten (90.91%) subjects required chest tube insertion with 54.54% (n=6) requiring chest tube size > 14 Fr. Two (18.18%) patients ended up having tracheostomy and 5 (45.45%) died before discharge. CONCLUSION(S): We found that secondary and iatrogenic PTX may be an infrequent complication of patients admitted for the treatment of SARS-CoV-2. This entity may be implicated in acute clinical deterioration with rapid oxygen desaturation in critically ill patients. CLINICAL IMPLICATIONS: Pneumothorax may be may be implicated in acute clinical deterioration with rapid oxygen desaturation in critically ill patients SARS-CoV-2. DISCLOSURES: No relevant relationships by Alvaro Ayala, source=Web Response No relevant relationships by Alex Chee, source=Web Response No relevant relationships by Fayez Kheir, source=Web Response Consultant relationship with Boston Scientific Please note: $1001 - $5000 by Adnan Majid, source=Web Response, value=Consulting fee Consultant relationship with olympus Please note: $5001 - $20000 by Adnan Majid, source=Web Response, value=Consulting fee Consultant relationship with pinacle biologics Please note: $1001 - $5000 by Adnan Majid, source=Web Response, value=Consulting fee Consultant relationship with cook medical Please note: $1001 - $5000 by Adnan Majid, source=Web Response, value=Consulting fee No relevant relationships by Mihir Parikh, source=Web Response No relevant relationships by Juan Pablo Uribe, source=Web ResponseCopyright © 2020 American College of Chest Physicians
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SESSION TITLE: Respiratory Infections: What have We Learned About COVID-19 and New Trial Data for Management of Aspergilloma SESSION TYPE: Original Investigations PRESENTED ON: October 18-21, 2020 PURPOSE: Previous studies have shown that demographics, baseline characteristics and comorbidities may play an important role in the outcomes of patients diagnosed with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Older patients, and those with respiratory or cardiovascular conditions, appear to be at greater risk for severe complications. We aim to describe baseline characteristics and mortality in patients with confirmed SARS-CoV-2 infection at our institution. METHOD(S): Retrospective medical records review of patients diagnosed with SARS-CoV-2 between January 1, 2020 and May 8, 2019 at Beth Israel Deaconess Medical Center, Boston MA. Patients were identified from our institutional database (Clinical Query 2). Demographics, baseline comorbidities, medications at admission and initial laboratories results were collected. Clinical outcomes such as mortality, ICU admission and mechanical ventilation were also recorded. RESULT(S): A total of 449 subjects were included (Age 57 years [IQR 41-69];BMI 30.2 kg/m [IQR 25.9-35.3];44.5% males). One hundred-fifteen patients (25.6%) required hospital admission with a median hospital stay of 6 days (IQR 3-12). From those, 28 patients (24.35 %) required ICU management with a median stay of 9 days (4-15.5). Seventeen subjects (14.78%) required mechanical ventilation with a mean time for of 10.65 days (SD 7.84). From the intubated patients, 2 (11.74%) ended up with tracheostomy. Twenty-nine (6.46%) of the total died due to SARS-CoV-2 complications. Elderly (82 vs 55 years, p=<0.001), smokers (37.9% vs 14.8%, p=0.003), congestive heart failure (31% vs 11%, p=0.004), dementia (24.1% vs 4%, p=<0.001), diabetes mellitus (44.8% vs 26.2%, p=0.05), chronic kidney disease (62.1% vs 13.6%, p=<0.001) and cancer patients (20.7% vs 7.9%, p=0.042) died more frequently due to SARS-CoV-2 related complications. Mortality for patients requiring ICU admission was 37.9% compared 4% (p=<0.001). For patient requiring mechanical ventilation, mortality was 24.1% compared to 2.4% (p=<0.001). CONCLUSION(S): Our review showed that elderly, presence of comorbidities, ICU admission and patient requiring mechanical ventilation died more frequently due to SARS-CoV-2 related complications. CLINICAL IMPLICATIONS: Impact of baseline characteristics and comorbid conditions in the outcomes of patients diagnosed with SARS-CoV-2 infection. DISCLOSURES: No relevant relationships by Ramsy Abdelghani, source=Web Response No relevant relationships by Alvaro Ayala, source=Web Response No relevant relationships by Alex Chee, source=Web Response No relevant relationships by Fayez Kheir, source=Web Response Consultant relationship with Boston Scientific Please note: $1001 - $5000 by Adnan Majid, source=Web Response, value=Consulting fee Consultant relationship with olympus Please note: $5001 - $20000 by Adnan Majid, source=Web Response, value=Consulting fee Consultant relationship with pinacle biologics Please note: $1001 - $5000 by Adnan Majid, source=Web Response, value=Consulting fee Consultant relationship with cook medical Please note: $1001 - $5000 by Adnan Majid, source=Web Response, value=Consulting fee No relevant relationships by Mihir Parikh, source=Web Response No relevant relationships by Priya Patel, source=Web Response No relevant relationships by Juan Pablo Uribe, source=Web ResponseCopyright © 2020 American College of Chest Physicians
ABSTRACT
Coronavirus infection (SARS-CoV-2), is a pandemic disease declared by the World Health Organization (WHO). This disease reports a high risk of contagion, especially by the transmission of aerosols in health care workers. In this scenario, aerosol exposure is increased in various procedures related to the airway, lungs, and pleural space. For this reason, it is important to have recommendations that reduce the risk of exposure and infection with COVID-19. In this document, a team of international specialists in interventional pulmonology elaborated a series of recommendations, based on the available evidence to define the risk stratification, diagnostic methods and technical considerations on procedures such as bronchoscopy, tracheostomy, and pleural procedures among others. As well as the precautions to reduce the risk of contagion when carrying out pulmonary interventions.