ABSTRACT
Common complications of coronavirus disease 2019 (COVID-19) related ARDS and ventilation are barotrauma-induced pneumothorax, pneumatocele and/or empyema. We analysed indications and results of video-assisted thoracoscopic surgery (VATS) in complicated COVID-19 patients. This is a retrospective single-institution study analysing a case series of patients treated by VATS for secondary spontaneous pneumothorax (SSP), pneumatocele and empyema complicating COVID-19, not responding to drainage in Lodi Maggiore Hospital between February 2020 and May 2021. Out of 2076 patients hospitalized in Lodi Maggiore Hospital with COVID-19, nine Males (0,43%; mean age 58,1-33-81) were treated by VATS for complications of pneumonia (6 SSP and 3 empyema; 1 case complicated by haemothorax). 7 patients (77%) had CPAP before surgery for 21.3 days mean (4-38). Mean Operative time was 80.9 min (38-154). Conversion rate was 0%. 3 (33%) patients were admitted to ICU before VATS. Treatments were: bullectomy in six patients (66%), drainage of the pleural space in all patients, pleural decortication and fluid aspiration in five cases (55%). two patients (22%) needed surgery interruption and bilateral ventilation to restore adequate oxygenation. Mortality was 1/9 (11%) due to respiratory failure for persistent pneumonia. In one patient (11%) redo surgery was performed for bleeding. Mean postop Length of Stay (LOS) was 37.9 days (10-77). Our report shows that VATS can be considered an extreme, but effective treatment for COVID-19 patients with SSP, pneumatocele or empyema, for patients who can tolerate general anaesthesia. Attention must be paid to the aerosol-generation of infected droplets.
ABSTRACT
Background and Aims: Starting from February 2020 it was clear that early identification of SARS-CoV-2 infected patients and their isolation was the key to block the spread of the new disease. The aim of the study is to identify strengths and weaknesses of a telemedicine program. Methods: In order to avoid the hospitalization we enrolled 543 patient on telemedicine service. Monitored patients were required to submit twice a day to the dedicated platform their oximetry, HR, RR, body temperature, systolic blood pressure and their symptoms. Every set of data generated a color coded score viewed realtime by the HPs who performed a phone call and decided to run phone tests for a new color coded score that induced to apply corrective actions: new call, home examination or emergency intervention network activation. Results: On 453 patients 87% healed and 6.4% were hospitalized, 11,79% needed oxygen therapy. The mean time spent in the telemonitoring program was 24.21 days. Malaise was the most common and persistent symptom, followed by cough, lack of appetite and myalgia. Conclusions: Telemonitoring is a safe, low budget and patientfriendly alternative to hospitalization for mild CoViD-19 patients. Relying on elementary instrumentation entrusted to fragile patients, for an effective telemonitoring program, especially during an outbreak, is essential a sound training of health professionals who can train unskilled operators. It also needs a strong collaboration with the general practitioner and the emergency division team.