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2.
J Thorac Cardiovasc Surg ; 162(6): 1654-1664, 2021 12.
Article in English | MEDLINE | ID: covidwho-1108501

ABSTRACT

OBJECTIVE: As the Coronavirus Disease 2019 pandemic continues, appropriate management of thoracic complications from Coronavirus Disease 2019 needs to be determined. Our objective is to evaluate which complications occurring in patients with Coronavirus Disease 2019 require thoracic surgery and to report the early outcomes. METHODS: This study is a single-institution retrospective case series at New York University Langone Health Manhattan campus evaluating patients with confirmed Coronavirus Disease 2019 infection who were hospitalized and required thoracic surgery from March 13 to July 18, 2020. RESULTS: From March 13 to August 8, 2020, 1954 patients were admitted to New York University Langone Health for Coronavirus Disease 2019. Of these patients, 13 (0.7%) required thoracic surgery. Two patients (15%) required surgery for complicated pneumothoraces, 5 patients (38%) underwent pneumatocele resection, 1 patient (8%) had an empyema requiring decortication, and 5 patients (38%) developed a hemothorax that required surgery. Three patients (23%) died after surgery, 9 patients (69%) were discharged, and 1 patient (8%) remains in the hospital. No healthcare providers were positive for Coronavirus Disease 2019 after the surgeries. CONCLUSIONS: Given the 77% survival, with a majority of patients already discharged from the hospital, thoracic surgery is feasible for the small percent of patients hospitalized with Coronavirus Disease 2019 who underwent surgery for complex pneumothorax, pneumatocele, empyema, or hemothorax. Our experience also supports the safety of surgical intervention for healthcare providers who operate on patients with Coronavirus Disease 2019.


Subject(s)
COVID-19/surgery , Empyema, Pleural/surgery , Hemothorax/surgery , Pandemics , Pneumothorax/surgery , Thoracic Surgical Procedures/methods , Adult , Aged , COVID-19/complications , COVID-19/epidemiology , Empyema, Pleural/diagnosis , Empyema, Pleural/etiology , Female , Follow-Up Studies , Hemothorax/diagnosis , Hemothorax/etiology , Humans , Male , Middle Aged , New York/epidemiology , Pneumothorax/diagnosis , Pneumothorax/etiology , RNA, Viral/analysis , Retrospective Studies , SARS-CoV-2/genetics , Tomography, X-Ray Computed , Treatment Outcome
3.
BMJ Case Rep ; 13(12)2020 Dec 22.
Article in English | MEDLINE | ID: covidwho-999234

ABSTRACT

A 50-year-old Caucasian man presented to the emergency department during the early stages of the COVID-19 pandemic with a rapidly progressive facial swelling, fever, malaise and myalgia. The patient had recently travelled to a COVID-19-prevalent European country and was therefore treated as COVID-19 suspect. The day before, the patient sustained a burn to his left forearm after falling unconscious next to a radiator. A CT neck and thorax showed a parapharyngeal abscess, which was surgically drained, and the patient was discharged following an intensive care admission. He then developed mediastinitis 3 weeks post-discharge which required readmission and transfer to a cardiothoracic unit for surgical drainage. This report discusses the evolution of a deep neck space infection into a mediastinitis, a rare and life-threatening complication, despite early surgical drainage. This report also highlights the difficulties faced with managing patients during the COVID-19 pandemic.


Subject(s)
COVID-19 , Drainage , Mediastinitis , Patient Care Management/methods , Postoperative Complications , Retropharyngeal Abscess , Thoracic Surgical Procedures/methods , COVID-19/drug therapy , COVID-19/epidemiology , COVID-19/therapy , Catastrophic Illness/therapy , Diagnosis, Differential , Drainage/adverse effects , Drainage/methods , Humans , Infection Control/methods , Male , Mediastinitis/diagnosis , Mediastinitis/etiology , Mediastinitis/physiopathology , Mediastinitis/surgery , Middle Aged , Neck/diagnostic imaging , Neck/surgery , Postoperative Complications/diagnosis , Postoperative Complications/physiopathology , Postoperative Complications/surgery , Retropharyngeal Abscess/diagnosis , Retropharyngeal Abscess/physiopathology , Retropharyngeal Abscess/surgery , SARS-CoV-2 , Treatment Outcome
4.
Anaesthesia ; 75(11): 1509-1516, 2020 11.
Article in English | MEDLINE | ID: covidwho-892195

ABSTRACT

Intra-operative aerosol-generating procedures are arguably unavoidable in the routine provision of thoracic anaesthesia. Airway management for such patients during the COVID-19 pandemic including tracheal intubation, lung isolation, one-lung ventilation and flexible bronchoscopy may pose a significant risk to healthcare professionals and patients. That said, there remains a need for timely thoracic surgery for patients with lung cancer or thoracic trauma. The thoracic anaesthetic community has been confronted with the need to modify existing techniques to maximise safety for patients and healthcare professionals. With appropriate modification, aerosol generation may be mitigated against in most circumstances. We developed a set of practice-based recommendations for airway management in thoracic surgical patients, which have been endorsed by the Association for Cardiothoracic Anaesthesia and Critical Care and the Society for Cardiothoracic Surgery in Great Britain and Ireland.


Subject(s)
Airway Management/methods , Betacoronavirus , Coronavirus Infections/epidemiology , One-Lung Ventilation/methods , Pneumonia, Viral/epidemiology , Thoracic Surgical Procedures/methods , Airway Extubation , Anesthesia, Cardiac Procedures , Bronchoscopy , COVID-19 , Continuous Positive Airway Pressure , Critical Care , Humans , Intubation, Intratracheal , Pandemics , SARS-CoV-2 , Societies, Medical
5.
Interact Cardiovasc Thorac Surg ; 31(6): 895-899, 2020 12 07.
Article in English | MEDLINE | ID: covidwho-889564

ABSTRACT

The current coronavirus disease 2019 (COVID-19) pandemic has made us aware of the weaknesses and often the inadequacies of our current technologies and practices and has presented us with a huge challenge: to reorganize the way we work and sometimes even think, in order to ensure the safety of our patients. The Italian Society of Thoracic Surgery has launched various initiatives in response to the COVID-19 pandemic, aimed at facilitating the exchange of information, strategies and personal experiences between institutions. This article presents the results of a survey amongst all Italian thoracic surgery units accredited to SICT, with the aim of providing a glimpse of the current working conditions in these units, and an understanding of the impact of COVID-19 on their daily activities and patient care.


Subject(s)
COVID-19/epidemiology , Medical Oncology/organization & administration , Neoplasms/surgery , Pandemics , Societies, Medical , Thoracic Surgery/organization & administration , Thoracic Surgical Procedures/methods , Comorbidity , Hospitals , Humans , Italy/epidemiology , Neoplasms/epidemiology , SARS-CoV-2 , Surveys and Questionnaires
6.
Ann Thorac Surg ; 110(5): e417-e419, 2020 11.
Article in English | MEDLINE | ID: covidwho-884669

ABSTRACT

Severe acute respiratory syndrome coronavirus 2 disease 2019 (COVID-19) has rapidly spread worldwide since December 2019. An acute respiratory distress syndrome develops in a relevant rate of patients, who require hospitalization. Among them, a nonnegligible rate of 9.8% to 15.2% of patients requires tracheal intubation for invasive ventilation. We report the case of a pneumomediastinum and subcutaneous emphysema developing in a COVID-19 patient secondary to postintubation tracheal injury. The management of COVID-19 patients can be challenging due to the risk of disease transmission to caregivers and epidemic spread. We performed a bedside tracheal injury surgical repair, after failure of conservative management, with resolution of pneumomediastinum and subcutaneous emphysema and improvement of the patient's conditions.


Subject(s)
Betacoronavirus , Coronavirus Infections/therapy , Intubation, Intratracheal/adverse effects , Mediastinal Emphysema/surgery , Pneumonia, Viral/therapy , Subcutaneous Emphysema/surgery , Thoracic Surgical Procedures/methods , Trachea/injuries , Aged , COVID-19 , Coronavirus Infections/epidemiology , Humans , Male , Mediastinal Emphysema/diagnosis , Mediastinal Emphysema/etiology , Neck , Pandemics , Pneumonia, Viral/epidemiology , SARS-CoV-2 , Subcutaneous Emphysema/diagnosis , Subcutaneous Emphysema/etiology , Tomography, X-Ray Computed
8.
Adv Respir Med ; 88(4): 366-368, 2020.
Article in English | MEDLINE | ID: covidwho-737868

ABSTRACT

We discuss the hypothesis that common Chest Drain Systems collected to a COVID-19 patient, could be a possible source of contamination for health care staff in a Thoracic Surgery ward and we propose an alternative way to minimize this further risk of transmission.


Subject(s)
Chest Tubes/adverse effects , Coronavirus Infections/transmission , Pneumonia, Viral/transmission , Thoracic Surgical Procedures/methods , COVID-19 , Clinical Competence , Coronavirus Infections/prevention & control , Drainage/adverse effects , Humans , Pandemics/prevention & control , Patient Care Management/methods , Pneumonia, Viral/prevention & control , Risk Assessment , Thoracostomy/methods
10.
J Cardiothorac Vasc Anesth ; 34(12): 3211-3217, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-665472

ABSTRACT

Anesthesia for thoracic surgery requires specialist intervention to provide adequate operating conditions and one-lung ventilation. The pandemic caused by severe acute respiratory syndrome-associated coronavirus 2 (SARS-CoV-2) is transmitted by aerosol and droplet spread. Because of its virulence, there is a risk of transmission to healthcare workers if appropriate preventive measures are not taken. Coronavirus disease 2019 (COVID-19) patients may show no clinical signs at the early stages of the disease or even remain asymptomatic for the whole course of the disease. Despite the lack of symptoms, they may be able to transfer the virus. Unfortunately, during current COVID-19 testing procedures, about 30% of tests are associated with a false-negative result. For these reasons, standard practice is to assume all patients are COVID-19 positive regardless of swab results. Here, the authors present the recommendations produced by the Israeli Society of Anesthesiologists for use in thoracic anesthesia for elective surgery during the COVID-19 pandemic for both the general population and COVID-19-confirmed patients. The objective of these recommendations is to make changes to some routine techniques in thoracic anesthesia to augment patients' and the medical staff's safety.


Subject(s)
Anesthesia/standards , Anesthesiologists/standards , COVID-19/epidemiology , Elective Surgical Procedures/standards , Pandemics , Thoracic Surgical Procedures/standards , Anesthesia/methods , COVID-19/prevention & control , Consensus , Elective Surgical Procedures/methods , Humans , Israel/epidemiology , Pandemics/prevention & control , Societies, Medical/standards , Thoracic Surgical Procedures/methods
11.
Asian Cardiovasc Thorac Ann ; 28(6): 322-329, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-628544

ABSTRACT

OBJECTIVES: Healthcare resources have been mobilized to combat the COVID-19 pandemic of 2020. The Thoracic Domain of the Asian Society for Cardiovascular and Thoracic Surgery reports a consensus statement on the provision of thoracic cancer surgery during this pandemic. METHODS: A Thoracic Experts Panel was convened by the Society. A consensus on the provision, safety, and setting of thoracic cancer surgery during the pandemic was obtained through a Delphi process. RESULTS: Responses were received from 26 panel members (96% response rate) from 10 regions across Asia. The Society recommended that elective thoracic cancer surgery services may need to be reduced or postponed if medical resources were needed for COVID-19 patients, especially intensive care unit beds and ventilators. However, thoracic cancer surgery should proceed as normal for all solid tumors, without restrictions based on disease stage, availability of non-surgical treatment options, or patient condition (unless there is a high likelihood of postoperative intensive care unit stay). Aerosol-forming procedures should be avoided intra- and perioperatively. The surgical approach does not make a difference in terms of safety. Services for thoracic cancer patients should be offered only in hospitals that maintain isolation wards for patients with confirmed or suspected COVID-19. CONCLUSIONS: Services for patients with thoracic cancer should be maintained during the COVID-19 pandemic. The position of the Society is that thoracic surgeons have a responsibility to perform good surgical management of thoracic cancer during the pandemic, to advocate for patients' rights to receive it, and to safeguard patients and staff from infection.


Subject(s)
Betacoronavirus , Coronavirus Infections/prevention & control , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Thoracic Neoplasms/surgery , Thoracic Surgical Procedures/methods , Asia , COVID-19 , Humans , SARS-CoV-2 , Societies, Medical
12.
Respir Med Res ; 78: 100769, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-343140

ABSTRACT

The objective of this document is to formalize a degraded mode management for patients with thoracic cancers in the context of the COVID-19 pandemic. The proposals are based on those of the French High Council for Public Health, on published data outside the context of COVID-19, and on a concerted analysis of the risk-benefit ratio for our patients by a panel of experts specialized on thoracic oncology under the aegis of the French-Language Society of Pulmonology (SPLF)/French-language oncology group. These proposals are evolving (10 April 2020) according to the situations encountered, which will enrich it, and are to be adapted to our institutional organisations and to the evolution of resources during the COVID-19 epidemic. Patients with symptoms and/or COVID-19+ are not discussed in this document and are managed within the framework of specific channels.


Subject(s)
COVID-19/epidemiology , COVID-19/prevention & control , Pandemics , Thoracic Neoplasms/therapy , Antineoplastic Agents/therapeutic use , COVID-19/complications , Chemoradiotherapy/methods , Chemoradiotherapy/standards , Clinical Trials as Topic/methods , Clinical Trials as Topic/organization & administration , Clinical Trials as Topic/standards , Humans , Mutation , Neoadjuvant Therapy/methods , Neoadjuvant Therapy/standards , Neoplasm Metastasis , Pulmonary Medicine/methods , Pulmonary Medicine/organization & administration , Pulmonary Medicine/standards , Risk Factors , Risk Reduction Behavior , SARS-CoV-2 , Thoracic Neoplasms/epidemiology , Thoracic Neoplasms/genetics , Thoracic Neoplasms/pathology , Thoracic Surgical Procedures/methods , Thoracic Surgical Procedures/standards
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