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1.
JAMA Surg ; 157(3): 269-274, 2022 Mar 01.
Article in English | MEDLINE | ID: covidwho-1653142

ABSTRACT

IMPORTANCE: Thoracostomy, or chest tube placement, is used in a variety of clinical indications and can be lifesaving in certain circumstances. There have been developments and modifications to thoracostomy tubes, or chest tubes, over time, but they continue to be a staple in the thoracic surgeon's toolbox as well as adjacent specialties in medicine. This review will provide the nonexpert clinician a comprehensive understanding of the types of chest tubes, indications for their effective use, and key management details for ideal patient outcomes. OBSERVATIONS: This review describes the types of chest tubes, indications for use, techniques for placement, common anatomical landmarks that are encountered with placement and management, and an overview of complications that may arise with tube thoracostomy. In addition, the future direction of chest tubes is explored, as well as the management of chest tubes during the COVID-19 pandemic. CONCLUSIONS AND RELEVANCE: Chest tube management is subjective, but the compilation of data can inform best practices and safe application to successfully manage the pleural space and ameliorate acquired pleural space disease.


Subject(s)
COVID-19 , Chest Tubes , Humans , Pandemics , SARS-CoV-2 , Thoracostomy/methods
2.
J Investig Med High Impact Case Rep ; 9: 23247096211013215, 2021.
Article in English | MEDLINE | ID: covidwho-1598539

ABSTRACT

Bronchopleural fistula (BPF) is associated with high morbidity if left untreated. Although rare, the frequency of BPF in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is becoming recognized in medical literature. We present a case of a 64-year-old male with BPF with persistent air leak due to SARS-CoV-2 pneumonia treated with Spiration Valve System endobronchial valve (EBV). An EBV was placed in the right middle lobe with successful cessation of air leak. In conclusion, the use of EBVs for BPF with persistent air leaks in SARS-CoV-2 patients who are poor surgical candidates is effective and safe.


Subject(s)
Bronchial Fistula/surgery , Bronchoscopy , COVID-19/complications , Empyema, Pleural/surgery , Pleural Diseases/surgery , Surgical Instruments , Bronchial Fistula/etiology , Chest Tubes , Empyema, Pleural/etiology , Humans , Male , Middle Aged , Pleural Diseases/etiology , SARS-CoV-2 , Thoracostomy
3.
BMJ Case Rep ; 14(4)2021 Apr 08.
Article in English | MEDLINE | ID: covidwho-1175140

ABSTRACT

A 71-year-old woman was brought in by ambulance to the emergency department with sudden-onset difficulty in breathing whilst shopping at a large UK retail shopping centre. She had no respiratory history and portable chest X-ray revealed a huge gastrothorax, secondary pneumothorax and mediastinal shift. Clinical deterioration with haemodynamic instability required urgent decompression. Successful needle decompression followed by tube thoracostomy improved patient condition with no further complications. Surgical repair was performed but was delayed by COVID-19. This case provides a rare presentation of an acute life-threatening tension gastrothorax with difficult management considerations. A review of the management options is undertaken.


Subject(s)
Hernia/diagnosis , Mediastinum/pathology , Acute Disease , Aged , COVID-19 , Chest Tubes , Decompression, Surgical , Diagnosis, Differential , Emergency Service, Hospital , Female , Hernia/therapy , Humans , Pneumothorax/diagnosis , Radiography, Thoracic , Respiratory Distress Syndrome/etiology , Thoracostomy
4.
J Coll Physicians Surg Pak ; 31(2): 132-137, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-1110941

ABSTRACT

OBJECTIVE: To determine the risk factors for spontaneous pneumomediastinum (SPM), its clinical course and effect on prognosis in patients with Coronavirus disease-19 (COVID-19) pneumonia. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Kayseri City Training and Research Hospital, Turkey, from April  to September 2020. METHODOLOGY: All COVID-19 patients' clinical, laboratory, and radiologic characteristics, as well as treatment outcome data, were obtained through medical record extraction. Group A had 50 patients (22 men and 28 women) without SPM, and Group B had 20 patients (10 men and 10 women) with SPM. RESULTS: Considering the accompanying comorbidities, the frequencies of asthma and inhaler-use was significantly higher in Group B than in Group A (p <0.05). In the CT evaluation at presentation, the rate of involvement of all five lobes of the lung in Group B was significantly higher than in Group A. Rates of tube thoracostomy, mechanical ventilator requirement, length of stay in hospital, and exitus were significantly higher in Group B than in Group A (p <0.05). CONCLUSION: SPM development in a patient with COVID-19 pneumonia is a sign that the prognosis will not be good, and these patients need a more aggressive treatment. Key Words: Spontaneous pneumomediastinum, COVID-19, Pneumothorax, Real-time polymerase chain reaction, Subcutaneous emphysema.


Subject(s)
COVID-19/complications , Lung/diagnostic imaging , Mediastinal Emphysema/etiology , Adult , Aged , COVID-19/diagnostic imaging , Chest Tubes , Female , Humans , Male , Mediastinal Emphysema/diagnosis , Mediastinal Emphysema/diagnostic imaging , Middle Aged , Pandemics , Pneumothorax/diagnostic imaging , Pneumothorax/virology , Prognosis , Real-Time Polymerase Chain Reaction , SARS-CoV-2 , Subcutaneous Emphysema/diagnostic imaging , Subcutaneous Emphysema/etiology , Thoracostomy , Tomography, X-Ray Computed
5.
BMJ Case Rep ; 14(1)2021 Jan 18.
Article in English | MEDLINE | ID: covidwho-1066837

ABSTRACT

A previously healthy 37-year-old man presented with fevers and myalgias for a week with a minimal dry cough. Initial SARS-CoV-2 nasopharyngeal testing was negative, but in light of high community prevalence, he was diagnosed with COVID-19, treated with supportive care and self-quarantined at home. Three days after resolution of all symptoms, he developed sudden onset chest pain. Chest imaging revealed a large right-sided pneumothorax and patchy subpleural ground glass opacities. IgM and IgG antibodies for SARS-CoV-2 were positive. His pneumothorax resolved after placement of a small-bore chest tube, which was removed after 2 days.This case demonstrates that patients with COVID-19 can develop a significant pulmonary complication, a large pneumothorax, despite only minimal lower respiratory tract symptoms and after resolution of the original illness. Medical professionals should consider development of a pneumothorax in patients who have recovered from COVID-19 and present with new respiratory symptoms.


Subject(s)
COVID-19/complications , Convalescence , Pneumothorax/etiology , Adult , COVID-19/physiopathology , COVID-19 Serological Testing , Chest Pain/physiopathology , Chest Tubes , Cough/physiopathology , Dyspnea/physiopathology , Fever/physiopathology , Humans , Male , Myalgia/physiopathology , Pneumothorax/diagnostic imaging , Pneumothorax/physiopathology , Pneumothorax/therapy , Radiography, Thoracic , SARS-CoV-2 , Severity of Illness Index , Thoracostomy , Tomography, X-Ray Computed
6.
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
7.
BMJ Case Rep ; 13(5)2020 May 17.
Article in English | MEDLINE | ID: covidwho-312776

ABSTRACT

A 36-year-old man was brought to the emergency department with suspected COVID-19, following a 3-week history of cough, fevers and shortness of breath, worsening suddenly in the preceding 4 hours. On presentation he was hypoxaemic, with an SpO2 of 88% on 15 L/min oxygen, tachycardic and had no audible breath sounds on auscultation of the left hemithorax. Local guidelines recommended that the patient should be initiated on continuous positive airway pressure while investigations were awaited, however given the examination findings an emergency portable chest radiograph was performed. The chest radiograph demonstrated a left-sided tension pneumothorax. This was treated with emergency needle decompression, with good effect, followed by chest drain insertion. A repeat chest radiograph demonstrated lung re-expansion, and the patient was admitted to a COVID-19 specific ward for further observation. This case demonstrates tension pneumothorax as a possible complication of suspected COVID-19 and emphasises the importance of thorough history-taking and clinical examination.


Subject(s)
Coronavirus Infections/complications , Pneumonia, Viral/complications , Pneumothorax/therapy , Adult , COVID-19 , Chest Tubes , Coronavirus Infections/diagnosis , Humans , Male , Pandemics , Pneumonia, Viral/diagnosis , Pneumothorax/etiology , Thoracostomy
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