ABSTRACT
OBJECTIVE: To determine the optimal management of pneumomediastinum in patients with a novel coronavirus infection (COVID-19). MATERIAL AND METHODS: There were 14 patients with pneumomediastinum and COVID-19 infection without mechanical ventilation. We discussed the world data on pneumomediastinum in patients with coronavirus infection. RESULTS: Before the COVID-19 pandemic, the annual number of own observations of spontaneous pneumomediastinum did not exceed 1-2 patients. The mechanism of pneumomediastinum is explained by the Macklin effect. COVID-19 pandemic in the Russian Federation was followed by increase of the number of patients with pneumomediastinum up to 2.4% of the total number of patients in the thoracic department. In this sample, pneumomediastinum occurred at all variants of the course of coronavirus infection. The timing of pneumomediastinum ranged from 2 to 18 (median 14) days after clinical manifestation of COVID-19. In 2 out of 14 cases, pneumomediastinum was the main symptom of coronavirus infection at admission. One patient had a combination of pneumomediastinum and pneumothorax. In 6 cases, pneumomediastinum was stable and regressed under conservative therapy. Eight patients underwent Razumovsky suprajugular mediastinotomy. There were no postoperative deaths. Recurrent pneumomediastinum was noted in one patient. CONCLUSION: The causes of pneumomediastinum in some patients with coronavirus infection, peculiarities of diagnosis and treatment and clarification of indications for invasive interventions require further study.
Subject(s)
COVID-19 , Mediastinal Emphysema , Humans , Mediastinal Emphysema/diagnosis , Mediastinal Emphysema/epidemiology , Mediastinal Emphysema/etiology , Pandemics , Russia/epidemiology , SARS-CoV-2ABSTRACT
AIM: To analyze the errors and complications of surgical care in patients with the first episode of spontaneous pneumothorax at different hospitals. MATERIAL AND METHODS: From 2005 to 2015 three hundreds and seventeen patients with the first episode of spontaneous pneumothorax have been treated at the thoracic department of Volgograd State Medical University. Patients were divided into 2 groups: 79 of them underwent thoracotomy while in 238 cases minimally invasive technologies were applied. Faster preoperative management and earlier active surgical tactics were suggested. RESULTS: There were 6 the most typical violations of surgical care in 42% of patients with the first episode of spontaneous pneumothorax. Medical and diagnostic violations at regional centers and central district hospitals were the same, but there were differences in certain types of errors and their incidence. Minimally invasive technologies do not significantly affect the number of violations of thoracic surgery principles. Early procedures against the recurrence by using of thoracoscopic interventions reduce postoperative morbidity from 1.2 to 0.3% and mortality by 8.25 times.
