Bronchopleural fistula due to cavitary pneumonia after SARS-CoV-2 infection treated with open thoracostomy.

Severe coronavirus disease of 2019 (COVID-19) disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection causes substantial parenchymal damage in some patients. There is a paucity of literature describing the surgical management COVID-19 associated bronchopleural fistula after failure of medical therapy. We present the case of a 59-year-old woman with SARS-CoV-2 pneumonia, secondary bacterial pneumonia with bronchopleural fistula and radiographic and clinical evidence of disease refractory to medical therapy. After a course of culture-driven antimicrobial therapy and failure to improve following drainage with tube thoracostomy, she was treated successfully with Clagett open thoracostomy. After resolution of the bronchopleural fistula, the thoracostomy was closed and she was discharged home. In cases of severe COVID-19 complicated by bronchopleural fistula with parenchymal destruction, a tailored approach involving surgical management when indicated can lead to acceptable outcomes without significant morbidity.

Evaluating physiologic outcomes of music interventions in the neonatal intensive care unit: a systematic review.

Music is widely used in the neonatal intensive care unit. The objectives of this systematic review are: (1) clarify the current literature in regards to the impact of music on neonatal physiologic parameters, (2) highlight the variability in definitions utilized for music interventions, and (3) provide a foundation for future music therapy research focused on influencing neonatal physiology. A systematic literature review was conducted in accordance with PRISMA guidelines, with search terms including "music," "music therapy," "neonates," "newborn," and "NICU." Four hundred and fifty-eight studies were reduced to 16 clinical trials divided based on methodological description of music intervention. Our review highlights variability in the existing literature specifically on neonatal physiological impact of music. Future studies should focus on consistent and well-defined data collection, utilization of standardized definitions for music interventions, and consideration of more sensitive markers of physiology, such as heart rate variability, to enhance study rigor and reproducibility.