Thoracic Surgery Consultations in COVID-19 Critically Ill Patients: Beyond Conservative Approach

Yasser Aljehani; Sharifah A Othman; Yousif Almubarak; Ayman Elbaz; Mohammed Sabry; Farouk Alreshaid; Hatem Y Elbawab; Zeead M Alghamdi; Mohammed Alshahrani

doi:10.1155/2021/6626150

Thoracic Surgery Consultations in COVID-19 Critically Ill Patients: Beyond Conservative Approach

Crit Care Res Pract. 2021 Mar 27:2021:6626150. doi: 10.1155/2021/6626150. eCollection 2021.

Authors

Affiliations

¹ Division of Thoracic Surgery, Department of Surgery, King Fahad Hospital of the University, Khobar, Saudi Arabia.
² College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
³ Department of Critical Care, King Fahad Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
⁴ Faculty of Medicine, Menoufia University, Shibin Al Kawm, Egypt.

Abstract

Introduction: Iatrogenic pneumothoracis, barotraumas, and tracheoesophageal fistulae, especially after prolonged intubation, and tracheal stenosis are all entities involving thoracic surgeons' consultation and management. With the surge of COVID-19 cases particularly in the critical care settings, various types of complications have been observed that require intervention from thoracic surgeons.

Methods and materials: A retrospective study was conducted in an academic healthcare institute in the Eastern Province of Saudi Arabia. We included all COVID-19 cases admitted to ICU in the period between March 15, 2020, and August 15, 2020, requiring thoracic surgery consultation and management. Non-COVID-19 critical cases and iatrogenic pneumothorax were excluded.

Results: Of 122 patients who were admitted to ICU with COVID-19, 18 patients (14.75%) required thoracic surgery consultation and management. We discovered a significant association between the outcomes and reintubation rates and the rate of pneumothorax occurrence. The survival analysis showed improvement in patients who had thoracostomy tube insertion as a management than the group who were treated conservatively. On the other hand, there was a significant difference between the COVID ICU group who had thoracic complication and those who did not regarding the length of hospital stay.

Conclusion: Noniatrogenic pneumothorax, subcutaneous emphysema, and mediastinal emphysema are well-known thoracic entities, but their presence in the context of COVID-19 disease is a harbinger for worse prognosis and outcomes. The presence of pneumothorax may be associated with better prognosis and outcome compared to surgical and mediastinal emphysema.