VATS in complicated COVID-19 patients: case series

Area of Science:

• Thoracic Surgery
• Pulmonology
• Infectious Diseases

Background:

• Complications of COVID-19 related acute respiratory distress syndrome (ARDS) and mechanical ventilation include barotrauma-induced pneumothorax, pneumatocele, and empyema.
• These complications can be life-threatening and may not respond to conventional drainage methods.
• Surgical intervention is sometimes necessary for managing these severe pulmonary issues in critically ill patients.

Purpose of the Study:

• To analyze the indications and outcomes of video-assisted thoracoscopic surgery (VATS) in patients with COVID-19.
• To evaluate the effectiveness of VATS for treating secondary spontaneous pneumothorax (SSP), pneumatocele, and empyema complicating COVID-19 pneumonia.
• To assess the safety and feasibility of VATS in a cohort of COVID-19 patients requiring surgical intervention.

Main Methods:

• A retrospective single-institution study was conducted on patients treated with VATS for COVID-19 complications between February 2020 and May 2021.
• Nine male patients with COVID-19 related SSP, pneumatocele, or empyema, unresponsive to drainage, underwent VATS.
• Data collected included patient demographics, pre-operative conditions (e.g., CPAP use, ICU admission), operative details (procedure, duration), and post-operative outcomes.

Main Results:

• Six patients underwent bullectomy, and all had pleural space drainage; five also had decortication and fluid aspiration.
• One patient experienced a 0% conversion rate to open surgery, but two required temporary bilateral ventilation during surgery.
• The mortality rate was 11% (one patient died from respiratory failure), and one patient required redo surgery for bleeding; mean post-operative length of stay was 37.9 days.

Conclusions:

• Video-assisted thoracoscopic surgery (VATS) can be an effective, albeit extreme, treatment option for severe COVID-19 complications like pneumothorax and empyema.
• VATS is feasible in patients who can tolerate general anesthesia, offering a chance for recovery when conservative measures fail.
• Careful attention to aerosol generation during the procedure is crucial due to the infectious nature of COVID-19 droplets.