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The role of thoracic surgery in the management of complicated acute and post-acute COVID-19 pneumonia (PASC)

Česká verzia

Authors: J. Herzinger 1 ;  V. Hytych 1;  J. Mališ 1;  K. Pavlíčková 2;  J. Čermák 1;  R. Demeš 1;  P. Svoboda 1;  P. Hedánková 1;  Š. Žbánková 1;  K. Česlarová 1;  A. Tašková 1
Authors place of work: Klinika hrudní chirurgie, 3. lékařská fakulta Univerzity Karlovy a fakultní Thomayerovy Nemocnice, Praha, Česká, republika 1;  Ústav patologie a molekulární medicíny, 3. lékařská fakulta Univerzity Karlovy a fakultní Thomayerovy Nemocnice, Praha, Česká republika 2
Published in the journal: Rozhl. Chir., 2024, roč. 103, č. 2, s. 57-64.
Category: Original articles
doi: https://doi.org/10.33699/PIS.2024.103.2.57–64

Summary

Introduction: COVID-19 is considered a respiratory virosis in its classic form, although it may present with heterogeneous symptoms. Thoracic complications occur in a small percentage of patients. Our objective was to evaluate existing experience with this disease and its thoracic manifestations and to determine the real-world status of care of these patients.

Methods: This study is a retrospective, single-institution analysis of a group of patients hospitalized with acute and post-acute COVID-19 pneumonia at Thomayer Hospital in Prague in the period from December 2020 to March 2022 and indicated for a thoracic surgical procedure.

Results: During the peak of COVID-19 pandemic, a thoracic intervention was performed in 46 admitted patients. Thoracic drainage (due to pneumothorax in 18 cases, fluidothorax in 3 cases, CT-guided lung abscess drainage in 2 cases, and CT-guided pneumatocele drainage in 2 cases) were the most common thoracic surgical procedures. Pleurectomy/decortication surgery was done in 10 cases. Additionally, 12 lung parenchyma-sparing resections were performed, while lobectomy was required in 2 cases. Resection of postintubation tracheal stenosis due to a severe course of COVID-19 pneumonia was indicated in 2 patients.

Conclusion: Even mild COVID-19 may cause a considerable morphological a functional alteration of the respiratory system. The most common complications of COVID-19 pneumonia that require a thoracic surgical intervention include pathologies associated with an air leak and accumulation of air (pneumothorax, pneumomediastinum and subcutaneous emphysema). The development of pulmonary necrosis, symptomatic bronchiectasis, pneumatocele, and bullous-fibrotic formations may result in pneumothorax, hemothorax or thoracic empyema in sporadic cases. An early thoracic surgical intervention to treat thoracic complications of COVID-19 pneumonia can improve the survival of COVID-19 patients.

Keywords:

complications – COVID-19 pneumonia – post-acute sequelae of COVID-19 (PASC) – thoracic surgery

Zdroje
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MUDr. Jaroslav Herzinger
Klinika hrudní chirurgie Thomayerovy nemocnice
e-mail: larsvonherz@gmail.com
ORCID: 0000-0001-7278-1537

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Perspectives in Surgery

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