Salvage Lobectomy to Treat Necrotizing SARS-CoV-2 Pneumonia Complicated by a Bronchopleural Fistula

Peeters, Kristel; Mesotten, Dieter; Willaert, Xavier; Deraedt, Karen; Nauwelaers, Sigi; Lauwers, Geert

doi:10.1016/j.athoracsur.2020.10.038

Cited by 10 publications

(7 citation statements)

References 4 publications

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“…A recent review reported only five cases during a six-year period [ 3 ]. It is also an infrequent complication in COVID-19 patients, with only a few reports to date [ 5 , 6 , 7 ]. Except for one case of NP reported in a cohort of 298 patients with COVID-19 pneumonia (less than 0.3%), the incidence of this complication in COVID-19 patients is unknown [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

Post-COVID-19 Necrotizing Pneumonia in Patients on Invasive Mechanical Ventilation

Hidrón

Quiceno

Cardeño

et al. 2021

Infectious Disease Reports

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(1) Background: Few reports of necrotizing pneumonia in patients with COVID-19 have been published. We have observed an elevated incidence at two hospitals in our city, suggesting this complication is not uncommon, and may have been overlooked. (2) Methods: This article presents a retrospective, descriptive cohort study that was undertaken from 22 March 2020 to 15 June 2021 in two tertiary care hospitals in Medellín, Colombia. All adult patients admitted to the intensive care unit (ICU) for respiratory failure related to confirmed COVID-19, on invasive mechanical ventilation (IMV), with imaging or surgical findings documenting necrotizing pneumonia (NP) were included. (3) Results: Of 936 patients with COVID-19 that required IMV, 42 (4.5%) developed NP. Overall mortality was 57% and in-hospital mortality was 71%, occurring 15–79 days after COVID-19 diagnosis. NP was diagnosed at a median of 27 days after COVID-19 symptom onset and 15.5 days after initiation of IMV. Infections were polymicrobial in 52.4% of patients. Klebsiella pneumoniae (57%) and Pseudomonas aeruginosa (33%) were the most common etiologic agents. Pulmonary embolism (PE) was documented in 13 patients overall (31%), and in 50% of patients who underwent an angioCT. Drainage and/or surgical procedures were performed on 19 patients (45.2%) with a 75% mortality rate. (4) Conclusions: In our experience, NP is a relatively common, albeit neglected, complication in mechanically ventilated COVID-19 patients, possibly originating in poorly vascularized areas of lung parenchyma. Associated mortality is high. Although drainage procedures did not seem to favorably impact patient outcomes, diagnosis and treatment were late events in the overall disease course, suggesting that early recognition and timely treatment could have a positive impact on prognosis.

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Section: Discussionmentioning

confidence: 99%

Post-COVID-19 Necrotizing Pneumonia in Patients on Invasive Mechanical Ventilation

Hidrón

Quiceno

Cardeño

et al. 2021

Infectious Disease Reports

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show abstract

“…Although there are a few reported cases of tension pneumothorax among COVID-19 pneumonia patients, bronchopleural fistula in relation to COVID-19 pneumonia has been reported only in very few ones. 7,8 Also, these reported cases were of patients with accompanied issues such as necrotic fungal co-infection 9 and long-term mechanical ventilation. 8,10 We think that patients with no comorbidities nor complicated hospital course might be overlooked for as such a rare complication as bronchopleural fistula.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, our patient was successfully treated conservatively with prolonged chest tube drainage (53 days), which indicates that surgical or more invasive treatment is not always required. On the contrary, the related cases in the literature were treated invasively with, for instance, salvage lobectomy, 7 and Endobronchial valves. 11…”

Section: Discussionmentioning

confidence: 99%

Bronchopleural fistula causing persistent pneumothorax in COVID‐19 pneumonia patient with no risk factors

Habib

Obeidat

Ali

et al. 2021

Clinical Case Reports

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“…Additionally, our patient was successfully treated conservatively with prolonged chest tube drainage (53 days), which indicates that surgical or more invasive treatment is not always required. On the other hand, the related cases in the literature were treated invasively with, for instance, salvage lobectomy [6], and Endobronchial valves [10].…”

Section: Discussionmentioning

confidence: 99%

Bronchopleural fistula causing persistent pneumothorax in COVID-19 pneumonia patient with no risk factors.

Habib

Obeidat

Ali

et al. 2021

Preprint

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Salvage Lobectomy to Treat Necrotizing SARS-CoV-2 Pneumonia Complicated by a Bronchopleural Fistula

Cited by 10 publications

References 4 publications

Post-COVID-19 Necrotizing Pneumonia in Patients on Invasive Mechanical Ventilation

Post-COVID-19 Necrotizing Pneumonia in Patients on Invasive Mechanical Ventilation

Bronchopleural fistula causing persistent pneumothorax in COVID‐19 pneumonia patient with no risk factors

Bronchopleural fistula causing persistent pneumothorax in COVID-19 pneumonia patient with no risk factors.

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