![]() ![]() ![]() Many COVID-19 patients admitted to critical care units require invasive mechanical ventilation ( 1, 2). Keywords: COVID-19 barotrauma thoracic surgery radiology pulmonary critical care Placement of chest tubes is discouraged unless a definite sizable pneumothorax develops. There were 3 patients who had percutaneous tubes placed before the study period all of whom had significant worsening of their sub-cutaneous air and air leak.Ĭonclusions: Conservative management of massive sub-cutaneous emphysema without pneumothorax in COVID-19 patients is safe and limits viral exposure to healthcare workers. Both had chest tubes placed without incident before there were any changes in oxygenation, hemodynamics, supportive medications, or ventilator settings. Two patients progressed to pneumothorax 3 and 8 days following initial presentation. ![]() 12 patients (41%) had improvement or resolution without intervention. Patients were intubated for an average of 2.4 days before SWAP was identified. Results: There were 29 cases of mediastinal air with SWAP out of 171 COVID positive intubated patients (17.0%) who were treated conservatively. Three patients had prophylactic chest tube placement prior to the study period without thoracic surgery consultation. All patients without pneumothorax were treated conservatively with daily chest x-ray and observation. Methods: All patients with mediastinal air and SWAP evaluated by the department of Thoracic Surgery at the Mount Sinai Hospital between March 30 and Apwere identified. Incidence and conservative management data of such barotraumatic complications during the COVID-19 pandemic are lacking. Risk of iatrogenic lung injury and release of virus into the environment is high. Prophylactic chest tube placement or sub-fascial “blowholes” are usually recommended to prevent tension pneumothorax and clinical decline. Policy of Dealing with Allegations of Research Misconductīrian Housman 1, Adam Jacobi 2, Andrea Carollo 1, Tamar Nobel 1, Corey Eber 2, Samuel Acquah 3, Charles Powell 3, Andrew Kaufman 1, Dong-Seok Lee 1, Daniel Nicastri 1, Ardeshir Hakami 1, Kimberly Song 1, Roopa Kohli-Seth 4, Raja Flores 1ġThoracic Surgery Department, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA 2Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA 3Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA 4Surgery, Institute for Critical Care Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USAĬontributions: I) Conception and design: B Housman, A Carollo, S Acquah, A Jacobi, R Flores (II) Administrative support: R Flores., C Eber, S Acquah, C Powell, A Kaufman (III) Provision of study materials or patients: B Housman, DS Lee, D Nicastri, A Hakami, K Song (IV) Collection and assembly of data: B Housman, A Carollo, T Nobel, A Jacobi (V) Data analysis and interpretation: B Housman, D Nicastri, A Hakami, K Song, R Kohli-Seth (VI) Manuscript writing: All authors (VII) Final approval of manuscript: All authors.īackground: COVID-19 patients requiring mechanical ventilation may develop significant pneumomediastinum and sub-cutaneous emphysema without associated pneumothorax (SWAP).Policy of Screening for Plagiarism Process. ![]()
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