Pulmonary Complications of Coronavirus Disease 2019 (COVID-19)

Rapid evolution of pulmonary complications associated with severe COVID-19 pneumonia often pose a management challenge to clinicians especially in the critical care setting. Serial chest imaging enable clinicians to better monitor disease progression and identify potential complications early which may decrease the mortality and morbidity associated with COVID-19. We report a case of severe COVID-19 pneumonia in a 69-year-old man that presented to University Malaya Medical Centre in March 2020 with multiple pulmonary complications including lung cavitation, bronchopleural fistula, pneumothorax, pneumomediastinum, subcutaneous emphysema and acute pulmonary embolism which we highlight through serial chest radiographs (CXR) and computed tomography (CT). The patient unfortunately succumbed to his disease one month after admission. COVID-19 patients may develop pulmonary complications due to a combination of direct viral lung damage, hypoxemia and high stress ventilation. Awareness of COVID-19 complications can prompt early diagnosis and timely management to reduce morbidity and mortality. Keywords: COVID-19 case report, lung cavitation, bronchopleural fistula, pneumothorax, pneumomediastinum

Download Full-text

POSSIBILITIES OF DIAGNOSIS AND SURGICAL TREATMENT OF COMPLICATIONS OF VIRAL LUNG DAMAGE IN COVID-19

Journal of the Grodno State Medical University ◽

10.25298/2221-8785-2021-19-1-112-118 ◽

2021 ◽

Vol 19 (1) ◽

pp. 112-118

Author(s):

A. A. Sushko ◽

◽

N. I. Prokopchik ◽

J. S. Kropa ◽

◽

...

Keyword(s):

Computed Tomography ◽

Differential Diagnosis ◽

Surgical Treatment ◽

Clinical Case ◽

Clinical Presentation ◽

Bronchopleural Fistula ◽

Laboratory Diagnosis ◽

Pulmonary Complications ◽

Lung Damage ◽

The Given

The article presents description of our own observation of a clinical case of severe viral infection caused by SARS- CoV-2 complicated by bilateral polysegmental pneumonia, complete bronchocutaneous fistula in a patient born in 1961. Brief information about the features of pathogenesis, clinical presentation, differential diagnosis and surgical treatment of pulmonary complications of this pathology according to modern literary data is presented. The study of the given clinical case indicates that the most important component of differential diagnosis of lung lesions with SARS-CoV-2 virus is laboratory diagnosis and high-resolution multispiral computed tomography. Pneumothorax and pyopnevothorax are a severe complication of COVID-19. However, in persistent bronchopleural fistula, it is necessary to continue active surgical treatment when it is clinically possible, performing minimally traumatic interventions.

Download Full-text

Association between Intraoperative Blood Transfusion and Mortality and Morbidity in Patients Undergoing Noncardiac Surgery

Anesthesiology ◽

10.1097/aln.0b013e3182054d06 ◽

2011 ◽

Vol 114 (2) ◽

pp. 283-292 ◽

Cited By ~ 312

Author(s):

Laurent G. Glance ◽

Andrew W. Dick ◽

Dana B. Mukamel ◽

Fergal J. Fleming ◽

Raymond A. Zollo ◽

...

Keyword(s):

Blood Transfusion ◽

Noncardiac Surgery ◽

Pulmonary Complications ◽

Wound Complications ◽

Severe Anemia ◽

Thromboembolic Complications ◽

Mortality And Morbidity ◽

Risk Of Death ◽

Increased Risk ◽

The Impact

Background The impact of intraoperative erythrocyte transfusion on outcomes of anemic patients undergoing noncardiac surgery has not been well characterized. The objective of this study was to examine the association between blood transfusion and mortality and morbidity in patients with severe anemia (hematocrit less than 30%) who are exposed to one or two units of erythrocytes intraoperatively. Methods This was a retrospective analysis of the association of blood transfusion and 30-day mortality and 30-day morbidity in 10,100 patients undergoing general, vascular, or orthopedic surgery. We estimated separate multivariate logistic regression models for 30-day mortality and for 30-day complications. Results Intraoperative blood transfusion was associated with an increased risk of death (odds ratio [OR], 1.29; 95% CI, 1.03-1.62). Patients receiving an intraoperative transfusion were more likely to have pulmonary, septic, wound, or thromboembolic complications, compared with patients not receiving an intraoperative transfusion. Compared with patients who were not transfused, patients receiving one or two units of erythrocytes were more likely to have pulmonary complications (OR, 1.76; 95% CI, 1.48-2.09), sepsis (OR, 1.43; 95% CI, 1.21-1.68), thromboembolic complications (OR, 1.77; 95% CI, 1.32-2.38), and wound complications (OR, 1.87; 95% CI, 1.47-2.37). Conclusions Intraoperative blood transfusion is associated with a higher risk of mortality and morbidity in surgical patients with severe anemia. It is unknown whether this association is due to the adverse effects of blood transfusion or is, instead, the result of increased blood loss in the patients receiving blood.

Download Full-text

Prognostic Significance of Chest Imaging by LUS and CT in COVID-19 Inpatients: The ECOVID Multicenter Study

Respiration ◽

10.1159/000518516 ◽

2021 ◽

pp. 1-10

Author(s):

Claudio Tana ◽

Fabrizio Ricci ◽

Maria Gabriella Coppola ◽

Cesare Mantini ◽

Fulvio Lauretani ◽

...

Keyword(s):

Hospital Mortality ◽

Cox Regression ◽

Pearson Correlation ◽

Prognostic Significance ◽

Chest Ct ◽

Lung Damage ◽

Chest Imaging ◽

Gold Standard Method ◽

Cox Regression Analysis ◽

Total Score Range

Background: Point-of-care lung ultrasound (LUS) score is a semiquantitative score of lung damage severity. High-resolution computed tomography (HRCT) is the gold standard method to evaluate the severity of lung involvement from the novel coronavirus disease (COVID-19). Few studies have investigated the clinical significance of LUS and HRCT scores in patients with COVID-19. Therefore, the aim of this study was to evaluate the prognostic yield of LUS and of HRCT in COVID-19 patients. Methods: We carried out a multicenter, retrospective study aimed at evaluating the prognostic yield of LUS and HRCT by exploring the survival curve of COVID-19 inpatients. LUS and chest CT scores were calculated retrospectively by 2 radiologists with >10 years of experience in chest imaging, and the decisions were reached in consensus. LUS score was calculated on the basis of the presence or not of pleural line abnormalities, B-lines, and lung consolidations. The total score (range 0–36) was obtained from the sum of the highest scores obtained in each region. CT score was calculated for each of the 5 lobes considering the anatomical extension according to the percentage parenchymal involvement. The resulting overall global semiquantitative CT score was the sum of each single lobar score and ranged from 0 (no involvement) to 25 (maximum involvement). Results: One hundred fifty-three COVID-19 inpatients (mean age 65 ± 15 years; 65% M), including 23 (15%) in-hospital deaths for any cause over a mean follow-up of 14 days were included. Mean LUS and CT scores were 19 ± 12 and 10 ± 7, respectively. A strong positive linear correlation between LUS and CT scores (Pearson correlation r = 0.754; R2 = 0.568; p < 0.001) was observed. By ROC curve analysis, the optimal cut-point for mortality prediction was 20 for LUS score and 4.5 for chest CT score. According to Kaplan-Meier survival analysis, in-hospital mortality significantly increased among COVID-19 patients presenting with an LUS score ≥20 (log-rank 0.003; HR 9.87, 95% CI: 2.22–43.83) or a chest CT score ≥4.5 (HR 4.34, 95% CI: 0.97–19.41). At multivariate Cox regression analysis, LUS score was the sole independent predictor of in-hospital mortality yielding an adjusted HR of 7.42 (95% CI: 1.59–34.5). Conclusion: LUS score is useful to stratify the risk in COVID-19 patients, predicting those that are at high risk of mortality.

Download Full-text

Conservative management of single foetal death in multiple pregnancy at a tertiary care hospital in Bangladesh: Two case reports

Bangladesh Medical Journal ◽

10.3329/bmj.v45i3.33142 ◽

2017 ◽

Vol 45 (3) ◽

pp. 172-174

Author(s):

Eva Rani Nandi ◽

Fatema Ashraf ◽

Nilofar Yasmin ◽

Hasina Begum

Keyword(s):

Case Reports ◽

Tertiary Care ◽

Multiple Pregnancy ◽

Care Hospital ◽

Foetal Death ◽

Mortality And Morbidity ◽

Risk Of Mortality ◽

Proper Diagnosis ◽

Management Challenge

The single fetal death in multiple pregnancy is not rare. Death of one fetus in multiple pregnancy increases the risk of mortality and morbidity of the surviving fetus. This might pose management challenge to the obstetrician. It is a cause of great concern and psychological stress to the parents. Proper diagnosis and intervention in appropriate time can improve the maternal and neonatal outcome. Adequate counseling, psychological support and close follow up are mandatory. There are potential complications to the mother and the surviving twin.Bangladesh Med J. 2016 Sep; 45 (3): 172-174

Download Full-text

Fibrin Glue Administration to Support Bronchial Stump Line

Asian Cardiovascular and Thoracic Annals ◽

10.1177/021849230801600604 ◽

2008 ◽

Vol 16 (6) ◽

pp. 450-453 ◽

Cited By ~ 9

Author(s):

Soner Gursoy ◽

Murat U Yapucu ◽

Ahmet Ucvet ◽

Serkan Yazgan ◽

Oktay Basok ◽

...

Keyword(s):

High Risk ◽

Fibrin Glue ◽

Pulmonary Resection ◽

Bronchopleural Fistula ◽

Surgical Margin ◽

Postoperative Mortality ◽

Lung Abscess ◽

Bronchial Stump ◽

Neoadjuvant Radiotherapy ◽

Mortality And Morbidity

Bronchopleural fistula is an important cause of mortality and morbidity after pulmonary resection. The use of fibrin glue to reduce the tension and number of sutures in the bronchial stump was assessed in this prospective study of 20 patients between June 2002 and May 2003. They all had a high risk of bronchopleural fistula development because of bronchiectasis, tuberculosis, lung abscess, diabetes mellitus, preoperative neoadjuvant radiotherapy, or residual tumor at the surgical margin. After pulmonary resection, the bronchial stump was closed with separate nonabsorbable sutures supported with fibrin glue. Bronchopleural fistula was observed in only 1 (5%) patient during 6.45 ± 3.09 months of follow-up. There was no postoperative mortality. Closing the bronchial stump with an appropriate technique and supporting it with fibrin glue were considered effective in preventing bronchopleural fistula development after pulmonary resection in high-risk patients.

Download Full-text

Endovascular Treatment of Acute Pulmonary Embolism: A Rapid Evolution

Journal of Cardiothoracic and Vascular Anesthesia ◽

10.1053/j.jvca.2020.01.030 ◽

2020 ◽

Vol 34 (6) ◽

pp. 1423-1425 ◽

Cited By ~ 2

Author(s):

Rohesh J. Fernando ◽

Daniel Cormican ◽

Harish Ramakrishna

Keyword(s):

Pulmonary Embolism ◽

Endovascular Treatment ◽

Acute Pulmonary Embolism ◽

Rapid Evolution

Download Full-text

Neutrophil extracellular traps infiltrate the lung airway, interstitial, and vascular compartments in severe COVID-19

Journal of Experimental Medicine ◽

10.1084/jem.20201012 ◽

2020 ◽

Vol 217 (12) ◽

Cited By ~ 22

Author(s):

Coraline Radermecker ◽

Nancy Detrembleur ◽

Julien Guiot ◽

Etienne Cavalier ◽

Monique Henket ◽

...

Keyword(s):

Respiratory Failure ◽

Neutrophil Extracellular Traps ◽

Pulmonary Complications ◽

Lung Damage ◽

Extracellular Traps

Infection with SARS-CoV-2 is causing a deadly and pandemic disease called coronavirus disease–19 (COVID-19). While SARS-CoV-2–triggered hyperinflammatory tissue-damaging and immunothrombotic responses are thought to be major causes of respiratory failure and death, how they relate to lung immunopathological changes remains unclear. Neutrophil extracellular traps (NETs) can contribute to inflammation-associated lung damage, thrombosis, and fibrosis. However, whether NETs infiltrate particular compartments in severe COVID-19 lungs remains to be clarified. Here we analyzed postmortem lung specimens from four patients who succumbed to COVID-19 and four patients who died from a COVID-19–unrelated cause. We report the presence of NETs in the lungs of each COVID-19 patient. NETs were found in the airway compartment and neutrophil-rich inflammatory areas of the interstitium, while NET-prone primed neutrophils were present in arteriolar microthrombi. Our results support the hypothesis that NETs may represent drivers of severe pulmonary complications of COVID-19 and suggest that NET-targeting approaches could be considered for the treatment of uncontrolled tissue-damaging and thrombotic responses in COVID-19.

Download Full-text

The Impact of Frailty on Morbidity and Mortality following Open Emergent Colectomies

BioMed Research International ◽

10.1155/2017/5126452 ◽

2017 ◽

Vol 2017 ◽

pp. 1-10 ◽

Cited By ~ 11

Author(s):

Dominick V. Congiusta ◽

Prashanth Palvannan ◽

Aziz M. Merchant

Keyword(s):

Care Setting ◽

Frailty Index ◽

Acute Care Setting ◽

Improvement Program ◽

Mortality And Morbidity ◽

National Quality ◽

American College Of Surgeons ◽

Modified Frailty Index ◽

The Impact ◽

The Relationship

Background. Elderly and frail patients undergo open emergency colectomies and are at greater risk for complications. The relationship between frailty and open emergent colectomies is yet unexplored.Objective. The purpose of this study was to evaluate the relationship between frailty and outcomes after open emergent colorectal surgery.Design. Using the American College of Surgeons National Quality Improvement Program database, a validated modified frailty index was used, along with logistic regression, to assess the relationship between frailty and outcomes.Main Outcome Measures. Outcomes included mortality (primary), Clavien-Dindo Complication Grade >3, reintubation, ventilator >48 hours, and reoperation (secondary).Results. The rates for 30-day mortality, Clavien-Dindo Grade >3, reintubation, ventilator > 48 hours, and reoperation in our cohort were 16.6%, 36.9%, 8.6%, 23.9%, and 15.0%, respectively. There was a statistically significant increase in prevalence of all outcomes with increasing frailty.Limitations. A causal relationship between frailty and complications cannot be established in a retrospective analysis. Also, extrapolation of our data to reflect outcomes beyond 30 days must be done with caution.Conclusions. Frailty is a statistically significant predictor of mortality and morbidity after open emergent colectomies and can be used in an acute care setting.

Download Full-text

Association of hypocalcemia with in-hospital mortality and complications in patients with acute pulmonary embolism: results from the 2017 Nationwide Inpatient Sample

BMC Pulmonary Medicine ◽

10.1186/s12890-021-01784-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Mukunthan Murthi ◽

Hafeez Shaka ◽

Zain El-amir ◽

Sujitha Velagapudi ◽

Abdul Jamil ◽

...

Keyword(s):

Pulmonary Embolism ◽

Regression Analysis ◽

Hospital Mortality ◽

Nationwide Inpatient Sample ◽

Acute Pulmonary Embolism ◽

Multivariate Logistic Regression Analysis ◽

Kidney Injury ◽

Medical Problem ◽

Mortality And Morbidity ◽

Acute Pe

Abstract Background Acute pulmonary embolism (PE) is a common cause for hospitalization associated with significant mortality and morbidity. Disorders of calcium metabolism are a frequently encountered medical problem. The effect of hypocalcemia is not well defined on the outcomes of patients with PE. We aimed to identify the prognostic value of hypocalcemia in hospitalized PE patients utilizing the 2017 Nationwide Inpatient Sample (NIS). Methods In this retrospective study, we selected patients with a primary diagnosis of Acute PE using ICD 10 codes. They were further stratified based on the presence of hypocalcemia. We primarily aimed to compare in-hospital mortality for PE patients with and without hypocalcemia. We performed multivariate logistic regression analysis to adjust for potential confounders. We also used propensity‐matched cohort of patients to compare mortality. Results In the 2017 NIS, 187,989 patients had a principal diagnosis of acute PE. Among the above study group, 1565 (0.8%) had an additional diagnosis of hypocalcemia. 12.4% of PE patients with hypocalcemia died in the hospital in comparison to 2.95% without hypocalcemia. On multivariate regression analysis, PE and hypocalcemia patients had 4 times higher odds (aOR-4.03, 95% CI 2.78–5.84, p < 0.001) of in-hospital mortality compared to those with only PE. We observed a similarly high odds of mortality (aOR = 4.4) on 1:1 propensity-matched analysis. The incidence of acute kidney injury (aOR = 2.62, CI 1.95–3.52, p < 0.001), acute respiratory failure (a0R = 1.84, CI 1.42–2.38, p < 0.001), sepsis (aOR = 4.99, CI 3.08–8.11, p < 0.001) and arrhythmias (aOR = 2.63, CI 1.99–3.48, p < 0.001) were also higher for PE patients with hypocalcemia. Conclusion PE patients with hypocalcemia have higher in-hospital mortality than those without hypocalcemia. The in-hospital complications were also higher, along with longer length of stay.

Download Full-text

Current Endovascular Treatment Options in Acute Pulmonary Embolism

Journal of Clinical Imaging Science ◽

10.25259/jcis_229_2020 ◽

2021 ◽

Vol 11 ◽

pp. 5

Author(s):

Kelli Moore ◽

Jeff Kunin ◽

Mohammed Alnijoumi ◽

Prashant Nagpal ◽

Ambarish P. Bhat

Keyword(s):

Pulmonary Embolism ◽

Endovascular Treatment ◽

Acute Pulmonary Embolism ◽

Treatment Options ◽

Mortality And Morbidity ◽

Response Team ◽

Promising Treatment ◽

Level I ◽

Acute Pe

Acute pulmonary embolism (PE) is a significant cause of mortality and morbidity across the globe. Over the last few decades, there have been major therapeutic advances in acute PE management, including catheter-based therapy. However, the effectiveness of catheter-based therapy in acute PE is not supported by Level I evidence, making the use of this promising treatment rather controversial and ambiguous. In this paper, we discuss the risk stratification of acute PE and review the medical and endovascular treatment options. We also summarize and review the data supporting the use of endovascular treatment options in acute PE and describe the potential role of the PE response team.

Download Full-text