Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jun:10:471-477.
doi: 10.1016/j.xjon.2022.03.008. Epub 2022 Apr 20.

Reduced survival in patients requiring chest tubes with COVID-19 acute respiratory distress syndrome

Nicholas W Rizer  1 , Benjamin Smood  2 , Blake Mergler  2 , Alexandra E Sperry  2 , Christian A Bermudez  2 , Jacob T Gutsche  3 , Asad A Usman  3
Affiliations

Reduced survival in patients requiring chest tubes with COVID-19 acute respiratory distress syndrome

Nicholas W Rizer et al. JTCVS Open. 2022 Jun.

Abstract

Background: Numerous complications requiring tube thoracostomy have been reported among critically ill patients with COVID-19; however, there has been a lack of evidence regarding outcomes following chest tube placement.

Methods: We developed a retrospective observational cohort of all patients admitted to an intensive care unit (ICU) with confirmed COVID-19 to describe the incidence of tube thoracostomy and factors associated with mortality following chest tube placement.

Results: In total, 1705 patients with laboratory confirmed COVID-19 patients were admitted to our ICUs from March 7, 2020, to March 1, 2021, with 69 out of 1705 patients (4.0%) receiving 130 chest tubes. Of these, 89 out of 130 (68%) chest tubes were indicated for pneumothorax. Patients receiving tube thoracostomy were much less likely to be alive 90 days post-ICU admission (52% vs 69%; P < .01), and had longer ICU (30 vs 5 days; P < .01) and hospital (37 vs 10 days; P < .01) lengths of stay compared with those without tube thoracostomy. Patients who received tube thoracostomy and survived at least 90 days post-ICU admission had shorter times to first chest tube insertion (8.5 vs 17.0 days; P = .01) and a nonsignificantly higher static compliance (20.0 vs 17.5 mL/cm H2O; P = .052) at the time of chest tube placement than those who had expired. Logistic regression analysis demonstrated an association between time to first chest tube and decreased survival when adjusted for covariates.

Conclusions: Requiring a chest tube in COVID-19 is a negative prognostic end point. Delayed development of chest tube requirement was associated with a decreased survival and could reflect a poor healing phenotype.

Keywords: ARDS, acute respiratory distress syndrome; COVID-19; ICU, intensive care unit; critical care; mechanical ventilation; tube thoracostomy.

PubMed Disclaimer

Figures

None
Graphical abstract
None
Case example of severe ARDS requiring both surgical chest tube and percutaneous pigtail.
Figure 1
Figure 1
Cumulative survival from intensive care unit (ICU) admission to 60 days by comparing the chest-tube cohort versus the nonchest-tube cohort from day 0 to day 60 of ICU admission.
Figure 2
Figure 2
Depiction of the study's methods, results, and implications.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. World Health Organization Novel coronavirus—China. http://www.who.int/csr/don/12-january-2020-novel-coronavirus-china/en/
    1. Coronavirus disease (COVID-19) https://www.who.int/emergencies/diseases/novel-coronavirus-2019
    1. Yang W., Cao Q., Qin L., Wang X., Cheng Z., Pan A., et al. Clinical characteristics and imaging manifestations of the 2019 novel coronavirus disease (COVID-19): a multi-center study in Wenzhou city, Zhejiang, China. J Infect. 2020;80:388–393. doi: 10.1016/j.jinf.2020.02.016. - DOI - PMC - PubMed
    1. Yang X., Yu Y., Xu J., Shu H., Xia J., Liu H., et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. 2020;8:475–481. doi: 10.1016/S2213-2600(20)30079-5. - DOI - PMC - PubMed
    1. Salehi S., Abedi A., Balakrishnan S., Gholamrezanezhad A. Coronavirus Disease 2019 (COVID-19): a systematic review of imaging findings in 919 patients. AJR Am J Roentgenol. 2020;215:82–93. doi: 10.2214/AJR.20.23034. - DOI - PubMed