| Id |
Subject |
Object |
Predicate |
Lexical cue |
| T116 |
0-10 |
Sentence |
denotes |
DISCUSSION |
| T117 |
11-285 |
Sentence |
denotes |
Novel pathological studies revealed exudative diffuse alveolar damage, capillary congestion and hyaline membrane formations in the early phase and interstitial and intra-alveolar proliferation of fibroblasts and fibrin deposition in the late phase of the COVID-19 infection. |
| T118 |
286-377 |
Sentence |
denotes |
Moreover, most autopsy reports showed disseminated fibrotic changes in the lung parenchyma. |
| T119 |
378-678 |
Sentence |
denotes |
Although these pathological changes are similar to those of ARDS, the clinical course is not the same in every patient, and pleural complications can develop due to these COVID-19-related pathophysiological changes, treatment and interventions applied or comorbid conditions of the patients [11, 12]. |
| T120 |
679-811 |
Sentence |
denotes |
Several studies showed that high positive end-expiratory pressure (PEEP) would be associated with alveolar rupture and pneumothorax. |
| T121 |
812-1032 |
Sentence |
denotes |
Therefore, it is important to see the prevailing pathophysiological picture and distinguish the ‘L-type’ and ‘H-type’ pneumonia in patients diagnosed with COVID-19 in order to manage the ventilator successfully [13, 14]. |
| T122 |
1033-1159 |
Sentence |
denotes |
In our case series, 4 of 6 patients who developed pneumothorax were intubated patients who underwent high PEEP (14–15 cm H2O). |
| T123 |
1160-1237 |
Sentence |
denotes |
These patients were those with H-type pneumonia who needed high PEEP therapy. |
| T124 |
1238-1360 |
Sentence |
denotes |
In 1 patient, pneumothorax developed secondary to tracheal laceration, and spontaneous pneumothorax was seen in 1 patient. |
| T125 |
1361-1431 |
Sentence |
denotes |
Detection of pneumothorax may be difficult in critically ill patients. |
| T126 |
1432-1584 |
Sentence |
denotes |
Therefore, sudden changes in respiratory parameters, especially in patients receiving high PEEP therapy, should suggest the possibility of pneumothorax. |
| T127 |
1585-1700 |
Sentence |
denotes |
We preferred to keep the chest tube clamped for 24 h before removing it in patients with COVID-19 and pneumothorax. |
| T128 |
1701-1758 |
Sentence |
denotes |
No recurrent pneumothorax was observed in these patients. |
| T129 |
1759-1897 |
Sentence |
denotes |
According to the novel case series and our clinical experience, isolated pleural effusion is extremely uncommon in patients with COVID-19. |
| T130 |
1898-1962 |
Sentence |
denotes |
In our case series, a total of 7 patients had pleural effusions. |
| T131 |
1963-2069 |
Sentence |
denotes |
Three of them had empyema; 2 had malignant effusions; 1 had parapneumonic effusion; and 1 had haemothorax. |
| T132 |
2070-2274 |
Sentence |
denotes |
It has been shown that viral infections facilitate secondary infections by disrupting mucociliary clearance, weakening neutrophil functions and affecting the functioning of immunological pathways [15–18]. |
| T133 |
2275-2349 |
Sentence |
denotes |
Secondary bacterial infections can also be seen in patients with COVID-19. |
| T134 |
2350-2459 |
Sentence |
denotes |
Zhou et al. [16] demonstrated that 50% of patients with COVID-19 who died had secondary bacterial infections. |
| T135 |
2460-2579 |
Sentence |
denotes |
Wang et al. [17] showed that the most common complications in patients with COVID-19 were bacterial infections (42.8%). |
| T136 |
2580-2646 |
Sentence |
denotes |
We detected empyema in 4 patients and performed tube thoracostomy. |
| T137 |
2647-2743 |
Sentence |
denotes |
In 1 of these patients, empyema developed secondary to prolonged air leakage after pneumothorax. |
| T138 |
2744-2950 |
Sentence |
denotes |
Despite the complete drainage of the empyema, regular irrigation of the pleural cavity with antibiotic solutions and appropriate antibiotherapy, the mean drainage time was relatively long (16.7 ± 6.3 days). |
| T139 |
2951-3021 |
Sentence |
denotes |
Prevention is the ideal solution for secondary infections in COVID-19. |
| T140 |
3022-3121 |
Sentence |
denotes |
Several studies have shown the positive effect of empiric antibiotherapy in patients with COVID-19. |
| T141 |
3122-3291 |
Sentence |
denotes |
However, it is extremely important to know institutional antibiograms, local drug resistance and hospital epidemiological prototypes when choosing empiric regimens [18]. |
| T142 |
3292-3360 |
Sentence |
denotes |
Malignant pleural effusion was detected in 2 patients with COVID-19. |
| T143 |
3361-3501 |
Sentence |
denotes |
The respiratory parameters of these patients were poor, and rapid progression of the effusions was observed despite recurrent thoracentesis. |
| T144 |
3502-3580 |
Sentence |
denotes |
Therefore, the chest tube was inserted, and total lung expansion was obtained. |
| T145 |
3581-3671 |
Sentence |
denotes |
Because of the poor general condition of these patients, talc slurry was not administered. |
| T146 |
3672-3795 |
Sentence |
denotes |
Massive haemothorax was observed in a patient undergoing ECMO with an indication of severe respiratory failure due to ARDS. |
| T147 |
3796-3901 |
Sentence |
denotes |
Haemothorax was unrelated to ECMO cannulation, and there was no history of cardiopulmonary resuscitation. |
| T148 |
3902-3991 |
Sentence |
denotes |
Left-sided tube thoracostomy was performed, and drainage of the haemothorax was obtained. |
| T149 |
3992-4112 |
Sentence |
denotes |
Low-dose heparin infusion (100 U/kg heparin) was discontinued, and intravenous tranexamic acid (500 mg q8h) was applied. |
| T150 |
4113-4186 |
Sentence |
denotes |
A total of 500 cc of haemorrhagic drainage was observed in the first 2 h. |
| T151 |
4187-4307 |
Sentence |
denotes |
Subsequently, a total of 1000 cc of haemorrhagic fluid drainage occurred in 24 h, and total lung expansion was obtained. |
| T152 |
4308-4400 |
Sentence |
denotes |
No deterioration was observed in the patient's vital signs with adequate volume replacement. |
| T153 |
4401-4448 |
Sentence |
denotes |
Therefore, no surgical intervention was needed. |
| T154 |
4449-4586 |
Sentence |
denotes |
Several guidelines and recommendations regarding a chest tube thoracostomy and patient follow-up during the pandemic have been published. |
| T155 |
4587-4743 |
Sentence |
denotes |
Common points in these guidelines include avoiding unnecessary surgical interventions and working with a small but sufficient number of medical staff [6–8]. |
| T156 |
4744-4892 |
Sentence |
denotes |
SARS-CoV-2 is not currently considered to be airborne, but several procedures like chest tube placement would be associated with aerosol generation. |
| T157 |
4893-5024 |
Sentence |
denotes |
Therefore, pleural procedures must be performed in a well-ventilated room, and personal protective equipment must be worn [19, 20]. |
| T158 |
5025-5099 |
Sentence |
denotes |
Another important point is the risk of droplet spread from the chest tube. |
| T159 |
5100-5250 |
Sentence |
denotes |
Traditional underwater seal drainage bottles have a port that allows the air to escape and, if necessary, to connect to the low-pressure wall suction. |
| T160 |
5251-5416 |
Sentence |
denotes |
In the presence of air leakage, aerosolization can occur inside the drainage bottle, and air escaping through the port would increase the risk of viral transmission. |
| T161 |
5417-5514 |
Sentence |
denotes |
This issue has been noted before, and various suggestions have been made in the literature [7–9]: |
| T162 |
5515-5743 |
Sentence |
denotes |
Bilkhu et al. [7] suggested connecting the chest drain to the wall suction and attaching a viral filter to the suction port of a chest drainage bottle or using digital drain circuits to reduce droplet spread from the chest tube. |
| T163 |
5744-5867 |
Sentence |
denotes |
Barr et al. [9] described the ‘rocket tubing’ method to prevent viral transmission through the port of the drainage bottle. |
| T164 |
5868-6027 |
Sentence |
denotes |
Coronaviruses are ∼65–125 nm in size, and unlike standard filters, HEPA filters have a minimum 99.97% efficiency rating for removing particles ≥30 nm [21, 22]. |
| T165 |
6028-6136 |
Sentence |
denotes |
Therefore, we used the HEPA filter mounted bottle system, including the trap and the underwater seal bottle. |
| T166 |
6137-6292 |
Sentence |
denotes |
The trap bottle was filled only with 200 cc (80%) of alcohol instead of water alone, and a HEPA filter was placed on the tip of the underwater seal bottle. |
| T167 |
6293-6408 |
Sentence |
denotes |
Pieracci et al. recommended adding dilute sodium hypochlorite (household bleach) to the water seal chamber [6, 10]. |
| T168 |
6409-6614 |
Sentence |
denotes |
Although there is no evidence for which one is more protective, we preferred adding alcohol into the trap bottle instead of sodium hypochlorite because it is easily accessible and applicable in our clinic. |
| T169 |
6615-6817 |
Sentence |
denotes |
To prevent viral dissemination, pleural catheters, which may be inserted with the Seldinger technique, are preferred instead of traditional chest tube systems, especially in loculated pleural effusions. |
| T170 |
6818-6893 |
Sentence |
denotes |
In our centre, only the 8-Fr size of these types of catheters is available. |
| T171 |
6894-7021 |
Sentence |
denotes |
Consequently, they often become occluded in a short time after the placement, and repeated surgical procedures can be required. |
| T172 |
7022-7211 |
Sentence |
denotes |
Therefore, we did not use this type of catheter with any patients during the study period; however, it should be kept in mind as an alternative method for the drainage of pleural effusions. |
| T173 |
7212-7326 |
Sentence |
denotes |
In our centre, we organized a pleural intervention team of 3 people: a surgeon, a nurse and a surgical technician. |
| T174 |
7327-7451 |
Sentence |
denotes |
The primary purpose was to limit and regulate the contact of healthcare professionals with patients diagnosed with COVID-19. |
| T175 |
7452-7581 |
Sentence |
denotes |
During the pandemic, COVID-19 (or related symptoms) was not observed in any of the healthcare professionals in our surgical team. |
| T176 |
7583-7594 |
Sentence |
denotes |
Limitations |
| T177 |
7595-7630 |
Sentence |
denotes |
This study has several limitations. |
| T178 |
7631-7703 |
Sentence |
denotes |
First, it is a retrospective case series, and there is no control group. |
| T179 |
7704-7826 |
Sentence |
denotes |
Second, our study includes a heterogeneous group of patients; therefore, it is difficult to make comprehensive inferences. |
| T180 |
7827-7932 |
Sentence |
denotes |
Besides, the number of patients in our case series is small, so the conclusions of the study are limited. |
| T181 |
7933-8112 |
Sentence |
denotes |
However, the primary purpose of our research was to provide knowledge and share our experiences under pandemic conditions rather than to produce statistically significant results. |