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latest on Covid

THERE IS HOPE AT THE END OF THE CHEST TUBE

The arrival of spring in March was the harbinger of not such good news for 71-year-old Mr. VS. He was diagnosed to have Severe Covid pneumonia and was admitted to the intensive care unit of Dr L H Hiranandani hospital. CT scan of his lungs showed bilateral ground glass opacities suggestive of severe inflammation. His declining levels of oxygen were corrected via high frequency nasal canula device. A stormy course ahead was foreseen but his ship would have to weather its worst fears -leaks!

In this case leaks from his lungs. Due to the friable nature of his covid affected lungs he developed spontaneous pneumothoraxes (air leak in the space between lung and rib cage) bilaterally causing further drop in oxygen levels. Intercostal drainage tubes were placed on both sides to relieve the pressure on the lungs and thereby improving oxygenation. His condition steadily improved, both drains were removed and his oxygen requirement decreased. His lungs, however, were healing with significant scarring (fibrosis) and thin air-filled cysts, as is commonly seen in severe covid cases, leaving him prone to develop pneumothorax again. He went on to develop pneumothorax on the right side once more followed by loculated large pneumothoraxes on the left side requiring drainage again after 3 weeks. While the right pneumothorax healed and sealed well despite the fibrosis with no further recurrence, the left pneumothorax was another story.

A repeat imaging of the lungs showed virtually no normal lung on the left lung, and only large air filled leaky pneumatocoeles (large air-filled cysts in lung) with large pneumothorax. In addition, he also developed paroxysmal supraventricular tachycardia (irregular heart rhythm) along with high CRP and cardiac enzymes, a condition quite similar to an inflammatory syndrome seen in children with covid. This arrhythmia got aggravated further with each adjustment and drain placement giving us quite a few skipped beats as well! All these made him a poor candidate for any surgical management. He responded well to appropriate medical management with steroids, cardiac rhythm control drugs, blood thinners and antifibrotics.

We were able to remove the left side chest drain once complete expansion of lung was seen at two weeks with no further recurrence. It took a multidisciplinary team consisting of pulmonologist, intensivist (Dr Arpita and team), radiologist and cardiologist to successfully deal with expected and unexpected challenges thrown up by this disease for 8 weeks.

Today Mr. VS walks tall in the corridors of the hospital, without oxygen support, proudly displaying his battle scars (read intercostal drain scars), ready for further pulmonary rehabilitation -- a true embodiment of the grit and determination of the human spirit.