Background Numerous complications requiring tube thoracostomy have been reported among critically ill COVID-19 patients, 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, 1,705 patients with laboratory confirmed COVID-19 patients were admitted to our ICUs from March 7, 2020 to March 1, 2021, with 69/1705 patients (4.0%) receiving 130 chest tubes. Of these 89/130 (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 < 0.01), and had longer ICU (30 vs 5 days, p < 0.01) and hospital (37 vs 10 days, p < 0.01) lengths of stay compared to 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 = 0.01) and a non-significantly higher static compliance (20.0 vs 17.5 mL/cm H2O, p = 0.052) 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 endpoint. Delayed development of chest tube requirement was associated with a decreased survival and could reflect a poor healing phenotype.
Reduced Survival in Patients Requiring Chest Tubes with COVID-19 Acute Respiratory Distress Syndrome