Perioperative ventilator-induced lung injury- An unexpected complication of post COVID-19 sequelae

Abstract

In today’s era of the COVID-19 pandemic, post-covid lung sequelae increases the incidence of ventilator-induced lung injury in patients undergoing cancer surgeries. A 68 years old female patient underwent surgery for squamous cell carcinoma lower lip under general anesthesia. 10 minutes after reversal and adequate respiratory efforts, sudden desaturation with high peak airway pressures of 35-40 cmH2O was noticed. Bilateral air entry was markedly reduced with crepitus all over the chest and abdomen with stable hemodynamics. Chest X-ray revealed a bilateral deep sulcus sign suggesting bilateral pneumothorax and subcutaneous emphysema. Bilateral thoracostomy tubes were inserted immediately. The saturation and airway pressure improved, and she was extubated the next day. Retrospectively, a possible history of previous undiagnosed COVID-19 infection was sought and this emphasizes the importance of this history, in the ongoing pandemic. Previous history of COVID-19 predisposes patients to a high risk of ventilator-induced lung injury perioperatively.