Post-operative management and issues
Post-operative period was even more complex. In one older patient
affected by chronic pulmonary disease, we observed on the fourth day
after surgery the onset of fever, dyspnea and desaturation during
wide-spectrum antibiotic therapy; for this reason, he underwent
chest-TC, which showed sign of interstitial involvement by an
inflammatory process. The infectious disease specialist, was then asked
to evaluate the patient and decided to move him from our inpatient
clinic to a ward dedicated to COVID-19 positive patients, waiting for
the result of NP and OP swabs. All the swabs resulted negative for
infection and were repeated after 24h for a confirmation. However, the
patient remained in the COVID-19 unit until the resolution of pulmonary
infection, thus prolonging his overall hospital stay. In another case,
we had a delay in the scheduled operatory session, due to the presence
of suspect radiologic findings in an asymptomatic patient with
ground-glass opacities and interstitial inflammation, emerged with a
staging chest-CT and not evident at the routine pre-admission chest-RX.
In a dialysis patient, the onset of fever and dyspnea on the second
postoperative day required a new COVID-19 test; due to the waiting of
the result (about 24 hours), the dialysis session was postponed by one
day, without systemic consequences. Finally, we report the case of a
female patient admitted to intensive care unit for dyspnoea, underwent
emergency orotracheal intubation for acute respiratory failure and the
case was considered suspect for SARS-CoV-2 infection; because of the
improvement of the clinical conditions, she was extubated, transferred
to medicine department and a COVID-19 swab resulted negative. Due to the
onset of dysphonia following orotracheal intubation, she performed ENT
evaluation with diagnosis of left vocal cord impaired mobility in
malignant laryngeal tumor.