ABSTRACT. The Sars-Cov2 second wave has reached all of Europe and the numbers of infected people, those hospitalized in intensive care and victims are already increasing. It seems that in this second wave the virus is more aggressive. What have we learned during the first months of the year, during the first phase of the pandemic?

The Sars-Cov2 patient is extremely fragile, especially the lungs. Sars-Cov2 caused ARDS often requires non-invasive ventilation, high-flow ventilation or intubation. The lungs, already compromised by the action of the virus and by any pre-existing diseases (COPD, emphysema ...) often suffer the negative effects of these ventilations. Frequently the Thoracic Surgeon is called in ICU to treat pneumothorax, pneumomediastinum, pneumatoceles, diffuse subcutaneous emphysema in urgency. In general, a conservative approach is enough, sometimes chest tube placement is required. A surgical approach may be necessary to control any persistent air loss or pneumomediastinum persistence. Another important Sars-Cov2 consequence is the increase in pulmonary infections caused by patient's immune system loss. We observed a higher rate of pleural empyemas and lung abscesses, which often required surgical resection. Pulmonary resection in Sars-Cov2 patient suffers from more complications than in the normal patient. In particular, two have been observed in our experience: persistent air loss and loss of re-expansion in the residual lung parenchyma, associated with an exceptional visceral pleura thickening. Possible respiratory failure then increased postoperative mortality for these patients.

The need to avoid operating Sars-Cov2 positive patients in elective surgery has imposed a considerable organizational effort in having oropharyngeal swabs performed on all patients, but this practice has allowed to drastically reduce postoperative morbidity and mortality, excluding positive patients from surgery.