Background: SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) is an extremely infectious virus causing COVID-19 illness. Respiratory failure is a consequence of COVID-19 illness related pneumonia, in which mechanical ventilation and endotracheal intubation are essential. Barotrauma is a chief complication due to mechanical ventilation, in which pneumothorax was established in 25% of COVID-19 barotrauma patients. The majority of complicated COVID-19 cases with a pleural effusion or pneumothorax require a thoracostomy. Objective: To recognize and analyse tube thoracostomy consequences in COVID-19 complicated individuals through this pandemic. Patientsand Methods: A retrospective study was accomplished in Thoracic Surgery Unit of Elkasr Elaini Medical Center, Cardiothoracic Surgery Department in Cairo University, Cairo, Egypt. We included fifteen COVID-19 individuals entered the ICU in the period between June 2020 and September 2021 requiring thoracic surgery consultation. Non-COVID-19 severe illness and iatrogenic pneumothorax were omitted from this study. Results: Nine pneumothorax cases (73.3%), two surgical emphysema associated with pneumothorax cases (13.3%), three pleural effusion cases (20%) and one hydropneumothorax case (6.7%) as a total of fifteen patients needed thoracic surgery consultation. After tube thoracostomy, there were no harm consequences. From the total number of patients, 12 well improved and discharged (80%) and three were dead (20%) within three days after tube thoracostomy who were mechanically ventilated due to respiratory failure after ARDS. Conclusion: COVID-19 complicated cases needed chest tube insertion is associated with good outcomes and improvement.