Author: Donatelli, Pierluigi; Trenatacosti, Fabiana; Pellegrino, Maria Rosaria; Tonelli, Roberto; Bruzzi, Giulia; Andreani, Alessandro; Cappiello, Gaia Francesca; Andrisani, Dario; Gozzi, Filippo; Mussini, Cristina; Busani, Stefano; Cavaliere, Gilda Valentina; Girardis, Massimo; Bertellini, Elisabetta; Clini, Enrico; Marchioni, Alessandro
Title: Endobronchial valve positioning for alveolar-pleural fistula following ICU management complicating COVID-19 pneumonia Cord-id: 33w5bvj1 Document date: 2021_9_27
ID: 33w5bvj1
Snippet: BACKGROUND: The main clinical consequences of severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) infection are pneumonia and respiratory failure even requiring mechanical ventilation. In this context, the lung parenchyma is highly prone to ventilator-related injury, with pneumothorax and persistent air leak as the most serious adverse events. So far, endobronchial valve (EBV) positioning has proved efficacious in treating air leaks with a high success rate. CASE PRESENTATION: We report
Document: BACKGROUND: The main clinical consequences of severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) infection are pneumonia and respiratory failure even requiring mechanical ventilation. In this context, the lung parenchyma is highly prone to ventilator-related injury, with pneumothorax and persistent air leak as the most serious adverse events. So far, endobronchial valve (EBV) positioning has proved efficacious in treating air leaks with a high success rate. CASE PRESENTATION: We report, for the first time, two cases of patients affected by SARS-CoV-2-related pneumonia complicated with bacterial super-infection, experiencing pneumothorax and persistent air leaks after invasive mechanical ventilation. Despite the severity of respiratory failure both patients underwent rigid interventional bronchoscopy and were successfully treated through EBV positioning. CONCLUSIONS: Persistent air leaks may result from lung tissue damage due to a complex interaction between inflammation and ventilator-related injury (VILI), especially in the advanced stages of ARDS. EBV positioning seems to be a feasible and effective minimally invasive therapeutic option for treating this subset of patients.
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