Endobronchial valve positioning for alveolar-pleural fistula following ICU management complicating COVID-19 pneumonia

BMC Pulmonary Medicine

Massimo Girardis¹  Gilda Valentina Cavaliere¹  Elisabetta Bertellini¹  Stefano Busani¹  Cristina Mussini²  Enrico Clini³  Alessandro Marchioni³  Giulia Bruzzi³  Alessandro Andreani³  Maria Rosaria Pellegrino³  Fabiana Trentacosti³  Gaia Francesca Cappiello³  Pierluigi Donatelli³  Dario Andrisani⁴  Filippo Gozzi⁴  Roberto Tonelli⁵ 

[1] University Hospital of Modena, Anesthesiology Unit, University of Modena Reggio Emilia, Modena, Italy;University Hospital of Modena, Infectious Diseases Unit, University of Modena Reggio Emilia, Modena, Italy;University Hospital of Modena, Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, Modena, Italy;University Hospital of Modena, Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, Modena, Italy;Clinical and Experimental Medicine PhD Program, University of Modena Reggio Emilia, Via Università 4, 41121, Modena, Italy;University Hospital of Modena, Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, Modena, Italy;Clinical and Experimental Medicine PhD Program, University of Modena Reggio Emilia, Via Università 4, 41121, Modena, Italy;Laboratory of Experimental Pneumology, Modena, Italy;Respiratory Diseases Unit and Center for Rare Lung Disease, Department of Surgical and Medical Sciences, University Hospital of Modena, Via del Pozzo, 71, 41125, Modena, Italy;

关键词: COVID-19;    Alveolar-pleural fistula;    Endobronchial valve;    Pneumothorax;    Klebsiella pneumoniae;   

DOI  :  10.1186/s12890-021-01653-w

来源: Springer

【 摘 要 】

BackgroundThe 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 presentationWe 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.ConclusionsPersistent 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.

【 授权许可】

CC BY