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1.
Journal of Emergency Practice and Trauma ; 8(2):141-144, 2022.
Article in English | Scopus | ID: covidwho-1965120

ABSTRACT

Objective: Bronchopleural fistula (BPF) is a pathological communication between the bronchial tree and pleural space. BPFs are commonly seen after lung surgery, and are less common in trauma, lung abscess, and radiation therapy. In this study, we describe the clinical course and surgery of a case of pulmonary necrosis and BPF in a patient infected with coronavirus disease 2019 (COVID-19). Case Presentation: The patient was a 54-year-old man with multiple myeloma and end-stage renal disease from the last 8 years. He had a history of coronary artery bypass grafting from the last 3 years. He also suffered from progressive shortness of breath and dry cough since March 2019. Conclusion: The results of this study showed that BPF is one of the most severe complications after thorax surgery, and there is no effective prevention method particularly in this patient who had COVID-19 pneumonia. Therefore, early intervention, especially when diagnosed at an early stage, by strengthening the stump inside the thorax or thoracotomy in the open window may eventually accelerate the closure of the BPF and improve the survival. © 2022 The Author(s).

2.
Cureus ; 14(6): e26464, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1939392

ABSTRACT

Pulmonary cavitation is an atypical finding in COVID-19 patients. In this rare case report, a 63-year-old woman (35 days from COVID-19 symptom onset) presented to our emergency department with acute chest pain and shortness of breath. A chest X-ray established right-sided total pneumothorax, hence a tube thoracostomy was performed. Due to a persistent air leak, chest computed tomography was performed, which showed areas of lung consolidation and a cavitary mass in the upper lobe of the right lung. The woman undertook a thoracoscopy, which established multiple petechiae on the lung surface and a bronchopleural fistula of the right lung's upper lobe. The treatment of choice was an atypical lung resection to remove the necrotic cavitary lesion. Histological and microbiological examination of the resected lung specimen showed a bland (aseptic) cavitary pulmonary infarct. Pulmonary infarction is a rare cause of cavitation in COVID-19 patients, nonetheless, something that should be considered in those presenting with respiratory symptoms or complications during or post-COVID-19.

3.
ASAIO Journal ; 68(SUPPL 1):28, 2022.
Article in English | EMBASE | ID: covidwho-1913084

ABSTRACT

Introduction: Massive bleeding on extracorporeal membrane oxygenation (ECMO) is associated with multiple coagulation defects, including depletion of coagulation factors and development of acquired von Willebrand syndrome (AVWS). The use of recombinant factors, in particular recombinant activated factor VII (rFVIIa, Novoseven), to treat severe refractory hemorrhage in ECMO has been described. However, the use of multiple recombinant factors has been avoided in large part due to concern for circuit complications and thrombosis. Here, we describe the safe and effective administration of rFVIIa and recombinant von Willebrand factor complex (vWF/ FVIII, Humate-P) via post-oxygenator pigtail catheter on VA-ECMO for the treatment of massive pulmonary hemorrhage. Case Description: A 21-month-old (13.4 kg) girl with a recent history of COVID-19 infection presented to an outside hospital with parainfluenza bronchiolitis resulting in acute refractory hypoxemic respiratory failure (oxygenation index 58), refractory septic shock, and myocardial dysfunction. She was cannulated to VA-ECMO and subsequently diagnosed with necrotizing pneumonia from Pseudomonas and herpes simplex infections. Her course was complicated by a large left-sided pneumatocele and bronchopleural fistula requiring multiple chest tubes. She also had right mainstem bronchus obstruction from necrotic airway debris and complete right lung atelectasis. She was noted to have prolonged episodes of mucosal and cutaneous bleeding (oropharynx, chest tube insertion sites, peripheral IV insertion sites) associated with absent high molecular weight von Willebrand multimers consistent with AVWS. Tranexamic acid infusion was initiated and bivalirudin anticoagulation was discontinued. VA-ECMO flows were escalated to 140-160 ml/kg/min to maintain circuit integrity and meet high patient metabolic demand in the absence of anticoagulation. On ECMO day 26, she underwent bronchoscopy to clear necrotic debris from her airway to assist with lung recruitment. The procedure was notable for mucosal bleeding requiring topical epinephrine and rFVIIa. Post-procedure, she developed acute hemorrhage from her right mainstem bronchus, resulting in significant hemothorax (estimated 950 ml) with mediastinal shift, increased venous pressures, desaturation and decreased ECMO blood flow rate, necessitating massive transfusion of 2,050 ml (150 ml/kg) of packed red blood cells, platelets, plasma and cryoprecipitate. An airway blocker was placed in the mid-trachea to control bleeding. In addition to transfusion of appropriate blood products and continuation of tranexamic acid infusion, she was given both rFVIIa (100mcg/kg) and vWF-FVIII (70 units vWF/kg loading dose on the day of hemorrhage, followed by 40 units vWF/kg every 12 hours for 3 additional doses). Both products were administered over 10 minutes through a post-oxygenator pigtail to allow the product to circulate throughout the patient prior to entering the ECMO circuit. The circuit was closely monitored during administration and no changes to circuit integrity were noted in the subsequent hours while hemostasis was achieved. The ECMO circuit remained without thrombosis for 9 days after the bleeding event. Discussion: Balancing anticoagulation and hemostasis is a central challenge in maintaining ECMO support, especially given the prevalence of acquired coagulopathies such as AVWS. For our patient, AVWS contributed to mucosal bleeding necessitating cessation of anticoagulation and utilization of a high ECMO blood flow strategy to minimize circuit clot burden. This was further complicated by absent native lung function and minimal myocardial function, resulting in complete dependence on ECMO. An acute massive pulmonary hemorrhage was treated with multiple recombinant factors (rFVIIa and vWF/FVIII), that are often avoided on ECMO. To minimize clotting risk to the circuit and to maximize transit of these factors to our patient, we added a post-oxygenator pigtail for administration. While this approach was the result of extreme circumstances, th use of a post-oxygenator pigtail for administration of recombinant factors may represent a viable strategy for refractory hemorrhage while on ECMO.

4.
Lung India ; 39(SUPPL 1):S137, 2022.
Article in English | EMBASE | ID: covidwho-1856958

ABSTRACT

Background: Development of spontaneous pneumothorax and pneumomediastinum is one of the complication of COVID-19 viral pneumonitis. This has been described in both mechanically ventilated patients or on non invasive/ high flow nasal cannula oxygen support. The Macklin effect can been proposed as a possible etiology owing to the propensity to the damage to type2 pneumocytes, alveolar rupture secondary to direct alveolar injury. Case: 32 year male, non smoker, non alcoholic with no comorbidities presented to emergency with sudden onset of shortness of breath, left chest pain. HRCT chest done showed left pneumothorax with mediastinal shift. Intercostal drainage tube(ICD) was placed on the left side and patient was stabilised. Patient has had similar complaints one week back for which right sided ICD was placed. Patient had history of COVID-19 infection one month back. He did not require any supplemental oxygen or ventilatory support. Right side ICD was removed 1 week later as there was no air leak. Left side had persistent air leak, with non expanding lung. Patient was put on supplemental oxygen. He was treated with antibiotics, other supplemental oxygen and repeat HRCT chest showed loculated hydropneumothorax with bronchopleural fistula (BPF) on the left side. The patient was discharge with ICD. After improving the general condition, the air leak was surgically corrected with left lobe decortication and BPF closure. Conclusion: COVID 19 infection renders more propensity to damage type 2 pneumocytes. The alveolar rupture is secondary to alveolar injury causing increased tendency for air leak without obviously increased pressures.

5.
Lung India ; 39(SUPPL 1):S22, 2022.
Article in English | EMBASE | ID: covidwho-1856884

ABSTRACT

Background: COVID-19 has become a dreadful pandemic. One of the important complication is the development of pneumothorax/ pneumomediastinum which gets further complicated by bronchopleural fistula. Case Study: A 44year male patient with severe COVID pneumonia developed Left sided pneumothorax and treated conservatively with ICD and negative suctioning for 2 months and referred to us with persistent pneumothorax with BPF. As patient was unfit for surgery, bronchoscopic management was planned. With flexible bronchoscope, 6F Fogarty balloon was passed and inflated, leak site was identified in left upper lobe upper division. A Watanabe spigot size 5 was deposited at the opening of upper division and manipulated to apical segment. Other small openings were sealed with cyanoacrylate glue and autologous blood patch. After procedure negative suction was reapplied. Repeat Xray showed resolution of pneumothorax. Pleurodesis was done with talc slurry, post pleurodesis showed no pneumothorax and ICD was removed. Patient was discharged, follow up X ray after 4weeks showed no evidence of pneumothorax. Discussion: In most cases of BPF, leak seals after tube thoracostomy, only 3-5% will continue to have persistent leak. For medically inoperable cases, bronchoscopic balloon occlusion of site and subsequent injection with fibrin glue, liquid bioadhesive or blood patch can be done. For large leak;Amplatzer device, stents, spigots, coils are used. Conclusion: Bronchoscopic treatment can work well for a medically inoperable, complicated pneumothorax in COVID-19 disease.

6.
Cureus ; 14(4): e24202, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1856244

ABSTRACT

Bronchopleural fistulas (BPFs) are associated with high morbidity and mortality. Though most commonly seen after surgical interventions, they are increasingly reported as complications of COVID-19 infection. We present the case of an 86-year-old man with COVID-19 pneumonia and subsequent bronchopleural fistula (BPF) with persistent air leak. Endobronchial valves were placed in apical and posterior segments of the right upper lobe resulting in successful cessation of the air leak. The purpose of the case report and literature review is to help guide the management of persistent air leak.

7.
Endoscopic Surgery ; 28(1):41-48, 2022.
Article in Russian | Scopus | ID: covidwho-1771923

ABSTRACT

Objective. The purpose of the study — evaluation of treatment results of patients with c COVID-19 pneumonia complications. Materials and methods. The experience of endoscopic treatment 6 patients with COVID-19 lung complications (5 men and 1 wom-en with age 33—67 years (mean 45.33±13.03 years)). The disease was complicated by the lung destruction with pleural empy-ema and bronchopleural fistula. Endoscopy bronchial valve was used in the treatment of these patients. The mean average duration of pleural drainage insertion before bronchial valve placement was 8±1.46 days (3—12 days). Results. There were no any difficulties with bronchial valve placement. The valves were placed in the intermediate bronchus in three patients, the lower lobe bronchus on the left in two, in the upper lobe bronchus on the left in one patient. In 1 patient, the air leak was stopped during the first day after the intervention, and in 1 patient on the third day. In 4 cases, the leak persist-ed for three days, which required an endoscopic examination with additional bronchial valve insertion in the upper lobe bronchus (on the right — 1 and on the left — 2) or their removal (1 patient) with the installation of larger blockers with a positive re-sult. One patient, 2 days after additional blocking of the upper lobe bronchus of the left lung, underwent replacement of blockers with large ones with a good clinical effect. One patient had multiple procedures for installing and replacing blockers. In all cas-es, it was possible to eliminate air leakage, achieve straightening of the lung tissue and remove drainage from the pleural cavity. Conclusion. Endoscopic bronchial valve placement is effective method of air leakage elimination. It allows improving the patient condition and achieving recovery with COVID-19 pneumonia complication. It’s necessary to take the need for additional bronchial valve placement due to the multilobarity of the lesion and fissure integrity in other lung segments and lobes. © 2022, Media Sphera Publishing Group. All rights reserved.

8.
J Investig Med High Impact Case Rep ; 9: 23247096211013215, 2021.
Article in English | MEDLINE | ID: covidwho-1598539

ABSTRACT

Bronchopleural fistula (BPF) is associated with high morbidity if left untreated. Although rare, the frequency of BPF in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is becoming recognized in medical literature. We present a case of a 64-year-old male with BPF with persistent air leak due to SARS-CoV-2 pneumonia treated with Spiration Valve System endobronchial valve (EBV). An EBV was placed in the right middle lobe with successful cessation of air leak. In conclusion, the use of EBVs for BPF with persistent air leaks in SARS-CoV-2 patients who are poor surgical candidates is effective and safe.


Subject(s)
Bronchial Fistula/surgery , Bronchoscopy , COVID-19/complications , Empyema, Pleural/surgery , Pleural Diseases/surgery , Surgical Instruments , Bronchial Fistula/etiology , Chest Tubes , Empyema, Pleural/etiology , Humans , Male , Middle Aged , Pleural Diseases/etiology , SARS-CoV-2 , Thoracostomy
9.
Clin Case Rep ; 9(11): e05149, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1536139

ABSTRACT

COVID-19 pneumonia causes several complications that include pneumothorax, hydropneumothorax, empyema, and rarely leads to bronchopleural fistula (BPF). BPF is a communication between the pleural space and the bronchial tree. We report a case of 24 years man with pneumothorax, hydropneumothorax, and BPF that appeared after COVID-19 infection.

10.
Clin Case Rep ; 9(11): e05128, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1536136

ABSTRACT

Although pneumothorax is a well-known complication of COVID-19 pneumonia especially in patients requiring mechanical ventilation, bronchopleural fistula causing persistent pneumothorax in sole COVID-19 pneumonia is extremely rare. In this case, we illustrate that bronchopleural fistula can be found in COVID-19 pneumonia, even with no risk factors nor mechanical ventilation administration.

11.
Front Surg ; 8: 679757, 2021.
Article in English | MEDLINE | ID: covidwho-1259416

ABSTRACT

Background: Venous and arterial thromboembolism is commonly reported in critically ill COVID-19 patients, although there are still no definitive statistical data regarding its incidence. Case presentation: we report a case of a patient who fell ill with Covid during hospitalization for a pneumonectomy complicated by empyema and bronchopleural fistula. The patient, despite being cured of COVID, died after 14 days for pulmonary thromboembolism. Conclusion: Our case strengthens the suggestion of adequate thromboprophylaxis in all hospitalized COVID patients and of increasing prophylaxis in critically ill patients even in the absence of randomized studies.

12.
Lung India ; 38(Supplement): S69-S71, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1123961

ABSTRACT

Coronavirus disease-2019 (COVID-19) pneumonia is one of the severe and most dreaded forms of illness caused by severe acute respiratory syndrome coronavirus 2. It often progresses to respiratory failure and acute respiratory distress syndrome (ARDS) requiring mechanical ventilation. ARDS can lead to multiple complications while on mechanical ventilation due to positive airway pressures in a fibrotic lung, one such complication is the development of alveolopleural fistula. Alveolopleural fistula has high morbidity and mortality. We used endobronchial valve in a patient with COVID-19-related ARDS with persistent air leak (alveolopleural fistula), which allowed us to remove the chest tube and wean the patient successfully off mechanical ventilation.

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