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1.
Digestive Endoscopy ; 34(SUPPL 1):168, 2022.
Article in English | EMBASE | ID: covidwho-1895971

ABSTRACT

AIM: Spontaneous pneumothorax and PAL are complications of SARS-CoV-2 infection. Endobronchial valves could be an effective and less invasive treatment option and may facilitate the weaning from the MV in patients with SARS-CoV-2 pneumonia. Despite the using of conservative options some patients may require thoracic surgery which must be balanced against their comorbidities and ability to tolerate the intervention. METHODS: A 32-year-old woman at 35 weeks of gestation was admitted to the hospital with a positive nasopharyngeal swab of SARS-CoV-2. On day 4, due to the progression of respiratory failure caused by bilateral pneumonia, she underwent a cesarean section. Then high-flow oxygen was delivered with a following decrease to 12 L/min. On day 10 patient felt sharp chest pain and her chest CT revealed bilateral consolidation with a right-sided pneumothorax. A chest tube was placed to the right pleural space. Due to the onset of life threating hypoxia, on day 20, the patient was put on ventilator and VVECMO was initiated immediately. MV via tracheotomy was continued. Despite the adequate suction drainage, the patient kept having recalcitrant pneumothorax with PAL. Given high risks of single lung ventilation, a decision to use the EBV with endoscopic insertion was made. Flexible bronchoscopy was performed under general anesthesia, a solution of hydrogen peroxide and sterile dye was injected into the pleural cavity via chest tube with their further detection in the lower right lobe. A size 11 Medlung endobronchial valve was installed into the intermediate bronchus, which led to the immediate cessation of air leakage. RESULTS: Chest X-ray after the intervention showed complete inflating of the lungs and the resolution of the pneumothorax. CONCLUSIONS: EBV may play a potential role in the treatment of PAL and contribute to weaning patients with COVID-19 from ventilation without the need for invasive intervention.

2.
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.

3.
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
4.
Ann R Coll Surg Engl ; 104(5): e137-e138, 2022 May.
Article in English | MEDLINE | ID: covidwho-1502041

ABSTRACT

Pneumothoraces may occur rarely in coronavirus (COVID-19) patients, often resulting from a combination of fibrotic parenchymal changes and prolonged high-pressure ventilation. Very few studies have been published describing the management of pneumothorax in the novel COVID-19 pneumonia patients. Although chest drain insertion represents the first line of treatment, a persistent pneumothorax and air leak requiring intervention could be managed by a thoracoscopic procedure or, as is the case here, by endobronchial valve insertion. Endobronchial valve insertion is a minimally invasive technique that provides a treatment option in patients with severe parenchymal COVID-19 related lung disease. As far as the authors are aware this is the first report of the use of endobronchial valves in a COVID-19 patient.

5.
BMC Pulm Med ; 21(1): 307, 2021 Sep 27.
Article in English | MEDLINE | ID: covidwho-1440925

ABSTRACT

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.


Subject(s)
Bronchial Fistula/surgery , COVID-19/therapy , Pleural Diseases/surgery , Pneumothorax/surgery , Respiration, Artificial/adverse effects , Aged , Bronchoscopy/methods , COVID-19/diagnosis , Humans , Intensive Care Units , Male , Respiratory Tract Fistula/surgery , SARS-CoV-2/genetics , Tomography, X-Ray Computed
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