ENDOBRONCHIAL VALVES POSSIBILITIES FOR PNEUMOTHORAX IN COVID-19

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.