Endobronchial valve positioning for alveolar-pleural fistula following ICU management complicating COVID-19 pneumonia
Pierluigi Donatelli, Fabiana Trentacosti, Maria Rosaria Pellegrino, Roberto Tonelli, Giulia Bruzzi, Alessandro Andreani, Gaia Cappiello, Dario Andrisani, Filippo Gozzi, Cristina Mussini, Stefano Busani, Gilda Valentina Cavaliere, Massimo Girardis, Elisabetta Bertellini, Enrico Clini, Alessandro Marchioni
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.