Successful use of endobronchial valve for persistent air leak in a patient with COVID-19 and bullous emphysema

Saha, Biplab K.; Bonnier, Alyssa; Chong, Woon H.; Chenna, Praveen

doi:10.1136/bcr-2021-246671

Cited by 7 publications

(6 citation statements)

References 37 publications

(34 reference statements)

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“…The air leak was resolved, and pleural drainage catheters were removed. EBVs were removed a few weeks after their insertion, and subsequent imaging showed partial expansion of the left upper lobe with residual areas of atelectasis [12].…”

Section: Discussionmentioning

confidence: 99%

Bronchopleural Fistula and Endobronchial Valve Placement in a Patient With COVID-19 Pneumonia: A Case Report With Literature Review

Umar¹,

Ilyas²,

Ashfaq³

et al. 2022

Cureus

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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.

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Section: Discussionmentioning

confidence: 99%

Bronchopleural Fistula and Endobronchial Valve Placement in a Patient With COVID-19 Pneumonia: A Case Report With Literature Review

Umar¹,

Ilyas²,

Ashfaq³

et al. 2022

Cureus

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“…The incidence of pneumothorax in SARS-CoV-2 is estimated at around 10% and is most associated with patients diagnosed with severe ARDS [8]. The possible mechanism of pneumothorax is related to the structural alterations in the lung parenchyma that lead to alveolar and bronchial damage.…”

Section: Discussionmentioning

confidence: 99%

“…We report two of the first few cases of COVID-19 complicated by PALs that were successfully managed with Endobronchial Valve placement. Our data search reveals six reported cases of COVID-19 that eventually developed PAL and managed with the placement of EBV and resulted in the successful resolution of the air leak [8,12,[15][16][17]. The ages of the cases in the patient group ranged from 42 to 73 years old.…”

Section: Discussionmentioning

confidence: 99%

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SARS Cov-2 Infection-Related Persistent Air Leaks Managed By Endobronchial Valves

Mukund¹,

Nikita²,

Archana³

et al. 2022

International Journal of Respiratory and Pulmonary Medicine

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Introduction:There have been recently documented reports of pneumothorax and persistent air leaks as complications associated with SARS CoV-2-related ARDS. Alveolar-pleural fistulas and broncho-pleural fistulas can lead to the development of pneumothorax. In more recent times, bronchoscopy-guided interventions, specifically Endobronchial Valves (EBV), have been established to serve as a treatment modality for these fistulas. In this case series, we present the first two cases of persistent pneumothorax and persistent air leak related to COVID-19 that were managed successfully with EBV placement.Case description: Case 1-A 44-year-old female was admitted for acute hypoxic respiratory failure secondary to COVID-19 pneumonia requiring invasive mechanical ventilation. Immediate post-intubation imaging found a large right-sided pneumothorax that required emergent insertion of a chest tube. Repeat chest imaging showed worsening pneumothorax requiring additional chest tubes; however, air leaks persisted. Subsequent chest imaging showed the possibility of a fistula near the right upper lobe bronchus. Bronchoscopy-guided placement of Endobronchial Valves was performed, and follow-up imaging showed resolution of pneumothorax and improvement in clinical symptoms. Case 2-A 48-year-old male with a recent admission for COVID-19 pneumonia was diagnosed with large leftsided hydropneumothorax. A chest tube was placed and put to suction; however, it failed multiple water seal trials. Bronchoscopy with endobronchial valve placement was performed over segments of the left upper lobe. Repeat chest imaging showed the complete resolution of pneumothorax. Conclusions:The current literature review describes only a few cases of COVID-19 related to BPF or APF. In both described cases, the diagnosis of PALs was made within 4-6 weeks of COVID-19 infection. The first case developed pneumothorax following mechanical ventilation. The etiology of the development of BPF, in this case, may be secondary to barotrauma. The second case was incidentally diagnosed with hydropneumothorax four weeks after the initial COVID infection that had not needed mechanical ventilation. This prompts the likelihood of multiple etiologies that can lead to the development of fistulas in patients with recent COVID-19 disease. Bronchoscopy is the gold standard in the management of PALs. Fistulas secondary to inflammatory processes, like a necrotizing infection, are better managed with an endobronchial intervention as lung parenchyma is too friable for surgical intervention. Recent literature has demonstrated that endobronchial valves are an effective, minimally invasive intervention for patients with PALs. We report two of the first few cases of COVID-19 complicated by PALs that were successfully managed with EBV placement. Our data search reveals six reported cases of COVID-19 that eventually developed PAL and managed with the placement of EBV and resulted in the successful resolution of the air leaks.

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“…Again, the risk of spread of infection while performing bronchoscopy should be considered in patients with active COVID-19. Autologous blood pleurodesis, Heimlich valve positioning, and albumin-glutaraldehyde tissue adhesives are additional less invasive options for recurrent and refractory cases[ 38 ].…”

Section: Managementmentioning

confidence: 99%

Air leaks in COVID-19

Juneja¹,

Kataria²,

Singh³

2022

WJV

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Coronavirus disease 2019 (COVID-19) continues to create havoc and may present with myriad complications involving many organ systems. However, the respiratory system bears the maximum brunt of the disease and continues to be most commonly affected. There is a high incidence of air leaks in patients with COVID-19, leading to acute worsening of clinical condition. The air leaks may develop independently of the severity of disease or positive pressure ventilation and even in the absence of any traditional risk factors like smoking and un-derlying lung disease. The exact pathophysiology of air leaks with COVID-19 remains unclear, but multiple factors may play a role in their development. A significant proportion of air leaks may be asymptomatic; hence, a high index of suspicion should be exercised for enabling early diagnosis to prevent further deterioration as it is associated with high morbidity and mortality. These air leaks may even develop weeks to months after the disease onset, leading to acute deterioration in the post-COVID period. Conservative management with close monitoring may suffice for many patients but most of the patients with pneumothorax may require intercostal drainage with only a few requiring surgical interventions for persistent air leaks.

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Successful use of endobronchial valve for persistent air leak in a patient with COVID-19 and bullous emphysema

Cited by 7 publications

References 37 publications

Bronchopleural Fistula and Endobronchial Valve Placement in a Patient With COVID-19 Pneumonia: A Case Report With Literature Review

Bronchopleural Fistula and Endobronchial Valve Placement in a Patient With COVID-19 Pneumonia: A Case Report With Literature Review

SARS Cov-2 Infection-Related Persistent Air Leaks Managed By Endobronchial Valves

Air leaks in COVID-19

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