Endobronchial valves: a bridge to definitive surgical management in COVID-19 recurrent pneumothorax

Szewczyk, Joanne; Adkinson, Brian Cody; Akkineni, S.; Nguyen, Dao M.; Arias, Sixto; Villamizar, Nestor

doi:10.21037/jtd-20-3248

Cited by 6 publications

(10 citation statements)

References 9 publications

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“…One patient required more than one pleural drain. 11 The air leak was localised to one lung lobe in two cases. 11 12 The other patient had bilobar involvement.…”

Section: Discussionmentioning

confidence: 95%

“…Our literature search identified three more cases where EBV was successfully used for PAL in patients with COVID-19 (table 1). [11][12][13] All reported patients were men in their fifth and sixth decades of life. All patients had unilateral pneumothorax, with two patients having involvement of the right side.…”

Section: Discussionmentioning

confidence: 99%

“…This patient developed recurrent pneumothorax and eventually required VATS and pleurodesis. 11 In addition to affecting pulmonary parenchyma, SARS-CoV-2 can also cause pleural complications. Commonly reported pleural abnormalities include pleural thickening, pleural retraction, pleural effusion and pneumothorax.…”

Section: Discussionmentioning

confidence: 99%

“…14 Like our patient, one other reported individual also suffered from bullous emphysema. 11 It is difficult to ascertain the individual contribution of the emphysema or SARS-CoV-2 pneumonia to the pathogenesis of APF in these patients.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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Patients with SARS-CoV-2 pneumonia can suffer from pneumothorax and persistent air leak (PAL). The pneumothorax occurs with or without pre-existing lung disease. PAL refers to air leak lasting more than 5–7 days and arises due to bronchopleural or alveolopleural fistula. The management of PAL can be challenging as a standard management guideline is lacking. Here we present the case of a 42-year-old smoker with COVID-19 who presented to the hospital with fever, cough, acute left-sided chest pain and shortness of breath. He suffered from a large left-sided pneumothorax requiring immediate chest tube drainage. Unfortunately, the air leak persisted for 13 days before one-way endobronchial valve (EBV) was used with complete resolution of the air leak. We also review the literature regarding other cases of EBV utilisation for PAL in patients with COVID-19.

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“…One patient required more than one pleural drain. 11 The air leak was localised to one lung lobe in two cases. 11 12 The other patient had bilobar involvement.…”

Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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“…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%

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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Hypoxemia After Endobronchial Valve Deployment for Persistent Air Leak

Boulos

Anam

Bhandary

et al. 2023

Journal of Cardiothoracic and Vascular Anesthesia

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Endobronchial valves: a bridge to definitive surgical management in COVID-19 recurrent pneumothorax

Cited by 6 publications

References 9 publications

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

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

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

Hypoxemia After Endobronchial Valve Deployment for Persistent Air Leak

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