A CURIOUS, PERSISTENT AIR LEAK IN A PATIENT WITH POST-COVID-19 FIBROTIC LUNG DISEASE ON MECHANICAL VENTILATION

A case of acquired tracheoesophageal fistula (TEF) is presented in a 44-year-old female who presented with acute respiratory failure due to bilateral aspiration pneumonia. The patient had persistent air leak while on mechanical ventilation and underwent bronchoscopy which revealed the above etiology. Histopathology showed Barrett's esophagitis. The patient underwent primary closure followed by a short course of proton pump inhibitors. There are only two prior reported cases of acquired TEF associated with Barrett's esophagitis. This condition should be taken under consideration when investigating of an explained persistent air leak in a mechanically ventilated patient.

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

BMJ Case Reports ◽

10.1136/bcr-2021-246671 ◽

2021 ◽

Vol 14 (11) ◽

pp. e246671

Author(s):

Biplab K Saha ◽

Alyssa Bonnier ◽

Woon Hean Chong ◽

Praveen Chenna

Keyword(s):

Chest Pain ◽

Lung Disease ◽

Chest Tube ◽

Complete Resolution ◽

Shortness Of Breath ◽

Air Leak ◽

Management Guideline ◽

Standard Management ◽

Endobronchial Valve ◽

Persistent Air Leak

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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Endobronchial One-Way Valve Therapy Facilitates Weaning from Extracorporeal Membrane Oxygenation in a Patient with ARDS and Persistent Air Leak

Case Reports in Critical Care ◽

10.1155/2018/9736217 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4 ◽

Cited By ~ 2

Author(s):

Alessandro Ghiani ◽

Matthias Hansen ◽

Konstantinos Tsitouras ◽

Claus Neurohr

Keyword(s):

Mechanical Ventilation ◽

Extracorporeal Membrane Oxygenation ◽

Practical Knowledge ◽

Left Lung ◽

Clinical Problem ◽

Lung Protective Ventilation ◽

Air Leak ◽

Membrane Oxygenation ◽

Protective Ventilation Strategy ◽

Persistent Air Leak

Prolonged pulmonary air leak (PAL) is a common clinical problem, associated with significant morbidity and mortality. There are numerous reports of treatment of PAL using endobronchial valves (EBV) in respiratory stable patients, but only few reports on critically ill patients, and there is virtually no practical knowledge in the treatment of PAL in mechanically ventilated patients with acute respiratory distress syndrome (ARDS), treated with veno-venous extracorporeal membrane oxygenation (vvECMO). We describe a case where EBV placement was performed in a patient with ARDS and PAL, treated with mechanical ventilation and vvECMO. Despite a lung protective ventilation strategy, a persistent air leak along with a large left-sided pneumothorax was observed. After bronchoscopic localisation of the fistula, two endobronchial valves were inserted into the left upper lobe, leading to an immediate decrease in the air flow and reexpansion of the left lung. During the following two weeks, the patient was weaned from vvECMO, and after another three weeks, complete liberation from mechanical ventilation was accomplished. EBV placement seems to be a safe method even in the presence of coagulopathy and may facilitate mechanical ventilation and weaning from vvECMO in patients with ARDS and PAL.

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A rare case of persistent air leak: beware of all the tubes

International Journal of Emergency Medicine ◽

10.1186/s12245-021-00381-6 ◽

2021 ◽

Vol 14 (1) ◽

Author(s):

Amarja Ashok Havaldar ◽

Abdul Rahim Fazal ◽

Abhilash Chennabasappa

Keyword(s):

Mechanical Ventilation ◽

Care Center ◽

Invasive Mechanical Ventilation ◽

Respiratory Muscles ◽

Air Leak ◽

Ventilator Support ◽

Case Presentation ◽

Health Care Center ◽

Ventilation Monitoring ◽

Persistent Air Leak

Abstract Background Patients with acute respiratory failure, impaired consciousness, and impaired airway reflexes will require invasive mechanical ventilation. Monitoring of such patients is important. The use of ventilator scalars and loops help in monitoring, diagnosing the abnormality, and treating the patients effectively. We report a rare cause one should suspect in a case of persistent and fixed air leak in a patient requiring mechanical ventilation. Case presentation We describe a 28-year-old young patient requiring ventilator support due to neuromuscular weakness. His neuromuscular weakness was rapidly progressing involving the respiratory muscles. The patient was intubated and put on mechanical ventilator support. He was transferred from another health care center to our hospital. On evaluation, the patient was intubated with ETT no 8. The patient had persistent air leak as observed on the ventilator graphics. We checked for ETT cuff malfunction, ventilator circuit, catheter mount, and HME for any disconnection causing the leak. The air leak which we observed in our patient was due to the malpositioned Ryle’s tube. Conclusions Vigilant monitoring of patients requiring mechanical ventilation is necessary. For the evaluation of the cause of air leak, algorithmic approach will help in correctly identifying the abnormality.

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Blood Patch Pleurodesis: An Option in Persistent Air Leak for Patients With Advanced Lung Disease

CHEST Journal ◽

10.1016/j.chest.2016.08.1140 ◽

2016 ◽

Vol 150 (4) ◽

pp. 1034A

Author(s):

Selma Demir ◽

Pavan Gorukanti ◽

Sushilkumar Gupta ◽

Mangalore Amith Shenoy ◽

Amit Agarwal ◽

...

Keyword(s):

Lung Disease ◽

Air Leak ◽

Blood Patch ◽

Persistent Air Leak

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Bronchopleural Fistula Resolution with Endobronchial Valve Placement and Liberation from Mechanical Ventilation in Acute Respiratory Distress Syndrome: A Case Series

Case Reports in Critical Care ◽

10.1155/2017/3092457 ◽

2017 ◽

Vol 2017 ◽

pp. 1-4 ◽

Cited By ~ 4

Author(s):

Haris Kalatoudis ◽

Meena Nikhil ◽

Fuad Zeid ◽

Yousef Shweihat

Keyword(s):

Mechanical Ventilation ◽

Acute Respiratory Distress Syndrome ◽

Respiratory Failure ◽

Respiratory Distress Syndrome ◽

Distress Syndrome ◽

Severe Respiratory Failure ◽

Air Leak ◽

Endobronchial Valve ◽

Valve Placement ◽

Persistent Air Leak

Patients who have acute respiratory distress syndrome (ARDS) with persistent air leaks have worse outcomes. Endobronchial valves (EBV) are frequently deployed after pulmonary resection in noncritically ill patients to reduce and eliminate bronchopleural fistulas (BPFs) with persistent air leak (PAL). Information regarding EBV placement in mechanically ventilated patients with ARDS and high volume persistent air leaks is rare and limited to case reports. We describe three cases where EBV placement facilitated endotracheal extubation in patients with severe respiratory failure on prolonged mechanical ventilation with BPFs. In each case, EBV placement led to immediate resolution of PAL. We believe endobronchial valve placement is a safe method treating persistent air leak with severe respiratory failure and may reduce days on mechanical ventilation.

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Secondary pneumothorax in end-stage lung disease complicated by noninvasive ventilation and a persistent air leak

Breathe ◽

10.1183/20734735.027318 ◽

2018 ◽

Vol 14 (4) ◽

pp. e119-e122 ◽

Cited By ~ 1

Author(s):

David J. McCracken ◽

Eihab O. Bedawi ◽

Maged Hassan ◽

Dionisios Stavroulias ◽

Najib M. Rahman

Keyword(s):

Lung Disease ◽

Noninvasive Ventilation ◽

Air Leak ◽

End Stage ◽

Persistent Air Leak

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Role of the IBV Valve in Persistent Air Leak

Current Respiratory Medicine Reviews ◽

10.2174/1573398x10666140115232721 ◽

2014 ◽

Vol 9 (4) ◽

pp. 254-256

Author(s):

Salim Surani ◽

Shweta Rao ◽

Saherish Surani ◽

Joseph Varon

Keyword(s):

Air Leak ◽

Persistent Air Leak

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Complications in Idiopathic Pulmonary Fibrosis: Focus on Their Clinical and Radiological Features

Diagnostics ◽

10.3390/diagnostics10070450 ◽

2020 ◽

Vol 10 (7) ◽

pp. 450

Author(s):

Federica Galioto ◽

Stefano Palmucci ◽

Giovanna M. Astuti ◽

Ada Vancheri ◽

Giulio Distefano ◽

...

Keyword(s):

Idiopathic Pulmonary Fibrosis ◽

Pulmonary Fibrosis ◽

Lung Disease ◽

Integrated Approach ◽

Correct Treatment ◽

Radiological Features ◽

Palliative Care Services ◽

Pictorial Essay ◽

Personalized Approach ◽

Fibrotic Lung Disease

Idiopathic pulmonary fibrosis (IPF) is a fibrotic lung disease with uncertain origins and pathogenesis; it represents the most common interstitial lung disease (ILD), associated with a pathological pattern of usual interstitial pneumonitis (UIP). This disease has a poor prognosis, having the most lethal prognosis among ILDs. In fact, the progressive fibrosis related to IPF could lead to the development of complications, such as acute exacerbation, lung cancer, infections, pneumothorax and pulmonary hypertension. Pneumologists, radiologists and pathologists play a key role in the identification of IPF disease, and in the characterization of its complications—which unfortunately increase disease mortality and reduce overall survival. The early identification of these complications is very important, and requires an integrated approach among specialists, in order to plane the correct treatment. In some cases, the degree of severity of patients having IPF complications may require a personalized approach, based on palliative care services. Therefore, in this paper, we have focused on clinical and radiological features of the complications that occurred in our IPF patients, providing a comprehensive and accurate pictorial essay for clinicians, radiologists and surgeons involved in their management.

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