University Hospital of Modena, Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, Modena, Italy.
Clinical and Experimental Medicine PhD Program, University of Modena Reggio Emilia, Via Università 4, 41121, Modena, Italy.
BMC Pulm Med. 2021 Sep 27;21(1):307. doi: 10.1186/s12890-021-01653-w.
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.
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.
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.
严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）感染的主要临床后果是肺炎和呼吸衰竭，甚至需要机械通气。在这种情况下，肺实质极易受到呼吸机相关损伤，气胸和持续性空气漏出是最严重的不良事件。到目前为止，支气管内瓣膜（EBV）定位已被证明对治疗空气漏出有效，成功率高。
我们首次报告了两例 SARS-CoV-2 相关肺炎合并细菌感染的患者，在侵入性机械通气后发生气胸和持续性空气漏出。尽管呼吸衰竭严重，但两名患者均接受了硬性介入性支气管镜检查，并通过 EBV 定位成功治疗。
持续性空气漏出可能是由于炎症和呼吸机相关损伤（VILI）之间的复杂相互作用导致的肺组织损伤所致，特别是在 ARDS 的晚期。EBV 定位似乎是治疗这组患者的一种可行且有效的微创治疗选择。
