Durrance Richard J, D'Souza Kenneth G, Obata Reiichiro, Bradley Ellen C, Perwaiz Muhammad K
Pulmonary-Critical Care Fellow. Icahn School of Medicine at Mount Sinai, Elmhurst Hospital, United States.
Interventional Pulmonology and Pulmonary Critical Care Attending, Icahn School of Medicine at Mount Sinai: Elmhurst Hospital, United States.
Respir Med Case Rep. 2022 May 28;38:101670. doi: 10.1016/j.rmcr.2022.101670. eCollection 2022.
Patients with severe COVID-19 Pneumonia requiring prolonged mechanical ventilation have an increased incidence of pneumothorax. Mechanically ventilated patients who are critically ill and develop a persistent air leak from pneumothorax are poor candidates for surgical repair. As the persistent air leak can be a significant barrier to vent-weaning and clinical stability, these patients present a unique clinical challenge.
A 65-year-old male intubated and on prolonged mechanical ventilation for severe COVID-19 Pneumonia developed a pneumothorax complicated by a persistent alveolar-pleural fistula with a persistent air-leak. Given his critical state with ongoing pressor requirements and elevated vent requirements, surgical repair was not an option. A bedside bronchoscopy occlusion study with isolation of the air leak, and subsequent autologous endobronchial blood-patch repair with thrombin was performed with rapid and definitive resolution of the air leak. The patient progressed favorably, ultimately being weaned from the ventilator, decannulated, and walking out of the hospital.
In critically ill ventilated patients with pneumothorax complicated by a persistent air-leak, bedside endobronchial evaluation and blood-patch repair is a feasible approach to management.
需要长时间机械通气的重症 COVID-19 肺炎患者气胸发生率增加。患有严重疾病且因气胸出现持续性漏气的机械通气患者不适合进行手术修复。由于持续性漏气可能是脱机和临床稳定的重大障碍，这些患者带来了独特的临床挑战。
一名 65 岁男性因重症 COVID-19 肺炎接受插管并长时间机械通气，发生气胸，并发持续性肺泡 - 胸膜瘘伴持续性漏气。鉴于其危急状态，持续需要血管活性药物支持且通气需求增加，手术修复不可行。进行了床边支气管镜封堵研究以隔离漏气部位，随后用凝血酶进行自体支气管内血补片修复，漏气迅速得到彻底解决。患者病情顺利进展，最终脱机、拔管，并出院步行。
对于患有气胸且并发持续性漏气的重症机械通气患者，床边支气管内评估和血补片修复是一种可行的治疗方法。
