Endobronchial blood-patch: A novel technique for a persistent pleural air leak
Introduction: 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 pe...
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| Format: | Article |
| Language: | English |
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Elsevier
2022-01-01
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| Series: | Respiratory Medicine Case Reports |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2213007122000922 |
| _version_ | 1818537659767717888 |
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| author | Richard J. Durrance Kenneth G. D'Souza Reiichiro Obata Ellen C. Bradley Muhammad K. Perwaiz |
| author_facet | Richard J. Durrance Kenneth G. D'Souza Reiichiro Obata Ellen C. Bradley Muhammad K. Perwaiz |
| author_sort | Richard J. Durrance |
| collection | DOAJ |
| description | Introduction: 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. Clinical case: 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. Conclusion: 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. |
| first_indexed | 2024-12-11T18:53:36Z |
| format | Article |
| id | doaj.art-c9b068ea87da46c1ab296f1b96359473 |
| institution | Directory Open Access Journal |
| issn | 2213-0071 |
| language | English |
| last_indexed | 2024-12-11T18:53:36Z |
| publishDate | 2022-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Respiratory Medicine Case Reports |
| spelling | doaj.art-c9b068ea87da46c1ab296f1b963594732022-12-22T00:54:14ZengElsevierRespiratory Medicine Case Reports2213-00712022-01-0138101670Endobronchial blood-patch: A novel technique for a persistent pleural air leakRichard J. Durrance0Kenneth G. D'Souza1Reiichiro Obata2Ellen C. Bradley3Muhammad K. Perwaiz4Pulmonary-Critical Care Fellow. Icahn School of Medicine at Mount Sinai, Elmhurst Hospital, United States; Corresponding author.Pulmonary-Critical Care Fellow. Icahn School of Medicine at Mount Sinai, Elmhurst Hospital, United StatesPulmonary-Critical Care Fellow. Icahn School of Medicine at Mount Sinai, Elmhurst Hospital, United StatesPulmonary-Critical Care Fellow. Icahn School of Medicine at Mount Sinai, Elmhurst Hospital, United StatesInterventional Pulmonology and Pulmonary Critical Care Attending, Icahn School of Medicine at Mount Sinai: Elmhurst Hospital, United StatesIntroduction: 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. Clinical case: 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. Conclusion: 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.http://www.sciencedirect.com/science/article/pii/S2213007122000922Alveolar-pleural fistulaPersistent air leakCovid-19Bronchoscopic air-leak repair |
| spellingShingle | Richard J. Durrance Kenneth G. D'Souza Reiichiro Obata Ellen C. Bradley Muhammad K. Perwaiz Endobronchial blood-patch: A novel technique for a persistent pleural air leak Respiratory Medicine Case Reports Alveolar-pleural fistula Persistent air leak Covid-19 Bronchoscopic air-leak repair |
| title | Endobronchial blood-patch: A novel technique for a persistent pleural air leak |
| title_full | Endobronchial blood-patch: A novel technique for a persistent pleural air leak |
| title_fullStr | Endobronchial blood-patch: A novel technique for a persistent pleural air leak |
| title_full_unstemmed | Endobronchial blood-patch: A novel technique for a persistent pleural air leak |
| title_short | Endobronchial blood-patch: A novel technique for a persistent pleural air leak |
| title_sort | endobronchial blood patch a novel technique for a persistent pleural air leak |
| topic | Alveolar-pleural fistula Persistent air leak Covid-19 Bronchoscopic air-leak repair |
| url | http://www.sciencedirect.com/science/article/pii/S2213007122000922 |
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