ENDOBRONCHIAL VALVE POSITIONING FOR ALVEOLAR-PLEURAL FISTULA COMPLICATING SEVERE COVID-19 PNEUMONIA

Background: Since December 2019, the world has experienced a pandemic of novel Coronavirus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]). The main clinical consequences are pneumonia and respiratory failure even requiring mechanical ventilation, frequently sharing clinical and radiologic similarities to acute respiratory distress syndrome (ARDS). 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. Case presentation: We report, for the first time, two cases of patients affected by SARS-CoV-2-related pneumonia experiencing pneumothorax and persistent air leaks after invasive mechanical ventilation, and successfully treated through EBV positioning. Conclusions: 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.