Endobronchial One-Way Valve Therapy Facilitates Weaning from Extracorporeal Membrane Oxygenation in a Patient with ARDS and 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 virtuall...

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Main Authors: Alessandro Ghiani, Matthias Hansen, Konstantinos Tsitouras, Claus Neurohr
Format: Article
Language:English
Published: Hindawi Limited 2018-01-01
Series:Case Reports in Critical Care
Online Access:http://dx.doi.org/10.1155/2018/9736217
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spelling doaj-769db69f850e442ab519497a38cb2f552020-11-24T22:07:38ZengHindawi LimitedCase Reports in Critical Care2090-64202090-64392018-01-01201810.1155/2018/97362179736217Endobronchial One-Way Valve Therapy Facilitates Weaning from Extracorporeal Membrane Oxygenation in a Patient with ARDS and Persistent Air LeakAlessandro Ghiani0Matthias Hansen1Konstantinos Tsitouras2Claus Neurohr3Schillerhoehe Lung Clinic (Robert-Bosch Hospital), Department of Pneumology and Critical Care Medicine, Solitudestr. 18, 70839 Gerlingen, GermanySchillerhoehe Lung Clinic (Robert-Bosch Hospital), Department of Anesthesiology and Critical Care Medicine, Solitudestr. 18, 70839 Gerlingen, GermanySchillerhoehe Lung Clinic (Robert-Bosch Hospital), Department of Pneumology and Critical Care Medicine, Solitudestr. 18, 70839 Gerlingen, GermanySchillerhoehe Lung Clinic (Robert-Bosch Hospital), Department of Pneumology and Critical Care Medicine, Solitudestr. 18, 70839 Gerlingen, GermanyProlonged 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.http://dx.doi.org/10.1155/2018/9736217
collection DOAJ
language English
format Article
sources DOAJ
author Alessandro Ghiani
Matthias Hansen
Konstantinos Tsitouras
Claus Neurohr
spellingShingle Alessandro Ghiani
Matthias Hansen
Konstantinos Tsitouras
Claus Neurohr
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
author_facet Alessandro Ghiani
Matthias Hansen
Konstantinos Tsitouras
Claus Neurohr
author_sort Alessandro Ghiani
title Endobronchial One-Way Valve Therapy Facilitates Weaning from Extracorporeal Membrane Oxygenation in a Patient with ARDS and Persistent Air Leak
title_short Endobronchial One-Way Valve Therapy Facilitates Weaning from Extracorporeal Membrane Oxygenation in a Patient with ARDS and Persistent Air Leak
title_full Endobronchial One-Way Valve Therapy Facilitates Weaning from Extracorporeal Membrane Oxygenation in a Patient with ARDS and Persistent Air Leak
title_fullStr Endobronchial One-Way Valve Therapy Facilitates Weaning from Extracorporeal Membrane Oxygenation in a Patient with ARDS and Persistent Air Leak
title_full_unstemmed Endobronchial One-Way Valve Therapy Facilitates Weaning from Extracorporeal Membrane Oxygenation in a Patient with ARDS and Persistent Air Leak
title_sort endobronchial one-way valve therapy facilitates weaning from extracorporeal membrane oxygenation in a patient with ards and persistent air leak
publisher Hindawi Limited
series Case Reports in Critical Care
issn 2090-6420
2090-6439
publishDate 2018-01-01
description 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.
url http://dx.doi.org/10.1155/2018/9736217
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