Endobronchial blood-patch: A novel technique for a persistent pleural air leak

Area of Science:

• Pulmonology
• Critical Care Medicine
• Interventional Pulmonology

Background:

• Severe COVID-19 pneumonia often necessitates prolonged mechanical ventilation.
• Pneumothorax is a recognized complication in these patients, with persistent air leaks posing significant management challenges.
• Critically ill, mechanically ventilated patients with persistent air leaks are often unsuitable for surgical intervention.

Observation:

• A case study involving a 65-year-old male with severe COVID-19 pneumonia and prolonged mechanical ventilation who developed a pneumothorax with a persistent air leak.
• The patient's critical condition precluded surgical repair due to ongoing pressor and ventilator support requirements.
• A bedside bronchoscopy occlusion study successfully identified the alveolar-pleural fistula responsible for the air leak.

Findings:

• Autologous endobronchial blood-patch repair using thrombin was performed at the bedside.
• This minimally invasive procedure led to rapid and definitive resolution of the persistent air leak.
• The patient demonstrated significant clinical improvement, was successfully weaned from the ventilator, decannulated, and discharged.

Implications:

• Bedside endobronchial evaluation and blood-patch repair represent a viable and effective management strategy for persistent air leaks in critically ill, ventilated patients.
• This approach offers a less invasive alternative to surgery, potentially improving outcomes and facilitating ventilator weaning.
• The successful case highlights the potential of interventional pulmonology techniques in managing complex respiratory complications.