Endobronchial valve positioning for alveolar-pleural fistula following ICU management of severe COVID-19 pneumonia.

Background- Since December 2019 the outbreak of novel Coronavirus (Severe Acute Respiratory Sindrome-2, SARS-CoV2) has spread across the world. The main clinical consequences are respiratory failure even requiring mechanical ventilation, and pneumonia 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 efficacy in treating air leaks with high success rate. Case presentation- We report, for the first time, two cases of patients affected by SARS-CoV2-related pneumonia suffering from 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 least-invasive therapeutic option for caring this subset of patients.