Post COVID-19 Bronchopleural Fistula Treated with “Closed-Lung” Minimal Ventilation and ECCO₂R: A Clinical Case Report

Abstract

A 59-year-old man was admitted to our ICU for severe SARS-CoV-2 pneumonia complicated by pneumomediastinum.

On admission the patient presented sedated and intubated with a chest tube, previously positioned. After an early attempt of extubation, the patient was reintubated due to respiratory deterioration and his clinical condition worsened, leading to the positioning of a second chest tube. Continuous air bubbling in the tube draining chamber and major leaks from the ventilator were detected. On suspicion of bronchopleural fistula, low-flow ECCO₂R treatment together with a “closed-lung” minimal ventilation strategy was initiated.

Closed lung ventilation was undertaken with the aim of reducing positive pressure ventilation injury and allow the healing of the fistula. Low alveolar stress and strain, extremely low tidal volume (3 mL/Kg PBW), and reduced mechanical power were aimed for. This strategy was maintained for 10 days.

After 10 days, the patient was disconnected from ECCO₂R. Percutaneous tracheostomy was performed on the 20th day.

Weaning from mechanical ventilation and physical therapy were successfully undertaken, and our patient was finally discharged on 51st day on spontaneous breathing with low-flow O₂ therapy on tracheostomy tube.