Valsalva manoeuvre-induced pneumothorax and pneumomediastinum in a COVID-19 patient with ARDS : an unusual mechanism for this complication

Article Article scientifique Rapport de cas Valsalva manoeuvre-induced pneumothorax and pneumomediastinum in a COVID-19 patient with ARDS : an unusual mechanism for this complication eng 2024-02-28 2024-02-28 author Weerawardane Totawatte Don Srilak Division of General Internal Medicine, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland 730481 author Bürgisser Nils Anthony 0009-0007-3375-1985 Division of General Internal Medicine, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland 406128 author Berner Amandine Division of General Internal Medicine, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland 643966 author Coen Matteo 0000-0002-6156-1691 Division of General Internal Medicine, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland; Unit of Development and Research in Medical Education (UDREM), University of Geneva, Geneva, Switzerland 601519 Département de médecine (DEMED) 004217 10.12890/2024_004217 38455690 2284-2594 https://ejcrim.com/index.php/EJCRIM/article/view/4217 <p>Background: Until now, only a few cases of Valsalva-induced barotraumas (pneumothorax, pneumomediastinum and subcutaneous emphysema) have been described, and none of them among COVID-19 patients. Case description: A man in his 50s was admitted for SARS-CoV-2-related acute respiratory distress syndrome (ARDS). Initial evolution was favourable with non-invasive ventilatory support, high-flow oxygen nasal cannula and the best supportive drugs available at the time. During the Valsalva manoeuvre while defecating, the patient reported sudden chest pain and showed a new acute hypoxemic respiratory failure due to a pneumothorax. It led to multiple complications (pulmonary embolism, haemoptysis, and cardiac arrest), and despite the best supportive care, led to the patient's death. Discussion: The Valsalva manoeuvre can be an overlooked cause of pneumothorax in patients with COVID-19. Predisposition to barotrauma in COVID-19 patients could be explained by several factors, including the extensive use of non-invasive and invasive ventilation during the pandemic, and the histological changes observed in the lungs of those infected with COVID-19. Conclusion: We report the first description of a Valsalva-induced barotrauma in a COVID-19 infection. We emphasise the importance of treating constipation particularly in severe COVID-19 cases, to prevent complications such as barotrauma.</p> COVID-19 Valsalva Pneumothorax Dewey 610/370 Dewey 616 56 Département de médecine 221 48 Unité de développement et de recherche en éducation médicale 204 false European journal of case reports in internal medicine 11 3 d9738c55-9186-476d-9c04-a23c86ae5361 Article (Published version) Public Article-scientifique-from-unpaywall.pdf 701261 application/pdf CC BY-NC-ND-4.0 eb5a0d5af3d40cb5649f8591445ff62c29bfb71eeff34b3cb5fbf14ed51024ab openAccess Faculté de médecine / Section de médecine clinique / Département de médecine Faculté de médecine / Unité de développement et de recherche en éducation médicale

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Valsalva manoeuvre-induced pneumothorax and pneumomediastinum in a COVID-19 patient with ARDS : an unusual mechanism for this complication	European journal of case reports in internal medicine			2024	87	55

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Weerawardane, Totawatte Don Srilak