Valsalva manoeuvre-induced pneumothorax and pneumomediastinum in a COVID-19 patient with ARDS: an unusual mechanism for this complication
  • Totawatte Don Srilak Weerawardane
    Division of General Internal Medicine, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
  • Nils Bürgisser
    Division of General Internal Medicine, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland
  • Amandine Berner
    Division of General Internal Medicine, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
  • Matteo Coen
    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

Keywords

COVID-19, Valsalva, pneumothorax

Abstract

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.

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    Published: 2024-02-28
    Issue: 2024: Vol 11 No 3 (view)

    How to cite:
    1.
    Weerawardane TDS, Bürgisser N, Berner A, Coen M. Valsalva manoeuvre-induced pneumothorax and pneumomediastinum in a COVID-19 patient with ARDS: an unusual mechanism for this complication. EJCRIM 2024;11 doi:10.12890/2024_004217.