{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T10:09:15Z","timestamp":1753870155120,"version":"3.41.2"},"reference-count":16,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2023,6,27]],"date-time":"2023-06-27T00:00:00Z","timestamp":1687824000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Respirology Case Reports"],"published-print":{"date-parts":[[2023,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>ARDS in general and severe COVID ARDS (CARDS) is particularly associated with high rates of barotrauma. Two cases with severe CARDS developed bilateral pneumothorax with persistent air leak (PAL). Conservative management with prolonged chest tube drainage did not help in PAL resolution and both patients continued to be on high\u2010end ventilatory support. The course was further complicated by the presence of septic shock. The 1st patient was taken up for a challenging procedure after spending 23\u2009days on the mechanical ventilator. Diagnostic pleuroscopy revealed left\u2010sided bullae and a surgical staple bullectomy was done. The right side showed a large bronchopleural fistula (BPF) on pleuroscopy, which was occluded using a customized endobronchial silicone blocker (CESB, described in 2018). This led to the reduction and finally, resolution of the bilateral PAL with subsequent removal of chest drains and weaning off the ventilator and oxygen. The second patient was managed with 2 CESB devices for occlusion of RUL anterior and posterior segment fistulae, followed by chest drain removal. These cases highlight effective out\u2010of\u2010the\u2010box multimodality treatment using a combination of interventional pulmonary techniques and surgical stapling for a life\u2010threatening bilateral PAL secondary to CARDS.<\/jats:p>","DOI":"10.1002\/rcr2.1173","type":"journal-article","created":{"date-parts":[[2023,6,27]],"date-time":"2023-06-27T08:17:30Z","timestamp":1687853850000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["A customized multimodality approach for prolonged air leaks (<scp>PAL<\/scp>) in mechanically ventilated patients"],"prefix":"10.1002","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5607-1914","authenticated-orcid":false,"given":"Sameer","family":"Bansal","sequence":"first","affiliation":[{"name":"Department of Pulmonary Medicine Apollo Hospitals  Bangalore India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arul","family":"Furtado","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular &amp; Thoracic Surgery Apollo Hospitals  Bangalore India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hariprasad","family":"Kalpakam","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine Apollo Hospitals  Bangalore India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chakravarthi","family":"Loknath","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine Apollo Hospitals  Bangalore India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ravindra M.","family":"Mehta","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine Apollo Hospitals  Bangalore India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,6,27]]},"reference":[{"key":"e_1_2_6_2_1","first-page":"216","article-title":"Prevention and management of postoperative air leaks","volume":"3","author":"Burt BM","year":"2014","journal-title":"Ann Cardiothorac Surg"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2004.04.007"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1010-7940(00)00541-8"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.21037\/jtd.2017.05.47"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejcts.2010.05.020"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2006.02.021"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2009.03.012"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-010-1757-0"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2009.05.068"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.14-0823"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/LBR.0000000000000459"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.2020202352"},{"issue":"2","key":"e_1_2_6_14_1","article-title":"Chest CT severity score: an imaging tool for assessing severe COVID\u201019","volume":"2","author":"Yang R","year":"2020","journal-title":"Radiology"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-004-2187-7"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/00128594-200310000-00005"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2012.12.036"}],"container-title":["Respirology Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/rcr2.1173","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,17]],"date-time":"2023-08-17T19:09:16Z","timestamp":1692299356000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/rcr2.1173"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,6,27]]},"references-count":16,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2023,7]]}},"alternative-id":["10.1002\/rcr2.1173"],"URL":"https:\/\/doi.org\/10.1002\/rcr2.1173","archive":["Portico"],"relation":{},"ISSN":["2051-3380","2051-3380"],"issn-type":[{"type":"print","value":"2051-3380"},{"type":"electronic","value":"2051-3380"}],"subject":[],"published":{"date-parts":[[2023,6,27]]},"assertion":[{"value":"2022-12-14","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-05-18","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-06-27","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e01173"}}