Bronchopleural fistula: successful selective bronchial occlusion with a Fogarty's catheter in a preterm infant

Selective Bronchial Occlusion for Treatment of a Bronchopleural Fistula in an Extremely Preterm Infant

Neonatal pulmonary air leak commonly occurs as a complication of mechanical ventilation in infants with underlying hyaline membrane disease. They can commonly be managed conservatively or with the application of a chest drain, but some severe cases pose a significant challenge in finding an alternative therapeutic solution. Selective bronchial occlusion represents an unconventional rescue therapy for treating bronchopleural fistula resistant to the standard therapy. A 27-week gestation preterm infant ventilated for respiratory distress syndrome developed tension right-sided pneumothorax. Conventional modalities of treatment were tried and were unsuccessful. Intermittent selective bronchial occlusion with a Fogarty’s catheter and high-frequency oscillatory ventilation resulted in considerable improvement in the infant’s clinical condition and radiographic findings.

Bronchopleural fistula in a newborn undergoing ECMO-transbronchial closure

Refractory pneumothoraces with bronchopleural fistula (BPF) pose a significant challenge in managing critically sick and ventilated neonates. We report a case of the term female neonate being treated with extracorporeal membrane oxygenation (ECMO) support for meconium aspiration and presumed sepsis, with a significant air leak refractory to pleural drainage that was managed using endobronchial application of cyanoacrylate (enbucrilate) glue to seal the leak.

Transbronchoscopic selective bronchial occlusion for intractable pneumothorax

BACKGROUND AND OBJECTIVE

The aim of this study was to evaluate the efficacy, complications and safety of the application of transbronchoscopic balloon detection (TBD) and selective bronchial occlusion (SBO) to intractable pneumothorax.

METHODS

Forty patients with pneumothorax, who had experienced more than 7 days of chest tube drainage without closure of the pleural fistula, underwent TBD and SBO. In 10 patients, oxygenation and pulse rates were recorded. A thoracic CT scan was performed 10 days after SBO.

RESULTS

The bronchi leading to the pleural fistula were located by TBD in 34 of 40 patients (85%). The air leakages ceased after the first occlusion in 30 patients, and five of these 30 patients underwent a second occlusion due to recurrence of pneumothorax 72 h after the first occlusion. In three of these patients, air leakages ceased after the second occlusion, while the remaining two patients underwent thoracoscopy. In total, 28 of 40 patients (70%) were cured using SBO. During TBD/SBO, the lowest SaO2 was 89.0 +/- 2.8%, the mean SaO2 was 93.4 +/- 2. 6% and the percentage of time during the procedure that SaO2 was <90% was 10.7 +/- 17.5%. Ten days after SBO, thoracic CT scans were performed on 10 patients and no obstructive atelectasis was detected in any patient.

CONCLUSIONS

These results indicate that TBD and SBO are safe and effective procedures for treating patients with intractable pneumothorax.