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Baden W, Hofbeck M, Warmann SW, Schaefer JF, Sieverding L. Interventional closure of a bronchopleural fistula in a 2 year old child with detachable coils. BMC Pediatr 2022; 22:250. [PMID: 35513808 PMCID: PMC9074316 DOI: 10.1186/s12887-022-03298-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 04/21/2022] [Indexed: 11/30/2022] Open
Abstract
Background Bronchopleural fistula (BPF) is a severe complication following pneumonia or pulmonary surgery, resulting in persistent air leakage (PAL) and pneumothorax. Surgical options include resection, coverage of the fistula by video-assisted thoracoscopic surgery (VATS), or pleurodesis. Interventional bronchoscopy is preferred in complex cases and involves the use of sclerosants, sealants and occlusive valve devices. Case presentation A 2.5-year-old girl was admitted to our hospital with persistent fever, cough and dyspnoea. Clinical and radiological examination revealed right-sided pneumonia and pleural effusion. The child was started on antibiotics, and the effusion was drained by pleural drainage. Following removal of the chest tube, the child developed tension pneumothorax. Despite insertion of a new drain, the air leak persisted. Thoracoscopic debridement with placement of another new drain was performed after 4 weeks, without abolishment of the air leak. Bronchoscopy with bronchography revealed a BPF in right lung segment 3 (right upper-lobe anterior bronchus). We opted for an interventional approach that was performed under general anaesthesia during repeat bronchoscopy. Following bronchographic visualisation of the fistula, a 2.7 French microcatheter was placed in right lung segment 3 (upper lobe), allowing occlusion of the fistula by successive implantation of 4 detachable high-density packing volume coils, which were placed into the fistula. Subsequent bronchography revealed no evidence of residual leakage, and the chest tube was removed 2 days later. The chest X-ray findings normalized, and follow-up over 4 years was uneventful. Conclusions Bronchoscopic superselective occlusion of BPF using detachable high-density packing large-volume coils was a successful minimally invasive therapeutic intervention performed with minimal trauma in this child and has not been reported thus far. In our small patient, the short interventional time, localized intervention and minimal damage in the lung seemed superior to the corresponding outcomes of surgical lobectomy or pleurodesis in a young growing lung, enabling normal development of the surrounding tissue. Follow-up over 4 years did not show any side effects and was uneventful, with normal lung-function test results to date. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-022-03298-y.
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Affiliation(s)
- Winfried Baden
- Department Paediatrics 2, Pulmonology, Cardiology, Intensive Care, Children's Hospital, University of Tuebingen, Hoppe-Seyler-Strasse 1, 72076, Tuebingen, Germany.
| | - Michael Hofbeck
- Department Paediatrics 2, Pulmonology, Cardiology, Intensive Care, Children's Hospital, University of Tuebingen, Hoppe-Seyler-Strasse 1, 72076, Tuebingen, Germany
| | - Steven W Warmann
- Department Paediatric Surgery and Paediatric Urology, Children's Hospital, University of Tuebingen, Tuebingen, Germany
| | - Juergen F Schaefer
- Department Radiology, Division of Paediatric Radiology, University Hospital, Tuebingen, Germany
| | - Ludger Sieverding
- Department Paediatrics 2, Pulmonology, Cardiology, Intensive Care, Children's Hospital, University of Tuebingen, Hoppe-Seyler-Strasse 1, 72076, Tuebingen, Germany
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Abstract
OBJECTIVE To describe the physiology of air leak in bronchopleural fistula in mechanically ventilated patients and how understanding of its physiology drives management of positive-pressure ventilation. To provide guidance of lung isolation, mechanical ventilator, pleural catheter, and endobronchial strategies for the management of bronchopleural fistula on mechanical ventilation. DATA SOURCES Online search of PubMed and manual review of articles (laboratory and patient studies) was performed. STUDY SELECTION Articles relevant to bronchopleural fistula, mechanical ventilation in patients with bronchopleural fistula, independent lung ventilation, high-flow ventilatory modes, physiology of persistent air leak, extracorporeal membrane oxygenation, fluid dynamics of bronchopleural fistula airflow, and intrapleural catheter management were selected. Randomized trials, observational studies, case reports, and physiologic studies were included. DATA EXTRACTION Data from selected studies were qualitatively evaluated for this review. We included data illustrating the physiology of driving pressure across a bronchopleural fistula as well as data, largely from case reports, demonstrating management and outcomes with various ventilator modes, intrapleural catheter techniques, endoscopic placement of occlusion and valve devices, and extracorporeal membrane oxygenation. Themes related to managing persistent air leak with mechanical ventilation were reviewed and extracted. DATA SYNTHESIS In case reports that demonstrate different approaches to managing patients with bronchopleural fistula requiring mechanical ventilation, common themes emerge. Strategies aimed at decreasing peak inspiratory pressure, using lower tidal volumes, lowering positive end-expiratory pressure, decreasing the inspiratory time, and decreasing the respiratory rate, while minimizing negative intrapleural pressure decreases airflow across the bronchopleural fistula. CONCLUSIONS Mechanical ventilation and intrapleural catheter management must be individualized and aimed at reducing air leak. Clinicians should emphasize reducing peak inspiratory pressures, reducing positive end-expiratory pressure, and limiting negative intrapleural pressure. In refractory cases, clinicians can consider lung isolation, independent lung ventilation, or extracorporeal membrane oxygenation in appropriate patients as well as definitive management with advanced bronchoscopic placement of valves or occlusion devices.
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S S, I T, H K. Endoscopic treatment of bronchopleural fistula using ethyl-2-cyanoacrylate: A report of two cases. Respir Med Case Rep 2020; 30:101123. [PMID: 32577364 PMCID: PMC7303975 DOI: 10.1016/j.rmcr.2020.101123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/05/2020] [Accepted: 06/09/2020] [Indexed: 11/15/2022] Open
Abstract
Bronchopleural fistula (BPF) is a serious complication after lung resection or chronic empyema. BPF often causes severe pneumonia or fatal airway bleeding due to bronchoarterial fistula. Although BPF often requires surgical treatment, another, more conservative treatment option is endoscopic bronchial occlusion for non-operable patients. Many endoscopic treatments have been reported. We report here two patients with BPF who underwent endoscopic bronchial occlusion. Patient 1 had postoperative BPF with empyema and Patient 2 had BPF due to chronic empyema. Because the BPF in Patient 1 was small, it could be successfully treated by endobronchial occlusion using only ethyl-2-cyanoacrylate. In contrast, because the BPF in Patient 2 was large, it could not be treated by endobronchial occlusion using ethyl-2-cyanoacrylate alone; it was successfully treated by endobronchial occlusion using the combination of ethyl-2-cyanoacrylate and a silicone spigot (endobronchial Watanabe spigot, EWS). When we attempt endoscopic bronchial occlusion with BPF for non-operable patients, ethyl-2-cyanoacrylate may be an option for small fistulas, while the combination of EWS and ethyl-2-cyanoacrylate may be suitable for large fistulas.
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Affiliation(s)
- Shigeki S
- Department of General Thoracic Surgery, Sagamihara Kyodo Hospital, Kanagawa, Japan
| | - Tomohiro I
- Department of General Thoracic Surgery, Sagamihara Kyodo Hospital, Kanagawa, Japan
| | - Kenichi H
- Department of General Thoracic Surgery, Sagamihara Kyodo Hospital, Kanagawa, Japan
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Zhang HT, Xie YH, Gu X, Li WP, Zeng YM, Li SY, Liu ZG, Wang HW, Bai C, Jin FG. Management of Persistent Air Leaks Using Endobronchial Autologous Blood Patch and Spigot Occlusion: A Multicentre Randomized Controlled Trial in China. Respiration 2019; 97:436-443. [PMID: 30904909 DOI: 10.1159/000495298] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 11/09/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Optimal management of persistent air leaks (PALs) in patients with secondary spontaneous pneumothorax (SSP) remains controversial. OBJECTIVE To evaluate the efficacy and safety of endobronchial autologous blood plus thrombin patch (ABP) and bronchial occlusion using silicone spigots (BOS) in patients with SSP accompanied by alveolar-pleural fistula (APF) and PALs. METHODS This prospective multicentre randomized controlled trial compared chest tube-attached water-seal drainage (CTD), ABP, and BOS that were performed between February 2015 and June 2017 in one of six tertiary care hospitals in China. Patients diagnosed with APF experiencing PALs (despite 7 days of CTD) and inoperable patients were included. Outcome measures included success rate of pneumothorax resolution at the end of the observation period (further 14 days), duration of air leak stop, lung expansion, hospital stay, and complications. RESULTS In total, 150 subjects were analysed in three groups (CTD, ABP, BOS) of 50 each. At 14 days, 60, 82, and 84% of CTD, ABP, and BOS subjects, respectively, experienced full resolution of pneumothorax (p = 0.008). All duration outcome measures were significantly better in the ABP and BOS groups than in the CTD group (p < 0.016 for all). The incidence of adverse events, including chest pain, cough, and fever, was not significantly different. All subjects in the ABP and BOS groups experienced temporary haemoptysis. Spigot displacement occurred in 8% of BOS subjects. CONCLUSION ABP and BOS resulted in clinically meaningful outcomes, including higher success rate, duration of air leak stop, lung expansion, and hospital stay, with an acceptable safety profile.
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Affiliation(s)
- Hai-Tao Zhang
- Department of Respiration, Tangdu Hospital, Air Force Military Medical University, Xi'an, China
| | - Yong-Hong Xie
- Department of Respiration, Tangdu Hospital, Air Force Military Medical University, Xi'an, China
| | - Xing Gu
- Department of Respiration, Tangdu Hospital, Air Force Military Medical University, Xi'an, China
| | - Wang-Ping Li
- Department of Respiration, Tangdu Hospital, Air Force Military Medical University, Xi'an, China
| | - Yi-Ming Zeng
- Department of Pulmonary and Critical Care Medicine, Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Shi-Yue Li
- Department of Respiratory, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhi-Guang Liu
- Department of Respiratory Medicine, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Hong-Wu Wang
- Department of Medical Oncology, Meitan General Hospital, Beijing, China
| | - Chong Bai
- Department of Respiratory Medicine, Changhai Hospital, Navy Military Medical University, Shanghai, China
| | - Fa-Guang Jin
- Department of Respiration, Tangdu Hospital, Air Force Military Medical University, Xi'an, China,
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Sakata KK, Reisenauer JS, Kern RM, Midthun DE, Utz JP, Blackmon SH, Mullon JJ, Wigle DA. Extracellular matrix fistula plug for repair of bronchopleural fistula. Respir Med Case Rep 2018; 25:207-10. [PMID: 30225191 DOI: 10.1016/j.rmcr.2018.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Accepted: 09/12/2018] [Indexed: 11/29/2022] Open
Abstract
Introduction Bronchopleural fistula (BPF) is a feared complication of pulmonary resection. Fistula plugs (FP) have been described as an adequate treatment in anorectal disease. We describe our early experience placing an FP in the treatment of BPF. Materials and methods We retrospectively reviewed 5 patients for whom a FP was placed for BPF at our institution. Demographic data, initial perioperative information, method and technique of FP placement, and success is reported. Results Five patients (4 male, 1 female) with a median age of 63 years (range, 57–76 years) underwent 6 FP placements for BPF. Two patients were post-pneumonectomy and 3 patients post-lobectomy. The median time to presentation following surgery was 118 days (range 22–218). Upon bronchoscopic or operative re-evaluation, 3 patients had successful cessation of their air leak at 0, 1 and 4 days. Two of three patients subsequently underwent a thoracic muscle flap placement to augment healing. One patient had a persistent air leak despite 2 separate FP placements. The air leak stopped with endobronchial valves (EBV) which were deployed proximal to the FP, 9 days after placement of the FP. Another patient had a successful muscle flap placed 80 days after FP placement. There were no complications associated with the FP. Three of five patients were deemed successfully treated with FP placement alone. Conclusion In patients with a postoperative BPF and pleural window, placement of a FP had a modest success rate and can be considered as a treatment modality option for BPF.
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Sakata KK, Reisenauer JS, Kern RM, Mullon JJ. Persistent air leak - review. Respir Med 2018; 137:213-218. [DOI: 10.1016/j.rmed.2018.03.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 03/06/2018] [Accepted: 03/13/2018] [Indexed: 10/17/2022]
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Abstract
Persistent air leak (PAL) is a cause of significant morbidity in patients who have undergone lung surgery and those with significant parenchymal lung disease suffering from a pneumothorax. Its management can be complex and challenging. Although conservative treatment with chest drain and observation is usually effective, other invasive techniques are needed when conservative treatment fails. Surgical management and medical pleurodesis have long been the usual treatments for PAL. More recently numerous bronchoscopic procedures have been introduced to treat PAL in those patients who are poor candidates for surgery or who decline surgery. These techniques include bronchoscopic use of sealants, sclerosants, and various types of implanted devices. Recently, removable one-way valves have been developed that are able to be placed bronchoscopically in the affected airways, ameliorating air-leaks in patients who are not candidates for surgery. Future comparative trials are needed to refine our understanding of the indications, effectiveness, and complications of bronchoscopic techniques for treating PAL. The following article will review the basic principles of management of PAL particularly focusing on bronchoscopic techniques.
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Affiliation(s)
- Donald R Lazarus
- Department of Pulmonary, Critical Care, and Sleep Section, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX, USA
| | - Roberto F Casal
- Department of Pulmonary Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
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9
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Abstract
Bronchopleural fistula (BPF) with prolonged air leak (PAL) is most often, though not always, a sequela of lung resection. When this complication occurs post-operatively, it is associated with substantial morbidity and mortality. Surgical closure of the defect is considered the definitive approach to controlling the source of the leak, but many patients with this condition are suboptimal operative candidates. Therefore there has been active interest for decades in the development of effective endoscopic management options. Successful use of numerous bronchoscopic techniques has been reported in the literature largely in the form of retrospective series and, at best, small prospective trials. In general, these modalities fall into one of two broad categories: implantation of a device or administration of a chemical agent. Closure rates are high in published reports, but the studies are limited by their small size and multiple sources of bias. The endoscopic procedure currently undergoing the most systematic investigation is the placement of endobronchial valves. The aim of this review is to present a concise discussion on the subject of PAL and summarize the described bronchoscopic approaches to its management.
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Affiliation(s)
- Sevak Keshishyan
- Division of Pulmonary, Critical Care, and Sleep Medicine, Westchester Medical Center, Valhalla, NY, USA
| | - Alberto E Revelo
- Division of Pulmonary, Critical Care, and Sleep Medicine, Westchester Medical Center, Valhalla, NY, USA
| | - Oleg Epelbaum
- Division of Pulmonary, Critical Care, and Sleep Medicine, Westchester Medical Center, Valhalla, NY, USA
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Mehta HJ, Malhotra P, Begnaud A, Penley AM, Jantz MA. Treatment of alveolar-pleural fistula with endobronchial application of synthetic hydrogel. Chest 2015; 147:695-699. [PMID: 25057803 DOI: 10.1378/chest.14-0823] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Alveolar-pleural fistula with persistent air leak is a common problem causing significant morbidity, prolonged hospital stay, and increased health-care costs. When conventional therapy fails, an alternative to prolonged chest-tube drainage or surgery is needed. New bronchoscopic techniques have been developed to close the air leak by reducing the flow of air through the leak. The objective of this study was to analyze our experience with bronchoscopic application of a synthetic hydrogel for the treatment of such fistulas. METHODS We conducted a retrospective study of patients with alveolar-pleural fistula with persistent air leaks treated with synthetic hydrogel application via flexible bronchoscopy. Patient characteristics, underlying disease, and outcome of endoscopic treatment were analyzed. RESULTS Between January 2009 and December 2013, 22 patients (14 men, eight women; mean age ± SD, 62 ± 10 years) were treated with one to three applications of a synthetic hydrogel per patient. The primary etiology of persistent air leak was necrotizing pneumonia (n = 8), post-thoracic surgery (n = 6), bullous emphysema (n = 5), idiopathic interstitial pneumonia (n = 2), and sarcoidosis (n = 1). Nineteen patients (86%) had complete resolution of the air leak, leading to successful removal of chest tube a mean ( ± SD) of 4.3 ± 0.9 days after last bronchoscopic application. The procedure was very well tolerated, with two patients coughing up the hydrogel and one having hypoxemia requiring bronchoscopic suctioning. CONCLUSIONS Bronchoscopic administration of a synthetic hydrogel is an effective, nonsurgical, minimally invasive intervention for patients with persistent pulmonary air leaks secondary to alveolar-pleural fistula.
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Affiliation(s)
- Hiren J Mehta
- Division of Pulmonary/Critical Care/Sleep Medicine, University of Florida College of Medicine, Gainesville, FL.
| | - Paras Malhotra
- Division of Pulmonary/Critical Care/Sleep Medicine, University of Florida College of Medicine, Gainesville, FL
| | - Abbie Begnaud
- Division of Pulmonary/Allergy/Critical Care/Sleep Medicine, University of Minnesota College of Medicine, Minneapolis, MN
| | - Andrea M Penley
- Division of Pulmonary/Critical Care/Sleep Medicine, University of Florida College of Medicine, Gainesville, FL
| | - Michael A Jantz
- Division of Pulmonary/Critical Care/Sleep Medicine, University of Florida College of Medicine, Gainesville, FL
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Amit M, Binenbaum Y, Cohen JT, Gil Z. Effectiveness of an Oxidized Cellulose Patch Hemostatic Agent in Thyroid Surgery: A Prospective, Randomized, Controlled Study. J Am Coll Surg 2013; 217:221-5. [DOI: 10.1016/j.jamcollsurg.2013.03.022] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2013] [Revised: 03/24/2013] [Accepted: 03/26/2013] [Indexed: 11/21/2022]
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Fujiwara M, Sassoon CS, Kota C, Mazdisnian F. Successful closure of bronchopleural fistula with Xeroform dressing. J Bronchology Interv Pulmonol 2012; 19:251-4. [PMID: 23207473 DOI: 10.1097/LBR.0b013e31825aad6b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Bronchopleural fistula (BPF) is a communication between the pleural space and the bronchial tree, and is associated with significant morbidity and mortality. Treatment options for BPF include surgical closure and medical therapy. In an unstable patient, invasive surgical intervention is not an option. In this article, we report the case of a 61-year-old man who developed pneumothorax with a large BPF after a bronchoscopic resection of a malignant endobronchial lesion. We inserted a piece of 1.5×1.5-cm Xeroform dressing to seal the massive air leak with successful closure of the BPF. To our knowledge, this is the first report of successful closure of a massive BPF with Xeroform dressing in an acutely decompensating patient.
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Chang JW, Choo OS, Shin YS, Hong J, Kim CH. Temporary closure of congenital tracheoesophageal fistula with Fogarty catheter. Laryngoscope 2013; 123:3219-22. [PMID: 23674212 DOI: 10.1002/lary.24164] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 03/11/2013] [Accepted: 03/29/2013] [Indexed: 11/08/2022]
Affiliation(s)
- Jae Won Chang
- Departments of Otolaryngology, School of Medicine, Ajou University, Suwon, South Korea
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Abstract
Chest trauma is one important factor for total morbidity and mortality in traumatized emergency patients. The complexity of injury in trauma patients makes it challenging to provide an optimal oxygenation while protecting the lung from further ventilator-induced injury to it. On the other hand, lung trauma needs to be treated on an individual basis, depending on the magnitude, location and type of lung or chest injury. Several aspects of ventilatory management in emergency patients are summarized herein and may give the clinician an overview of the treatment possibilities for chest trauma victims.
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Affiliation(s)
- Torsten Richter
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Dresden Carl Gustav Carus, Technical University, Dresden, Germany
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Liberman M, Cassivi SD. Bronchial Stump Dehiscence: Update on Prevention and Management. Semin Thorac Cardiovasc Surg 2007; 19:366-73. [DOI: 10.1053/j.semtcvs.2007.11.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2007] [Indexed: 11/11/2022]
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Mohos E, Szabó E, Módi J, Beller J, Szabados G, Nagy A. [Surgical case of bronchopleural fistula caused by necrotizing pneumonia in a two year old child]. Magy Seb 2007; 60:518-22. [PMID: 17474307 DOI: 10.1556/maseb.60.2007.1.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The treatment possibilities of broncho-pleural fistula (BPF) caused by necrotizing pneumonia (NP) are discussed based on the experiences of a case and on the basis of the literature. In case of pleural fluid caused by NP the importance of thoracic drainage and--in selected cases--video assisted thoracoscopy (VATS) are emphasized. If BPF develops and the oxygen saturation in the blood can not be kept on acceptable level because of the large volume of the lost air through the fistula bronchoscopic occlusion of the bronchus leading to the BPF is recommended. In conservative therapy resistant cases thoracotomy can be indicated.
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Affiliation(s)
- Elemér Mohos
- Veszprém Megyei Csolnoki Ferenc Kórház Altalános Sebészeti Osztály
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Martínez-Escobar S, Ruiz-Bailén M, Lorente-Acosta MJ, Vicente-Rull JR, Martínez-Coronel JF, Rodríguez-Cuartero A. Pleurodesis using autologous blood: a new concept in the management of persistent air leak in acute respiratory distress syndrome. J Crit Care 2006; 21:209-16. [PMID: 16769470 DOI: 10.1016/j.jcrc.2005.10.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2004] [Revised: 08/10/2005] [Accepted: 10/07/2005] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Pneumothorax is present as a frequent complication in acute respiratory distress syndrome (ARDS). Persistent air leak (PAL) prolongs pneumothorax in 2% of cases of ARDS, increasing the rate of mortality by 26%. Pleurodesis using autologous blood (PAB) is an effective method in cases of oncological pulmonary surgery. The goal of this study was to compare PAB with the conventional drain and water seal in the management of PAL in patients with ARDS and pneumothorax. DESIGN The study was a case-control, prospective, nonrandomized one comparing 2 groups subjected to artificial pairing (1:1). SETTING The study took place at the Torrecardenas Hospital (Andalusian Health Service, Almería, Spain). PATIENTS Participants were 2 groups of 27 patients, all with ARDS, pneumothorax, and PAL. INTERVENTIONS One group received conventional treatment whereas the other received PAB. MAIN RESULTS The severity of the conditions of both groups is homogeneous, shown by sex; age; Murray, Marshall, and Acute Physiology and Chronic Health Evaluation II scores; and etiology of ARDS. The patients in the PAB group had a shorter stay in the ICU, shorter weaning time (WT), and lower death rate. The average differences between the groups were 11 days less WT (adjusted odds ratio [OR] = 0.1) and 9 days less on average time spent in the ICU (adjusted OR = 0.24). The death rates in the PAB group and the control group were 3.7% and 29.6%, respectively (adjusted OR = 0.6). CONCLUSIONS The use of PAB makes possible a decrease in ventilator WT and a shorter stay in the ICU, with a resulting increase in functional recuperation and decrease in patient mortality.
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Abstract
A bronchopleural fistula (BPF) is a communication between the pleural space and the bronchial tree. Although rare, BPFs represent a challenging management problem and are associated with high morbidity and mortality. By far, the postoperative complication of pulmonary resection is the most common cause, followed by lung necrosis complicating infection, persistent spontaneous pneumothorax, chemotherapy or radiotherapy (for lung cancer), and tuberculosis. The treatment of BPF includes various surgical and medical procedures, and of particular interest is the use of bronchoscopy and different glues, coils, and sealants. Localization of the fistula and size may indicate potential benefits of surgical vs endoscopic procedures. In high-risk surgical patients, endoscopic procedures may serve as a temporary bridge until the patient's clinical status is improved, while in other patients endoscopic procedures may be the only option. Therapeutic success has been variable, and the lack of consensus suggests that no optimal therapy is available; rather, the current therapeutic options seem to be complementary, and the treatment should be individualized.
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Affiliation(s)
- Manuel Lois
- Department of Pulmonary Medicine, University Hospital AZ-VUB, 101, Laarbeeklaan, B 1090 Brussels, Belgium
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Miyazaki Y, Sakashita H, Tanaka T, Watanabe A, Yoshizawa Y. Bronchopleural Fistula Successfully Treated With Surgical Sponge: . ACTA ACUST UNITED AC 2001; 8:282-5. [DOI: 10.1097/00128594-200110000-00009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Okada S, Kano K, Yamauchi H, Satoh S. Emergent bronchofiberoptic bronchial occlusion for intractable pneumothorax with severe emphysema. Jpn J Thorac Cardiovasc Surg 1998; 46:1078-81. [PMID: 9884555 DOI: 10.1007/bf03217879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Emergent bronchofiberoptic bronchial occlusion using fibrin glue and woven polyglycolic acid mesh for persistent pneumothorax with severe emphysema is described. A 74-year-old man who had severe pulmonary dysfunction accompanying chronic emphysema was admitted with a complaint of sudden severe dyspnea. The chest X-ray on admission revealed collapse of the right lung. The patient was placed on a mechanical ventilator because of acute respiratory failure. In spite of continuous suction through a chest drainage tube, air leakage persisted. On the seventh hospital day, subcutaneous emphysema was apparent in the face and scrotum in addition to the chest. First, a double-lumen catheter was inserted into the right B5 bronchus, and fibrin glue was infused into the drainage bronchus via the double-lumen catheter. However, the procedure failed. Next, a combination of fibrin glue and woven polyglycolic acid mesh which had been cut into small pieces was introduced and pushed into the B5 bronchus using forceps. The air leakage stopped immediately after the administration. This procedure is simple and a minimally invasive method for the treatment of intractable pneumothorax in a compromised patient on a mechanical ventilator.
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Affiliation(s)
- S Okada
- Department of Thoracic Surgery and Medicine, Kamaishi Municipal Hospital, Iwate, Japan
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Glória C, Reis L. Reparação de múltiplas fístulas broncopleurais periféricas por oclusão brônquica selectiva com catéter de Swan-Ganz. Revista Portuguesa de Pneumologia 1995. [DOI: 10.1016/s0873-2159(15)31227-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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