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Bai Y, Chi J, Wang H, Li Y, Guo S. Case report: Endobronchial closure of postoperative bronchopleural fistula with embolization coil: a sandwich-like approach. Front Med (Lausanne) 2024; 11:1333157. [PMID: 38803344 PMCID: PMC11128611 DOI: 10.3389/fmed.2024.1333157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 04/29/2024] [Indexed: 05/29/2024] Open
Abstract
Background Embolization Coil has been reported to effectively treat postoperative bronchopleural fistula (BPF). Little detailed information was available on computer tomography (CT) imaging features of postoperative BPF and treating procedures with pushable Embolization Coil. Objective We aimed to specify the imaging characteristics of postoperative BPFs and present our experience treating them with the pushable Embolization Coil. Methods Six consecutive patients (four males and two females aged 29-56 years) diagnosed with postoperative BPF receiving bronchoscopic treatment with the pushable Nester® Embolization Coil (Cook Medical, Bloomington, Indiana) were included in this single-center, retrospective study. Multiplanar reconstruction of multidetector CT scans was reviewed for the presence, location, size, and radiological complications of each BPF, including air collection, pneumothorax, bronchiectasis, and chest tube. Using standardized data abstraction forms, demographic traits and clinical outcomes were extracted from the medical files of these patients. Results The underlying diseases for lung resection surgery were pulmonary tuberculosis (n = 3), lung adenocarcinoma (n = 2), and pulmonary aspergillosis (n = 1). All patients had air or air-fluid collection with chest tubes on radiological findings. Multiplanar reconstruction identified the presence of postoperative BPF in all patients. Five fistulas were central, located proximal to the main or lobar bronchus, while one was peripheral, distant from the lobar bronchus. Fistula sizes ranged from 0.8 to 5.8 mm. Subsequent bronchoscopy and occlusion testing confirmed fistula openings in the bronchial stump: right main bronchus (n = 1), right upper lobe (n = 2), and left upper lobe (n = 3). The angioplasty catheter-based procedure allows precise fistula occlusion "like a sandwich" with the pushable Embolization Coil. Five patients with BPF sizes ranging from 0.8 to 1.5 mm were successfully treated with a pushable Embolization Coil, except for one with a BPF size of 5.8 mm. No adverse events or complications were observed throughout follow-up, ranging from 29 to 1,307 days. Conclusion The pushable Nester® Embolization Coil seems a minimally invasive, cost-effective, and relatively easy-to-perform bronchoscopic treatment for postoperative BPF with a size less than 2 mm. Further studies are required to ensure the use of pushable Embolization Coil in treating postoperative BPF.
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Affiliation(s)
- Yang Bai
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jing Chi
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hansheng Wang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yishi Li
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shuliang Guo
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Li Y, Chen Z, Tian S, Han X, Wang C, Wang Y, Liu B. Stereotactic ablative brachytherapy versus percutaneous microwave ablation as salvage treatments for lung oligometastasis from colorectal cancer. BMC Cancer 2024; 24:481. [PMID: 38627695 PMCID: PMC11020186 DOI: 10.1186/s12885-024-12163-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/21/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND The treatment for lung oligometastasis from colorectal cancer (CRC) remains challenging. This retrospective study aimed to compare the local tumor control, survival and procedure-related complications in CRC patients undergoing low-dose rate stereotactic ablative brachytherapy (L-SABT) versus percutaneous microwave ablation (MWA) for lung oligometastasis. METHODS Patients between November 2017 and December 2020 were retrospectively analyzed. Local tumor progression-free survival (LTPFS) and overall survival (OS) were analyzed in the entire cohort as well as by stratified analysis based on the minimal ablation margin (MAM) around the tumor. RESULTS The final analysis included 122 patients: 74 and 48 in the brachytherapy and MWA groups, respectively, with a median follow-up of 30.5 and 35.3 months. The 1- and 3-year LTPFS rate was 54.1% and 40.5% in the brachytherapy group versus 58.3% and 41.7% in the MWA group (P = 0.524 and 0.889, respectively). The 1- and 3-year OS rate was 75.7% and 48.6% versus 75.0% and 50.0% (P = 0.775 and 0.918, respectively). Neither LTPFS nor OS differed significantly between the patients with MAM of 5-10 mm versus > 10 mm. Pulmonary complication rate did not differ in the overall analysis, but was significantly higher in the MWA group in the subgroup analysis that only included patients with lesion within 10 mm from the key structures (P = 0.005). The increased complications was primarily bronchopleural fistula. CONCLUSIONS Considering the caveats associated with radioisotope use in L-SABT, MWA is generally preferable. In patients with lesion within 10 mm from the key pulmonary structures, however, L-SABT could be considered as an alternative due to lower risk of bronchopleural fistula.
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Affiliation(s)
- Yuliang Li
- Department of Interventional Medicine and Minimally Invasive Oncology, The Second Hospital of Shandong University, No. 247 Beiyuan Street, Jinan, 250033, PR of China
- Interventional Oncology Institute, Shandong University, Jinan, PR of China
| | - Zitong Chen
- Department of Interventional Medicine and Minimally Invasive Oncology, The Second Hospital of Shandong University, No. 247 Beiyuan Street, Jinan, 250033, PR of China
| | - Shuhui Tian
- Department of Interventional Medicine and Minimally Invasive Oncology, The Second Hospital of Shandong University, No. 247 Beiyuan Street, Jinan, 250033, PR of China
| | - Xujian Han
- Interventional Oncology Institute, Shandong University, Jinan, PR of China
- Department of Radiology, Shandong Provincial Hospital, Jinan, PR of China
| | - Changjun Wang
- Interventional Oncology Institute, Shandong University, Jinan, PR of China
- Department of Radiology, People's Hospital of Jiyang County, Jinan, PR of China
| | - Yongzheng Wang
- Department of Interventional Medicine and Minimally Invasive Oncology, The Second Hospital of Shandong University, No. 247 Beiyuan Street, Jinan, 250033, PR of China
- Interventional Oncology Institute, Shandong University, Jinan, PR of China
| | - Bin Liu
- Department of Interventional Medicine and Minimally Invasive Oncology, The Second Hospital of Shandong University, No. 247 Beiyuan Street, Jinan, 250033, PR of China.
- Interventional Oncology Institute, Shandong University, Jinan, PR of China.
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Duranti L, Tavecchio L. Surgery-related outcomes from a close-knit surgeons' team in thoracic oncology. Updates Surg 2024; 76:641-646. [PMID: 38007402 DOI: 10.1007/s13304-023-01700-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/07/2023] [Indexed: 11/27/2023]
Abstract
Reducing morbidity, length of hospital stay, and readmission rate are of paramount importance to improve patients' care. In the present paper, we aim to describe our experience in managing major oncologic thoracic surgery in clinical practice. This is a retrospective experience over the last 7 years. Data from 215 consecutive patients (performed by a single-team of two surgeon) undergoing thoracic surgery were reviewed and evaluated. The total hospital mean stay was 3,3 days. Complications were represented by 4 hemothorax, 1 pleural empyema without fistula, 3 arrhythmias (atrial fibrillation), 2 pnuemonias and 1 chylotorax. No 30-day severe surgery-related complication occurred, no mortality. In 169 Vats procedures, no convertion was necessary. We conclude that a united team work represented by two close-knit surgeons, with similar clinical background, propensity to share problems, no competitive behavior, allow to do faster surgery, to standardize the procedure improving the post-operative outcomes of cancer patients.
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Affiliation(s)
- Leonardo Duranti
- Thoracic Surgery, Fondazione IRCCS Istituto Nazionale Tumori, Via G Venezian 1, 20133, Milan, Italy.
| | - Luca Tavecchio
- Thoracic Surgery, Fondazione IRCCS Istituto Nazionale Tumori, Via G Venezian 1, 20133, Milan, Italy
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Wadiwala IJ, Fernandez-Bussy S, Garg P, Ali M, Feinglass NG, Thomas M, Pham SM. Novel treatment of bronchopleural fistula in a lung transplant recipient with endobronchial sealant and endobronchial valve placement via robotic-assisted bronchoscopy. J Surg Case Rep 2023; 2023:rjad383. [PMID: 37434719 PMCID: PMC10331800 DOI: 10.1093/jscr/rjad383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 06/15/2023] [Indexed: 07/13/2023] Open
Abstract
Bronchopleural fistulas (BPFs) are a dreaded complication following pulmonary surgery. Endobronchial valves (EVs), with endobronchial sealant (ES), instilled with robotic bronchoscopy (RB), allow occlusion of BPF, avoiding surgery. The patient was a 71-year-old woman with a history of chronic obstructive pulmonary disease and bronchiectasis who underwent bilateral lung transplantation and wedge resection of the right middle lobe and left lingula. A BPF was discovered on postoperative day (POD) 21. Conservative measures with chest tubes failed, and robotic-assisted bronchoscopy aided in reaching the bronchial segment and instilling ES, and EV was deployed with the conventional bronchoscope. The pneumothorax was cleared 12 days later, and on POD 56, she was discharged. The RB procedure was successful, with no pneumothorax or BPF symptoms after a median follow-up of POD 284. Robotic endobronchial closure of BPF with EV and ES is an effective treatment option avoiding invasive surgeries.
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Affiliation(s)
- Ishaq J Wadiwala
- Cardiothoracic Surgery Research Unit, Mayo Clinic, Jacksonville, FL, USA
| | | | - Pankaj Garg
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Mostafa Ali
- Cardiothoracic Surgery Research Unit, Mayo Clinic, Jacksonville, FL, USA
| | - Neil G Feinglass
- Department of Anesthesiology, Mayo Clinic, Jacksonville, FL, USA
| | - Mathew Thomas
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Si M Pham
- Correspondence address. Mayo Clinic College of Medicine and Science Chair, Department of Cardiothoracic Surgery, Mayo Clinic Florida 4500 San Pablo Rd S, Jacksonville, Florida 32224, USA. Tel: 904-956-3212, 904-953-2000; Fax: 904-956-8060; E-mail:
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Murthy PR, A K AK, N N, K V VG. Adolescent tuberculosis in the ICU. Indian J Tuberc 2023; 70 Suppl 1:S24-S28. [PMID: 38110256 DOI: 10.1016/j.ijtb.2023.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 06/19/2023] [Accepted: 06/27/2023] [Indexed: 12/20/2023]
Abstract
TB is a major concern in the paediatric age group, especially in India. More than 3.33 lakh children between 0 and 14 years of age are affected by TB. Adolescent tuberculosis has been a neglected area and this age group accounts for about 800,000 cases of tuberculosis (TB) cases every year. Information regarding adolescent tuberculosis patient requiring ICU admission/care is very scanty (unlike adult tuberculosis), and the authors believe that the mode of ICU presentation and challenges in adolescents would almost be the same as in adults, although the outcome is generally expected to be better in the adolescent population in view of lesser comorbidities when compared to adults. ARDS, multiorgan dysfunction and meningitis are the most common reasons for admission to ICU. Critically ill patients with TB carry a high mortality and the increased mortality is likely due to multiorgan dysfunction, nosocomial infections and sepsis. Advanced disease with chronic undernourishment influences not just morbidity but mortality as well. Further, the heavy financial burden incurred for ICU care in TB patients with poor expected outcome is a major concern since TB occurs predominantly in low socio-economic populations.
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Affiliation(s)
- Pooja R Murthy
- Department of Critical Care Medicine, Aster Whitefield Hospital, Bengaluru, (560 066), Karnataka, India
| | - Ajith Kumar A K
- Department of Critical Care Medicine, Aster Whitefield Hospital, Bengaluru, (560 066), Karnataka, India.
| | - Nikhil N
- Department of Critical Care Medicine, Aster Whitefield Hospital, Bengaluru, (560 066), Karnataka, India
| | - Venkatesha Gupta K V
- Department of Critical Care Medicine, Aster Whitefield Hospital, Bengaluru, (560 066), Karnataka, India
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6
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Shen L, Jiang YH, Dai XY. Successful surgical treatment of bronchopleural fistula caused by severe pulmonary tuberculosis: A case report and review of literature. World J Clin Cases 2023; 11:2282-2289. [PMID: 37122506 PMCID: PMC10131018 DOI: 10.12998/wjcc.v11.i10.2282] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/01/2023] [Accepted: 03/09/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Bronchopleural fistula (BPF) is a relatively rare, but severe complication of pulmonary tuberculosis. It is associated with significant mortality; however, its management remains a major therapeutic challenge.
CASE SUMMARY We present a 24-year-old man with BPF resulting from severe pulmonary tuberculosis combined with mixed infections. The damaged right upper lobe and concomitant empyema were demonstrated via computed tomography. After undergoing open-window thoracostomy and tuberculosis treatment for 4 mo, decortication and right upper lobectomy were subsequently performed, leading to the resolution of tuberculosis and other concurrent pulmonary infections. Follow-up, 6 mo after surgery, failed to reveal any evidence of infection recurrence resulting in a good prognosis.
CONCLUSION The disease course of tuberculous BPF is particularly challenging. Surgical intervention serves as an effective and safe therapeutic strategy for BPF.
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Affiliation(s)
- Lei Shen
- Department of Thoracic Surgery, Wuhan Pulmonary Hospital, Wuhan 430030, Hubei Province, China
| | - Yu-Hui Jiang
- Department of Thoracic Surgery, Wuhan Pulmonary Hospital, Wuhan 430030, Hubei Province, China
| | - Xi-Yong Dai
- Department of Thoracic Surgery, Wuhan Pulmonary Hospital, Wuhan 430030, Hubei Province, China
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Bai Y, Yin Y, Chi J, Li S, Li Y, Guo S. Management of stent-related tracheoesophageal fistula in complex post-tuberculosis tracheobronchial stenosis: A case report. Front Med (Lausanne) 2022; 9:996140. [PMID: 36507523 PMCID: PMC9729335 DOI: 10.3389/fmed.2022.996140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 11/14/2022] [Indexed: 11/25/2022] Open
Abstract
Background The covered self-expandable metallic stents (SEMS) have been used to manage benign tracheobronchial stenosis, especially the complex post-tuberculosis (TB) tracheobronchial stenosis (PTTS) with cartilage destruction or malacia. This procedure could lead to stent-related tracheoesophageal fistula (TEF). Case presentation A 21-year-old woman, who had one covered Y-shaped SEMS inserted to manage complex PTTS 2 years ago, presented with dyspnea and frequent coughing on drinking water. The bronchoscopy confirmed extensive granulation tissue hyperplasia and a TEF on the upper edge of the covered SEMS. The covered SEMS was removed in three steps, and another fully covered Y-shape SEMS (Microtech Co., Ltd., Nanjing, China) was inserted to restore patency in the tracheobronchial tree and occlude the TEF orifice. Recombinant bovine basic fibroblast growth factor (rbFGF) (6,000 IU/time) was sprayed into and around the fistula through the V-System single-use cannula via the flexible bronchoscope every other week. The patient showed sustained clinical and radiographic improvement, and the TEF healed. Conclusion We presented a three-step bronchoscopic approach to managing a stent-related TEF in a patient with complex PTTS. Subsequently, regular bronchoscopic debridement of granulation tissue developing on the upper edge of SEMS is necessary to maintain the stent patency and reduce the risk of recurrent stent-related TEF. A fully covered SEMS associated with the local administration of rbFGF seems to offer an alternative simplified one-stage procedure for the temporary management of TEF combined with complex PTTS in non-surgical candidates.
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Affiliation(s)
- Yang Bai
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuting Yin
- Department of Respiratory and Critical Care Medicine, Chongqing Shapingba District People’s Hospital, Chongqing, China
| | - Jing Chi
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shuang Li
- Department of Gastrointestinal Surgery, Jinshan Hospital, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yishi Li
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China,Yishi Li,
| | - Shuliang Guo
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China,*Correspondence: Shuliang Guo,
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8
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Djouani A, Hurley P, Lampridis S, Bille A. Successful Closure of Post-pneumonectomy Bronchopleural Fistula With Suture Repair Reinforced With Porcine Acellular Dermal Matrix (Permacol) and Hydrogel Sealant (Progel): A Case Report. Cureus 2022; 14:e28529. [PMID: 36185841 PMCID: PMC9517695 DOI: 10.7759/cureus.28529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2022] [Indexed: 11/15/2022] Open
Abstract
Bronchopleural fistula (BPF) is a feared and potentially life-threatening complication of pneumonectomy. Clinical features such as a productive cough and subcutaneous emphysema raise suspicion of BPF with CT imaging and bronchoscopy providing a definitive diagnosis. In light of the significant morbidity and mortality associated with the condition, a significant proportion of cases necessitate surgical repair of the bronchial stump. Currently, there is no consensus on optimal surgical strategy. Traditionally, various vascularised tissue flaps, including pericardial fat pad, omentum, and muscle, have been used to buttress the repaired stump, with varying success rates. In light of this, novel approaches have been devised with the aim of achieving more consistent surgical outcomes. In this case report, we describe a novel approach to reinforcing the suture repair using porcine dermal collagen matrix (Permacol, Medtronic, Minneapolis, MN) and hydrogel sealant (Progel, BD, Franklin Lakes, NJ) to achieve successful closure of a BPF in an adult male patient following pneumonectomy for squamous cell carcinoma. The use of porcine dermal collagen matrix covered with hydrogel sealant is a viable alternative to traditional BPF closure strategies and can achieve good patient outcomes. This technique has several benefits including cost-effectiveness and sparing of native tissues, and it is technically straightforward. Further studies are required to compare the clinical outcomes of this and other novel techniques with traditional BPF closure approaches.
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Haldar N, Fernandez C, Evans NR, Werner-Wasik M. Conservatively Managed Chronic Bronchopleural Fistula After Lung Cancer Tri-Modality Therapy: A Case Report. Adv Radiat Oncol 2021; 7:100811. [PMID: 34761140 PMCID: PMC8568602 DOI: 10.1016/j.adro.2021.100811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/20/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
| | | | - Nathaniel R Evans
- Cardiothoracic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
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Pinto BM, Mondadori DC, Lorenzi W, Quintao AM, Saueressig MG. Use of extracorporeal membrane oxygenation in the management of severe tracheobronchial injuries. J Bras Pneumol 2021; 47:e20200635. [PMID: 34669833 PMCID: PMC9013527 DOI: 10.36416/1806-3756/e20200635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023] Open
Affiliation(s)
- Bruno Maineri Pinto
- . Serviço de Cirurgia Torácica, Hospital Geral de Caxias do Sul, Caxias do Sul (RS), Brasil
| | - Diego Corsetti Mondadori
- . Serviço de Cirurgia Torácica, Grupo de Transplante Pulmonar, Hospital de Clínicas de Porto Alegre, Porto Alegre (RS), Brasil
| | - William Lorenzi
- . Serviço de Cirurgia Torácica, Grupo de Transplante Pulmonar, Hospital de Clínicas de Porto Alegre, Porto Alegre (RS), Brasil
| | | | - Mauricio Guidi Saueressig
- . Serviço de Cirurgia Torácica, Grupo de Transplante Pulmonar, Hospital de Clínicas de Porto Alegre, Porto Alegre (RS), Brasil
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Bai Y, Li Y, Chi J, Guo S. Endobronchial closure of the bronchopleural fistula with the ventricular septal defect occluder: a case series. BMC Pulm Med 2021; 21:313. [PMID: 34620149 PMCID: PMC8496023 DOI: 10.1186/s12890-021-01676-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 09/20/2021] [Indexed: 11/10/2022] Open
Abstract
Objectives The ventricular septal defect (VSD) occluder has been reported to be a novel method for the closure of bronchopleural fistula (BPF). Our study was to confirm the use of VSD occluder in treating BPF after pneumonectomy or lobectomy. Methods
We performed a single-center, retrospective study of 10 consecutive patients (8 men and 2 women aged 29–70 years) with postoperative BPF receiving the VSD occluder treatment. We used the HeartR™ Membranous VSD occluder (Lifetech Scientific Co., Shenzhen, China) for the closure of BPF through flexible bronchoscopy under general anesthesia. Demographic characteristics, BPF characteristics, and clinical outcomes were collected from patients’ files using the standardized data abstraction forms. Results The underlying diseases were lung cancer in 6 patients, pulmonary tuberculosis in 3, and bronchiectasis in 1. Right-sided BPFs occurred in 6 patients, and left-sided BPFs occurred in 4. Five patients were underweight with a body mass index < 18.5 kg/m2. The VSD was placed in all 10 patients with a 100% technical success rate and a 70% complete closure rate during follow-up with no complications, on a median follow-up period of 115 days (range 46–975 days). In 1 patient, the VSD occluder was reinstalled with complete closure; in 1 and 2 patients with underweight and chronic empyema, the VSD occluders partially and completely failed with good physical tolerance, respectively. Conclusions Our study demonstrated the bronchoscopic closure of BPF after lung resection using the VSD occluder is an off-label but safe and effective method. We prefer to stabilize the BPF by eradicating the underlying diseases and providing nutritional support to those receiving VSD occluder closure treatment.
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Affiliation(s)
- Yang Bai
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016, PR China
| | - Yishi Li
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016, PR China
| | - Jing Chi
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016, PR China
| | - Shuliang Guo
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016, PR China.
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Madsen K, de Bont MP, Palmers K. Endoscopic sealing of a chronic bronchopleural fistula using acrylate co‐monomer glue. EQUINE VET EDUC 2021. [DOI: 10.1111/eve.13344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- K. Madsen
- Equine Clinic De Morette Asse Belgium
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13
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Guo S, Bai Y, Li Y, Chen T. A Large Central Bronchopleural Fistula Closed by Bronchoscopic Administration of Recombinant Bovine Basic Fibroblast Growth Factor: A Case Report. Respiration 2021; 100:1000-1004. [PMID: 34515226 DOI: 10.1159/000514717] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 01/14/2021] [Indexed: 11/19/2022] Open
Abstract
A large central bronchopleural fistula (BPF) surrounded by mediastinal tissue was successfully closed by local administration of recombinant bovine basic fibroblast growth factor (rbFGF) using the bronchoscope. No complications were observed during and after this bronchoscopic treatment. This is the first report of the bronchoscopic treatment of a large central BPF by the local spray of rbFGF. The bronchoscopic treatment with rbFGF is a potentially cost-effective method for central BPF surrounded by mediastinal tissue.
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Affiliation(s)
- Shuliang Guo
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yang Bai
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yishi Li
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Tao Chen
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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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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Azuma Y, Sano A, Sakai T, Koezuka S, Otsuka H, Tochigi N, Isobe K, Sakamoto S, Takai Y, Iyoda A. Prognostic and functional impact of perioperative LAMA/LABA inhaled therapy in patients with lung cancer and chronic obstructive pulmonary disease. BMC Pulm Med 2021; 21:174. [PMID: 34020622 PMCID: PMC8139148 DOI: 10.1186/s12890-021-01537-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 05/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is an important risk factor for postoperative complications and mortality. To determine the effects of perioperative combination therapy, using a long-acting muscarinic antagonist (LAMA) and a long-acting β2 agonist (LABA), on preoperative lung function, postoperative morbidity and mortality, and long-term outcome in COPD patients. METHODS Between January 2005 and October 2019, 130 consecutive patients with newly diagnosed COPD underwent surgery for lung cancer. We conducted a retrospective review of their medical record to evaluate that LAMA/LABA might be an optimal regimen for patients with COPD undergoing surgery for lung cancer. All patients were received perioperative rehabilitation and divided into 3 groups according to the type of perioperative inhaled therapy and management: LAMA/LABA (n = 64), LAMA (n = 23) and rehabilitation only (no bronchodilator) (n = 43). We conducted a retrospective review of their medical records. RESULTS Patients who received preoperative LAMA/LABA therapy showed significant improvement in lung function before surgery (p < 0.001 for both forced expiratory volume in 1 s (FEV1) and percentage of predicted forced expiratory volume in 1 s (FEV1%pred). Compared with patients who received preoperative LAMA therapy, patients with LAMA/LABA therapy had significantly improved lung function (ΔFEV1, LAMA/LABA 223.1 mL vs. LAMA 130.0 mL, ΔFEV1%pred, LAMA/LABA 10.8% vs. LAMA 6.8%; both p < 0.05). Postoperative complications were lower frequent in the LAMA/LABA group than in the LAMA group (p = 0.007). In patients with moderate to severe air flow limitation (n = 61), those who received LAMA/LABA therapy had significantly longer overall survival and disease-free survival compared with the LAMA (p = 0.049, p = 0.026) and rehabilitation-only groups (p = 0.001, p < 0.001). Perioperative LAMA/LABA therapy was also associated with lower recurrence rates (vs. LAMA p = 0.006, vs. rehabilitation-only p = 0.008). CONCLUSIONS We believe this treatment combination is optimal for patients with lung cancer and COPD.
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Affiliation(s)
- Yoko Azuma
- Division of Chest Surgery, Department of Surgery, Toho University School of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Atsushi Sano
- Division of Chest Surgery, Department of Surgery, Toho University School of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Takashi Sakai
- Division of Chest Surgery, Department of Surgery, Toho University School of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Satoshi Koezuka
- Division of Chest Surgery, Department of Surgery, Toho University School of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Hajime Otsuka
- Division of Chest Surgery, Department of Surgery, Toho University School of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Naobumi Tochigi
- Department of Surgical Pathology, Toho University School of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Kazutoshi Isobe
- Division of Respiratory Medicine, Toho University School of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Susumu Sakamoto
- Division of Respiratory Medicine, Toho University School of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Yujiro Takai
- Division of Respiratory Medicine, Toho University School of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Akira Iyoda
- Division of Chest Surgery, Department of Surgery, Toho University School of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541, Japan.
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16
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Stewart AGA, Boyd SC. Tuberculous bronchopleural fistula. Respirol Case Rep 2021; 9:e00740. [PMID: 33747520 PMCID: PMC7961156 DOI: 10.1002/rcr2.740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 02/23/2021] [Accepted: 02/28/2021] [Indexed: 11/27/2022] Open
Abstract
Tuberculous bronchopleural fistula is a rare complication of pulmonary tuberculosis with presentation ranging from patients who are asymptomatic with incidental findings on imaging to those who present with acute tension pneumothorax.
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Affiliation(s)
| | - Sarah C. Boyd
- Western Health, Infectious Diseases UnitFootscray HospitalFootscrayVICAustralia
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17
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Zeng J, Wu X, Chen Z, Zhang M, Ke M. Modified silicone stent for the treatment of post-surgical bronchopleural fistula: a clinical observation of 17 cases. BMC Pulm Med 2021; 21:10. [PMID: 33407326 PMCID: PMC7789393 DOI: 10.1186/s12890-020-01372-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 12/11/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Bronchopleural fistula is a rare but life-threatening event with limited therapeutic options. We aimed to investigate the efficacy and safety of the modified silicone stent in patients with post-surgical bronchopleural fistula. METHODS Between March 2016 and April 2020, we retrospectively reviewed the records of 17 patients with bronchopleural fistula and who underwent bronchoscopic placement of the Y-shaped silicone stent. The rate of initial success, clinical success and clinical cure, and complications were analyzed. RESULTS Stent placement was successful in 16 patients in the first attempt (initial success rate: 94.1%). The median follow-up time was 107 (range, 5-431) days. All patients achieved amelioration of respiratory symptoms. The clinical success rate was 76.5%. Of the 14 patients with empyema, the daily drainage was progressively decreased in 11 patients, and empyema completely disappeared in six patients. Seven stents were removed during follow-up: four (26.7%) for the cure of fistula, two for severe proliferation of granulomatous tissue and one for stent dislocation. No severe adverse events (i.e. massive hemoptysis, suture dehiscence) took place. Seven patients died (due to progression of malignancy, uncontrolled infection, myocardial infarction and left heart failure). CONCLUSIONS The modified silicone stent may be an effective and safe option for patients with post-surgical bronchopleural fistula patients in whom conventional therapy is contraindicated.
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Affiliation(s)
- Junli Zeng
- Department of Respiratory Centre, The Second Affiliated Hospital of Xiamen Medical College, 566 Shengguang Road, Xiamen, 361000, Fujian Province, China
| | - Xuemei Wu
- Department of Respiratory Centre, The Second Affiliated Hospital of Xiamen Medical College, 566 Shengguang Road, Xiamen, 361000, Fujian Province, China
| | - Zhide Chen
- Department of Respiratory Centre, The Second Affiliated Hospital of Xiamen Medical College, 566 Shengguang Road, Xiamen, 361000, Fujian Province, China
| | - Meihua Zhang
- Department of Respiratory Centre, The Second Affiliated Hospital of Xiamen Medical College, 566 Shengguang Road, Xiamen, 361000, Fujian Province, China
| | - Mingyao Ke
- Department of Respiratory Centre, The Second Affiliated Hospital of Xiamen Medical College, 566 Shengguang Road, Xiamen, 361000, Fujian Province, China.
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18
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Ualikhanov A, Batyrbekov K. Endoscopic closure of the fistula stump of the bronchus after pulmonectomy. Respir Med Case Rep 2020; 31:101249. [PMID: 33101897 PMCID: PMC7569211 DOI: 10.1016/j.rmcr.2020.101249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 10/07/2020] [Indexed: 12/19/2022] Open
Abstract
A 58-year-old male patient with a bronchopleural fistula underwent endoscopic installation of an occluder at the mouth of the fistula. The fistula was located in the stump of the main bronchus of the right lung after a pulmonectomy in 2019. During medical bronchoscopy, mucopurulent contents were actively received from the mouth of the fistula. To close the fistula, the patient was simultaneously drained of the pleural cavity by Bulau and installed an occluder from an improvised tool designed for cleaning the endoscope's biopsy channel. In dynamics, purulent contents do not come from the mouth of the fistula and the liquid content in the pleural cavity has significantly decreased. The patient with improved General condition was discharged for observation at the place of residence.
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Affiliation(s)
- A Ualikhanov
- National Research Oncology Center, Nur-Sultan, Kazakhstan
| | - K Batyrbekov
- National Research Oncology Center, Nur-Sultan, Kazakhstan
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19
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Porkhanov VA, Polyakov IS, Kononenko VB, Lyubavin AN, Kovalenko AL, Baryshev AG, Sitnik SD, Zhikharev VA. [Transsternal occlusion of main bronchi fistulae after pneumonectomy]. Khirurgiia (Mosk) 2020:11-22. [PMID: 33047581 DOI: 10.17116/hirurgia202010111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To summarize our experience in transsternal occlusion of main bronchus fistula. MATERIAL AND METHODS We have performed 146 transsternal occlusions of the main bronchi for the period from 1979 to 2018. There were 123 (84.2%) men and 23 (15.7%) women. Mean age of patients was 63 years. Lung tuberculosis was diagnosed in 36 (24.7%) patients, lung cancer - 91 (62.3%) patients, non-specific suppurative lung diseases - 14 (9.6%) patients, trauma - 5 (3.4%) patients. All patients underwent transsternal occlusion of the main bronchi fistulae with or without pericardial cavity dissection. Wedge-shaped bronchial resection or tracheal bifurcation resection were carried out for a short stump fistula. RESULTS Perioperative complications occurred in 28 (19.2%) out of 146 patients. Intraoperative complications developed in 4 (2.6%) patients. Postoperative complications were observed in 25 (17.1%) patients. Intraoperative mortality rate was 1.4% (n=2), postoperative mortality - 6.2% (n=9). Thus, overall mortality rate was 7.6% (n=11 It should be noted that intraoperative complications were absent if dissection of the pericardium and pulmonary artery stump ligation were not performed. CONCLUSION Transsternal occlusion of the main bronchi fistulae was successful in 80.8% of patients. In these cases, healing of fistulae was not associated with any complications. Thus, we believe that transsternal occlusion of the main bronchial stump fistula should be considered as preferable surgical strategy.
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Affiliation(s)
- V A Porkhanov
- Research Institute - Ochapovsky Regional Clinical Hospital No. 1, Krasnodar, Russia.,Kuban State Medical University, Krasnodar, Russia
| | - I S Polyakov
- Research Institute - Ochapovsky Regional Clinical Hospital No. 1, Krasnodar, Russia.,Kuban State Medical University, Krasnodar, Russia
| | - V B Kononenko
- Research Institute - Ochapovsky Regional Clinical Hospital No. 1, Krasnodar, Russia
| | - A N Lyubavin
- Research Institute - Ochapovsky Regional Clinical Hospital No. 1, Krasnodar, Russia
| | - A L Kovalenko
- Research Institute - Ochapovsky Regional Clinical Hospital No. 1, Krasnodar, Russia
| | - A G Baryshev
- Research Institute - Ochapovsky Regional Clinical Hospital No. 1, Krasnodar, Russia.,Kuban State Medical University, Krasnodar, Russia
| | - S D Sitnik
- Research Institute - Ochapovsky Regional Clinical Hospital No. 1, Krasnodar, Russia
| | - V A Zhikharev
- Research Institute - Ochapovsky Regional Clinical Hospital No. 1, Krasnodar, Russia
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20
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Goh QY, Kong A. Videolaryngoscope-Assisted Double-Lumen Endotracheal Tube Intubation in an Awake Patient With Known Difficult Airway and Bronchopleural Fistula: A Case Report. A A Pract 2020; 14:e01186. [PMID: 32224691 DOI: 10.1213/xaa.0000000000001186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Awake endotracheal intubation is the technique of choice to secure the airway when both mask ventilation and intubation are anticipated to be difficult. We present a case of a patient with a known difficult airway, bronchopleural fistula (BPF), and acute respiratory distress syndrome (ARDS) who was intubated with a double-lumen endotracheal tube (DL ETT) under awake condition using a videolaryngoscope. Independent lung ventilation (ILV) was instituted because of the BPF. The patient was treated successfully for ARDS and discharged home. To our knowledge, this is the first reported case of successful videolaryngoscope-assisted DL ETT intubation in an awake patient.
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Affiliation(s)
- Qing Yuan Goh
- From the Division of Anesthesiology and Perioperative Medicine, Department of Surgical Intensive Care, Singapore General Hospital, Singapore
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21
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Tokunaga Y, Kita Y, Okamoto T. Analysis of Risk Factors for Bronchopleural Fistula after Surgical Treatment of Lung Cancer. Ann Thorac Cardiovasc Surg 2020; 26:311-319. [PMID: 32224595 PMCID: PMC7801181 DOI: 10.5761/atcs.oa.20-00010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Bronchopleural fistula (BPF) is a potential serious complication of lobectomy or more radical surgery for non-small-cell lung cancer (NSCLC). We aimed to evaluate the risk factors for BPF. METHODS The study cohort comprised 635 patients who had undergone lobectomy or more radical surgery for NSCLC from March 2005 to December 2017. We examined the following risk factors for BPF: surgical procedure, medical history, preoperative treatment, and surgical management. RESULTS In all, 10 patients (1.6%) had developed postoperative BPFs. Univariate logistic regression analysis showed that surgical procedure, medical history (arteriosclerosis obliterans [ASO]), and bronchial stump reinforcement were significant risk factors. Multivariate analysis showed that only surgical procedure (right lower lobectomy, p = 0.011, odds ratio = 17.4; right middle lower lobectomy, p = 0.003, odds ratio = 59.4; right pneumonectomy, p <0.001, odds ratio = 166.0) was a significant risk factor. Multivariate analysis confined to the surgical procedure of lobectomy showed that right lower lobectomy (p = 0.011, odds ratio = 36.5) and diabetes (HbA1c ≥8.0) (p = 0.022, odds ratio = 31.7) were significant risk factors. CONCLUSION When lobectomy or more radical surgery is performed for NSCLC, right lower lobectomy, middle lower lobectomy, and right pneumonectomy are significant risk factors for postoperative BPF. Thoracic surgeons should acquire the techniques of bronchoplasty and angioplasty to avoid such invasive procedures.
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Affiliation(s)
- Yoshimasa Tokunaga
- Department of General Thoracic Surgery, Kochi Health Sciences Center, Kochi, Kochi, Japan
| | - Yusuke Kita
- Department of General Thoracic Surgery, Kochi Health Sciences Center, Kochi, Kochi, Japan
| | - Taku Okamoto
- Department of General Thoracic Surgery, Kochi Health Sciences Center, Kochi, Kochi, Japan
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22
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Gritsiuta AY, Eguchi T, Jones DR, Rocco G. A Stepwise Approach for Postlobectomy Bronchopleural Fistula. ACTA ACUST UNITED AC 2019; 25:85-104. [PMID: 34177378 DOI: 10.1053/j.optechstcvs.2019.11.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Although rare, bronchopleural fistula (BPF) following anatomic lung resection is a serious complication associated with high rates of mortality (25%-71%). Risk factors for BPF include surgical approach, neoadjuvant therapy, diabetes mellitus, and chronic obstructive pulmonary disease. As neoadjuvant treatment is increasingly being administered to patients with locally advanced lung cancer, and as more patients are being diagnosed with lung cancer at an older age-elderly patients present with a higher index of multiple comorbidities-the incidence of BPF among patients undergoing anatomic resection for lung cancer is expected to increase. In this manuscript, we detail risk factors and considerations for BPF and describe a stepwise approach to treat BPF following lobectomy for lung cancer.
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Affiliation(s)
- Andrei Y Gritsiuta
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, New York 10065
| | - Takashi Eguchi
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, New York 10065
| | - David R Jones
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, New York 10065
| | - Gaetano Rocco
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, New York 10065
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23
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24
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Alexis-Ruiz A, Ghadimi K, Raiten J, Mackay E, Laudanski K, Cannon J, Ramakrishna H, Evans A, Augoustides JG, Vallabhajosyula P, Milewski R, McDonald M, Patel P, Vernick W, Gutsche J. Hypoxia and Complications of Oxygenation in Extracorporeal Membrane Oxygenation. J Cardiothorac Vasc Anesth 2019; 33:1375-1381. [DOI: 10.1053/j.jvca.2018.05.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Indexed: 11/11/2022]
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25
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[Biliopleural fistula after laparoscopic cholecystectomy in a nonagenarian patient]. Rev Esp Geriatr Gerontol 2019; 54:364-365. [PMID: 30777386 DOI: 10.1016/j.regg.2019.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 12/09/2018] [Accepted: 01/03/2019] [Indexed: 11/21/2022]
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26
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Kim SY, Jeong SJ, Lee JG, Park MS, Paik HC, Na S, Kim J. Critical Care after Lung Transplantation. Acute Crit Care 2018; 33:206-215. [PMID: 31723887 PMCID: PMC6849028 DOI: 10.4266/acc.2018.00360] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 11/27/2018] [Indexed: 12/28/2022] Open
Abstract
Since the first successful lung transplantation in 1983, there have been many advances in the field. Nevertheless, the latest data from the International Society for Heart and Lung Transplantation revealed that the risk of death from transplantation is 9%. Various aspects of postoperative management, including mechanical ventilation, could affect intensive care unit stay, hospital stay, and immediate postoperative morbidity and mortality. Complications such as reperfusion injury, graft rejection, infection, and dehiscence of anastomosis increase fatal adverse side effects immediately after surgery. In this article, we review the possible immediate complications after lung transplantation and summarize current knowledge on prevention and treatment.
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Affiliation(s)
- Song Yee Kim
- Division of Pulmonology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Su Jin Jeong
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Gu Lee
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Moo Suk Park
- Division of Pulmonology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hyo Chae Paik
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Sungwon Na
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jeongmin Kim
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
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27
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Risk assessments for broncho-pleural fistula and respiratory failure after lung cancer surgery by National Clinical Database Japan. Gen Thorac Cardiovasc Surg 2018; 67:297-305. [DOI: 10.1007/s11748-018-1022-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 10/05/2018] [Indexed: 10/28/2022]
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28
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Lorut C, Giraud F, Lefebvre A. [Bronchoscopic treatment of bronchopleural fistula]. REVUE DE PNEUMOLOGIE CLINIQUE 2018; 74:359-362. [PMID: 30316652 DOI: 10.1016/j.pneumo.2018.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Bronchopleural fistula is an uncommon complication occurring especially following lung resection (pneumonectomy) and associated with high morbidity and mortality rates. The treatment is surgical but some studies reported bronchoscopic treatment. Localization and size of the fistula may indicate different endoscopic procedures. This overview described the different endoscopic procedures and their benefits.
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Affiliation(s)
- C Lorut
- Service de pneumologie, hôpital Cochin, 27, boulevard du Faubourg-Saint-Jacques, 75014 Paris, France.
| | - F Giraud
- Service de pneumologie, hôpital Cochin, 27, boulevard du Faubourg-Saint-Jacques, 75014 Paris, France
| | - A Lefebvre
- Service de pneumologie, hôpital Cochin, 27, boulevard du Faubourg-Saint-Jacques, 75014 Paris, France
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29
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Kawamoto N, Anayama T, Okada H, Hirohashi K, Miyazaki R, Yamamoto M, Kume M, Orihashi K. Indocyanine green fluorescence/thermography evaluation of intercostal muscle flap vascularization. Thorac Cancer 2018; 9:1631-1637. [PMID: 30264917 PMCID: PMC6275828 DOI: 10.1111/1759-7714.12871] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 08/17/2018] [Accepted: 08/18/2018] [Indexed: 11/28/2022] Open
Abstract
Background During anatomical lung resection in high‐risk patients, the bronchial stump is covered with tissue flaps (e.g. pericardial fat tissue and intercostal muscle) to prevent bronchopleural fistula development. This is vital for reliable reinforcement of the bronchial stump. We evaluated the blood supply of the flap using indocyanine green fluorescence (ICG‐FL) and thermography intraoperatively in 27 patients at high risk for developing a bronchopleural fistula. Methods Before reinforcing the stump with a flap, the fluorescence agent was intravenously injected and the blood supply was evaluated. The surface temperature of the flap was measured with thermography. The two modalities were then compared. Results ICG‐FL intensity and surface temperature on the distal compared to the proximal side of the flap decreased by 32.6 ± 29.4% (P < 0.0001) and 3.5 ± 2.0°C (P < 0.0001), respectively. In patients with a higher ICG‐FL intensity value at the tip than the median, the surface temperature at the tip decreased by 2.7 ± 1.7°C compared to the proximal side. In patients with a lower ICG‐FL value at the tip, the surface temperature decreased by 4.6 ± 1.7°C (P = 0.0574). The bronchial stump reinforced the part of the flap with adequate blood supply; none of the patients developed a bronchopleural fistula. Conclusions ICG‐FL confirmed variation in the blood supply of the intercostal muscle flap, even if prepared using the same surgical procedure. Thermography analysis tends to correlate with the fluorescence method, but may be influenced by the state of flap preservation during surgery.
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Affiliation(s)
- Nobutaka Kawamoto
- Department of Surgery II, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Takashi Anayama
- Department of Surgery II, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Hironobu Okada
- Department of Surgery II, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Kentaro Hirohashi
- Department of Surgery II, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Ryohei Miyazaki
- Department of Surgery II, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Marino Yamamoto
- Department of Surgery II, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Motohiko Kume
- Department of Surgery II, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Kazumasa Orihashi
- Department of Surgery II, Kochi Medical School, Kochi University, Nankoku, Japan
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30
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Abelleira R, Toubes ME, Alegría AMD, Valdés L. Late biliobronchial fistula. Pulmonology 2018; 24:317-320. [DOI: 10.1016/j.pulmoe.2018.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 08/04/2018] [Indexed: 11/25/2022] Open
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31
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Chu X. [Bronchopleural Fistula - the Pulmonary Surgery Complications that Should Be Emphasized by Thoracic Surgeons]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2018; 21:239-240. [PMID: 29587952 PMCID: PMC5973032 DOI: 10.3779/j.issn.1009-3419.2018.03.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Xiangyang Chu
- Department of Thoracic Surgery, PLA General Hospital
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32
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Okuda M, Go T, Yokomise H. Risk factor of bronchopleural fistula after general thoracic surgery: review article. Gen Thorac Cardiovasc Surg 2017; 65:679-685. [DOI: 10.1007/s11748-017-0846-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 10/03/2017] [Indexed: 10/18/2022]
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33
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Shi Z, Xu Y, Wang Z, Zhang X. One successful primary closure case of bronchopleural fistula after pneumonectomy by a new method. J Thorac Dis 2017; 9:E358-E363. [PMID: 28523178 DOI: 10.21037/jtd.2017.03.69] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
One case of successful primary closure of a bronchopleural fistula (BPF) after right pneumonectomy by sealing from both inside the chest cavity and bronchus is reported. The patient was a 47-year-old man who underwent right pneumonectomy due to right lung total collapse and atelectasis which was long-term compressed by a huge cyst inside the right chest cavity. A BPF was found on day 20 after surgery. A thoracotomy approach was performed because it was difficult to find an appropriate location for close drainage. Once the effusion and bloody coagulum was cleaned up from the right chest cavity, it was still difficult to find the bronchial stump because of the thick pleural fibrous membranes, and no visible fistula was found. Inside the chest cavity, a bright spot could be seen when the bronchoscope was inserted to the right bronchial stump. Anastomotic glue (OB Glue) was smeared on the bright spot and NEOVEIL (Gunze Co., Tokyo, Japan) was used to cover and reinforce the area. Meanwhile OB Glue (Gzbme Co., Guangzhou, China) was placed on the bronchial stump by bronchoscope. Closed drainage was performed after the operation. The patient recovered well having an uncomplicated postoperative course and was discharged 7 days after the treatment.
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Affiliation(s)
- Zhenliang Shi
- Department of Thoracic Surgery, Tianjin Chest Hospital, Tianjin 300000, China
| | - Yijun Xu
- Department of Thoracic Surgery, Tianjin Chest Hospital, Tianjin 300000, China
| | - Zheng Wang
- Department of Thoracic Surgery, Tianjin Chest Hospital, Tianjin 300000, China
| | - Xun Zhang
- Department of Thoracic Surgery, Tianjin Chest Hospital, Tianjin 300000, China
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Ventilator Management of Bronchopleural Fistula Secondary to Methicillin-Resistant Staphylococcus aureus Necrotizing Pneumonia in a Pregnant Patient with Systemic Lupus Erythematosus. Case Rep Med 2017; 2017:1492910. [PMID: 28588618 PMCID: PMC5446874 DOI: 10.1155/2017/1492910] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 03/03/2017] [Accepted: 03/12/2017] [Indexed: 11/22/2022] Open
Abstract
Managing mechanical ventilation in patient with bronchopleural fistula with coexisting acute respiratory distress syndrome is a challenging situation for the intensivist. We are reporting a case of a pregnant patient with systemic lupus erythematosus on immunosuppressive medications who developed methicillin-resistant Staphylococcus aureus necrotizing pneumonia complicated by bronchopleural fistula and acute respiratory distress syndrome.
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Omori C, Toyama H, Takei Y, Ejima Y, Yamauchi M. Positive pressure ventilation in a patient with a right upper lobar bronchocutaneous fistula: right upper bronchus occlusion using the cuff of a left-sided double lumen endobronchial tube. J Anesth 2017; 31:627-630. [PMID: 28315041 DOI: 10.1007/s00540-017-2336-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 03/13/2017] [Indexed: 11/24/2022]
Abstract
In patients with a bronchocutaneous fistula, positive pressure ventilation leads to air leakage and potential hypoxemia. A male patient with a right upper bronchocutaneous fistula was scheduled for esophageal reconstruction. His preoperative chest computed tomography image revealed aeration in the right middle and lower lobe, a large bulla in the left upper lobe, and pleural effusion and pneumonia in the left lower lobe. Therefore, left one-lung ventilation was considered to result in hypoxemia. Before anesthesia induction, the bronchocutaneous fistula was covered with gauze and film to prevent air leakage. After anesthesia induction, mask ventilation was performed with a peak positive pressure of 10 cmH2O. A left-sided double lumen endobronchial tube (DLT) was then inserted into the right main bronchus for occluding only the right superior bronchus, and two-lung ventilation was performed to minimize airway pressure and maintain oxygenation, which did not cause air leakage through the fistula. During anesthesia, no ventilation-related difficulty was faced. The method of inserting a left-sided DLT into the right main bronchus and occluding the right upper bronchus selectively by bronchial cuff is considered to be an option for mechanical ventilation in patients with a right upper bronchial fistula, as demonstrated in the present case.
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Affiliation(s)
- Chieko Omori
- Department of Anesthesiology, Tohoku University Hospital, 1-1 Seiryomachi, Aoba-ku, Sendai, 980-8574, Japan.
| | - Hiroaki Toyama
- Department of Anesthesiology, Tohoku University Hospital, 1-1 Seiryomachi, Aoba-ku, Sendai, 980-8574, Japan
| | - Yusuke Takei
- Anesthesiology and Perioperative Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yutaka Ejima
- Division of Surgical Center and Supply, Sterilization, Tohoku University Hospital, Sendai, Japan
| | - Masanori Yamauchi
- Anesthesiology and Perioperative Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
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Ning Y, Huang H, Xue L, Zhao X. Endobronchial Naso-bronchial Lavage: An Alternative Interventional Treatment for Post-lobectomy Bronchopleural Fistula. World J Surg 2016; 41:785-789. [DOI: 10.1007/s00268-016-3779-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Li SJ, Zhou XD, Huang J, Liu J, Tian L, Che GW. A systematic review and meta-analysis-does chronic obstructive pulmonary disease predispose to bronchopleural fistula formation in patients undergoing lung cancer surgery? J Thorac Dis 2016; 8:1625-38. [PMID: 27499951 DOI: 10.21037/jtd.2016.05.78] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND we conducted this systematic meta-analysis to determine the association between chronic obstructive pulmonary disease (COPD) and risk of bronchopleural fistula (BPF) in patients undergoing lung cancer surgery. METHODS Literature retrieval was performed in PubMed, Embase and the Web of Science to identify the full-text articles that met our eligibility criteria. Odds ratio (OR) with 95% confidence interval (CI) served as the summarized statistics. Q-test and I(2)-statistic were used to evaluate the level of heterogeneity. Sensitivity analysis was performed to further examine the stability of pooled OR. Publication bias was detected by both Begg's test and Egger's test. RESULTS Eight retrospective observational studies were included into this meta-analysis. The overall summarized OR was 2.03 (95% CI: 1.44-2.86; P<0.001), revealing that COPD was significantly associated with the risk of BPF after lung cancer surgery. In subgroup analysis, the relationship between COPD and BPF occurrence remained statistically prominent in the subgroups stratified by statistical analysis (univariate analysis, OR: 1.91; 95% CI: 1.35-2.69; P<0.001; multivariate analysis, OR: 3.18; 95% CI: 1.95-5.19; P<0.001), operative modes (pneumonectomy, OR: 2.11; 95% CI: 1.15-3.87; P=0.016) and in non-Asian populations (OR: 2.36; 95% CI: 1.18-4.73; P=0.016). No significant impact of COPD on BPF risk was observed in Asian patients (OR: 1.48; 95% CI: 0.85-2.57; P=0.16). No significant heterogeneity or publication bias was discovered across the included studies. CONCLUSIONS Our meta-analysis indicates that COPD can significantly predispose to BPF formation in patients undergoing lung cancer surgery. Because some limitations still exist in this meta-analysis, our findings should be further verified and modified in the future.
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Affiliation(s)
- Shuang-Jiang Li
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610065, China
| | - Xu-Dong Zhou
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610065, China
| | - Jian Huang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610065, China
| | - Jing Liu
- Institution of Medical Statistics, West China School of Public Health, Sichuan University, Chengdu 610065, China
| | - Long Tian
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610065, China
| | - Guo-Wei Che
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610065, China
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Li SJ, Fan J, Zhou J, Ren YT, Shen C, Che GW. Diabetes Mellitus and Risk of Bronchopleural Fistula After Pulmonary Resections: A Meta-Analysis. Ann Thorac Surg 2016; 102:328-39. [DOI: 10.1016/j.athoracsur.2016.01.013] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 11/30/2015] [Accepted: 01/04/2016] [Indexed: 01/14/2023]
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Li S, Fan J, Liu J, Zhou J, Ren Y, Shen C, Che G. Neoadjuvant therapy and risk of bronchopleural fistula after lung cancer surgery: a systematic meta-analysis of 14 912 patients. Jpn J Clin Oncol 2016; 46:534-46. [DOI: 10.1093/jjco/hyw037] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 02/26/2016] [Indexed: 01/11/2023] Open
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Toneloto MGC, Moreira MM, Bustorff-Silva JM, Souza GFD, Martins LC, Dragosavac D, Falcão ALE. Adjustable inspiratory occlusion valve in experimental bronchopleural fistula. A new therapeutic perspective. Acta Cir Bras 2016; 30:561-7. [PMID: 26352336 DOI: 10.1590/s0102-865020150080000007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To assess the efficacy of an adjustable inspiratory occlusion valve in experimental bronchopleural fistula during mechanical ventilation. METHODS We studied six mechanically ventilated pigs in a surgically created, reproducible model of bronchopleural fistula managed with mechanical ventilation and water-sealed thoracic drainage. An adjustable inspiratory occlusion valve was placed between the thoracic drain and the endotracheal tube. Hemodynamic data, capnography and blood gases were recorded before and after the creation of the bronchopleural fistula as well as after every adjustment of the inspiratory occlusion valve. RESULTS When compared with the standard water-sealed drainage treatment, the use of an adjustable inspiratory occlusion valve improved the alveolar tidal volume and reduced bronchopleural air leak (p<0.001), without hemodynamic compromise when compared with conventional water sealed drainage. CONCLUSION The use of an adjustable inspiratory occlusion valve improved the alveolar tidal volume, reduced alveolar leak, in an experimental reproducible model of bronchopleural fistula, without causing any hemodynamic derangements when compared with conventional water sealed drainage.
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Affiliation(s)
| | - Marcos Mello Moreira
- Department of Internal Medicine, Faculty of Medical School, Universidade de Campinas, BR
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Li S, Fan J, Zhou J, Ren Y, Shen C, Che G. Residual disease at the bronchial stump is positively associated with the risk of bronchoplerual fistula in patients undergoing lung cancer surgery: a meta-analysis. Interact Cardiovasc Thorac Surg 2015; 22:327-35. [PMID: 26614527 DOI: 10.1093/icvts/ivv327] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 10/24/2015] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES Residual disease at the bronchial stump (RDBS) is regarded as an important factor possibly resulting in bronchopleural fistula (BPF) after lung cancer surgery, but this has not been confirmed. We conducted this meta-analysis to evaluate the effects of RDBS on BPF formation in patients undergoing lung cancer surgery. METHODS PubMed and EMBASE databases were searched for full-text articles that met our eligibility criteria. Odds ratios (ORs) with 95% confidence interval (95% CI) served as the summarized outcomes. Q-test and I(2) statistic were used to evaluate the level of heterogeneity, determining the fixed-effect model or random-effect model for quantitative synthesis. Sensitivity analysis was conducted to identify the possible origins of heterogeneity. The publication bias was assessed by Begg's test. RESULTS A total of eight retrospective observational studies were included in our meta-analysis. In overall analysis, the pooled outcomes indicated that RDBS was significantly associated with BPF formation after lung cancer surgery (OR: 3.12; 95% CI: 1.72-5.64; P < 0.001). In subgroup analysis, the pooled outcomes revealed a significantly increased risk of post-pneumonectomy BPF in patients with RDBS (OR: 2.78; 95% CI: 1.06-7.28; P = 0.037). The subgroup analysis assessing the effects of RDBS on post-lobectomy BPF was given up due to the scarcity of available data. No heterogeneity was revealed within this meta-analysis. No evidence for publication bias was detected by Begg's test. CONCLUSIONS Our meta-analysis indicates that RDBS is positively associated with the increased risk of BPF in patients undergoing lung cancer surgery. The further analysis also reveals an increased risk of post-pneumonectomy BPF in patients with RDBS. More accurate and comprehensive evidence should be collected and summarized in updated meta-analyses.
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Affiliation(s)
- Shuangjiang Li
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jun Fan
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jian Zhou
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yutao Ren
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Cheng Shen
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Guowei Che
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
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Díaz-Agero Álvarez PJ, Bellido-Reyes YA, Sánchez-Girón JG, García-Olmo D, García-Arranz M. Novel bronchoscopic treatment for bronchopleural fistula using adipose-derived stromal cells. Cytotherapy 2015; 18:36-40. [PMID: 26552766 DOI: 10.1016/j.jcyt.2015.10.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 09/18/2015] [Accepted: 10/01/2015] [Indexed: 12/01/2022]
Abstract
BACKGROUND AIMS In this report, we describe the successful bronchoscopic management of bronchopleural fistula in two patients, using autologous adipose-derived stromal cells. Cell therapy was considered for 2 cases of bronchopleural fistula refractory to conventional surgical treatment after control of the primary disease was confirmed and active pleural infection was ruled out. Briefly, adipose-derived stem cells were first isolated from lipoaspirate and used without cell expansion. In 24 months, we have not received more patients with bronchopleural fistula in our hospital and we have not been able to include more patients. METHODS Briefly, adipose-derived stem cells were first isolated from lipo-aspirate and used without cell expansion. A bronchopleural fistula was identified through bronchoscopy, and the mucosa surrounding the fistula was ablated with an argon plasma coagulator. Isolated stem cells were then endoscopically injected into the de-epithelialized area and fistulous tract. If an open thoracostomy was present at the time of the intervention, the same procedure was performed on the pleural side. Bronchoscopic follow-up was scheduled weekly during the first month, monthly during the first year, and then yearly. The underlying etiologies were left pneumonectomy and right lower video-assisted lobectomy for non-small-cell lung cancer. The sizes of the fistulas were 6 mm and 3 mm in diameter, respectively. RESULTS Both patients were discharged on the first postoperative day. The 3-year follow-up revealed a successful and maintained fistula closure, no treatment-related adverse reactions, nonlocal malignant recurrence and improved quality of life. CONCLUSIONS This preliminary study showed that bronchoscopic application of autologous adipose-derived stem cells is a feasible, safe and effective procedure for treating bronchopleural fistula.
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Affiliation(s)
| | | | | | - Damián García-Olmo
- Health Research Institute-Fundación Jiménez Díaz, (IIS-FJD), Madrid, Spain; Department of Surgery, Universidad Autónoma de Madrid, Madrid, Spain
| | - Mariano García-Arranz
- Health Research Institute-Fundación Jiménez Díaz, (IIS-FJD), Madrid, Spain; Department of Surgery, Universidad Autónoma de Madrid, Madrid, Spain.
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Wang Z, Yu HB, Luo Q, Liu YY. Treatment of Bronchopleural Fistula with Carbolic Acid instilled through Bronchofiberscope in post-pulmonectomy patients. J Cardiothorac Surg 2015; 10:120. [PMID: 26374436 PMCID: PMC4572687 DOI: 10.1186/s13019-015-0316-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 08/24/2015] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE To investigate the efficacy of carbolic acid treatment of bronchopleural fistula (BPF) using bronchofiberscope (BFS) in post-pulmonectomy patients. METHOD Twelve patients with post-pulmonectomy BPF were enrolled in this study at the Liaoning Tumor Hospital between February 2009 and March 2012. Three patients had BPF after the right pneumonectomy, six patients after left pneumonectomy, one patient after the right middle and low lobectomy and two patients after left upper lobectomy. BPF patients were instilled with 100 % carbolic acid (0.5-1 ml one time every week) through BFS on the mucosal surface around the fistula, and the bubble disappearance was monitored. Treatment was repeated if the bubble remained. RESULTS No haemorrhage, severe dyspnea or SpO2 declines occurred in all the 12 patients during the bronchoscopic therapy. BPF orifices were closed in five patients after receiving 5 treatments with carbolic acid, 1 patient received 2 treatments, 1 patient was given 3 treatments, 2 patients received 4 treatments and 3 patients were given 7 treatments. Follow-up was conducted for six months following bronchoscopy. The average treatment and fistula closure time were calculated from the data collected as 20 min and 30 days, respectively, and the cure rate was 100 %. Hematoxylin-eosin (HE) staining results revealed that the white flat hyperplasia tissue after carbolic acid treatment was inflammatory granulation tissue. CONCLUSION Our results revealed that instillation of 100 % carbolic acid with BFS to treat BPF was 100 % effective, which can be a support for post-pulmonectomy BPF.
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Affiliation(s)
- Zheng Wang
- Department of Thoracic Surgery, Liaoning Tumor Hospital, Xiaoheyan Road No.44, Dadong District, Shenyang, 110042, P.R. China.
| | - Han-Bing Yu
- Department of Thoracic Surgery, Liaoning Tumor Hospital, Xiaoheyan Road No.44, Dadong District, Shenyang, 110042, P.R. China.
| | - Quan Luo
- Department of Thoracic Surgery, Liaoning Tumor Hospital, Xiaoheyan Road No.44, Dadong District, Shenyang, 110042, P.R. China.
| | - Yong-Yu Liu
- Department of Thoracic Surgery, Liaoning Tumor Hospital, Xiaoheyan Road No.44, Dadong District, Shenyang, 110042, P.R. China.
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Oliveira DGD, Toneloto MGC, Moreira MM, Bustorff-Silva JM, Souza GFD, Martins LC, Kosour C, Dragosavac D, Falcão ALE. Hemodynamic, ventilatory and gasometric evaluation of an experimental bronchopleural fistula. Acta Cir Bras 2015; 30:1-5. [PMID: 25627265 DOI: 10.1590/s0102-86502015001000001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 12/18/2014] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To investigate the hemodynamic and ventilatory changes associated with the creation of an experimental bronchopleural fistula (BPF) treated by mechanical ventilation and thoracic drainage with or without a water seal. METHODS Six large white pigs weighing 25 kg each which, after general anesthesia, underwent endotracheal intubation (6mm), and mechanically ventilation. Through a left thoracotomy, a resection of the lingula was performed in order to create a BPF with an output exceeding 50% of the inspired volume. The chest cavity was closed and drained into the water sealed system for initial observation of the high output BPF. RESULTS Significant reduction in BPF output and PaCO2 was related after insertion of a water-sealed thoracic drain, p< 0.05. CONCLUSION Insertion of a water-sealed thoracic drain resulted in reduction in bronchopleural fistula output and better CO2 clearance without any drop in cardiac output or significant changes in mean arterial pressure.
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Affiliation(s)
| | | | | | | | | | | | - Carolina Kosour
- Department of Nursing, Federal University of Alfenas, Campinas, SP, Brazil
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Yamamoto S, Endo S, Minegishi K, Shibano T, Nakano T, Tetsuka K. Polyglycolic acid mesh occlusion for postoperative bronchopleural fistula. Asian Cardiovasc Thorac Ann 2015; 23:931-6. [PMID: 26187458 DOI: 10.1177/0218492315594071] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Postoperative bronchopleural fistula is one of the most life-threatening complications after anatomical pulmonary resection. Bronchopleural fistula may cause empyema and aspiration pneumonia with subsequent acute respiratory distress syndrome. Surgical interventions for bronchopleural fistula can prolong hospitalization and impair postoperative quality of life. Postoperative care requires minimally invasive endoscopic occlusion. METHODS We retrospectively reviewed the records of 7 patients who developed bronchopleural fistula among 689 patients who underwent segmentectomy or lobectomy without sleeve resection for lung cancer in Jichi Medical University from 2009 to 2013. Bronchopleural fistula occurred in the right lower bronchial stump in 3 patients, in the superior segmental bronchus of the right lower lobe in 2, in the superior segmental bronchus of the left lower lobe in one, and in the right intermediate bronchus in one. Flexible bronchoscopy was used to occlude 3-mm fistulas with polyglycolic acid mesh in 2 patients. Larger fistulas in 5 patients were occluded with polyglycolic acid mesh plus fibrin glue to secure the mesh. The median procedure was 37 min. Procedures were considered complete upon resolution of air leakage from the chest drainage system. RESULTS Bronchoscopic interventions for bronchopleural fistula were repeated an average of 2 times. No procedure-related complications or death occurred. Bronchoscopic interventions were successful in all patients. CONCLUSIONS Bronchoscopic occlusion with polyglycolic acid mesh with or without fibrin glue is easy and feasible as the first step in postoperative management of bronchopleural fistula.
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Affiliation(s)
- Shinichi Yamamoto
- Department of General Thoracic Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Shunsuke Endo
- Department of General Thoracic Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Kentaro Minegishi
- Department of General Thoracic Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Tomoki Shibano
- Department of General Thoracic Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Tomoyuki Nakano
- Department of General Thoracic Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Kenji Tetsuka
- Department of General Thoracic Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
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Jabłoński S, Brocki M, Wawrzycki M, Klejszmit P, Kutwin L, Kozakiewicz M. Pericardial flap: an effective method of surgical repair of late post-pneumonectomy fistula. Surg Infect (Larchmt) 2014; 15:560-6. [PMID: 24830332 DOI: 10.1089/sur.2012.194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND We report our experience with the surgical closure of late post-pneumonectomy bronchopleural fistula (PBF) using our own method of coverage of the bronchial stump: Pedicled pericardial flap in combination with fibrin glue. METHODS We reviewed the surgical results of 33 patients who underwent surgical closure of PBF by thoracotomy access using three methods: Myoplasty (MYO)-12, omentoplasty (OMT)-10, and pedicled pericardial flap (PPF) with fibrin glue-11. Post-operative follow up was six months. RESULTS The patients' demography was comparable among the groups. The diameter of the fistulas ranged from 5 mm to total dehiscence. The mean time of the fistula manifestation (in weeks) was 21.5 in the MYO group, 19.50 in the OMT, and 20.1 in the PPF group. The shortest period of hospital drainage of the pleural space was noted in the PPF group. Healing of the fistula was obtained in 66.67% in the MYO group, 80% in the OMT, and 100% in the PPF group. The number of complications was similar in all groups. The hospitalization time was significantly shorter in the PPF group (13.00 d) versus the MYO group (19.58 d) and the OMT (20.01 d). Overall mortality rate was 18.18%; 33.33% of the patients in the MYO group and 20% in the OMT group died. There were no hospital deaths in the PPF group. CONCLUSION Pericardial flap supported by fibrin glue can be an effective method adjunctive to the treatment of postpneumonectomy PBF in selected patients. Compared with other methods of bronchial stump coverage (omentopasty and myoplasty), this one showed a higher percentage of healing of the fistulas and shorter duration of hospital drainage and hospitalization.
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Affiliation(s)
- Sławomir Jabłoński
- 1 Department of Thoracic Surgery, General and Oncological Surgery, Medical University of Lodz , Lodz, Poland
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Flow dynamics using high-frequency jet ventilation in a model of bronchopleural fistula † †Presented in part at the Anaesthetic Research Society meeting, London, November 2010, and at the Association of Cardiothoracic Anaesthetists meeting, Loughborough, November 2011. Br J Anaesth 2014; 112:355-66. [DOI: 10.1093/bja/aet343] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Shin SY, Lee H, Kwon W, Ryu HG. Management of bronchopleural fistula using a modified single lumen tube. Korean J Anesthesiol 2014; 65:S127-9. [PMID: 24478843 PMCID: PMC3903831 DOI: 10.4097/kjae.2013.65.6s.s127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Seung Yeon Shin
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hannah Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
| | - Wooil Kwon
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
| | - Ho-Geol Ryu
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
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Bronchoscopic blood patch for treatment of persistent alveolar-pleural fistula. J Bronchology Interv Pulmonol 2013; 20:171-4. [PMID: 23609256 DOI: 10.1097/lbr.0b013e31828f4de0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Airway pleural fistulas remain a significant treatment challenge despite improved antimicrobial therapy and surgical techniques. We present a case of a 56-year-old female who was admitted with severe bilateral cavitary pneumonia requiring mechanical ventilation. The patient suffered bilateral pneumothoraces related to necrotic pneumonia resulting in bilateral chest tube placement. Despite conservative measures, the air leak persisted preventing chest tube removal. Bronchoscopy with Fogarty balloon (Edwards) occlusion was performed in attempts to isolate an airway responsible for the air leak. No one single airway could be bronchoscopically occluded to isolate the right-sided fistula. Efforts were focused on the left airway where the fistula could be isolated to the anteromedial basal segment. Several alternating layers of an absorbable hemostat (knitted fabric prepared by controlled oxidation of cellulose-Surgicel; Ethicon) were placed within the left anteromedial basal segment using bronchoscopy forceps. Through a cut Fogarty balloon, 3 mL of the patient's blood was delivered onto the absorbable hemostat to create an occluding blood patch. No air leak was present at the completion of the procedure. While on mechanical ventilation, the left chest tube was removed 2 days later without radiographic recurrence of her pneumothorax.
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Fielding DI, Bashirzadeh F, Deller D, Douglas A, Boots R, Hopkins P. Life-saving closure of a pulmonary cavity by endobronchial valve placement. Am J Respir Crit Care Med 2013; 187:1145-6. [PMID: 23675725 DOI: 10.1164/rccm.201210-1833le] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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