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Ye Y, Xu T, Lin J, Cai Y, Su Z, Lu L, Chen Y, Zhong C, Tang C, Xiao W, Liao H, Li S, Chen X. Efficacy and Safety of Platelet-Rich Plasma on Bronchopleural Fistula: A Pilot Prospective Cohort Study. Arch Bronconeumol 2024:S0300-2896(24)00243-6. [PMID: 39214770 DOI: 10.1016/j.arbres.2024.06.018] [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: 04/22/2024] [Revised: 06/26/2024] [Accepted: 06/27/2024] [Indexed: 09/04/2024]
Abstract
INTRODUCTION Bronchopleural fistula (BPF) is associated with high morbidity and mortality rates in patients undergoing pulmonary resections. Surgery, bronchoscopy, and conservative management have their limitations for small fistulas. Platelet-rich plasma (PRP) has regenerative properties, which might be efficient in enhancing tissue recovery and repairing small BPF. This study aimed to investigate efficacy and safety of PRP on BPF. METHODS This is a pilot prospective cohort study. Patients whose fistulas smaller than 4mm were enrolled in this study, treated with PRP under bronchoscopy and followed up at 2 weeks and 4-6 weeks after the last PRP treatment. The cure rate, improvement rate and ineffectiveness rate were investigated. The severity of respiratory symptoms was evaluated by modified Medical Research Council dyspnea scale (mMRC) and COPD Assessment Test (CAT). The recurrence of fistula, new infection and mortality rate were examined. Adverse events were documented to explore the safety profile of PRP therapy. RESULTS A total of 16 patients (mean age, 50.1 years) met the eligibility criteria. The median time from the first PRP treatment to the closure of the fistula was 12.0 (IQR 6.0, 21.5) days. Our findings indicate an effectiveness rate of 87.6%, with 68.8% of cure and 18.8% of improvement, along with significant improvement of respiratory symptoms evaluated by mMRC (P<0.001) and CAT (P<0.001). No recurrent of fistulas, newly developed infection, or death was observed. Adverse events of the procedure were most mild (82.6%) and temporary. CONCLUSIONS PRP is a potential treatment for small BPF and is well tolerated.
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Affiliation(s)
- Yongshun Ye
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China; Huizhou Central People's Hospital, Huizhou 516000, China
| | - Tingting Xu
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Jinxia Lin
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Yongna Cai
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Zhuquan Su
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Liya Lu
- Department of Anesthesiology Department, The First Affiliated Hospital of Guangzhou Medical University, 151 Yan Jiang Rd, Guangzhou 510120, China
| | - Yu Chen
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Changgao Zhong
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Chunli Tang
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Weiquan Xiao
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Haojie Liao
- Huizhou Central People's Hospital, Huizhou 516000, China
| | - Shiyue Li
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.
| | - Xiaobo Chen
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.
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Luo X, Zhan K, Bai Y. Embolization coils in treating postoperative bronchopleural fistula: a systematic review. Front Med (Lausanne) 2024; 11:1364994. [PMID: 38966535 PMCID: PMC11222595 DOI: 10.3389/fmed.2024.1364994] [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: 01/03/2024] [Accepted: 06/12/2024] [Indexed: 07/06/2024] Open
Abstract
Objective This study aims to comprehensively evaluate embolization coils in treating postoperative bronchopleural fistula (BPF). Methods A systematic review based on PubMed, Embase, and The Cochrane Library studies was conducted. All cases receiving embolization coils in treating postoperative BPF were included. The primary outcome was the efficacy of embolization coils in achieving closure of postoperative BPF. Results 20 patients from 9 studies were included in this systematic review. A median number of 3 (range: 1-10) embolization coils with sealants obtained a complete closure rate of 80% in patients with postoperative BPF with sizes ranging from 2 to 3.1 mm. Three patients with BPF over 3 mm and one with multiple organ failure failed this treatment. Two cases of coil migration were reported without causing respiratory failure or fistula recurrence. Conclusion Embolization coils might be considered a safe and effective bronchoscopic treatment for small postoperative BPF of less than 3 mm in size. More extensive and rigorous studies are needed to further evaluate and confirm the optimal use of embolization coils in the context of an alternative to surgical repair.
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Affiliation(s)
- Xiaojuan Luo
- Department of Endoscopy Center, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ke Zhan
- Department of Gastroenterology, 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
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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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Steimer D, Coughlin JM, Yates E, Xie Y, Mazzola E, Jaklitsch MT, Swanson SJ, Orgill D, Marshall MB. Empiric flap coverage for the pneumonectomy stump: How protective is it? A single-institution cohort study. J Thorac Cardiovasc Surg 2024; 167:849-858. [PMID: 37689236 DOI: 10.1016/j.jtcvs.2023.08.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/31/2023] [Accepted: 08/23/2023] [Indexed: 09/11/2023]
Abstract
OBJECTIVE To evaluate the impact of empiric tissue flaps on bronchopleural fistula (BPF) rates after pneumonectomy. METHODS Patients who underwent pneumonectomy between January 2001 and December 2019 were included. Primary end point was development of BPF. Secondary end points were impact of flap type on BPF rates, time to BPF development, and perioperative mortality. RESULTS During the study period, 383 pneumonectomies were performed; 93 were extrapleural pneumonectomy. Most pneumonectomy cases had empiric flap coverage, with greater use in right-sided operations (right: 97%, 154/159; left: 80%, 179/224, P < .001). Empiric flaps harvested included intercostal, latissimus dorsi, serratus anterior, omentum, pectoralis major, pericardial fat/thymus, pericardium, and pleura. BPF occurred in 10.4% of the entire cohort but decreased to 6.6% when extrapleural pneumonectomy cases were excluded; 90% (36/40) of BPFs occurred on the right side (P < .001). Median time to develop BPF was 63 days, and 90-day mortality was greater in patients with BPF (12.5% BPF vs 7.4% non-BPF, P < .0001). Intercostal muscle had the lowest rate of BPF (4.5%), even in right-sided operations (8.7%). In contrast, larger muscle flaps such as latissimus dorsi (21%) and serratus anterior (33%) had greater rates of BPF, but the sample size was small in these cohorts. CONCLUSIONS Empiric bronchial stump coverage should be performed in all right pneumonectomy cases due to greater risk of BPF. In our series, intercostal muscle flaps had low BPF rates, even in right-sided operations. Coverage of the left pneumonectomy stump is unnecessary due to low incidence of BPF in these cases.
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Affiliation(s)
- Desiree Steimer
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass.
| | - Julia M Coughlin
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass
| | - Elizabeth Yates
- Department of Surgery, Brigham and Women's Hospital, Boston, Mass
| | - Yue Xie
- Department of Data Sciences, Dana Farber Cancer Institute, Boston, Mass
| | - Emanuele Mazzola
- Department of Data Sciences, Dana Farber Cancer Institute, Boston, Mass
| | | | - Scott J Swanson
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass
| | - Dennis Orgill
- Division of Plastic Surgery, Brigham and Women's Hospital, Boston, Mass
| | - M Blair Marshall
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass
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Goussard P, Eber E, Venkatakrishna S, Frigati L, Greybe L, Janson J, Schubert P, Andronikou S. Interventional bronchoscopy in pediatric pulmonary tuberculosis. Expert Rev Respir Med 2023; 17:1159-1175. [PMID: 38140708 DOI: 10.1080/17476348.2023.2299336] [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: 11/14/2023] [Accepted: 12/21/2023] [Indexed: 12/24/2023]
Abstract
INTRODUCTION Lymphobronchial tuberculosis (TB) is common in children with primary TB and enlarged lymph nodes can cause airway compression of the large airways. If not treated correctly, airway compression can result in persistent and permanent parenchymal pathology, as well as irreversible lung destruction. Bronchoscopy was originally used to collect diagnostic samples; however, its role has evolved, and it is now used as an interventional tool in the diagnosis and management of complicated airway disease. Endoscopic treatment guidelines for children with TB are scarce. AREAS COVERED The role of interventional bronchoscopy in the diagnosis and management of complicated pulmonary TB will be discussed. This review will provide practical insights into how and when to perform interventional procedures in children with complicated TB for both diagnostic and therapeutic purposes. This discussion incorporates current scientific evidence and refers to adult literature, as some of the interventions have only been done in adults but may have a role in children. Limitations and future perspectives will be examined. EXPERT OPINION Pediatric pulmonary TB lends itself to endoscopic interventions as it is a disease with a good outcome if treated correctly. However, interventions must be limited to safeguard the parenchyma and prevent permanent damage.
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Affiliation(s)
- Pierre Goussard
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Ernst Eber
- Division of Paediatric Pulmonology and Allergology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Shyam Venkatakrishna
- Department of Pediatric Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Lisa Frigati
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Leonore Greybe
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Jacques Janson
- Department of Surgical Sciences, Division of Cardiothoracic Surgery, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Pawel Schubert
- Division of Anatomical Pathology, Tygerberg Hospital, National Health Laboratory Service, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Savvas Andronikou
- Department of Pediatric Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Woldemariam ST, Molla IB, Merine SK, Yilma DG. Prevalence and treatment outcome of bronchopleural fistula: a multi-center study in Ethiopia. J Cardiothorac Surg 2023; 18:227. [PMID: 37438756 DOI: 10.1186/s13019-023-02325-y] [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: 12/20/2022] [Accepted: 06/29/2023] [Indexed: 07/14/2023] Open
Abstract
PURPOSE The study aimed to assess the magnitude, risk factors, and management outcome of patients with a bronchopleural fistula at multiple centres in Ethiopia. METHOD AND MATERIALS A ten years (September 2012 - August 2021) institution-based multicenter retrospective cohort study was conducted from September 13 to September 30, 2021. we surveyed the cards of all patients having a diagnosis of bronchopleural fistula for the last 10 years. The document was reviewed using an extraction checklist. Descriptive statistics (mean, standard deviation, frequency, percentages) and crosstabulation were used to describe the outcome variable. RESULT A total of 52(2%) patients were diagnosed to have bronchopleural fistula out of 2546 patients admitted to the cardiothoracic unit in three hospitals from September 2012 - August 2021 and 69% of study participants were male. The mean age of study participants was 33.42 years with SD = 12.5. Thirty-one (60%) of the cases spontaneously developed a bronchopleural fistula and 20 (38%) were post-surgical and 1(2%) was a post-traumatic fistula. Of the total of post-surgical bronchopleural fistula, 14 (26.9%) of them were lung resection, 4 (7.7%) were hydatid cystectomy and 1(1.9%) are decortications, and bullectomy respectively. of the total post-lung resection, 8 (57%) were pneumonectomies followed by 3 (21.5%) Lobectomy, 2 (14.5%) wedge resection and 1(7%) bilobectomy respectively. Fifty patients were managed surgically and two patients were managed conservatively. Bronchopleural fistula (BPF) was closed in 40 (85.4%) and there were two (3.9%) deaths, and the cause of death was sepsis secondary to pneumonia of the contralateral lung in one case. CONCLUSION Having thoracic surgery is a risk factor for the development of bronchopleural fistula. Management of bronchopleural fistula needs to be individualized.
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Affiliation(s)
| | | | - Seyoum Kassa Merine
- Department of Surgery, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Dereje Gulilat Yilma
- Department of Surgery, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Iizuka S, Uebayashi A, Nakamura T, Funai K. Spontaneous closure of a metachronous brochopleural fistula after omentoplasty for a preceding fistula: Case report. Ann Med Surg (Lond) 2022; 82:104645. [PMID: 36268306 PMCID: PMC9577646 DOI: 10.1016/j.amsu.2022.104645] [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] [Received: 08/22/2022] [Accepted: 09/09/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction A bronchopleural fistula (BPF) after an anatomical lung resection commonly arises singly. We report a case of a metachronous BPF, which developed after omentoplasty of a preceding fistula and subsequently closed without any intervention. Case presentation A 77-year-old patient underwent omentoplasty for a brochopleural fistula (BPF) following a right lower lobectomy. A sudden massive air leak developed from the novel BPF approximately 1 cm proximal to the preceding fistula 3 days later. The air leak resolved spontaneously without any intervention one week later. The corresponding fistula was found to be completely closed. Computed tomography showed the omental flap covered both fistulae. Conclusion The present case suggested that a metachronous BPF could develop and a harvested omental flap might migrate even after being anchored. A metachronous bronchopleural fistula (BPF) developed 3 days after an omentoplasty for a preceding fistula following a right lower lobectomy. The BPF was closed spontaneously without any subsequent intervention and a computed tomography revealed that the omental flap covered both fistulae. A metachronous BPF could develop and a harvested omental flap might migrate even after being anchored.
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Development of a novel material to promote wound healing at bronchial defects. Ann Thorac Surg 2022:S0003-4975(22)00934-1. [PMID: 35798283 DOI: 10.1016/j.athoracsur.2022.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 05/12/2022] [Accepted: 06/11/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Bronchopleural fistula (BPF) is a critical complication that may progress to pneumonia and empyema, but optimal treatment remains uncertain. Our purpose was to develop a novel material for bronchial occlusion that can be used to treat BPF by blocking airflow and promoting wound healing. METHODS Sponges were prepared in concentrations of 25, 40, and 50 mg/dL of silk-elastin by hydrophobic processing. Five adult Beagle dogs underwent right anterior lobectomy, and 5 underwent left posterior lobectomy. Silk-elastin sponges were placed at bronchial stumps of 8 dogs, and silicone plugs were placed at the stumps of 2 dogs as a control. RESULTS Postoperative complications were not observed, except in 1 dog in which the silicone plug had been placed and which had massive subcutaneous emphysema at 4 weeks after operation. Histologic examination revealed that stumps were covered with connective tissue and that there was more regeneration of airway epithelium in the silk-elastin sponge group than in the silicone plug group. There were increased numbers of myofibroblasts around the bronchial stump occluded by silk-elastin sponges at 2 weeks after placement, which completely disappeared after 2 months, during which abundant neovascularization occurred. CONCLUSIONS We showed that silk-elastin sponges can manage and promote regeneration of bronchial epithelium. Our results demonstrate that bronchial occlusion with a silk-elastin sponge is a promising option for treatment of BPF.
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Yang YH, Park SY, Kim HE, Park BJ, Lee CY, Lee JG, Kim DJ, Paik HC. Postoperative bronchopleural fistula repair: Surgical outcomes and adverse factors for its success. Thorac Cancer 2022; 13:1401-1405. [PMID: 35393787 PMCID: PMC9058303 DOI: 10.1111/1759-7714.14404] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/13/2022] [Accepted: 03/14/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The purpose of this study was to investigate the results of postoperative bronchopleural fistula repair and to identify adverse factors for its success. METHODS We retrospectively reviewed the surgical results of 39 patients who underwent surgical repair for postoperative bronchopleural fistula between January 2010 and June 2020. Success of bronchopleural fistula repair was defined as the visual closure of the bronchopleural fistula with the absence of an air leak, a recurrence of bronchopleural fistula and infection in the thoracic cavity. RESULTS Twenty-five (64.1%) bronchopleural fistulas occurred after pulmonary resection and 14 (35.9%) after lung transplantation. Bronchopleural fistula was diagnosed 19 days (median) and repaired 28 days (median) after the initial operation by primary closure in 27 (69.2%) patients, and by additional resection in 12 (30.8%) patients. The overall success rate was 59% (23/39) and the overall mortality was 56.4% (22/39). Multivariable analysis revealed that the patients who were supported by mechanical ventilation at the time of repair had significantly lower success rates than those without (15.4%, 2/13 vs. 80.8%, 21/26, respectively, p < 0.001). The omental flap group tended to have a better success rate than the muscle flap group (p = 0.07). CONCLUSIONS There was a high overall mortality rate after bronchopleural fistula repair and a low success rate. Mechanical ventilation at the time of bronchopleural fistula repair was significantly related to the failure of bronchopleural fistula repair.
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Affiliation(s)
- Young Ho Yang
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea
| | - Seong Yong Park
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea.,Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ha Eun Kim
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea
| | - Byung Jo Park
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea
| | - Chang Young Lee
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea
| | - Jin Gu Lee
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea
| | - Dae Joon Kim
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea
| | - Hyo Chae Paik
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea
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Nakada T, Ohtsuka T. Thoracolaparoscopic carinal resection and reconstruction using pedicle omental flap. Transl Lung Cancer Res 2021; 10:3855-3857. [PMID: 34733634 PMCID: PMC8512463 DOI: 10.21037/tlcr-21-662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 09/07/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Takeo Nakada
- Division of Thoracic Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Takashi Ohtsuka
- Division of Thoracic Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
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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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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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Zheng Y, Pierce AF, Wagner WL, Khalil HA, Chen Z, Servais AB, Ackermann M, Mentzer SJ. Functional Adhesion of Pectin Biopolymers to the Lung Visceral Pleura. Polymers (Basel) 2021; 13:2976. [PMID: 34503016 PMCID: PMC8433721 DOI: 10.3390/polym13172976] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 08/23/2021] [Accepted: 08/25/2021] [Indexed: 01/10/2023] Open
Abstract
Pleural injuries and the associated "air leak" are the most common complications after pulmonary surgery. Air leaks are the primary reason for prolonged chest tube use and increased hospital length of stay. Pectin, a plant-derived heteropolysaccharide, has been shown to be an air-tight sealant of pulmonary air leaks. Here, we investigate the morphologic and mechanical properties of pectin adhesion to the visceral pleural surface of the lung. After the application of high-methoxyl citrus pectin films to the murine lung, we used scanning electron microscopy to demonstrate intimate binding to the lung surface. To quantitatively assess pectin adhesion to the pleural surface, we used a custom adhesion test with force, distance, and time recordings. These assays demonstrated that pectin-glycocalyceal tensile adhesive strength was greater than nanocellulose fiber films or pressure-sensitive adhesives (p < 0.001). Simultaneous videomicroscopy recordings demonstrated that pectin-glycocalyceal adhesion was also stronger than the submesothelial connective tissue as avulsed surface remnants were visualized on the separated pectin films. Finally, pleural abrasion and hyaluronidase enzyme digestion confirmed that pectin binding was dependent on the pleural glycocalyx (p < 0.001). The results indicate that high methoxyl citrus pectin is a promising sealant for the treatment of pleural lung injuries.
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Affiliation(s)
- Yifan Zheng
- Laboratory of Adaptive and Regenerative Biology, Brigham & Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA; (Y.Z.); (A.F.P.); (W.L.W.); (H.A.K.); (Z.C.); (A.B.S.)
| | - Aidan F. Pierce
- Laboratory of Adaptive and Regenerative Biology, Brigham & Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA; (Y.Z.); (A.F.P.); (W.L.W.); (H.A.K.); (Z.C.); (A.B.S.)
| | - Willi L. Wagner
- Laboratory of Adaptive and Regenerative Biology, Brigham & Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA; (Y.Z.); (A.F.P.); (W.L.W.); (H.A.K.); (Z.C.); (A.B.S.)
- Department of Diagnostic and Interventional Radiology, Translational Lung Research Center, University of Heidelberg, 69120 Heidelberg, Germany
| | - Hassan A. Khalil
- Laboratory of Adaptive and Regenerative Biology, Brigham & Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA; (Y.Z.); (A.F.P.); (W.L.W.); (H.A.K.); (Z.C.); (A.B.S.)
| | - Zi Chen
- Laboratory of Adaptive and Regenerative Biology, Brigham & Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA; (Y.Z.); (A.F.P.); (W.L.W.); (H.A.K.); (Z.C.); (A.B.S.)
| | - Andrew B. Servais
- Laboratory of Adaptive and Regenerative Biology, Brigham & Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA; (Y.Z.); (A.F.P.); (W.L.W.); (H.A.K.); (Z.C.); (A.B.S.)
| | - Maximilian Ackermann
- Institute of Functional and Clinical Anatomy, University Medical Center of the Johannes Gutenberg-University, 55131 Mainz, Germany;
| | - Steven J. Mentzer
- Laboratory of Adaptive and Regenerative Biology, Brigham & Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA; (Y.Z.); (A.F.P.); (W.L.W.); (H.A.K.); (Z.C.); (A.B.S.)
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Motono N, Ishikawa M, Iwai S, Iijima Y, Usuda K, Uramoto H. Benign emptying of the post-pneumonectomy space: A case report. Int J Surg Case Rep 2021; 80:105699. [PMID: 33662914 PMCID: PMC7930581 DOI: 10.1016/j.ijscr.2021.105699] [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: 01/23/2021] [Revised: 02/19/2021] [Accepted: 02/20/2021] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Benign emptying of the post-pneumonectomy space (BEPS) is characterized by a decreased air-fluid level after pneumonectomy, albeit without the presence of bronchopleural fistula (BPF). CASE PRESENTATION A 66-year-old man with lung cancer diagnosed clinical stage IIIA received right pneumonectomy. The air-fluid level of the right pleural cavity suddenly dropped on the 19th postoperative day. Although we were unable to detect the fistula of the bronchial stump using bronchoscopy, we performed re-operationt. Although a pressure of 30 cmH2O was applied into the airway and air leakage from the bronchial stump was not detected, we covered the bronchial stump with the omentum. Because the air-fluid level of the right pleural cavity decreased 9 days after the 2nd operation without any symptom, we diagnosed the condition as BEPS. CLINICAL DISCUSSION If a fistula of the bronchial stump cannot be identified using bronchoscopy or thoracoscopy, then determining whether it is BEPS or microscopic BPF can be difficult. CONCLUSION It is currently unclear what the optimal strategy is in this case.
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Affiliation(s)
- Nozomu Motono
- Department of Thoracic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa, Japan.
| | - Masahito Ishikawa
- Department of Thoracic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa, Japan
| | - Shun Iwai
- Department of Thoracic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa, Japan
| | - Yoshihito Iijima
- Department of Thoracic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa, Japan
| | - Katsuo Usuda
- Department of Thoracic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa, Japan
| | - Hidetaka Uramoto
- Department of Thoracic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa, Japan
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Intrathoracic Breast Transposition: A New Method in the Treatment of Bronchopleural Fistula and Empyema. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 7:e2531. [PMID: 32537290 PMCID: PMC7288868 DOI: 10.1097/gox.0000000000002531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 10/03/2019] [Indexed: 11/26/2022]
Abstract
A bronchopleural fistula (BF) is a life-threatening complication. Optimal management of a BF is still debated although surgery remains the preferred treatment. Usually, the fistula is a result of inadequate healing at the bronchial stump after pneumonectomy. Successful closure of a BF after pneumonectomy depends on evacuation of empyema, coverage of the suture line after fistula closure with vascularized tissue, and obliteration of the residual pleural cavity. Extrathoracic muscles and omentum are the first choice for intrathoracal transposition. We report a unique case of a cachectic female patient with a BF from the left main stem bronchus complicated with empyema following right-sided pneumonectomy. Previous surgeries excluded the use of extrathoracic muscles or only omentum. The BF could not be closed with sutures. Using a parachute technique, omentum was sutured into the fistula opening resulting in a tension-free fistula closure. A well-vascularized breast was transposed into the residual pleural cavity to obliterate dead space and to support the omentoplasty, so it would be able to withstand changes in intrathoracic pressure. The postoperative course was uneventful. Tension-free closure of a BF can be obtained by suturing well-vascularized tissue into the fistula opening using a parachute technique. Intrathoracic breast transposition could be a new option in the treatment of a BF and associated empyema in a female patient. In selected patients, a large breast can obliterate the dead space after pneumonectomy and support the omentoplasty.
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Chong WH, Saha BK. Eloesser Flap Procedure for Bronchopleural Fistula After Pneumonectomy for Pulmonary Aspergillosis. Am J Med Sci 2020; 361:e1-e2. [PMID: 32723515 DOI: 10.1016/j.amjms.2020.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 06/04/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Woon H Chong
- Department of Pulmonary and Critical Care, Albany Medical Center, Albany, New York.
| | - Biplab K Saha
- Department of Pulmonary and Critical Care, Ozarks Medical Center, West Plains, Missouri
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Kondo N, Hashimoto M, Takuwa T, Matsumoto S, Okumura Y, Hasegawa S. Treatment of bronchial fistula after extraplural pneumonectomy using flexible bronchoscopy with the administration of OK432, fibroblast growth factor basic and fibrin glue sealant. Gen Thorac Cardiovasc Surg 2020; 68:1562-1564. [PMID: 32279197 DOI: 10.1007/s11748-020-01349-8] [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: 12/11/2019] [Accepted: 03/26/2020] [Indexed: 10/24/2022]
Abstract
Treatment options for bronchial fistula (BF) after pneumonectomy are often limited and carry significant morbidity and mortality. The patient underwent right extrapleural pneumonectomy for malignant pleural mesothelioma had BF without macroscopic fistula found by bronchography. We treated this minor BF using bronchoscopy with the administration of OK-432, fibroblast growth factor basic, and fibrin glue sealant. Two weeks after this treatment, we confirmed the improvement of the fistula by bronchography. Bronchoscopic therapy for BF was useful for a small, early fistula without infection.
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Affiliation(s)
- Nobuyuki Kondo
- Department of Thoracic Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan.
| | - Masaki Hashimoto
- Department of Thoracic Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Teruhisa Takuwa
- Department of Thoracic Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Seiji Matsumoto
- Department of Thoracic Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Yoshitomo Okumura
- Department of Thoracic Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan.,Department of Thoracic Surgery, Itami Municipal Hospital, Hyogo, Japan
| | - Seiki Hasegawa
- Department of Thoracic Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
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Asaad M, Van Handel A, Akhavan AA, Huang TCT, Rajesh A, Allen MA, Shen KR, Sharaf B, Moran SL. Muscle Flap Transposition for the Management of Intrathoracic Fistulas. Plast Reconstr Surg 2020; 145:829e-838e. [PMID: 32221235 DOI: 10.1097/prs.0000000000006670] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Intrathoracic fistulas pose unique challenges for thoracic and reconstructive surgeons. To decrease the incidence of fistula recurrence, pedicled flaps have been suggested to buttress the repair site. The authors aimed to report their experience with muscle flap transposition for the management of intrathoracic fistulas. METHODS A retrospective review of all patients who underwent intrathoracic muscle flap transposition for the management of intrathoracic fistulas from 1990 to 2010 was conducted. Patient demographics, surgical characteristics, and complication rates were abstracted and analyzed. RESULTS A total of 198 patients were identified. Bronchopleural fistula was present in 156 of the patients (79 percent), and 48 had esophageal fistula (24 percent). A total of 238 flaps were used, constituting an average of 1.2 flaps per patient. After the initial fistula repair, bronchopleural fistula complicated the course of 34 patients (17 percent), and esophageal fistula occurred in 13 patients (7 percent). Partial flap loss was identified in 11 flaps (6 percent), and total flap loss occurred in four flaps (2 percent). Median follow-up was 27 months. At the last follow-up, 182 of the patients (92 percent) had no evidence of fistula, 175 (89 percent) achieved successful chest closure, and 164 (83 percent) had successful treatment. Preoperative radiation therapy and American Society of Anesthesiologists score of 4 or greater were identified as risk factors for unsuccessful treatment. CONCLUSIONS Intrathoracic fistulas remain a source of major morbidity and mortality. Reinforcement of the fistula closure with vascularized muscle flaps is a viable option for preventing dehiscence of the repair site and can be potentially life-saving. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Affiliation(s)
- Malke Asaad
- From the Divisions of Plastic Surgery and General Thoracic Surgery, Department of Surgery, Mayo Clinic; and the Mayo Clinic Alix School of Medicine
| | - Amelia Van Handel
- From the Divisions of Plastic Surgery and General Thoracic Surgery, Department of Surgery, Mayo Clinic; and the Mayo Clinic Alix School of Medicine
| | - Arya A Akhavan
- From the Divisions of Plastic Surgery and General Thoracic Surgery, Department of Surgery, Mayo Clinic; and the Mayo Clinic Alix School of Medicine
| | - Tony C T Huang
- From the Divisions of Plastic Surgery and General Thoracic Surgery, Department of Surgery, Mayo Clinic; and the Mayo Clinic Alix School of Medicine
| | - Aashish Rajesh
- From the Divisions of Plastic Surgery and General Thoracic Surgery, Department of Surgery, Mayo Clinic; and the Mayo Clinic Alix School of Medicine
| | - Mark A Allen
- From the Divisions of Plastic Surgery and General Thoracic Surgery, Department of Surgery, Mayo Clinic; and the Mayo Clinic Alix School of Medicine
| | - K Robert Shen
- From the Divisions of Plastic Surgery and General Thoracic Surgery, Department of Surgery, Mayo Clinic; and the Mayo Clinic Alix School of Medicine
| | - Basel Sharaf
- From the Divisions of Plastic Surgery and General Thoracic Surgery, Department of Surgery, Mayo Clinic; and the Mayo Clinic Alix School of Medicine
| | - Steven L Moran
- From the Divisions of Plastic Surgery and General Thoracic Surgery, Department of Surgery, Mayo Clinic; and the Mayo Clinic Alix School of Medicine
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Beckmann N, Luttrell J, Petty B, Rhodes C, Thompson J. Injection bronchoplasty with carboxymethlycellulose with cystoscopy needle for neonatal persistent bronchopleural fistulae. Int J Pediatr Otorhinolaryngol 2019; 127:109651. [PMID: 31470204 DOI: 10.1016/j.ijporl.2019.109651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 08/18/2019] [Accepted: 08/19/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE We describe the novel use of injectable carboxymethylcellulose to close a persistent bronchopleural fistula (BPF) in a neonate who underwent an ex utero intrapartum treatment (EXIT) after aborted fetoscopy. METHODS In this case, a patient with laryngeal atresia underwent fetoscopy that was halted after concern for instruments within the mediastinum, and thus ultimately required an EXIT to establish an airway. Bilateral pneumothoraces and eventually multiple BPF were identified that continued to persist despite multiple attempts at removal of chest tubes over a four-week period. We look at the role of endoscopy and a substance often used in the larynx to help close a persistent BPF. RESULTS At initial bronchoscopy, no BPF was identified, but at subsequent evaluation due to persistent pneumothorax, we used increased positive end expiratory pressure to help reveal the fistula. Given the bronchial location of the fistula, traditional laryngeal instruments could not be used, requiring the use of urologic cystoscopy needles to assist in accessing these challenging locations. At postoperative day 2 from the injection, the chest tube was removed and did not require replacement. CONCLUSION There are many methods to help treat BPF. The endoscopic injection of carboxymethylcellulose adds a technique to the pediatric otolaryngologist's armamentarium.
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Affiliation(s)
- Nicholas Beckmann
- Department of Otolaryngology, University of Tennessee Health Science Center, Memphis, TN, USA; LeBonheur Children's Hospital, Memphis, TN, USA.
| | - Jordan Luttrell
- Department of Otolaryngology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Brad Petty
- Department of Otolaryngology, University of Tennessee Health Science Center, Memphis, TN, USA; LeBonheur Children's Hospital, Memphis, TN, USA
| | - Cecil Rhodes
- Department of Otolaryngology, University of Tennessee Health Science Center, Memphis, TN, USA; LeBonheur Children's Hospital, Memphis, TN, USA
| | - Jerome Thompson
- Department of Otolaryngology, University of Tennessee Health Science Center, Memphis, TN, USA; LeBonheur Children's Hospital, Memphis, TN, USA
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Nadeem R, Elhoufi A, Abuhijleh R, Saleh A, Zahra A. Successful Closure of Bronchopleural Fistula by Catheter-Assisted Intrabronchiolar Insertion of Microvascular Plug: A Case Report. DUBAI MEDICAL JOURNAL 2019. [DOI: 10.1159/000501031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Bronchopleural fistula (BPF) is a pathological connection between the bronchial tree and pleural space usually formed as a result of local or systemic illness affecting pulmonary or pleural tissue. It is associated with significant morbidity and prolonged stay in the hospital. We present the case of a 33-year-old male with multiple sclerosis with multiple co-morbidities who developed respiratory failure from pneumonia requiring mechanical ventilation (MV) and tracheostomy. He developed pneumothorax which remained persistent despite medical management and chest tube insertion suggesting BPF. A high-resolution CT chest confirmed BPF. The patient was not a suitable candidate for endoscopic or surgical repair. An occlusive microvascular plug was placed under fluoroscopy to close the leak. High-resolution chest CT confirmed resolution of air leak. The patient was subsequently discharged to a long-term ventilator facility for liberation of MV. Follow-up after discharge revealed successful liberation from the ventilator. BPF management is a challenge which requires multidisciplinary approach and careful assessment to choose the best approach for treatment especially in high-risk patients with a compromised pulmonary status. For patients who are not suitable candidates for surgical or endoscopic repair, radiologically guided application of an occluding device or sealants are attractive options.
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21
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Fukui T, Matsukura T, Wakatsuki Y, Yamawaki S. Simple chest closure of open window thoracostomy for postpneumonectomy empyema: a case report. Surg Case Rep 2019; 5:53. [PMID: 30953209 PMCID: PMC6450984 DOI: 10.1186/s40792-019-0612-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 03/25/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Management of postpneumonectomy empyema requires comprehensive strategies, especially when the condition is associated with large bronchopleural fistulae. We report a case involving the simple chest closure of open window thoracostomy with remaining residual space. CASE PRESENTATION We performed open window thoracostomy for empyema with a huge bronchial stump dehiscence after right pneumonectomy for a large lung cancer. We definitively closed the chest window infected with chronic persistent Pseudomonas aeruginosa via a simple chest closure technique with the remaining residual space, after repairing the bronchial dehiscence using an omental flap and the appearance of healthy granulation tissue throughout the cavity. The patient died of recurrent cancer 10 months after the definitive chest closure. Until the patient died, there were no symptoms or signs suggestive of recurrent empyema. CONCLUSION This simple chest closure technique allows "silent empyema" to be observed carefully, is less invasive, and can even be applied to cases of recurrent cancer.
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Affiliation(s)
- Tetsuya Fukui
- Department of General Thoracic Surgery, Japanese Red Cross Fukui Hospital, 2-4-1 Tsukimi Fukui, Fukui, 918-8501, Japan.
| | - Tadashi Matsukura
- Department of General Thoracic Surgery, Japanese Red Cross Fukui Hospital, 2-4-1 Tsukimi Fukui, Fukui, 918-8501, Japan
| | - Yusuke Wakatsuki
- Department of General Thoracic Surgery, Japanese Red Cross Fukui Hospital, 2-4-1 Tsukimi Fukui, Fukui, 918-8501, Japan
| | - Satoko Yamawaki
- Department of Plastic Surgery, Japanese Red Cross Fukui Hospital, Fukui, 2-4-1 Tsukimi Fukui, 918-8501, Japan
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22
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Sakuraba S, Omae T, Kawagoe I, Koh K, Inada E. Respiratory failure caused by impending tension pneumothorax after extrapleural pneumonectomy: a case report. JA Clin Rep 2018; 4:45. [PMID: 32026087 PMCID: PMC6967187 DOI: 10.1186/s40981-018-0184-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 05/30/2018] [Indexed: 11/10/2022] Open
Abstract
Background Case presentation Conclusions
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23
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Criss CN, Barbaro R, Bauman KA, Folafoluwa O, Vellody R, Jarboe MD. Selective Management of Multiple Bronchopleural Fistulae in a Pediatric Patient on Extracorporeal Membrane Oxygenation: A Multidisciplinary Approach. J Laparoendosc Adv Surg Tech A 2018; 28:1271-1274. [PMID: 29920152 DOI: 10.1089/lap.2018.0078] [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: 11/13/2022] Open
Abstract
INTRODUCTION This case highlights the successful utilization of a multidisciplinary approach to numerous bilateral bronchopleural fistulae (BPF) using minimally invasive techniques. In this study, we present a previously healthy 14-year-old male hospitalized with 2009 H1N1 influenza and methicillin-resistant Staphylococcus aureus coinfection complicated by severe acute respiratory distress syndrome and multifocal necrotizing pneumonia, with significant lung tissue damage requiring prolonged extracorporeal membrane oxygenation (ECMO) support. METHODS The development of multiple BPFs precluded lung recruitment necessary to wean from ECMO. Treatment options were very limited and endobronchial valves were considered. However, localizing single airleaks with a fogarty balloon is normally the technique to determine appropriate location to place the valves. With multiple fistulae, this technique would be ineffective. Therefore, the patient was brought to interventional radiology and bronchography was performed for selective fistula mapping. With this precise localization, the multiple fistulae were ultimately controlled using image-guided embolization and the placement of multiple endobronchial valves. The success of this intervention enabled positive pressure ventilator support and rehabilitation required for weaning from ECMO support. CONCLUSION This case highlights the successful utilization of a multidisciplinary approach to numerous bilateral BPFs using minimally invasive techniques.
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Affiliation(s)
- Cory N Criss
- 1 Section of Pediatric Surgery, Department of Surgery, Michigan Medicine , Ann Arbor, Michigan
| | - Ryan Barbaro
- 2 Division of Pediatric Critical Care Medicine, Department of Pediatrics, Michigan Medicine , Ann Arbor, Michigan
| | - Kristy Ann Bauman
- 3 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Michigan Medicine , Ann Arbor, Michigan
| | - Odetola Folafoluwa
- 2 Division of Pediatric Critical Care Medicine, Department of Pediatrics, Michigan Medicine , Ann Arbor, Michigan
| | - Ranjith Vellody
- 4 Department of Interventional Radiology, Children's National Health System , Washington, District of Columbia
| | - Marcus D Jarboe
- 1 Section of Pediatric Surgery, Department of Surgery, Michigan Medicine , Ann Arbor, Michigan
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24
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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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25
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Page C, Blazy L, Jenkins M, Spiritoso R. Marked cachexia in probable invasive pulmonary aspergillosis with bronchopleural fistula. BMJ Case Rep 2018; 2018:bcr-2017-222143. [PMID: 29348280 DOI: 10.1136/bcr-2017-222143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 49-year-old man with a medical history of diabetes and heavy smoking was admitted to intensive care with severe bilateral pneumonia associated with marked cachexia. He developed a complex right-sided bronchopleural fistula and was transferred to our tertiary centre for consideration of surgical intervention.Despite escalation of antibiotic therapy, he did not improve and further investigations led to a diagnosis of invasive pulmonary aspergillosis. Definitive treatment plans required a right pneumonectomy; however, given the severity of cachexia, he remained unable to undergo such a large operation. This case demonstrates an atypical presentation of invasive pulmonary aspergillosis in a mildly immunodeficient individual. It highlights the challenges in assessment and management of critically ill patients' nutrition as well as optimal timing for surgical intervention.
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Affiliation(s)
- Christiana Page
- Department of Intensive Care, Barts Health NHS Trust, St Bartholomew's Hospital, London, UK
| | - Laura Blazy
- Department of Intensive Care, Saint George's Hospital, London, UK
| | - Melanie Jenkins
- Department of Thoracic Surgery, Saint George's Healthcare NHS Trust, St George's Hospital, London, UK
| | - Rosalba Spiritoso
- Department of Intensive Care, Barts Health NHS Trust, St Bartholomew's Hospital, London, UK
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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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The American Association for Thoracic Surgery consensus guidelines for the management of empyema. J Thorac Cardiovasc Surg 2017; 153:e129-e146. [PMID: 28274565 DOI: 10.1016/j.jtcvs.2017.01.030] [Citation(s) in RCA: 188] [Impact Index Per Article: 26.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 12/24/2016] [Accepted: 01/08/2017] [Indexed: 11/24/2022]
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Khan JH, Rahman SB, McElhinney DB, Harmon AL, Anthony JP, Hall TS, Jablons DM. Management Strategies for Complex Bronchopleural Fistula. Asian Cardiovasc Thorac Ann 2016. [DOI: 10.1177/021849230000800124] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The management of complex bronchopleural fistula remains a major therapeutic challenge for the thoracic surgeon. Although the incidence of bronchopleural fistula following lung resection has decreased in recent years to 1% to 2%, when it occurs, it is associated with significant morbidity and mortality. Using illustrative cases, the epidemiology and pathophysiology of bronchopleural fistula are reviewed and operative strategies are discussed. Algorithms for the diagnosis and treatment are suggested on the basis of cases described in the literature. The best way to prevent a fistula is to rigorously follow the surgical techniques described, with minimal devascularization of the bronchus and prophylactic coverage of the stump in high-risk patients. Successful management of a fistula is combined with treatment of the associated empyema cavity. Definitive repair should be accomplished expeditiously, minimizing the number of procedures performed. When treatment is protracted, secondary complications are more likely and survival is adversely affected. The first step should be control of active infection and adequate drainage of the hemithorax, followed by timely repair of the bronchopleural fistula when possible and reinforcement of the stump with vascularized tissue. If a residual cavity is present it must also be obliterated with a pedicled muscle flap.
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Affiliation(s)
| | - Sarah B Rahman
- Department of Medicine UCSF-Mount Zion San Francisco, California, USA
| | | | - Adam L Harmon
- Division of Cardiothoracic Surgery Washington Hospital Healthcare System Fremont, California, USA
| | - James P Anthony
- Division of Plastic Surgery UCSF-Mount Zion San Francisco, California, USA
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Pneumonectomy Complicated by Bronchopleural Fistula and Empyema. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2016. [DOI: 10.1097/ipc.0000000000000369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lu C, Feng Z, Ge D, Yuan Y, Zhang Y, Qi F, Gu J, Xu F. Pedicle muscle flap transposition for chronic empyema with persistent bronchopleural fistula: experience of a single clinical center in China. Surg Today 2016; 46:1132-7. [PMID: 26743783 DOI: 10.1007/s00595-015-1288-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 11/10/2015] [Indexed: 01/27/2023]
Abstract
PURPOSE The management of chronic empyema with persistent bronchopleural fistula (BPF) is a major challenge for surgeons. We report our experience of performing pedicle muscle flap transposition for chronic empyema with BPF in a clinical center in China. METHODS The subjects of this study were 13 patients with postoperative chronic empyema and persistent BPF. The surgical procedure performed was chosen according to the degree of infection in the empyema cavity. Patients with mild contamination underwent one-stage cavity decortication with flap transposition, whereas patients with severe infection underwent two-stage surgery including open-window thoracostomy and pedicle muscle flap transposition. RESULTS Five patients underwent one-stage surgery, followed by an uneventful postoperative course in all except one. The other eight patients underwent two-stage surgery. The fistulas closed spontaneously during the course of dressings and six of these eight patients underwent second-stage surgery uneventfully. A bronchopleurocutaneous sinus developed in the wounds of the other two patients. CONCLUSIONS Pedicle muscle flap transposition is a viable option for chronic empyema with BPF; however, surgical procedures should be selected according to the degree of contamination. For two-stage surgery, obliteration of the cavity should be considered, preferably after closure of the fistula.
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Affiliation(s)
- Chunlai Lu
- Department of Thoracic Surgery, Fudan University Zhongshan Hospital, Fenglin Road 180, Shanghai, 200032, China
| | - Zihao Feng
- Department of Plastic and Reconstructive Surgery, Fudan University Zhongshan Hospital, Fenglin Road 180, Shanghai, 200032, China
| | - Di Ge
- Department of Thoracic Surgery, Fudan University Zhongshan Hospital, Fenglin Road 180, Shanghai, 200032, China.
| | - Yunfeng Yuan
- Department of Thoracic Surgery, Fudan University Zhongshan Hospital, Fenglin Road 180, Shanghai, 200032, China
| | - Yong Zhang
- Department of Plastic and Reconstructive Surgery, Fudan University Zhongshan Hospital, Fenglin Road 180, Shanghai, 200032, China
| | - Fazhi Qi
- Department of Plastic and Reconstructive Surgery, Fudan University Zhongshan Hospital, Fenglin Road 180, Shanghai, 200032, China.
| | - Jie Gu
- Department of Thoracic Surgery, Fudan University Zhongshan Hospital, Fenglin Road 180, Shanghai, 200032, China
| | - Fengkai Xu
- Department of Thoracic Surgery, Fudan University Zhongshan Hospital, Fenglin Road 180, Shanghai, 200032, China
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Maeda H, Kanzaki M, Kikkawa T, Onuki T. Video-assisted thoracoscpic muscle transposition for acute empyema. J Cardiothorac Surg 2015; 10:124. [PMID: 26449404 PMCID: PMC4599663 DOI: 10.1186/s13019-015-0332-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 10/05/2015] [Indexed: 11/15/2022] Open
Abstract
Muscle flap transposition is one of the surgical treatment options for empyema with alveolarpleural fistula (APF) or bronchopleural fistula (BPF). This surgical procedure is invasive because it is typically performed by standard thoracotomy. We performed video-assisted thoracoscopic surgery (VATS) debridement, decortication, and obliteration of an empyema cavity using a pedicled latissimus dorsi muscle (LDM) flap harvested through minimal skin incisions for a case of acute empyema with APF. This VATS procedure is effective and less invasive and can be a new option for the thoracoscopic surgical treatment of acute empyema with APF.
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Affiliation(s)
- Hideyuki Maeda
- Department of Surgery I, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
| | - Masato Kanzaki
- Department of Surgery I, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
| | - Takuma Kikkawa
- Department of Surgery I, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
| | - Takamasa Onuki
- Department of Surgery I, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
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Qi F, Tian Q, Chen L, Li C, Zhang S, Liu X, Xiao B. Use of endobronchial valve insertion to treat relapsing pneumothorax: a case report and literature review. CLINICAL RESPIRATORY JOURNAL 2015; 11:411-418. [PMID: 26259915 DOI: 10.1111/crj.12355] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 06/24/2015] [Accepted: 08/03/2015] [Indexed: 11/28/2022]
Abstract
Backgorund and Aims: Unidirectional endobronchial valves have recently been shown to be beneficial as treatment for persistent air leaks. This report presents a first case of endobronchial valve implantation to treat relapsing pneumothorax in a Chinese patient, and also presents a review of the literature on the use of one-way valve insertion for the treatment of persistent air leaks. METHODS The patient did undergo a recent but failed chest tube intervention. By bronchoscopy and using Chartis® system measurements, the upper left lobe (including the left apical bronchus) was closed using a catheter. RESULTS After the expected decrease in airflow following bronchial occlusion, increased air pressure and decreased spilled air were noted; it was concluded that the pneumothorax was located in the left upper lobe. A Zephyr® endobronchial valve was placed in the left upper apical bronchus. The health benefits of the procedure were noticed in the following days. CONCLUSION Our review suggests that the use of endobronchial valves could be used as an effective, minimally invasive, low-risk intervention for patients with pneumothorax that cannot be treated surgically.
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Affiliation(s)
- Fei Qi
- Department of Respiratory Medicine, Chinese PLA General Hospital, Beijing, China
| | - Qing Tian
- Department of Respiratory Medicine, Chinese PLA General Hospital, Beijing, China
| | - Liang'an Chen
- Department of Respiratory Medicine, Chinese PLA General Hospital, Beijing, China
| | - Chunyan Li
- Department of Respiratory Medicine, Chinese PLA General Hospital, Beijing, China
| | - Shu Zhang
- Department of Respiratory Medicine, Chinese PLA General Hospital, Beijing, China
| | - Xingchen Liu
- Department of Respiratory Medicine, Chinese PLA General Hospital, Beijing, China
| | - Binbin Xiao
- Department of Respiratory Medicine, Chinese PLA General Hospital, Beijing, China
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Klotz LV, Gesierich W, Schott-Hildebrand S, Hatz RA, Lindner M. Endobronchial closure of bronchopleural fistula using Amplatzer device. J Thorac Dis 2015; 7:1478-82. [PMID: 26380774 DOI: 10.3978/j.issn.2072-1439.2015.08.25] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Accepted: 08/25/2015] [Indexed: 11/14/2022]
Abstract
BACKGROUND Bronchopleural fistulas (BPF) are a dreaded complication after lobectomy and pneumonectomy and are associated with high morbidity and mortality. BPF are treated by a range of surgical and endoscopic techniques. Amplatzer devices (ADs), normally used for the closure of cardiac defects, may enable the minimally invasive occlusion of these defects. METHODS Three patients with BPF were treated with the bronchoscopic closure of BPF using AD. Under general anaesthesia, the fistula was located using bronchography and the self-expanding AD was placed under direct bronchoscopic and fluoroscopic guidance into the fistula. Bronchography was used to control the complete occlusion of the BPF. RESULTS Three male patients with a mean age of 63 years (range, 53-73 years) were successfully treated by AD. Two BPF occurred after lobectomy of the right lower lobe for lung cancer and one after right pneumonectomy for lung cancer. In all patients the bronchoscopic procedure was successful and symptoms of empyema and BPF showed no recurrence over a median follow-up of 22 months. CONCLUSIONS Endobronchial closure of BPF using AD represents a safe, effective and promising method for postoperative BPF.
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Affiliation(s)
- Laura V Klotz
- 1 Department of Thoracic Surgery, 2 Department of Pneumology, Center for Thoracic Surgery Munich, (Asklepios Medical Center Munich-Gauting/Ludwig-Maximilians-University Munich), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Wolfgang Gesierich
- 1 Department of Thoracic Surgery, 2 Department of Pneumology, Center for Thoracic Surgery Munich, (Asklepios Medical Center Munich-Gauting/Ludwig-Maximilians-University Munich), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Sabine Schott-Hildebrand
- 1 Department of Thoracic Surgery, 2 Department of Pneumology, Center for Thoracic Surgery Munich, (Asklepios Medical Center Munich-Gauting/Ludwig-Maximilians-University Munich), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Rudolf A Hatz
- 1 Department of Thoracic Surgery, 2 Department of Pneumology, Center for Thoracic Surgery Munich, (Asklepios Medical Center Munich-Gauting/Ludwig-Maximilians-University Munich), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Michael Lindner
- 1 Department of Thoracic Surgery, 2 Department of Pneumology, Center for Thoracic Surgery Munich, (Asklepios Medical Center Munich-Gauting/Ludwig-Maximilians-University Munich), Member of the German Center for Lung Research (DZL), Munich, Germany
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Musani AI, Dutau H. Management of alveolar-pleural fistula: a complex medical and surgical problem. Chest 2015; 147:590-592. [PMID: 25732439 DOI: 10.1378/chest.14-2202] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Ali I Musani
- Division of Pulmonary, Critical Care and Sleep Medicine, Thoracic Oncology, Pleural Diseases and Interventional Pulmonology Department, North University Hospital, Marseille, France.
| | - Hervé Dutau
- National Jewish Health, Thoracic Endoscopy Unit, Thoracic Oncology, Pleural Diseases and Interventional Pulmonology Department, North University Hospital, Marseille, France
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Vannucci J, Scarnecchia E, Cagini L, Puma F. Pneumoperitoneum as a valuable option in the treatment of post lower lobectomy bronchopleural fistula. Interact Cardiovasc Thorac Surg 2015; 21:121-3. [DOI: 10.1093/icvts/ivv079] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Accepted: 03/12/2015] [Indexed: 11/14/2022] Open
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Okonta KE, Ocheli EO, Gbeneol TJ. Surgical management of recalcitrant peripheral bronchopleural fistula with empyema: A preliminary experience. Niger Med J 2015; 56:12-6. [PMID: 25657487 PMCID: PMC4314853 DOI: 10.4103/0300-1652.149164] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background: Peripheral bronchopleural fistula (BPF) and empyema from necrotising infections of the lung and pleural is difficult to treat resulting in increased morbidity and mortality rates. The aim of this study was to show the effectiveness of the Latissimus Dorsi muscle (LDM) flap and patch closure techniques in the management of recalcitrant peripheral BPFs with the aid of thoracotomy. Materials and Methods: Five patients with BPF and empyema out of 26 patients who were initially treated for empyema thoracis by single or multiple chest tube insertions and/or ultrasound-guided drainage were prospectively identified and followed up for 2 years, postoperatively. The postoperative hospital stay, dyspnoea score, function of the ipsilateral upper limb and any deformity of chest wall were assessed at follow-up visits by asking relevant questions. Results: The mean age was 46.8 years (23-69 years) (4 males and 1 female). The cause of the BPF in 18 patients was Mycobacterium tuberculosis and 8 was pneumonia. The mean total months of the chest tube insertions was 1.5 months (range 2.5-6 months) prior to the thoracotomy and closure of fistula procedures performed on the 5 patients (with LDM flap in 4 patients and pleural patch in 1 patient). The complications recorded were: subcutaneous emphysema, residual pus and haemothorax in three patients. The mean postoperative hospital stay was 20.8 days (13-28 days);There was improved dyspnoea score to 1 or 2 in the 5 (19.2%) patients. There was no recurrence of BPF or residual pus in all the patients; no loss of function or deformity of the chest wall. Conclusion: The use of LDM Flap was effective in treating peripheral BFP without any adverse long-term outcome.
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Affiliation(s)
- Kelechi E Okonta
- Department of Surgery, Cardiothoracic Surgery Division, University of Port Harcourt Teaching Hospital, Rivers State, Nigeria
| | - Emmanuel O Ocheli
- Department of Surgery, Cardiothoracic Surgery Division, University of Port Harcourt Teaching Hospital, Rivers State, Nigeria
| | - Tombari J Gbeneol
- Plastic and Reconstructive Surgery Division, University of Port Harcourt Teaching Hospital, Rivers State, Nigeria
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Park JS, Eom JS, Choi SH, Kim YH, Kim EK. Use of a serratus anterior musculocutaneous flap for surgical obliteration of a bronchopleural fistula. Interact Cardiovasc Thorac Surg 2015; 20:569-74. [PMID: 25636324 DOI: 10.1093/icvts/ivv005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 12/27/2014] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Successful management of post-resection bronchopleural fistula (BPF) is a challenge, and various loco-regional flaps have been used to directly cover or to enhance closure of the bronchial stump. The serratus anterior muscle (SAM) is one of the workhorse flaps, although its use as a musculocutaneous flap has been debated. Here, we present our early experience with serratus anterior musculocutaneous (SAMC) flaps for the obliteration of BPF. METHODS A retrospective review of patients with surgical management of BPF from April 2005 to June 2014 was performed. A de-epithelized SAMC flap has replaced the conventional SAM flap since August 2013. Nine of consecutive former SAM flaps and 5 consecutive later SAMC flaps were identified. A detailed review of the SAMC flap cases was performed to describe medical and surgical history, BPF diagnosis and location, and the outcome of the flap surgery. RESULTS All five BPFs treated by SAMC flap were greater than 1 cm in diameter and all occurred on the right side. The leading primary diagnosis of a BPF was lung cancer, and the 4 lung cancer patients all underwent previous irradiation. The average size of the skin paddle was 19 × 6.6 cm(2), and the average volume of the skin paddle was 100.3 cm(3). Recurrence of the BPF was noted in 1 patient 6 weeks after surgery. In 4 of 5 patients, viable adipose tissue was confirmed by computed tomography scans. CONCLUSIONS The SAMC flap holds merits of a local flap such as short operation time, relative safety, no need of position change and faster recovery, with increased freedom of flap transfer and additional volume, thus widening surgical indication of the large, recalcitrant BPFs. We suggest that the SAMC flap could be safely harvested and used for management of a BPF or similar intrathoracic lesion when extensive flap length or bulk is required.
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Affiliation(s)
- Joo Seok Park
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Sup Eom
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Se Hoon Choi
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yong Hee Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Key Kim
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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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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Abstract
Sleeve resections of the lungs have affected the oncologic radicality, parenchyma and lung function-saving resections and extended the indications for operations in thoracic surgery. Whenever lung amputations can be avoided by bronchoplastic and/or angioplastic procedures with the same radicality, sleeve resection should be performed. In centrally located distinct malignomas, intraluminal tumor growth (T3) infiltrations of peribronchial or extrabronchial areas, the lobular ostia and the pulmonary artery (T2/T3) as well as lymph node involvement (N1/N2), these procedures give a better qualitative survival and lower morbidity and mortality rates. Broncoscope-guided localization of a double lumen tube and routine anesthesia monitoring are mandatory. Before performing sleeve resections a complete lymph node dissection should be done without denuding the area of the anastomosis and sparing the bronchial arteries. Preoperative endoscopic biopsies, knowledge of the topography and mobilization of the vascular and bronchial tree, subtile operation techniques, perioperative and postoperative videobronchoscopic guidance as well as intraoperative frozen sections and a tension-free and smooth anastomosis, avoid postoperative complications. Depending on the blood supply of the bronchial tree a vascularized flap is indicated. Operability can therefore be achieved in elderly patients with limited pulmonary function, particularly those under adjuvant or neoadjuvant therapy who are no longer suitable for pneumonectomy.
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Ambrosino N, Ribechini A, Allidi F, Gabbrielli L. Use of endobronchial valves in persistent air leaks: a case report and review of the literature. Expert Rev Respir Med 2014; 7:85-90. [DOI: 10.1586/ers.12.76] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Intrabronchial valves: a case series describing a minimally invasive approach to bronchopleural fistulas in medical intensive care unit patients. J Bronchology Interv Pulmonol 2013. [PMID: 23207358 DOI: 10.1097/lbr.0b013e318251c897] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Bronchopleural fistulas (BPF) are conditions associated with prolonged hospital course, high morbidity, and possibly increased mortality. The presence of BPFs in critically ill patients may cause difficulty in ventilation and increased oxygen requirements. Intrabronchial valves (Spiration IBV) serve as a noninvasive therapeutic option for the closure of BPFs. METHODS This report is a retrospective description of 3 patients transferred to our medical intensive care unit (ICU) with BPFs and persistent air leaks (PAL). One patient required high levels of oxygen supplementation through a nonrebreather face mask, whereas 2 required mechanical ventilation because of respiratory failure. IBVs were placed in each patient with the intention of closing their BPF and weaning them from respiratory support. RESULTS The use of IBVs in ICU patients with BPFs and PALs resulted in 1 patient being weaned from the persistent need for a nonrebreather face mask to room air and also aided in the liberation from mechanical ventilation of 2 patients who had been failing spontaneous breathing trials. CONCLUSIONS The use of IBVs is safe and well tolerated in ICU patients with BPFs and PALs. The placement of IBVs results in significant clinical improvement, allowing for either weaning from high levels of oxygen support or liberation from mechanical ventilation.
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Lee DY, Shin YR, Suh JW, Haam SJ, Chang YS, Watanabe Y. Treatment of intractable pneumothorax with emphysema using endobronchial watanabe spigots. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2013; 46:226-9. [PMID: 23772414 PMCID: PMC3680612 DOI: 10.5090/kjtcs.2013.46.3.226] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 12/13/2012] [Accepted: 12/18/2012] [Indexed: 11/16/2022]
Abstract
Prolonged air leakage is a major cause of morbidity in pneumothorax. When conservative management is not effective, surgery should be performed. However, surgery is not appropriate in patients with low pulmonary function. In these patients, occlusion of the airway with endobronchial blockers may be attempted under bronchoscopy. We treated two patients with prolonged air leakage using endobronchial Watanabe spigots under fibrobronchoscopy.
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Affiliation(s)
- Doo Yun Lee
- Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Korea
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Bronchopleural fistula after pneumonectomy: interdisciplinary surgical closure by an ipsilateral pedicled latissimus dorsi flap supported by video-assisted thoracoscopy. J Plast Reconstr Aesthet Surg 2013; 66:1600-3. [PMID: 23587680 DOI: 10.1016/j.bjps.2013.03.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Accepted: 03/09/2013] [Indexed: 11/22/2022]
Abstract
Post-pneumonectomy bronchopleural fistula (BPF) remains a rare but often life-threatening complication and therapeutic challenge. Traditional surgical procedures include chronic open drainage, attempts at direct stump closure, thoracoplasty with or without chest wall muscle transposition and trans-sternal bronchial closure. We describe a case with successful closure of a chronic BPF after pneumonectomy by intrathoracic transposition of a pedicled latissimus dorsi muscle flap circumferentially fixed on the surrounding pleural tissue under continuous video-assisted thoracoscopic overview. The postoperative course was without complications; no tumour, empyema or fistula re-occurred. In this article we want to present the potential advantages of video-assisted thoracoscopic support and interdisciplinary teamwork to improve the outcome of patients with BPFs after pneumonectomy.
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Tsai YM, Chen SL, Hsieh CM, Chang CK, Tzao C. Treatment of empyema and bronchopleural fistula by bovine pericardium and latissimus flap. Ann Thorac Surg 2013; 95:e39-40. [PMID: 23336914 DOI: 10.1016/j.athoracsur.2012.07.071] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2012] [Revised: 07/13/2012] [Accepted: 07/17/2012] [Indexed: 10/27/2022]
Abstract
Management of empyema with bronchopleural fistula remains a challenge. A 38-year-old man who had bullous emphysema was hospitalized on account of a right-sided necrotizing pneumonia complicated by empyema that mandated a tube drainage. Persistent air leak from the chest tube was noted, and chest computed tomography confirmed an empyema cavity with a suspicious bronchopleural fistula. This complex condition was successfully treated using fibrin glue with buttressed bovine pericardium to seal the fistula, followed by obliteration of the empyema cavity using a pedicled muscle flap of the latissimus dorsi. There was no recurrence of empyema at a follow-up 5 years after this procedure.
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Affiliation(s)
- Yuan-Ming Tsai
- Division of Thoracic Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Watanabe K, Kiyokawa K, Ino K, Nishi Y, Rikimaru H, Inoue Y. Treatment strategies for refractory pulmonary fistulae using a latissimus dorsi muscle flap. J Plast Reconstr Aesthet Surg 2011; 64:1014-21. [PMID: 21396896 DOI: 10.1016/j.bjps.2011.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Revised: 01/26/2011] [Accepted: 02/09/2011] [Indexed: 11/26/2022]
Abstract
BACKGROUND As a common treatment for pulmonary fistula, pleurosclerosis is performed. However, in the case of pulmonary fistula with empyema, it is difficult to develop adhesion through pleurosclerosis. Therefore, it is necessary to fill the dead space with a tissue graft. METHOD This surgical procedure is performed in two stages. In the first-stage surgery, the thoracic empyema cavity is opened widely, and sufficient drainage and debridement are performed within the thoracic empyema cavity. After the surgery, the wound is washed every day to suppress infection and promote the proliferation of benign granulation tissue (wound bed preparation). In the following second-stage surgery, a graft of latissimus dorsi muscle flap is performed to fill the dead space and close the fistula. In this case, a negative pressure drain is placed around the fistula to reliably drain air leaks from the pulmonary fistula, and thus the latissimus dorsi muscle flap and the tissue surrounding the pulmonary fistula can reliably adhere to the site. CASES AND RESULTS: Treatment with this method was performed in five cases, all of which successfully healed with no complications or recurrence. CONCLUSION When treating pulmonary fistula that has developed into thoracic empyema, it is believed that the following three points are important: (1) wound bed preparation around the pulmonary fistula, (2) inserting a latissimus dorsi muscle flap having a high wound-healing capacity and (3) promoting strong adhesion of the muscle flap and tissue surrounding the pulmonary fistula by reliably draining air leaks from the pulmonary fistula with a negative pressure drain.
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Affiliation(s)
- Koichi Watanabe
- Department of Plastic and Reconstructive and Maxillofacial Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume-shi, Fukuoka Prefecture 830-0011, Japan
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Sasada S, Tamura K, Chang YS, Okamoto N, Matsuura Y, Tamiya M, Suzuki H, Uehara N, Kobayashi M, Hirashima T, Kawase I. Clinical evaluation of endoscopic bronchial occlusion with silicone spigots for the management of persistent pulmonary air leaks. Intern Med 2011; 50:1169-73. [PMID: 21628931 DOI: 10.2169/internalmedicine.50.5016] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the clinical effectiveness of endoscopic bronchial occlusion (EBO) with endobronchial Watanabe spigots (EWSs), a type of silicone bronchial blocker, for managing prolonged pulmonary air leaks. PATIENTS AND METHODS Between October 2002 and April 2010, 24 patients with surgically incurable pulmonary air leaks underwent EBO with EWSs. The spigot was grasped with forceps and inserted into the affected bronchus by using a flexible bronchoscope through an endotracheal or a tracheostomy tube. RESULTS In each patient, at least one EWS (mean=2.8) was placed for air leaks due to pneumothorax (n=15), empyema (n=8), or postsurgical complications (n=1). Twelve patients (50%) had complete resolution of the air leaks and seven (29.2%) had a reduction in air leaks, but five (20.8%) showed no improvement. Twenty-three patients required thoracic drainage tubes, which were successfully removed after EBO in 15 patients (65.2%). Of the 24 patients, four experienced severe respiratory failure requiring mechanical ventilation but were successfully treated. Complications were spigot migration, atelectasis, pneumonia, and lung abscess, but none caused significant mortality. CONCLUSION EBO with EWSs seems to be a reasonable and manageable treatment option for patients with prolonged pulmonary air leaks, including those with severe respiratory failure requiring mechanical ventilation.
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Affiliation(s)
- Shinji Sasada
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Japan.
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Free anterolateral thigh combined flap for chronic postpneumonectomy empyema. Ann Thorac Surg 2010; 90:651-4. [PMID: 20667374 DOI: 10.1016/j.athoracsur.2010.01.074] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2009] [Revised: 12/31/2009] [Accepted: 01/06/2010] [Indexed: 11/20/2022]
Abstract
Management of postpneumonectomy empyema has always been a challenging task. Local flaps or free muscle flaps are options for recalcitrant cases when traditional therapeutic attempts fail. This report presents 2 patients with chronic postpneumonectomy empyema who were treated with an anterolateral thigh combined flap consisting of vastus lateralis and rectus femoris muscles. This method showed promising results for reconstruction of large empyema defect.
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Nosotti M, Cioffi U, De Simone M, Mendogni P, Palleschi A, Rosso L, Ciulla MM, Santambrogio L. Omentoplasty and thoracoplasty for treating postpneumonectomy bronchopleural fistula in a patient previously submitted to aortic prosthesis implantation. J Cardiothorac Surg 2009; 4:38. [PMID: 19630966 PMCID: PMC2723096 DOI: 10.1186/1749-8090-4-38] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2009] [Accepted: 07/24/2009] [Indexed: 11/10/2022] Open
Abstract
Bronchopleural fistula following pneumonectomy is a serious and frightening complication in chest surgery with a high mortality rate. The possibility of curing this complication using a conservative treatment is extremely poor. Below we describe a case of a patient affected by left pleural empyema due to a postpneumonectomy bronchopleural fistula. The patient had previously undergone an aortic prosthesis implantation. He was successfully treated using omental pedicle in order to cover the bronchial stump, to fill the pleural space and to protect the aortic prosthesis. He also underwent thoracoplasty to collapse the residual pleural space. The postoperative course was uneventful. During the follow-up, after thirty months, the patient was asymptomatic, and no recurrence of the fistula was present.
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Affiliation(s)
- Mario Nosotti
- Department of Surgery-Thoracic and Transplant Unit, Fondazione IRCCS Ospedale Maggiore Policlinico, Milano, Italy.
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50
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Shekar K, Foot C, Fraser J, Ziegenfuss M, Hopkins P, Windsor M. Bronchopleural fistula: an update for intensivists. J Crit Care 2009; 25:47-55. [PMID: 19592205 DOI: 10.1016/j.jcrc.2009.05.007] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2008] [Revised: 03/09/2009] [Accepted: 05/02/2009] [Indexed: 11/27/2022]
Abstract
Bronchopleural fistula is a potentially fatal condition that may result after a variety of clinical conditions, most commonly after pulmonary resection. Either surgical or bronchoscopic repair is required to definitively correct these lesions, though a small number may resolve spontaneously with optimal ventilatory care and other options available to an intensivist in the management of this complex condition. The successful management of a bronchopleural fistula depends on formulating a treatment strategy tailored to individual patient needs.
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Affiliation(s)
- Kiran Shekar
- Critical Care Research Group, The Prince Charles Hospital, Chermside 4032, Queensland, Australia.
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