Detachable balloon occlusion of bronchopleural fistulae in dogs

Central bronchopleural fistulas closed by bronchoscopic injection of absolute ethanol

Five consecutive bronchopleural fistulas (BPFs) were successfully treated by injecting absolute ethanol directly into the submucosal layer of the fistula under flexible bronchoscopic observation. No complications occurred as a result of this treatment. Our nonsurgical treatment may be very useful to reduce the costs of and duration of hospitalization and to improve the patient's quality of life. This is the first report of the bronchoscopic closure of BPFs by injecting absolute ethanol, and we would recommend this treatment as a first-line therapy for patients with a postoperative central BPF with an orifice that is < 3 mm in diameter.

Treatment of peripheral bronchopleural fistulas with endobronchial occlusion coils

Persistent peripheral bronchopleural fistulas can be difficult to manage. Endoscopic plugging of involved bronchi has been accomplished in a number of ways. We have devised a method of permanently blocking small peripheral airways using Gianturco vascular occlusion coils placed endobronchially by modified angiographic techniques. This procedure has been applied in 5 cases of complicated parenchymal air leaks. Complete or substantial partial control was achieved in all cases. There were no complications.

Endobronchial vascular occlusion coils for control of a large parenchymal bronchopleural fistula

Angiographic occlusion coils placed endobronchially under fluoroscopic guidance succeeded in controlling a large parenchymal bronchopleural fistula after failure of surgical treatment and transbronchoscopic fibrin glue application.

Medical management and therapy of bronchopleural fistulas in the mechanically ventilated patient

Bronchopleural fistulas are associated with high morbidity and mortality and are particularly challenging in the ventilated patient. Familiarity with both basic and more technical medical management techniques may lessen morbidity and improve survival. Prompt recognition of BPFs and appropriate placement of a chest tube with an adequate suction device are crucial to prevent potential tension pneumothorax and to drain an infected pleural space. The chest tube may be used therapeutically to decrease BPF air leak and to promote fistula repair. Appropriate conventional ventilator manipulations aimed at decreasing fistula air leak and maintaining adequate oxygenation and ventilation may fail and necessitate a trial of HFV. Definitive therapy by the bronchoscopic application of a sealing agent to occlude the fistula site can be used, particularly in the poor surgical candidate.

The performance of four pleural drainage systems in an animal model of bronchopleural fistula

In order to compare the performance of four pleural drainage units (PDU [Emerson Post-Operative Pump, Pleur-Evac, Sentinel Seal, Thora-Klex]), we created an animal model of bronchopleural fistula that simulated the type of air leak seen clinically (mean maximal flow = 5 L/min). The PDU were tested at 0 cm (water seal), -20 cm and -40 cmH2O suction. Compared to water seal, -20 cmH2O suction significantly increased the ability of all four PDU to evacuate air via the chest tube and abolished small differences in chest tube air leak seen among the PDU at water seal. An increase in suction to -40 cmH2O did not significantly alter flow via the chest tube. Previously demonstrated differences among the PDU in handling large air flows were not seen in this lower flow model of bronchopleural fistula. However, because of their higher resistance, use of the Sentinel Seal and of the Thora-Klex was technically impractical even at air leaks of 4 to 5 L/min.

Fiberoptic bronchial blockade in a small bronchopleural fistula

A patient with bronchopleural fistula was successfully treated by selective intrabronchial injection of doxycycline and blood under fiberoptic bronchoscopic guidance. This simple and relatively noninvasive therapeutic approach is an effective and safe alternative in treating selective patients with a bronchopleural fistula.