Bronchopleural fistula: An update for intensivists

Shekar, Kiran; Foot, Carole; Fraser, John F.; Ziegenfuss, Marc; Hopkins, Peter; Windsor, Morgan

doi:10.1016/j.jcrc.2009.05.007

Cited by 75 publications

(92 citation statements)

References 79 publications

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“…Several studies have described tentative strategies to control BPF output during MV [1][2][3][4][5][6][7][8][9] . However, these studies are mostly case reports and reviews, which failed to present an adequate solution to complications such as pneumothorax, hemodynamic instability, persistent air leak and severe hypoxemia [8][9][10][11][12]16 .…”

Section: Discussionmentioning

confidence: 99%

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Hemodynamic, ventilatory and gasometric evaluation of an experimental bronchopleural fistula

Oliveira

Toneloto²,

Moreira

et al. 2015

Acta Cir. Bras.

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PURPOSE:To investigate the hemodynamic and ventilatory changes associated with the creation of an experimental bronchopleural fistula (BPF) treated by mechanical ventilation and thoracic drainage with or without a water seal. METHODS:Six large white pigs weighing 25 kg each which, after general anesthesia, underwent endotracheal intubation (6mm), and mechanically ventilation. Through a left thoracotomy, a resection of the lingula was performed in order to create a BPF with an output exceeding 50% of the inspired volume. The chest cavity was closed and drained into the water sealed system for initial observation of the high output BPF. RESULTS:Significant reduction in BPF output and PaCO 2 was related after insertion of a water-sealed thoracic drain, p< 0.05. CONCLUSION:Insertion of a water-sealed thoracic drain resulted in reduction in bronchopleural fistula output and better CO 2 clearance without any drop in cardiac output or significant changes in mean arterial pressure.

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Section: Discussionmentioning

confidence: 99%

“…It manifests initially as a tension pneumothorax that, after drainage, results in persistent air leak. The diagnosis is established when the drainage bottle shows continuous bubbling for more than 24hs [1][2][3][4][5][6][7][8][9][10] .…”

Section: Introductionmentioning

confidence: 99%

Hemodynamic, ventilatory and gasometric evaluation of an experimental bronchopleural fistula

Oliveira

Toneloto²,

Moreira

et al. 2015

Acta Cir. Bras.

View full text Add to dashboard Cite

show abstract

“…On arrival, she was invasively ventilated with inspi- heal [2]. Nevertheless, spontaneous breathing under mechanical ventilation with pneumatic trigger is quite impossible in patients with a large BPF because of autotriggering [7].…”

Section: Case Descriptionmentioning

confidence: 99%

“…Intercostal chest tubes are required to clear out the air accumulating in the pleural space and to drain coexisting pleural effusions. Spontaneous ventilation should be maintained whenever feasible [2]. When mechanical ventilation is required, the strategies for support rely on minimizing the air leak and maintaining acceptable gas exchange.…”

Section: Introductionmentioning

confidence: 99%

Effective Neurally Adjusted Ventilatory Assist (NAVA) Ventilation in a Child with a Large Bronchopleural Fistula

Jean-Michel¹,

Chenouard²,

Sebastien³

et al. 2018

Int J Crit Care Emerg Med

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“…It is a severe complication after pneumonectomy and carries a high mortality rate, ranging from 25% to 67% (2,3). The etiology of BPF includes incomplete tumor resection, use of steroids, intraoperative infection and prolonged postoperative mechanical ventilation as major risk factors of BPF (1). The clinical manifestations of BPF can be frequently classified as acute, subacute, or chronic.…”

Section: Introductionmentioning

confidence: 99%

One successful primary closure case of bronchopleural fistula after pneumonectomy by a new method

Shi

Wang

et al. 2017

J. Thorac. Dis.

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One case of successful primary closure of a bronchopleural fistula (BPF) after right pneumonectomy by sealing from both inside the chest cavity and bronchus is reported. The patient was a 47-year-old man who underwent right pneumonectomy due to right lung total collapse and atelectasis which was long-term compressed by a huge cyst inside the right chest cavity. A BPF was found on day 20 after surgery. A thoracotomy approach was performed because it was difficult to find an appropriate location for close drainage. Once the effusion and bloody coagulum was cleaned up from the right chest cavity, it was still difficult to find the bronchial stump because of the thick pleural fibrous membranes, and no visible fistula was found. Inside the chest cavity, a bright spot could be seen when the bronchoscope was inserted to the right bronchial stump. Anastomotic glue (OB Glue) was smeared on the bright spot and NEOVEIL (Gunze Co., Tokyo, Japan) was used to cover and reinforce the area. Meanwhile OB Glue (Gzbme Co., Guangzhou, China) was placed on the bronchial stump by bronchoscope. Closed drainage was performed after the operation. The patient recovered well having an uncomplicated postoperative course and was discharged 7 days after the treatment. there is no such case reported before. Case presentationA 47-year-old male patient, who had short of breath and chest distress for 1 week and was found to have a mass in the chest cavity 5 years ago. Chest DR and CT scan (Figure 1) showed a huge cystic space-occupying lesion in the right chest cavity and the right lung was completely compressed. Diagnosis before surgery was considered as teratoma. The cyst located in the right pleural cavity occupied most of the cavity. Cyst resection was planned and severe adhesion (Figure 2A) to chest wall and right lung was found during the operation. About 3,000 mL of brown and nepheloid liquid was extracted from the cyst. Most of the right visceral pleura were cut off because of serious adhesion. The right lung was completely compressed and atelectatic with severe air leakage when the cyst was completely resected, so a right pneumonectomy was made to prevent pyothorax and further complications. The cyst is about 30 cm × 20 cm in size ( Figure 2B,C), and pathological diagnosis confirmed simple cyst. The patient was discharged on postoperative day (POD) 6 with anemia and hypoproteinemia because of personal reasons and was readmitted on POD 20 for serious cough with plenty kermesinus begma. At the time of admission, the patient had WBC 3,190/mL, ALB 3.4 g/dL, HBG 80g/L, height 171 cm, weight 55.7 kg, heart rate 87/min, blood pressure 122/66 mmHg, temperature 36.5℃, and SpO 2 97%. BPF was suspected and radioscopy revealed air and multiple encapsulated effusion in the right chest cavity with no obvious fistula was found between bronchial stump and chest cavity (Figure 3). The effusion was encapsulated and partly organized, so a thoracotomy was planned to clean up the right cavity because it was hard to find an appropriate position to...

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Bronchopleural fistula: An update for intensivists

Cited by 75 publications

References 79 publications

Hemodynamic, ventilatory and gasometric evaluation of an experimental bronchopleural fistula

Hemodynamic, ventilatory and gasometric evaluation of an experimental bronchopleural fistula

Effective Neurally Adjusted Ventilatory Assist (NAVA) Ventilation in a Child with a Large Bronchopleural Fistula

One successful primary closure case of bronchopleural fistula after pneumonectomy by a new method

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