Endoscopic Diagnosis and Treatment of Postoperative Bronchopleural Fistula

York, Ernest L.; Lewall, David B.; Hirji, Mohamed; Gelfand, Elliot T.; Modry, Dennis L.

doi:10.1378/chest.97.6.1390

Cited by 77 publications

(29 citation statements)

References 6 publications

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“…Flexible bronchoscopy has been used to confirm and/or treat persistent BPF [157,158]. When a BPF is not clearly visible on bronchoscopy, selective bronchography at the suspected site may be utilised [159]. Alternatively, selective instillation of methylene blue into segmental bronchi with its subsequent appearance in the chest drainage may help confirm and localise BPF [160].…”

Section: Bronchopleural Fistula Treatmentmentioning

confidence: 99%

ERS statement: interventional bronchoscopy in children

et al. 2017

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Paediatric airway endoscopy is accepted as a diagnostic and therapeutic procedure, with an expanding number of indications and applications in children. The aim of this European Respiratory Society task force was to produce a statement on interventional bronchoscopy in children, describing the evidence available at present and current clinical practice, and identifying areas deserving further investigation. The multidisciplinary task force panel performed a systematic review of the literature, focusing on whole lung lavage, transbronchial and endobronchial biopsy, transbronchial needle aspiration with endobronchial ultrasound, foreign body extraction, balloon dilation and occlusion, laser-assisted procedures, usage of airway stents, microdebriders, cryotherapy, endoscopic intubation, application of drugs and other liquids, and caregiver perspectives. There is a scarcity of published evidence in this field, and in many cases the task force had to resort to the collective clinical experience of the committee to develop this statement. The highlighted gaps in knowledge underline the need for further research and serve as a call to paediatric bronchoscopists to work together in multicentre collaborations, for the benefit of children with airway disorders.

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Section: Bronchopleural Fistula Treatmentmentioning

confidence: 99%

ERS statement: interventional bronchoscopy in children

et al. 2017

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“…(26)(27)(28)(29) Kjaergard et al, (30) em um modelo semelhante ao desenvolvido em nosso estudo, submeteram um grupo de suí-nos a suturas pulmonares com aplicação de fibrina autó-loga (Vivostat-ConvaTec; Skillman NJ) e usaram um grupo controle em que as suturas pulmonares foram recobertas por albumina humana a 20%. Sob pressão positiva crescente na via aérea, testou-se a resistência de cada material ao "teste do borracheiro".…”

Section: Discussionunclassified

Estudo sobre a eficácia da aerostasia pulmonar, em modelo animal, utilizando diferentes tipos de suturas

Filho

2003

J. Pneumologia

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295Estudo sobre a eficácia da aerostasia pulmonar, em modelo animal, utilizando diferentes tipos de suturas Estudo sobre a eficácia da aerostasia pulmonar, em modelo animal, utilizando diferentes tipos de suturas * Study about the ability of the pulmonary aerostasia, in animal model, using differents parenchymal pulmonary types of the sutures DARCY Resultados: A média de pressão em que se observou perda do hermetismo pulmonar foi de 29cmH 2 O no tipo 1 (n = 10); 38,5cmH 2 O no tipo 2 (n = 10); 44cmH 2 O no tipo 3 (n = 10) e 51,4cmH 2 O no tipo 4 (n = 10). A comparação entre as médias mostrou diferença estatística apenas entre as suturas tipo 1 e as suturas tipo 3 e 4, p = 0,04 e p < 0,01. Conclusão:As suturas pulmonares com grampeadores revestidos por pericárdio bovino ou recobertos por cola biológica, quando comparadas às suturas que utilizaram fio cirúrgico isoladamente, mostraram maior eficácia em manter aerostasia pulmonar em pulmões de suínos. No entanto, não há diferença na eficácia em manter aerostasia pulmonar de suínos, quando se utilizaram suturas com grampeadores isolados ou revestidos por pericárdio bovino ou cola biológica. Background:The search for an ideal procedure to accomplish aerostasis, after partial surgical resection of the lung parenchyma, remains a practical challenge for the thoracic surgeon.Objective: The objective of this study was to compare the ability of four types of parenchymal pulmonary sutures in preventing air leaks, using a porcine model with incremental endobronchial pressures.Method: Ex vivo experimental study in porcine lungs (n = 5) at the Laboratory of Experimental Surgery of the Universidade de Caxias do Sul. Four different parenchymal pulmonary types of suture were analyzed: type 1 (absorbable suture), type 2: (stapled suture), type 3 (stapled suture with bovine pericardium) and type 4 (stapled suture with biologic glue). The surgical sutures (n = 40) were exposed to different intrabronchial pressure levels, varying from 10 cmH 2 O to 60 cmH 2 O. The presence of air leaks along the suture line was verified through the water seal maneuver. Results:The mean intrabronchial pressure level needed to cause suture line air leaks for each type were: type 1 (n = 10): 29 cmH 2 O; type 2 (n = 10): 38.5 cmH 2 O; type 3 (n = 10): 44 cmH 2 O; and type 4 (n = 10): 51.4 cmH 2 O. The comparison between the mean intrabronchial pressure level of type 1 and of types 2 and 3 sutures was statistically significant, respectively: p = 0.04 and p = 0.01. However, the comparison between types 2, 3 and 4 did not show statistic significance (p > 0.05). Conclusions:The pulmonary suture covered by biologic glue demonstrated more resistance to incremental levels of intrabronchial pressure. Parenchymal pulmonary sutures using stapled suture exclusively or stapled with bovine pericardium or biologic glue demonstrated an increased ability to avoid air leaks if compared to absorbable sutures in a model of porcine lung with incremental levels of intrabronchial pressure. There were no differences between...

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“…Bronchoscopic fistula closure usually entails application of fibrin or synthetic glues to plug the bronchial defect [2,4,5,8,11]. Fibrin glue is the most popular form of endoscopic fistula therapy.…”

Section: Discussionmentioning

confidence: 99%

“…Success rates of ∼50% are reported, but closure of a large fistula (>5 mm) is unusual with this technique [1]. Despite training in centers with experience in its use [5,11], one of us (J.D.U.) has become less enthusiastic about this therapy in recent years.…”

Section: Discussionmentioning

confidence: 99%

Bronchoscopic sclerotherapy combined with thoracoscopic drainage for postpneumonectomy bronchial fistula and empyema

1999

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A postpneumonectomy bronchial fistula is a very morbid complication that often requires major surgical procedures for treatment. Since patients with postpneumonectomy bronchial fistula and empyema are physiologically compromised, corrective surgical interventions pose considerable risk. We report a case of a postpneumonectomy fistula with an associated empyema. Our patient's empyema was treated with thoracoscopic debridement and antibiotic instillation (modification of the Clagett procedure). Bronchoscopic and thoracoscopic treatment strategies that are appropriate for selected patients with postpneumonectomy bronchial fistula and empyema are discussed.

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Endoscopic Diagnosis and Treatment of Postoperative Bronchopleural Fistula

Cited by 77 publications

References 6 publications

ERS statement: interventional bronchoscopy in children

ERS statement: interventional bronchoscopy in children

Estudo sobre a eficácia da aerostasia pulmonar, em modelo animal, utilizando diferentes tipos de suturas

Bronchoscopic sclerotherapy combined with thoracoscopic drainage for postpneumonectomy bronchial fistula and empyema

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