An Innovative Solution for Prolonged Air Leaks

Mehta, Ravindra; Singla, Abhinav; Bhat, Rajani; Godara, Rakesh; Lokanath, Chakravarthi; Cutaia, Michael

doi:10.1097/lbr.0000000000000459

Cited by 10 publications

(6 citation statements)

References 29 publications

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“…However, they are also available in limited sizes (5-7 mm), are expensive and migration rates are high. 15 The CESB device was described in 2018 for the management of PALs in 31 patients, 11 with complete cessation of PAL with these devices in 84% and reduction by more than 50% in another 6% of patients. The CESB was successfully deployed for both BPF and APF, with sizes used from 4 to 20 mm.…”

Section: Discussionmentioning

confidence: 99%

“…A review of the literature mentions various bronchoscopic sealants and occlusive devices for less critical situations, and different options based on whether it is an APF or BPF and the size of the bronchus. [5][6][7][8][9][10][11]15 However, there is scant data on CARDS with PAL. Sealants close the fistula with an adhesive-like substance.…”

Section: Discussionmentioning

confidence: 99%

“…[5][6][7][8][9][10] Expanding the armamentarium for PAL therapy, in 2018 we described an innovative method of PAL treatment using a customized endobronchial silicone blocker (CESB) via rigid bronchoscopy in 31 patients, with a success rate of 84%. 11 CARDS was associated with significant barotrauma and PAL, especially in patients receiving higher doses of steroids and positive pressure ventilation for respiratory failure. PAL's were challenging to treat and associated with worse outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…Various bronchoscopic substances and devices have been developed to occlude an identified BPF or the segment related to the APF, which allows parenchymal rest and promotes distal healing, with variable success rates 5–10 . Expanding the armamentarium for PAL therapy, in 2018 we described an innovative method of PAL treatment using a customized endobronchial silicone blocker (CESB) via rigid bronchoscopy in 31 patients, with a success rate of 84% 11 …”

Section: Introductionmentioning

confidence: 99%

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A customized multimodality approach for prolonged air leaks (PAL) in mechanically ventilated patients

Bansal

Furtado

Kalpakam

et al. 2023

Respirology Case Reports

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ARDS in general and severe COVID ARDS (CARDS) is particularly associated with high rates of barotrauma. Two cases with severe CARDS developed bilateral pneumothorax with persistent air leak (PAL). Conservative management with prolonged chest tube drainage did not help in PAL resolution and both patients continued to be on high‐end ventilatory support. The course was further complicated by the presence of septic shock. The 1st patient was taken up for a challenging procedure after spending 23 days on the mechanical ventilator. Diagnostic pleuroscopy revealed left‐sided bullae and a surgical staple bullectomy was done. The right side showed a large bronchopleural fistula (BPF) on pleuroscopy, which was occluded using a customized endobronchial silicone blocker (CESB, described in 2018). This led to the reduction and finally, resolution of the bilateral PAL with subsequent removal of chest drains and weaning off the ventilator and oxygen. The second patient was managed with 2 CESB devices for occlusion of RUL anterior and posterior segment fistulae, followed by chest drain removal. These cases highlight effective out‐of‐the‐box multimodality treatment using a combination of interventional pulmonary techniques and surgical stapling for a life‐threatening bilateral PAL secondary to CARDS.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

A customized multimodality approach for prolonged air leaks (PAL) in mechanically ventilated patients

Bansal

Furtado

Kalpakam

et al. 2023

Respirology Case Reports

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“…Persistent air leaks are known to prolong ICU stay and are associated with worse clinical outcomes [ 5 , 6 ]. Endobronchial treatment for persistent air leaks has been described by a number of techniques, using valves, spigots, and a combination of autologous blood with hemostatic synthetic material [ [7] , [8] , [9] , [10] , [11] ]. Autologous blood-patch repair with thrombin has been described only recently [ 4 , 8 , 12 ], and only once at bedside [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

Endobronchial blood-patch: A novel technique for a persistent pleural air leak

Durrance

D'Souza

Obata

et al. 2022

Respiratory Medicine Case Reports

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Silicone blockers for bronchial leaks: Expanding the literature base with a larger and longer experience in this complex entity

Bansal,

Chokhani,

Mehta

2024

Respirology Case Reports

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To the Editor We noted with interest the case series presented by Zhao et al., 1 on selective bronchial occlusion using a customized silicone blocker for broncho-biliary fistula. Certain key aspects deserve mention:1. There is scant literature on the use of occlusive blockers as an effective strategy in bronchial or alveolar fistulae, and most of the available literature pertains to PAL (prolonged air leak), which is either due to alveolar pleural fistula (APF) or bronchopleural fistula (BPF). 2. We have reported in 2 publications, the use of a similar blocker indigenously produced and named by us as the CESB (customize endobronchial silicon blocker). The CESB is made on the spot using readily available silicon stents, and shown to be an effective strategy for PAL. In our report, the success rate of these was 83.3%. We suggest the authors check the relevant publications referenced below, 2,3 one of which is in the same journal (Respirology Case Reports). In our opinion, our innovation is described earlier and has many advantages, and the discussion and review of literature of this report will be augmented with a comparison of both devices and referencing our articles. 3. To add to this further, the cardinal difference between the blocker used by the authors and our blocker (CESB) is that ours can be made by anybody using easily available material, while the personalized silicone plugs used by the authors seem to be commercially manufactured in the country of the report. The CESB can be customized on site, has a mild and easy learning curve with the technique well described in the referenced paper. The distinct advantage is ease of production, applicability in any part of the world, and sizing as per requirement, with adjustment in case there is any sizing issue. 4. Of note, the suture applied to the blocker to facilitate insertion/removal is very similar to our technique described in the publication in 2018, 2 referred by us as a 'bucket handle stitch', to facilitate removal of the blocker after the primary problem with the PAL was resolved. (Figure 1) 5. In summary, these innovative techniques help in these complex situations where options are few, stakes are high and favourable outcomes can be achieved in a short span of time. Our addition to literature with the CESB precedes this report with experience in a much larger cohort of patients for a longer duration, albeit in a PAL situation.

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An Innovative Solution for Prolonged Air Leaks

Abstract: CESBs represent a safe, effective, and innovative approach in the management of PAL. They should be considered in patients who are not surgical candidates, fail surgery, or those who have a recurrence following surgery.

Cited by 10 publications

References 29 publications

A customized multimodality approach for prolonged air leaks (PAL) in mechanically ventilated patients

A customized multimodality approach for prolonged air leaks (PAL) in mechanically ventilated patients

Endobronchial blood-patch: A novel technique for a persistent pleural air leak

Silicone blockers for bronchial leaks: Expanding the literature base with a larger and longer experience in this complex entity

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