Bronchopleural Fistula Resolution with Endobronchial Valve Placement and Liberation from Mechanical Ventilation in Acute Respiratory Distress Syndrome: A Case Series

Abstract

Patients who have acute respiratory distress syndrome (ARDS) with persistent air leaks have worse outcomes. Endobronchial valves (EBV) are frequently deployed after pulmonary resection in noncritically ill patients to reduce and eliminate bronchopleural fistulas (BPFs) with persistent air leak (PAL). Information regarding EBV placement in mechanically ventilated patients with ARDS and high volume persistent air leaks is rare and limited to case reports. We describe three cases where EBV placement facilitated endotracheal extubation in patients with severe respiratory failure on prolonged mechanical ventilation with BPFs. In each case, EBV placement led to immediate resolution of PAL. We believe endobronchial valve placement is a safe method treating persistent air leak with severe respiratory failure and may reduce days on mechanical ventilation.

Endobronchial Valves for the Treatment of Bronchopleural Fistula and Pneumothorax Caused by Pulmonary Cryptococcosis in an AIDS Patient

“…Furthermore, EBVs can be easily removed when the air leaks are resolved to allow adequate time for tissue healing (11). We summarized the published cases using EBVs for PAL(s) in Table 1 (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27). Only three cases were of patients with AIDS, and our case was the only patient whose SP was secondary to PC.…”

Endobronchial One-Way Valve Therapy Facilitates Weaning from Extracorporeal Membrane Oxygenation in a Patient with ARDS and Persistent Air Leak

“…To date, only a few reports exist on mechanically ventilated, critically ill patients with PAL [ 10 ], and there is little practical knowledge in the treatment of PAL in patients with ARDS. Recently, a case series described endobronchial one-way valve placement as a feasible procedure in those patients [ 7 ].…”

“…There is little practical knowledge in the treatment of PAL in mechanically ventilated patients with acute respiratory distress syndrome (ARDS) [ 7 ] and even less experience in patients with ARDS and PAL, treated with veno-venous extracorporeal membrane oxygenation (vvECMO) [ 8 ].…”

Management der postoperativ prolongierten Parenchymfistel

“…Bei kritisch kranken Patienten unter intensivmedizinischer Behandlung mit akutem ARDS kommen viele andere Verfahren aufgrund des kritischen Gesamtzustands des Patienten nicht infrage. Trotz kleiner Fallzahlen gibt es bereits Veröffentlichungen, welche den Nutzen und Therapieerfolg einer endobronchialen Ventilimplantation bei Parenchymfistel gerade auch zum schnelleren Weaning zeigen [34].…”