Bronchoscopic management of bronchopleural fistula with intrabronchial instillation of glue (N-butyl cyanoacrylate)

Chawla, Rakesh K.; Madan, Arun; Bhardwaj, PK; Chawla, Kiran

doi:10.4103/0970-2113.92350

Cited by 28 publications

(28 citation statements)

References 13 publications

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“…Among the sealants reported are autologous blood [15, 16], fibrin glue [24], cyanoacrylate glue [25, 26], oxidized cellulose [27], albumin-glutaraldehyde glue [28], and hydrogel [29]. Autologous blood was used as the injection material to treat pneumothorax and PAL, not only because of its favourable bioadhesive properties, but also because it is relatively safe and is easily archived [15].…”

Section: Discussionmentioning

confidence: 99%

Management of Persistent Air Leaks Using Endobronchial Autologous Blood Patch and Spigot Occlusion: A Multicentre Randomized Controlled Trial in China

Zhang¹,

Xie²,

Gu³

et al. 2019

Respiration

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Background: Optimal management of persistent air leaks (PALs) in patients with secondary spontaneous pneumothorax (SSP) remains controversial. Objective: To evaluate the efficacy and safety of endobronchial autologous blood plus thrombin patch (ABP) and bronchial occlusion using silicone spigots (BOS) in patients with SSP accompanied by alveolar-pleural fistula (APF) and PALs. Methods: This prospective multicentre randomized controlled trial compared chest tube-attached water-seal drainage (CTD), ABP, and BOS that were performed between February 2015 and June 2017 in one of six tertiary care hospitals in China. Patients diagnosed with APF experiencing PALs (despite 7 days of CTD) and inoperable patients were included. Outcome measures included success rate of pneumothorax resolution at the end of the observation period (further 14 days), duration of air leak stop, lung expansion, hospital stay, and complications. Results: In total, 150 subjects were analysed in three groups (CTD, ABP, BOS) of 50 each. At 14 days, 60, 82, and 84% of CTD, ABP, and BOS subjects, respectively, experienced full resolution of pneumothorax (p = 0.008). All duration outcome measures were significantly better in the ABP and BOS groups than in the CTD group (p < 0.016 for all). The incidence of adverse events, including chest pain, cough, and fever, was not significantly different. All subjects in the ABP and BOS groups experienced temporary haemoptysis. Spigot displacement occurred in 8% of BOS subjects. Conclusion: ABP and BOS resulted in clinically meaningful outcomes, including higher success rate, duration of air leak stop, lung expansion, and hospital stay, with an acceptable safety profile.

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Section: Discussionmentioning

confidence: 99%

Management of Persistent Air Leaks Using Endobronchial Autologous Blood Patch and Spigot Occlusion: A Multicentre Randomized Controlled Trial in China

Zhang¹,

Xie²,

Gu³

et al. 2019

Respiration

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“…Chawla et al treated nine patients with N-butyl-cyanoacrylate glue and were able to seal the air leak successfully in eight. 42 In one patient, a bronchial defect > 8 mm post-right pneumonectomy could not be sealed. All other patients successfully proceeded to chest drain removal and no complications were observed during 6 months of follow up.…”

Section: Tissue Glues and Sealantsmentioning

confidence: 95%

Management of Pneumothorax and Prolonged Air Leak

Slade

2014

Semin Respir Crit Care Med

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Pneumothorax refers to the presence of air within the pleural cavity, which may arise from a spontaneous defect in the visceral pleural surface, or through iatrogenic or other thoracic trauma. The most common cause in the developed world is iatrogenic pneumothorax. Most frequently, it can be managed conservatively or through simple pleural aspiration or drainage. A persistent air leak, >2 days' duration, develops in one-third of patients. When patients are managed with chest drainage alone, the median time for resolution of air leak is longer in patients with a pneumothorax secondary to an underlying lung disease (11 vs. 7 days). Interventional pulmonology is not usually required for the resolution of simple pneumothorax, but offers important minimally invasive techniques for treating persistent air leak and bronchopleural fistula. Following assessment of the site of the air leak within the bronchial tree, techniques are described for the sealing of leak using tissue or fibrin glues, endobronchial devices of various kinds, and combination approaches. Bronchoscopic sealing of air leaks can often avoid the requirement for thoracic surgical intervention. They may prove life-saving in patients who are difficult to wean from mechanical ventilation or extracorporeal membrane oxygenation because of catastrophic air leaks.

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“…Risk factors associated with BPF incidence are technical errors, anemia, hypoproteinemia, steroid use, etc. (8). Anemia and hypoproteinemia resulted an undesirable healing leading to a BPF after right pneumonectomy to this patient.…”

Section: Discussionmentioning

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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Bronchoscopic management of bronchopleural fistula with intrabronchial instillation of glue (N-butyl cyanoacrylate)

Cited by 28 publications

References 13 publications

Management of Persistent Air Leaks Using Endobronchial Autologous Blood Patch and Spigot Occlusion: A Multicentre Randomized Controlled Trial in China

Management of Persistent Air Leaks Using Endobronchial Autologous Blood Patch and Spigot Occlusion: A Multicentre Randomized Controlled Trial in China

Management of Pneumothorax and Prolonged Air Leak

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

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