High frequency oscillatory ventilation in the management of a high output bronchopleural fistula: a case report

Ha, D.; Johnson, David H.

doi:10.1007/bf03018553

Cited by 39 publications

(19 citation statements)

References 25 publications

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“…2 In a recent case report, HFOV has been described as a useful technique to manage a high output BPF when conventional positive pressure ventilation failed. 5 However, older studies did not show better outcomes in terms of gas exchange, airway pressures, or air leak. 6,7 Few articles describe the combination of high frequency ventilation with spontaneous breathing.…”

Section: Discussionmentioning

confidence: 98%

High frequency ventilation combined with spontaneous breathing during bronchopleural fistula repair: a case report

Poulin

Vaillancourt

Somma

et al. 2008

Can J Anesth/J Can Anesth

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Purpose We report the addition of high frequency oscillatory ventilation (HFOV), combined with spontaneous breathing under general anesthesia, during an uncommon technique to occlude a late post-pneumonectomy bronchopleural fistula. Clinical features A 41-year-old woman underwent an extended right pneumonectomy with chest wall resection and prosthetic reconstruction for a large adenocarcinoma of the upper lobe (T3N0M0). Her postoperative recovery was satisfactory, and she subsequently received adjuvant chemotherapy. Four months later, however, she was readmitted for investigation of confusion and pink expectorations. On cerebral magnetic resonance imaging, a frontal metastasis with surrounding edema was discovered, as well as a possible secondary lesion in the occipital lobe. In view of the comorbidities, thoracoscopy was planned as an interim measure, with the goal being to debride the fistula and to seal the prosthetic plug. During this case, a HFOV system was used to allow an addition of 2.5 LÁmin -1 of minute ventilation to the patient's spontaneous respiration, while maintaining eucapnia without increasing airway pressure.Conclusions With the addition of high frequency ventilation under general anesthesia in a patient with a persistent bronchopleural fistula, the PaCO 2 level was adequately controlled during the simultaneous use of fibreoptic bronchoscopy and video assisted thoracoscopy to facilitate a successful surgical repair. RésuméObjectif Nous rapportons l'ajout du mode de ventilation ah aute fre´quence par oscillation (VHFO) a`la respiration spontane´e sous anesthe´sie ge´ne´rale pendant une technique peu commune visant a`re´aliser l'occlusion d'une fistule bronchopleurale survenue a`la suite d'une pneumonectomie. É léments Cliniques Une patiente de 41 ans a subi une pneumonectomie droite extensive avec re´section de la paroi thoracique et reconstruction prothe´tique en traitement d'un important ade´nocarcinome du lobe supe´rieur (T3N0M0). Sa re´cupe´ration postope´ratoire fut satisfaisante et elle reçut par la suite une chimiothe´rapie adjuvante. Cependant, quatre mois plus tard, elle fut re´admise al 'hôpital pour un examen approfondi de troubles de confusion et d'expectorations rose´es. La re´sonance magne´tique ce´re´brale re´ve´la une me´tastase frontale entoure´e d'un oede`me, ainsi qu'une le´sion secondaire potentielle au niveau du lobe occipital. E´tant donne´les comorbidite´s, une thoracoscopie a e´te´pre´vue comme mesure inte´rimaire, et dont l'objectif e´tait de de´brider la fistule et sceller le bouchon prothe´tique. Pendant cette

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Section: Discussionmentioning

confidence: 98%

High frequency ventilation combined with spontaneous breathing during bronchopleural fistula repair: a case report

Poulin

Vaillancourt

Somma

et al. 2008

Can J Anesth/J Can Anesth

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“…[8][9][10][11] Furthermore, anecdotal reports suggest that HFOV may be effective in adults with bronchopleural fistula. 3,4 Ha et al reported a 55-year-old with empyema who developed bronchopleural fistula following decortication. 4 There was substantial air leak via the bronchopleural fistula with the high PIP on conventional mechanical ventilation, but HFOV was associated with much less air leak and improved oxygenation and ventilation in that patient.…”

Section: Discussionmentioning

confidence: 99%

“…4,6 Persistent bronchopleural fistula during mechanical ventilation can lead to pneumothorax and ventilation-perfusion mismatch. 6 Since much of the inspired volume exits through the fistula rather than going to the alveoli, alveolar ventilation may profoundly decrease and cause moderate to severe respiratory acidosis.…”

Section: Discussionmentioning

confidence: 99%

“…In this setting, high-frequency oscillatory ventilation (HFOV) may be more effective than conventional mechanical ventilation because it avoids cyclic stretching of lung and pleural tissue, thus increasing the likelihood that the bronchopleural fistula will spontaneously seal. 3,4 We present the case of a previously healthy 8-month-old infant with community-acquired-MRSA pneumonia complicated by bronchopleural fistula, who failed conventional mechanical ventilation and was subsequently successfully supported with HFOV.…”

Section: Introductionmentioning

confidence: 99%

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High-Frequency Oscillatory Ventilation in an Infant With Necrotizing Pneumonia and Bronchopleural Fistula

et al. 2011

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“…Ventilator strategies utilizing reduced tidal volumes, PEEP, and inspiratory times are used to limit air flow through a BPF and promote healing [81][82][83][84]. Additional alternative methods of ventilation have also been tried including selective intubation of the healthy lung, double lumen intubation with independent ventilation, high-frequency oscillatory ventilation, high-frequency jet ventilation, and extracorporeal support methods [81,82,85,86]. Differential lung ventilation with either selective mainstem bronchial intubation or double lumen intubation reduces or eliminates air flow to the lung with the BPF but requires the unaffected lung to be healthy enough to support ventilation and oxygenation.…”

Section: Persistent Bronchopleural Fistulamentioning

confidence: 99%

Management options for the complicated pleural space

Hsia

Musani

2013

Curr Respir Care Rep

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Clinicians frequently encounter patients with malignant and benign diseases involving the pleural space.Complications from these disease processes pose clinical challenges that often require a multi-disciplinary management approach. Here we discuss therapeutic options available for complicated diseases of the pleural space, including loculated malignant effusions, complicated pleural infections, hemothorax, nonexpanding lung, pleural thickening, and persistent bronchopleural fistulas. Our objective is to review current literature on management of these complex issues.

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High frequency oscillatory ventilation in the management of a high output bronchopleural fistula: a case report

Abstract: We report the successful use of HFOV in a patient with high output BPF. We suggest that HFOV is a useful technique in patients with a BPF when conventional positive pressure ventilation fails.

Cited by 39 publications

References 25 publications

High frequency ventilation combined with spontaneous breathing during bronchopleural fistula repair: a case report

High frequency ventilation combined with spontaneous breathing during bronchopleural fistula repair: a case report

High-Frequency Oscillatory Ventilation in an Infant With Necrotizing Pneumonia and Bronchopleural Fistula

Management options for the complicated pleural space

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