Natural history of bronchopleural fistula after pneumonectomy: A review of 96 cases

Hollaus, Peter H.; Lax, Franz; El-Nashef, Basem B.; Hauck, Herwig; Lucciarini, Paolo; Pridun, N

doi:10.1016/s0003-4975(97)00409-8

Cited by 132 publications

(95 citation statements)

References 14 publications

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“…2 When conventional methods of pulmonary isolation fail, anesthesia and surgery pose unusual challenges during the operative management of BPCF. 3,4 Careful planning and meticulous anesthetic management can transform a difficult case into a manageable one. 1 We extend this concept to the emergent airway management outside the OR and describe the "critical airway" (CA).…”

Section: Anesthetic Management Of Bronchopleurocutaneous Fistula -An mentioning

confidence: 99%

“…A rapid sequence induction and intubation is not always indicated or applicable. 3 3) The airway devices available are limited and the work environment suboptimal.…”

Section: Ramasamy Govindarajanmentioning

confidence: 99%

“…4,5 The inability to efficiently bag mask ventilate and the persistence to intubate a "full" stomach patient are at the core of most complications in the remote setting. 3 The CA is a dynamic concept that demands the anesthesiologist to be skilled in "all four dimensions" of the airway management techniques: bag mask ventilation (BMV), supraglottic airway (SGA; laryngeal mask airway, Combitube, laryngeal tube...), glottic airway (GA; laryngoscopy, endotracheal intubation, Eschmann), or infraglottic airway (IGA; cricothyroid membrane or surgical techniques); any of the techniques can be used as the first option (Figure).…”

Section: Ramasamy Govindarajanmentioning

confidence: 99%

“…3,4 Careful planning and meticulous anesthetic management can transform a difficult case into a manageable one. …”

mentioning

confidence: 99%

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“The critical airway”

Matioc

Arndt

2005

Can J Anesth/J Can Anesth

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A 48-yr-old man with a persistent left bronchopleurocutaneous fistula (BPCF) and empyema thoracis following pneumonectomy presented for bronchial stump closure and left thoracoplasty. The patient refused any attempts at awake intubation.He was placed in semi-recumbent position with the left side down after topicalization and mask induction. Right-sided double-lumen tube (DLT) placement was attempted while the patient was breathing spontaneously, but was unsuccessful in the absence of adequate muscle relaxation. Attempts to position a left bronchial blocker under fibreoptic guidance resulted in the balloon either slipping into the fistulous opening or backing up into the trachea. Advancing a single-lumen tube into the right main stem bronchus resulted in right upper lobe obstruction and attempted DLT insertion over a tube exchanger was also unsuccessful.When rescheduled, he was positioned and induced in the same manner as before and intubated with an 8.5 size endotracheal tube. Anesthesia was maintained with air, oxygen and sevoflurane using a Bain circuit, the patient breathing spontaneously. A triple-lumen central line and a transesopheal echocardiograph (TEE) were added to standard monitoring. The patient was positioned in the sitting position and stabilized in the appropriate frame, with his hands abducted and flexed forwards. The surgeon approached the BPCF through a left thoracotomy by transaxillary approach.Transtracheal jet-ventilation was delivered through the tip of a catheter placed above the level of fistula, to lessen the possibility of barotrauma. Anesthesia was maintained with an infusion of ketamine. During jet-ventilation PaO 2 values were 80 to 90 mmHg while PaCO 2 increased to 60 mmHg. The fistula was repaired and leak tested while purulent material from the left chest cavity was suctioned clean. Controlled ventilation restored blood gas levels towards normal. Left thoracoplasty was completed and the patient was extubated in the operating room. Postoperative pain control was achieved by a thoracic epidural catheter with continuous infusion of bupivacaine and fentanyl.While anesthetizing the patient with BPCF in the sitting position, oxygenation can be assured with jetventilation, and gravity aids in draining away purulent secretions from the trachea.1 CO 2 accumulation can be managed by limiting the surgical time and establishing controlled ventilation at the earliest opportunity. Hypotension can be corrected with crystalloid infusion. The hazard of air embolism can be monitored with TEE and treated with a triple lumen central venous catheter. 2When conventional methods of pulmonary isolation fail, anesthesia and surgery pose unusual challenges during the operative management of BPCF. 3,4 Careful planning and meticulous anesthetic management can transform a difficult case into a manageable one. Ramasamy Govindarajan

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Section: Anesthetic Management Of Bronchopleurocutaneous Fistula -An mentioning

confidence: 99%

“…A rapid sequence induction and intubation is not always indicated or applicable. 3 3) The airway devices available are limited and the work environment suboptimal.…”

Section: Ramasamy Govindarajanmentioning

confidence: 99%

Section: Ramasamy Govindarajanmentioning

confidence: 99%

“…3,4 Careful planning and meticulous anesthetic management can transform a difficult case into a manageable one. …”

mentioning

confidence: 99%

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“The critical airway”

Matioc

Arndt

2005

Can J Anesth/J Can Anesth

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“…(1) Nos casos específicos de fístulas do coto brônquico, a utilização de suturas com fios inabsorvíveis, a manutenção de adequada irrigação sanguínea do coto brônquico e a cobertura da broncorrafia com retalhos pediculados de tecidos intratorácicos (pleura parietal, gordura pericárdica, músculos intercostais) reduziram sua incidência de 50% na década de 50 para índices que, nos dias atuais, variam de 1,6% a 6,8%. (2,3) No entanto, as fístulas broncopleurais relacionadas com o parênquima pulmonar algumas vezes são de muito difí-cil controle e representam o fator que motivou o desenvolvimento deste estudo.…”

Section: Introductionunclassified

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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Pulmonary-Respiratory Medicine

2001

JAMA

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Natural history of bronchopleural fistula after pneumonectomy: A review of 96 cases

Cited by 132 publications

References 14 publications

“The critical airway”

“The critical airway”

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

Pulmonary-Respiratory Medicine

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