Perioperative Management of Shock in Two Fontan Patients With Plastic Bronchitis

Singhal, Niel Raj; Cruz, Eduardo M. da; Nicolarsen, Jeremy; Schwartz, Lawrence; Merritt, Glenn; Barrett, Cindy; Twite, Mark; Ing, Richard J.

doi:10.1177/1089253213475879

Cited by 8 publications

(4 citation statements)

References 23 publications

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“…According to the relevant published literature, PB is characterized by a high rate of mortality, i.e., about 50% [ 1 ]. The available data are inconclusive; however, the worst prognoses have been observed in patients after the Fontan procedure [ 42 ]. Brogan et al [ 23 ] conducted the follow-up of their 42 patients with PB over a much longer period of time (1991–2001).…”

Section: Discussionmentioning

confidence: 99%

Plastic Bronchitis—A Serious Rare Complication Affecting Children Only after Fontan Procedure?

Pałyga-Bysiecka

Polewczyk

Kołodziej

et al. 2021

JCM

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Background: Plastic bronchitis (PB) may occur not only in children following palliative Fontan procedure but also in those without underlying heart disease. We aim to assess the clinical course, therapeutic measures, outcome, and follow-up of PB in children with congenital heart disease (CHD) and children without cardiac problems. Methods: This retrospective case series assessed children with PB admitted to hospital between 2015 and 2019. Parents or guardians of patients were contacted by e-mail or telephone between September 2017 and June 2019 to enquiry about recurrence of PB and strategy of treatment. The diagnosis of PB was based on the expectoration (spontaneous or during bronchoscopy) of endobronchial plugs. Results: This study delineated the clinical, histological, and laboratory features of plastic bronchitis in children following Fontan procedure (Group A) and in those without heart defects (Group B, non-CHD children). The main symptoms were cough accompanied by dyspnea, and hypoxemia with a decrease in oxygen saturation, often leading to acute respiratory failure. In children with CHD, the first episode of PB occurred at a relatively young age. Although chronic, i.e., lasting more than 3 weeks, inhaled therapy was implemented in both groups of patients, the recurrences of PB were observed. The mean time to PB recurrence after the first episode in Group A was longer than that in Group B (1.47 vs. 0.265 years, p = 0.2035). There was no re-episode with recurrence of PB in 3 cases out of 10 in total in Group A (30%) and 1 case out of 4 in total in Group B (25%). While the majority of children in Group A usually developed bronchial casts on the right side, the patients in Group B (without CHD) suffered from bronchial casts located only on the left side. Conclusions: Despite many similarities, clinical, histological, and laboratory studies in the children with plastic bronchitis after Fontan’s surgery and in children without heart defects suggest that there are differences in the course of the disease in patients without CHD, such as a more advanced age of the first episode of PB, the location of plastic casts on the left side, and a stronger role of inflammatory factors and mechanisms. Further research is needed to understand the pathophysiology of PB and choose the most appropriate therapy.

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Section: Discussionmentioning

confidence: 99%

Plastic Bronchitis—A Serious Rare Complication Affecting Children Only after Fontan Procedure?

Pałyga-Bysiecka

Polewczyk

Kołodziej

et al. 2021

JCM

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“…A meta‐analysis of acute lung injury in animals showed that, compared to controls, t‐PA improved survival, arterial pO 2 and pCO 2 better than either urokinase plasminogen activator or plasmin, although none of the studies included viral‐induced ARDS 50 . In other studies, intra‐airway delivered t‐PA improved survival and morbidity associated with acute plastic bronchitis crisis, in which intra‐airway clotting occurs 46,53–60 . Both nebulized and direct instillation of t‐PA into the airways via bronchoscopy have been used off‐label to treat fibrin airway casts 61 .…”

Section: Fibrinolysis Ards and The Possible Role Of Fibrinolytic Thmentioning

confidence: 99%

“…50 In other studies, intra-airway delivered t-PA improved survival and morbidity associated with acute plastic bronchitis crisis, in which intra-airway clotting occurs. 46,[53][54][55][56][57][58][59][60] Both nebulized and direct instillation of t-PA into the airways via bronchoscopy have been used off-label to treat fibrin airway casts. 61 In a lethal animal model of both severe pulmonary microvascular thrombi and severe bronchial…”

Section: Fibrinolysis Ards and The Possible Role Of Fibrinolytic Therapy In Covid-19mentioning

confidence: 99%

Fibrinolytic therapy for refractory COVID‐19 acute respiratory distress syndrome: Scientific rationale and review

Barrett

Moore

et al. 2020

Research and Practice in Thrombosis and Haemostasis

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The coronavirus disease 2019 (COVID‐19) pandemic has caused respiratory failure and associated mortality in numbers that have overwhelmed global health systems. Thrombotic coagulopathy is present in nearly three quarters of patients with COVID‐19 admitted to the intensive care unit, and both the clinical picture and pathologic findings are consistent with microvascular occlusive phenomena being a major contributor to their unique form of respiratory failure. Numerous studies are ongoing focusing on anticytokine therapies, antibiotics, and antiviral agents, but none to date have focused on treating the underlying thrombotic coagulopathy in an effort to improve respiratory failure in COVID‐19. There are animal data and a previous human trial demonstrating a survival advantage with fibrinolytic therapy to treat acute respiratory distress syndrome. Here, we review the extant and emerging literature on the relationship between thrombotic coagulopathy and pulmonary failure in the context of COVID‐19 and present the scientific rationale for consideration of targeting the coagulation and fibrinolytic systems to improve pulmonary function in these patients.

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“…Children present with dyspnea, coughing, wheezing, tachypnea, and cyanosis. [1][2][3] Anesthetic management for bronchoscopic removal of casts can be challenging because children are often apprehensive, uncooperative, and in respiratory distress from critical airway compromise. Because positive pressure ventilation can potentially displace casts distally, inhalational mask induction and preservation of spontaneous breathing is prudent in patients with non-tenuous cardiopulmonary status.…”

mentioning

confidence: 99%

Plastic Bronchitis

Chhabada

Khanna

2020

Anesthesiology

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Perioperative Management of Shock in Two Fontan Patients With Plastic Bronchitis

Cited by 8 publications

References 23 publications

Plastic Bronchitis—A Serious Rare Complication Affecting Children Only after Fontan Procedure?

Plastic Bronchitis—A Serious Rare Complication Affecting Children Only after Fontan Procedure?

Fibrinolytic therapy for refractory COVID‐19 acute respiratory distress syndrome: Scientific rationale and review

Plastic Bronchitis

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