Persistent air leak - review

Sakata, Keiko; Reisenauer, Janani; Kern, Ryan; Mullon, John J.

doi:10.1016/j.rmed.2018.03.017

Cited by 51 publications

(63 citation statements)

References 61 publications

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“…Most persistent air leaks resolve spontaneously, and the insertion of chest tubes are the initial treatment of choice. However, the best approach to persistent air leaks that do not heal remains controversial [4,6,7]. During the first days of hospitalization, severe airway obstruction due to enlarged mediastinal lymph nodes caused significant parenchymal emphysema and an air leak that could not be controlled with drainage tubes.…”

Section: Discussionmentioning

confidence: 99%

“…In this case, because HFOV had failed, more aggressive management was considered, with the main treatment options being selective left main bronchus intubation or occlusion of the main bronchus of the affected lung to prevent air from escaping through the bronchopleural fistula [4,6]. Several techniques have been used to occlude the bronchi, but none have been widely studied.…”

Section: Discussionmentioning

confidence: 99%

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A Case of Persistent Air Leak Managed by Selective Left Main Bronchus Intubation in an Infant with Pulmonary Tuberculosis

et al. 2020

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Unusual clinical course Background: Persistent air leak, or persistent pneumothorax, is defined as a pneumothorax that persists beyond the first week, or air leak through a chest drain for more than 48 hours. The most common findings in pediatric pulmonary tuberculosis are parenchymal disease and mediastinal lymphadenopathy, but airway obstruction can cause emphysema and pneumothorax. A case is presented of persistent air leak in a 3-month-old infant with pulmonary tuberculosis that was managed by selective left main bronchus intubation. Case Report: A 3-month-old boy presented with respiratory distress and fever. Imaging findings suggested pulmonary tuberculosis, and first-line anti-tuberculous treatment was initiated with isoniazid, rifampicin, pyrazinamide, and ethambutol (HRZE). He was discharged home after eight days, but was admitted four days later with respiratory distress. Chest X-rays showed a tension pneumothorax that required drainage and chest computed tomography (CT) showed right lung emphysema. Bronchoscopy found extrinsic obstruction of both main bronchi. Chest drains continued to leak air leak after 48 h. Right middle and lower lobectomy and drainage of multiple lymph nodes resulted in significant improvement. He developed pneumonia and acute respiratory distress syndrome, which prevented mechanical ventilation. The left main bronchus was selectively intubated to allow the air leak to heal and to ventilate the lung. He was extubated 10 days later and recovered completely. Conclusions: This case highlights that when medical management of persistent air leak associated with tuberculosis is not effective, surgery, active ventilation, and selective main bronchus intubation should be considered.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A Case of Persistent Air Leak Managed by Selective Left Main Bronchus Intubation in an Infant with Pulmonary Tuberculosis

et al. 2020

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“…Postoperative bronchopleurale Fisteln (BPF) stellen eine seltene Komplikation mit einer hohen Morbidität und Mortalität dar [1-3]. BPF führen zu einer persistierenden Leckage von Luft mit den klinischen Folgen eines Pneumothorax und/oder Pleuraempyems sowie einer respiratorischen Insuffizienz [1].…”

Section: Transfer In Die Praxis Von Dr Stefanie Keymel (Düsseldorf)unclassified

“…Hierzu zählen neben der pleuralen Applikation von autologem Blut der endoskopische Verschluss durch lokale Applikation okkludierender Substanzen wie Fibrin- oder Gewebekleber, Stammzellen oder endobronchiale Devices. Als endobronchiale Devices wurden endobronchiale Klappen, Watanabe Spigots, Coils, kardiovaskuläre Verschlusssysteme und endobronchiale Stents erfolgreich eingesetzt [1, 3-5].…”

Section: Transfer In Die Praxis Von Dr Stefanie Keymel (Düsseldorf)unclassified

Postoperative bronchopleurale Fisteln: Modifizierte Stents als maßgeschneiderte interventionelle Therapieoption

Keymel¹

2021

Kompass Pneumol

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Background: Bronchopleural fistula is a rare but life-threatening event with limited therapeutic options. We aimed to investigate the efficacy and safety of the modified silicone stent in patients with post-surgical bronchopleural fistula. Methods: Between March 2016 and April 2020, we retrospectively reviewed the records of 17 patients with bronchopleural fistula and who underwent bronchoscopic placement of the Y-shaped silicone stent. The rate of initial success, clinical success and clinical cure, and complications were analyzed. Results: Stent placement was successful in 16 patients in the first attempt (initial success rate: 94.1%). The median follow-up time was 107 (range, 5–431) days. All patients achieved amelioration of respiratory symptoms. The clinical success rate was 76.5%. Of the 14 patients with empyema, the daily drainage was progressively decreased in 11 patients, and empyema completely disappeared in six patients. Seven stents were removed during follow-up: four (26.7%) for the cure of fistula, two for severe proliferation of granulomatous tissue and one for stent dislocation. No severe adverse events (i.e. massive hemoptysis, suture dehiscence) took place. Seven patients died (due to progression of malignancy, uncontrolled infection, myocardial infarction and left heart failure). Conclusions: The modified silicone stent may be an effective and safe option for patients with post-surgical bronchopleural fistula patients in whom conventional therapy is contraindicated.

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“…Other therapies for refractory BAPF have included surgical repair, endobronchial procedures (endobronchial valves, etc. ), and pleurodesis ( 7 ). There is considerable variability in the management of BAPFs, depending on the etiology and local expertise.…”

mentioning

confidence: 99%

Treatment of Bronchopleural and Alveolopleural Fistulas in Acute Respiratory Distress Syndrome With Extracorporeal Membrane Oxygenation, a Case Series and Literature Review

Odish

Yang

Cheng

et al. 2021

Critical Care Explorations

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OBJECTIVES: To describe a ventilator and extracorporeal membrane oxygenation management strategy for patients with acute respiratory distress syndrome complicated by bronchopleural and alveolopleural fistula with air leaks. DESIGN, SETTING, AND PARTICIPANTS: Case series from 2019 to 2020. Single tertiary referral center—University of California, San Diego. Four patients with various etiologies of acute respiratory distress syndrome, including influenza, methicillin-resistant Staphylococcus aureus pneumonia, e-cigarette or vaping product use-associated lung injury, and coronavirus disease 2019, complicated by bronchopleural and alveolopleural fistula and chest tubes with air leaks. MEASUREMENTS AND MAIN RESULTS: Bronchopleural and alveolopleural fistula closure and survival to discharge. All four patients were placed on extracorporeal membrane oxygenation with ventilator settings even lower than Extracorporeal Life Support Organization guideline recommended ultraprotective lung ventilation. The patients bronchopleural and alveolopleural fistulas closed during extracorporeal membrane oxygenation and minimal ventilatory support. All four patients survived to discharge. CONCLUSIONS: In patients with acute respiratory distress syndrome and bronchopleural and alveolopleural fistula with persistent air leaks, the use of extracorporeal membrane oxygenation to allow for even lower ventilator settings than ultraprotective lung ventilation is safe and feasible to mediate bronchopleural and alveolopleural fistula healing.

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Persistent air leak - review

Cited by 51 publications

References 61 publications

A Case of Persistent Air Leak Managed by Selective Left Main Bronchus Intubation in an Infant with Pulmonary Tuberculosis

A Case of Persistent Air Leak Managed by Selective Left Main Bronchus Intubation in an Infant with Pulmonary Tuberculosis

Postoperative bronchopleurale Fisteln: Modifizierte Stents als maßgeschneiderte interventionelle Therapieoption

Treatment of Bronchopleural and Alveolopleural Fistulas in Acute Respiratory Distress Syndrome With Extracorporeal Membrane Oxygenation, a Case Series and Literature Review

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