Persistent Bronchopleural Air Leak during Mechanical Ventilation

Pierson, David J.; Horton, C A; Bates, Pamela

doi:10.1378/chest.90.3.321

Cited by 126 publications

(78 citation statements)

References 16 publications

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“…Several studies have described tentative strategies to control BPF output during MV [1][2][3][4][5][6][7][8][9] . However, these studies are mostly case reports and reviews, which failed to present an adequate solution to complications such as pneumothorax, hemodynamic instability, persistent air leak and severe hypoxemia [8][9][10][11][12]16 .…”

Section: Discussionmentioning

confidence: 99%

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Hemodynamic, ventilatory and gasometric evaluation of an experimental bronchopleural fistula

Oliveira

Toneloto²,

Moreira

et al. 2015

Acta Cir. Bras.

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PURPOSE:To investigate the hemodynamic and ventilatory changes associated with the creation of an experimental bronchopleural fistula (BPF) treated by mechanical ventilation and thoracic drainage with or without a water seal. METHODS:Six large white pigs weighing 25 kg each which, after general anesthesia, underwent endotracheal intubation (6mm), and mechanically ventilation. Through a left thoracotomy, a resection of the lingula was performed in order to create a BPF with an output exceeding 50% of the inspired volume. The chest cavity was closed and drained into the water sealed system for initial observation of the high output BPF. RESULTS:Significant reduction in BPF output and PaCO 2 was related after insertion of a water-sealed thoracic drain, p< 0.05. CONCLUSION:Insertion of a water-sealed thoracic drain resulted in reduction in bronchopleural fistula output and better CO 2 clearance without any drop in cardiac output or significant changes in mean arterial pressure.

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Section: Discussionmentioning

confidence: 99%

“…It manifests initially as a tension pneumothorax that, after drainage, results in persistent air leak. The diagnosis is established when the drainage bottle shows continuous bubbling for more than 24hs [1][2][3][4][5][6][7][8][9][10] .…”

Section: Introductionmentioning

confidence: 99%

Hemodynamic, ventilatory and gasometric evaluation of an experimental bronchopleural fistula

Oliveira

Toneloto²,

Moreira

et al. 2015

Acta Cir. Bras.

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“…A review of 3 years' experience at Harborview Medical Center yielded 39 cases of bronchopleural fistula in mechanically ventilated patients, many of which developed in the course of management of ARDS. 68 In 8 patients the leaks exceeded 500 mL per breath, and all 8 of those patients died. 68 Many of the complications associated with mechanical ventilation appear to have decreased in the era of lungprotective ventilation.…”

Section: Adverse Effects Of Oxygenmentioning

confidence: 94%

“…68 In 8 patients the leaks exceeded 500 mL per breath, and all 8 of those patients died. 68 Many of the complications associated with mechanical ventilation appear to have decreased in the era of lungprotective ventilation. Evidence on the incidence of pneumothorax, bronchopleural fistula, and other forms of clin-ical barotrauma in ventilated patients over time is scant, although at centers that manage large numbers of such patients the impression is that it has decreased in recent decades.…”

Section: Adverse Effects Of Oxygenmentioning

confidence: 94%

Oxygen in Respiratory Care: A Personal Perspective from 40 Years in the Field

Pierson

2012

Respir Care

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Oxygen is necessary for all aerobic life, and nothing is more important in respiratory care than its proper understanding, assessment, and administration. By the early 1970s P aO 2 had become the gold standard for clinically assessing oxygenation in the body. Since the 1980s the measurement of arterial oxygen saturation by pulse oximetry has also been increasingly used as an adjunct to (but not a replacement for) P aO 2 . Despite the desirability of measuring tissue oxygenation directly, no reliable and clinically relevant such measure has emerged. The 2 areas in which oxygen has proven most important in respiratory care are long-term oxygen therapy (LTOT) and the management of potentially life-threatening hypoxemia in acute respiratory failure. That LTOT improves survival in appropriately selected patients with COPD was demonstrated by multicenter studies published more than 30 years ago, and their original selection criteria have so far not been improved upon. Severe hypoxemia in acute lung injury and ARDS can be improved by ventilation with PEEP, and also in many patients by various adjunctive techniques and alternative support strategies. However, the latter measures have not brought clear improvements in survival or other patient-relevant outcomes. In addition, the original goals of "normalizing" arterial oxygenation with high tidal volumes and lung-distending pressures have required modification as appreciation for ventilatorrelated lung injury has emerged. High concentrations of inspired oxygen may play a role in such injury, but aggressive measures to reduce them in order to avoid oxygen toxicity-which dominated ventilator management in previous decades-have been tempered in the present era of lungprotective ventilation. Although some additions and modifications have emerged, much of what we understand today about oxygen in respiratory care is owed to the pioneering work of Thomas L Petty more than 40 years ago.

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“…A broncho-or pleuroparenchymal fistula (PPF) is a communication between the pleural space and the lung parenchyma and is associated with significant morbidity and mortality [2][3][4][5]. The incidence of this condition ranges from 0.93% to 20% after pneumonectomy and <1% after lobectomy [2,3,6].…”

Section: Introductionmentioning

confidence: 99%

Successful non-surgical management of pleuroparenchymal fistula following cervical intraspinal empyema

Ull

Aach

Reichert

et al. 2018

Monaldi Arch Chest Dis

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Pulmonary infections are life-threatening complications in patients with spinal cord injuries. In particular, paraplegic patients are at risk if they are ventilator-dependent. This case history refers to a spinal cord injury with a complete sensorimotor tetraplegia below C2 caused by a septic scattering of an intraspinal empyema at C2-C5 and T3-T4. A right-sided purulent pneumonia led to a complex lung infection with the formation of a pleuroparenchymal fistula. The manuscript describes successful, considerate, non-surgical management with shortterm separate lung ventilation. Treatment aimed to achieve the best possible result without additional harm.A variety of surgical and conservative strategies for the treatment of pleuroparenchymal fistula (PPF) have been described with different degrees of success. We detail the non-surgical management of a persistent PPF with temporary separate lung ventilation (SLV) via a double-lumen tube (DLT) in combination with talc pleurodesis as an approach in patients who are unable to undergo surgical treatment.

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Persistent Bronchopleural Air Leak during Mechanical Ventilation

Cited by 126 publications

References 16 publications

Hemodynamic, ventilatory and gasometric evaluation of an experimental bronchopleural fistula

Hemodynamic, ventilatory and gasometric evaluation of an experimental bronchopleural fistula

Oxygen in Respiratory Care: A Personal Perspective from 40 Years in the Field

Successful non-surgical management of pleuroparenchymal fistula following cervical intraspinal empyema

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