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Critical Care Medicine Feb 2021To describe the physiology of air leak in bronchopleural fistula in mechanically ventilated patients and how understanding of its physiology drives management of... (Review)
Review
OBJECTIVE
To describe the physiology of air leak in bronchopleural fistula in mechanically ventilated patients and how understanding of its physiology drives management of positive-pressure ventilation. To provide guidance of lung isolation, mechanical ventilator, pleural catheter, and endobronchial strategies for the management of bronchopleural fistula on mechanical ventilation.
DATA SOURCES
Online search of PubMed and manual review of articles (laboratory and patient studies) was performed.
STUDY SELECTION
Articles relevant to bronchopleural fistula, mechanical ventilation in patients with bronchopleural fistula, independent lung ventilation, high-flow ventilatory modes, physiology of persistent air leak, extracorporeal membrane oxygenation, fluid dynamics of bronchopleural fistula airflow, and intrapleural catheter management were selected. Randomized trials, observational studies, case reports, and physiologic studies were included.
DATA EXTRACTION
Data from selected studies were qualitatively evaluated for this review. We included data illustrating the physiology of driving pressure across a bronchopleural fistula as well as data, largely from case reports, demonstrating management and outcomes with various ventilator modes, intrapleural catheter techniques, endoscopic placement of occlusion and valve devices, and extracorporeal membrane oxygenation. Themes related to managing persistent air leak with mechanical ventilation were reviewed and extracted.
DATA SYNTHESIS
In case reports that demonstrate different approaches to managing patients with bronchopleural fistula requiring mechanical ventilation, common themes emerge. Strategies aimed at decreasing peak inspiratory pressure, using lower tidal volumes, lowering positive end-expiratory pressure, decreasing the inspiratory time, and decreasing the respiratory rate, while minimizing negative intrapleural pressure decreases airflow across the bronchopleural fistula.
CONCLUSIONS
Mechanical ventilation and intrapleural catheter management must be individualized and aimed at reducing air leak. Clinicians should emphasize reducing peak inspiratory pressures, reducing positive end-expiratory pressure, and limiting negative intrapleural pressure. In refractory cases, clinicians can consider lung isolation, independent lung ventilation, or extracorporeal membrane oxygenation in appropriate patients as well as definitive management with advanced bronchoscopic placement of valves or occlusion devices.
Topics: Bronchial Fistula; Female; Humans; Male; Pleural Diseases; Positive-Pressure Respiration; Ventilators, Mechanical
PubMed: 33372747
DOI: 10.1097/CCM.0000000000004771 -
Kyobu Geka. the Japanese Journal of... Jul 2017Postoperative bronchopleural fistula( BPF) is a life-threatening complication requiring immediate and proper treatments. Now days, the main method for closure of the... (Review)
Review
Postoperative bronchopleural fistula( BPF) is a life-threatening complication requiring immediate and proper treatments. Now days, the main method for closure of the bronchial stump after lung resection is mechanical stapling because of prevailing of commonly performed video-assisted thoracoscopic surgery. The frequencies of BPF seem to be decreased compared with the age of manual sutures under open thoracotomy, probably due to improvement of the stapling instruments. However, if once BPF occurs, the severity of the disease does not differ between these 2 closing methods. Thoracic surgeons should well understand the etiology, prevention, diagnosis, and treatment of the postoperative BPF.
Topics: Bronchial Fistula; Fistula; Humans; Pleural Diseases; Pneumonectomy; Postoperative Complications; Thoracic Surgery, Video-Assisted
PubMed: 28790287
DOI: No ID Found -
Thoracic Cancer May 2022The purpose of this study was to investigate the results of postoperative bronchopleural fistula repair and to identify adverse factors for its success.
BACKGROUND
The purpose of this study was to investigate the results of postoperative bronchopleural fistula repair and to identify adverse factors for its success.
METHODS
We retrospectively reviewed the surgical results of 39 patients who underwent surgical repair for postoperative bronchopleural fistula between January 2010 and June 2020. Success of bronchopleural fistula repair was defined as the visual closure of the bronchopleural fistula with the absence of an air leak, a recurrence of bronchopleural fistula and infection in the thoracic cavity.
RESULTS
Twenty-five (64.1%) bronchopleural fistulas occurred after pulmonary resection and 14 (35.9%) after lung transplantation. Bronchopleural fistula was diagnosed 19 days (median) and repaired 28 days (median) after the initial operation by primary closure in 27 (69.2%) patients, and by additional resection in 12 (30.8%) patients. The overall success rate was 59% (23/39) and the overall mortality was 56.4% (22/39). Multivariable analysis revealed that the patients who were supported by mechanical ventilation at the time of repair had significantly lower success rates than those without (15.4%, 2/13 vs. 80.8%, 21/26, respectively, p < 0.001). The omental flap group tended to have a better success rate than the muscle flap group (p = 0.07).
CONCLUSIONS
There was a high overall mortality rate after bronchopleural fistula repair and a low success rate. Mechanical ventilation at the time of bronchopleural fistula repair was significantly related to the failure of bronchopleural fistula repair.
Topics: Bronchial Fistula; Humans; Pleural Diseases; Pneumonectomy; Postoperative Complications; Retrospective Studies; Treatment Outcome
PubMed: 35393787
DOI: 10.1111/1759-7714.14404 -
British Medical Journal Nov 1976
Topics: Bronchial Fistula; Fistula; Humans; Pleural Diseases; Postoperative Complications
PubMed: 990782
DOI: No ID Found -
General Thoracic and Cardiovascular... Dec 2017The aim of this article was to clarify recent risk factors for the early bronchopleural fistula after anatomical lung resection. (Review)
Review
OBJECTIVE
The aim of this article was to clarify recent risk factors for the early bronchopleural fistula after anatomical lung resection.
METHODS
Reports on early bronchopleural fistula after anatomical lung resection in adults, including information on risk factors, published between 2006 and 2016 were reviewed and our institutional data were evaluated. The early period was defined as within 30 days from surgery or as described early in the manuscript.
RESULTS
A total of seven retrospective observational articles were selected. Four articles investigated lobectomy and pneumonectomy, while the other three articles investigated only pneumonectomy. The surgical procedure, preoperative therapy, complications after surgery, right side, patient age, past history, and tumor residuals were mentioned as risk factors of bronchopleural fistula. Our data concluded that neoadjuvant therapy and a right lower lobe location were risk factors after a lobectomy, while a right side and complete pneumonectomy were risk factors after a pneumonectomy.
CONCLUSIONS
Although recent studies have reached nearly the same conclusions as older reports, continuous research of potential risk factor is needed as therapeutic procedures continue to evolve.
Topics: Bronchial Fistula; Fistula; Global Health; Humans; Incidence; Pleural Diseases; Postoperative Complications; Risk Assessment; Thoracic Surgical Procedures
PubMed: 29027099
DOI: 10.1007/s11748-017-0846-1 -
The Annals of Thoracic Surgery Nov 2022Bronchopleural fistulas (BPFs) represent a rare catastrophic complication of pulmonary resection and carry a high mortality rate. Surgical treatments of BPF are often...
Bronchopleural fistulas (BPFs) represent a rare catastrophic complication of pulmonary resection and carry a high mortality rate. Surgical treatments of BPF are often technically difficult and can be tolerated only by a limited number of patients, while less invasive endoscopic approaches show variable success rates, mainly related to the size of the fistula. In this report, we describe the successful treatment of a large BPF by means of endoscopic autologous fat implantation; we also discuss the technical details of this surgical procedure.
Topics: Humans; Pneumonectomy; Bronchial Fistula; Pleural Diseases; Endoscopy; Bronchi
PubMed: 35216996
DOI: 10.1016/j.athoracsur.2022.02.014 -
The Indian Journal of Chest Diseases &... 2010The diagnosis and management of bronchopleural fistula (BPF) remain a major therapeutic challenge for clinicians. It is associated with significant morbidity and... (Review)
Review
The diagnosis and management of bronchopleural fistula (BPF) remain a major therapeutic challenge for clinicians. It is associated with significant morbidity and mortality. Diagnosis and localisation of BPF is sometimes difficult and may require multiple imaging and bronchoscopies. Successful management of a fistula is combined with treatment of the associated empyema cavity. The first step, therefore, should be control of active infection and adequate drainage of the hemithorax. When deemed required, definitive surgical repair should be accomplished expeditiously, minimising the number of procedures performed. In cases of a small fistula or where the surgical risk is high, various bronchoscopic methods have been used to close the fistula. When treatment is protracted, secondary complications are more likely and survival is adversely affected. In this article, approaches to the diagnosis and treatment of BPF are discussed, with particular emphasis on bronchoscopic management options.
Topics: Bronchial Fistula; Bronchoscopy; Diagnosis, Differential; Fistula; Humans; Pleural Diseases; Suture Techniques; Thoracotomy; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 20578402
DOI: No ID Found -
The Annals of Thoracic Surgery Apr 1993
Topics: Bronchial Fistula; Fistula; Humans; Pleural Diseases; Semantics
PubMed: 8466325
DOI: 10.1016/0003-4975(93)90151-7 -
Respiration; International Review of... 2019Closure of bronchopleural fistula remains a difficult challenge for clinicians. Although several therapeutic approaches have been proposed, the clinical results are... (Review)
Review
Closure of bronchopleural fistula remains a difficult challenge for clinicians. Although several therapeutic approaches have been proposed, the clinical results are commonly unsatisfactory. Previous reports have indicated that autologous mesenchymal stem cells (MSCs) are useful for aiding treatment of bronchopleural fistula. We report here the use of umbilical cord MSCs to effect the successful closure of a bronchopleural fistula (5 mm) in a 33-year-old woman 6 months after a lobectomy. A review of the relevant literature is included. The use of MSCs may be a promising therapeutic method for the closure of bronchopleural fistula. Randomized controlled trials with larger samples are required.
Topics: Adult; Bronchial Fistula; Bronchoscopy; Female; Fistula; Humans; Injections; Mesenchymal Stem Cell Transplantation; Mesenchymal Stem Cells; Pleural Diseases; Pneumonectomy; Postoperative Complications; Tomography, X-Ray Computed
PubMed: 30368513
DOI: 10.1159/000493757 -
Thoracic Surgery Clinics Aug 2020Prolonged air leak or alveolar-pleural fistula is common after lung resection and can usually be managed with continued pleural drainage until resolution. Further... (Review)
Review
Prolonged air leak or alveolar-pleural fistula is common after lung resection and can usually be managed with continued pleural drainage until resolution. Further management options include blood patch administration, chemical pleurodesis, and 1-way endobronchial valve placement. Bronchopleural fistula is rare but is associated with high mortality, often caused by development of concomitant empyema. Bronchopleural fistula should be confirmed with bronchoscopy, which may allow bronchoscopic intervention; however, transthoracic stump revision or window thoracostomy may be required.
Topics: Bronchial Fistula; Bronchoscopy; Humans; Pleural Diseases; Pneumonectomy; Pneumothorax; Respiratory Tract Fistula; Risk Factors
PubMed: 32593367
DOI: 10.1016/j.thorsurg.2020.04.008