Subject(s)
Humans , Male , Infant , Subcutaneous Emphysema/etiology , Subcutaneous Emphysema/diagnostic imaging , Bronchial Fistula/therapy , Bronchial Fistula/diagnostic imaging , Subcutaneous Emphysema/therapy , Cystic Adenomatoid Malformation of Lung, Congenital/surgery , Cystic Adenomatoid Malformation of Lung, Congenital/diagnostic imaging , Diagnosis, DifferentialABSTRACT
PURPOSE: To assess the efficacy of an adjustable inspiratory occlusion valve in experimental bronchopleural fistula during mechanical ventilation.METHODS:We studied six mechanically ventilated pigs in a surgically created, reproducible model of bronchopleural fistula managed with mechanical ventilation and water-sealed thoracic drainage. An adjustable inspiratory occlusion valve was placed between the thoracic drain and the endotracheal tube. Hemodynamic data, capnography and blood gases were recorded before and after the creation of the bronchopleural fistula as well as after every adjustment of the inspiratory occlusion valve.RESULTS:When compared with the standard water-sealed drainage treatment, the use of an adjustable inspiratory occlusion valve improved the alveolar tidal volume and reduced bronchopleural air leak (p<0.001), without hemodynamic compromise when compared with conventional water sealed drainage.CONCLUSION: The use of an adjustable inspiratory occlusion valve improved the alveolar tidal volume, reduced alveolar leak, in an experimental reproducible model of bronchopleural fistula, without causing any hemodynamic derangements when compared with conventional water sealed drainage.
Subject(s)
Animals , Bronchial Fistula/therapy , Drainage/instrumentation , Pleural Diseases/therapy , Therapeutic Occlusion/instrumentation , Ventilators, Mechanical , Arterial Pressure/physiology , Blood Gas Analysis , Drainage/methods , Hemodynamics/physiology , Intubation, Intratracheal/instrumentation , Medical Illustration , Reproducibility of Results , Respiration, Artificial/methods , Respiratory Function Tests/methods , Swine , Treatment Outcome , Therapeutic Occlusion/methodsABSTRACT
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 PaCO2 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 CO2 clearance without any drop in cardiac output or significant changes in mean arterial pressure. .
Subject(s)
Animals , Bronchial Fistula/physiopathology , Disease Models, Animal , Hemodynamics/physiology , Pleural Diseases/physiopathology , Pulmonary Ventilation/physiology , Blood Gas Analysis , Bronchial Fistula/blood , Bronchial Fistula/therapy , Cardiac Output/physiology , Drainage/methods , Pleural Diseases/blood , Pleural Diseases/therapy , Reference Values , Reproducibility of Results , Respiratory Function Tests , Respiration, Artificial/methods , Swine , Time Factors , Treatment OutcomeABSTRACT
Fístula bronquiobiliar (FBB) é uma afecção rara, de alta morbidade e mortalidade, decorrente da comunicação anormal entre a árvore brônquica e a via biliar, sendo a bilioptise um sinal clínico patognomônico. Normalmente está associada a doenças hepatobiliares, mas principalmente ao trauma e complicações de cirurgias hepatobiliares. Devido à gravidade e à complexidade, associadas à baixa incidência, seu manejo é desafiador, não havendo um consenso na literatura. Este trabalho identifica os métodos diagnósticos e terapêuticos mais utilizados, e propõe um fluxograma do manejo da FBB com intuito de auxiliar a conduta de novos casos.
Bronchobiliary fistula is a rare clinical finding, with a high morbidity and mortality rate, characterized by abnormal communication between the biliary tract and the bronchial tree, having bilioptysis as a pathognomonic sign. It is usually associated to hepatobiliary diseases, but mostly related to trauma and as a complication of hepatobiliary surgery. Due to the low incidence, complexity and gravity, its management is a challenge, and little consensus on its diagnosis and treatment exists. We identified the most used diagnostic and therapeutic procedures, and propose a flowchart that could assist in the management of news cases.
Subject(s)
Humans , Biliary Fistula/diagnostic imaging , Bronchial Fistula/diagnostic imaging , Biliary Fistula/surgery , Biliary Fistula/therapy , Bronchial Fistula/surgery , Bronchial Fistula/therapy , Abdominal Abscess , Echinococcosis , Liver Abscess , Lung AbscessABSTRACT
Broncho-esophageal fistula (BEF) are quite rare in adults, more so the congenital variety. The common causes of BEF in adults include infections, trauma, and malignancies. We report a rare case of congenital BEF manifesting in adulthood with repeated pulmonary infections. We emphasize mainly on the preoperative preparation and perioperative management of this patient. It is essential to have a high index of suspicion to diagnose congenital BEF in adults. Anesthesiologists play an important role in successful management of these cases.
Subject(s)
Adult , Anesthesia/methods , Bronchial Fistula/complications , Bronchial Fistula/congenital , Bronchial Fistula/diagnosis , Bronchial Fistula/therapy , Cough/etiology , Esophageal Fistula/complications , Esophageal Fistula/congenital , Esophageal Fistula/diagnosis , Esophageal Fistula/therapy , Humans , Lung Diseases/etiology , MaleABSTRACT
In recent years successful bronchoscopic management of bronchopleural fistulas (BPFs) by locating its site and then blocking the leaking segment with any of the several agents available has gained recognition. It is now considered as an alternate mode of management of BPF. Here we present a case of non-resolving pneumothorax that was managed successfully using bronchoscopic glue (cyanoacrylate glue) instillation.
Subject(s)
Bronchial Fistula/diagnosis , Bronchial Fistula/therapy , Bronchoscopy , Cyanoacrylates/administration & dosage , Female , Humans , Middle Aged , Pleural Diseases/diagnosis , Pleural Diseases/therapy , Respiratory Tract Fistula/diagnosis , Respiratory Tract Fistula/therapy , Tissue Adhesives/administration & dosageABSTRACT
As fístulas da árvore traqueobrônquica, sejam elas broncopleurais ou traqueoesofágicas, apresentam etiologia multifatorial, com incidência variável na literatura. Em geral, apresentam alta morbidade e mortalidade, com indicação formal de correção cirúrgica. Entretanto, a condição clínica dos pacientes muitas vezes não permite uma reintervenção cirúrgica de grande porte. Além disso, as tentativas de fechamento endoscópico raramente têm sucesso, principalmente em fístulas de grande diâmetro. Relatamos os casos de três pacientes submetidos ao fechamento endoscópico de fístulas, sendo duas maiores que 10 mm, com a aplicação de dispositivos oclusores utilizados na cardiologia intervencionista, de forma minimamente invasiva e com resultados iniciais positivos. Esses dados sinalizam que essa pode ser uma técnica promissora na resolução de fístulas da árvore traqueobrônquica.
Fistulas in the tracheobronchial tree (bronchopleural and tracheoesophageal fistulas) have a multifactorial etiology and present a variable incidence in the literature. In general, the related morbidity and mortality are high. Once such a fistula has been diagnosed, surgical closure is formally indicated. However, the clinical status of affected patients is usually unfavorable, which precludes the use of additional, extensive surgical interventions. In addition, attempts at endoscopic closure of these fistulas have seldom been successful, especially when the fistula is large in diameter. We report the cases of three patients submitted to endoscopic closure of fistulas, two of which were larger than 10 mm in diameter, by means of the insertion of atrial septal defect occluders. The procedure was minimally invasive, and the initial results were positive. The results indicate that this is a promising technique for the resolution of tracheobronchial tree fistulas.
Subject(s)
Aged , Humans , Male , Middle Aged , Bronchoscopy , Bronchial Fistula/therapy , Respiratory Tract Fistula/therapy , Septal Occluder Device , Tracheal Diseases/therapySubject(s)
Humans , Male , Middle Aged , Bronchial Fistula/therapy , Stents , Bronchial Fistula , BronchoscopyABSTRACT
A fístula gastrobrônquica é uma condição rara como complicação decorrente de cirurgia da obesidade. O seu manejo exige a participação ativa de um pneumologista, o qual deve conhecer alguns aspectos dos principais tipos de cirurgia bariátrica. Neste relato, descrevemos dois casos de pacientes que apresentaram abscessos subfrênico e pulmonar recidivantes secundários a fístula no ângulo de His durante 19,5 meses, em média. Após o insucesso das relaparotomias, a cura foi obtida por meio da antibioticoterapia e, principalmente, por meio da estenostomia e da dilatação endoscópica, além do uso de clipes e cola de fibrina na fístula. Estas complicações pulmonares não devem ser tratadas isoladamente sem uma avaliação gastrintestinal pois isso pode resultar em piora do quadro respiratório, dificultando o manejo anestesiológico durante procedimentos endoscópicos.
Gastrobronchial fistula is a rare condition as a complication following bariatric surgery. The management of this condition requires the active participation of a pulmonologist, who should be familiar with aspects of the main types of bariatric surgery. Herein, we report the cases of two patients who presented recurrent subphrenic and lung abscess secondary to fistula at the angle of His for an average of 19.5 months. After relaparotomy was unsuccessful, cure was achieved by antibiotic therapy and, more importantly, by stenostomy and endoscopic dilatation, together with the use of clips and fibrin glue in the fistula. These pulmonary complications should not be treated in isolation without a gastrointestinal evaluation since this can result in worsening of the respiratory condition, thus making anesthetic management difficult during endoscopic procedures.
Subject(s)
Adult , Female , Humans , Male , Bronchial Fistula/etiology , Gastric Fistula/etiology , Gastroplasty/adverse effects , Lung Abscess/etiology , Obesity/surgery , Bronchial Fistula/therapy , Endoscopy , Fibrin Tissue Adhesive , Gastric Fistula/therapy , Lung Abscess , Lung Abscess/therapy , Obesity, Morbid/surgery , Suture Techniques/instrumentationABSTRACT
Se presenta la experiencia del uso del parche de sangre autólogo en pacientes con diagnóstico de fuga de aire persistente a través del drenaje torácico, producto de la complicación de fístula broncopleural. Estos pacientes luego de este tratamiento tuvieron resultados alentadores y pudieron salir de alta en buenas condiciones evitándose intervenciones quirúrgicas innecesarias para resolver esta complicación.
Is presented the experience of autologus blood patch in patients with persistent air leak related to broncho pleural fistulae. The follow up after the treatment of the patients showed good results and they discharged out from the hospital in good conditions and this treatment precluded innecesary surgery.
Subject(s)
Humans , Male , Female , Child , Middle Aged , Bronchial Fistula/complications , Bronchial Fistula/therapy , Blood Patch, Epidural , Blood Patch, Epidural , Case ReportsABSTRACT
Introducción: La fístula broncopleural (FBP) secundaria a cirugía o infección es un reto terapéutico. Su tratamiento puede ser expectante o quirúrgico, describiéndose cada vez más el cierre endoscópico. Objetivo: Descripción de caso clínico de un paciente en quién se logró el cierre de una FBP vía endoscópica mientras evolucionaba con un síndrome de distress respiratorio agudo (SDRA) grave. Caso clínico: Paciente de 14 años de edad con antecedente de lobectomía inferior izquierda por bronquiectasias crónicas, quien desarrolló una FBP central secundaria al drenaje transtorácico de un absceso lingular. Presentó un shock séptico asociado a un SDRA. En su evolución la FBP de alto flujo impidió una ventilación mecánica adecuada, siendo esta cerrada por vía broncoscópica con tetraciclina y Gelfoam®, lo que permitió una disminución significativa de su débito, con cierre definitivo a las tres semanas del procedimiento. Conclusión: La FBP secundaria a un absceso pulmonar, puede ser tratada eficientemente con selle fibrobroncoscópico durante el curso de un fallo respiratorio grave en un paciente críticamente enfermo, evitando alternativas quirúrgicas de mayor riesgo.
Subject(s)
Male , Adolescent , Humans , Bronchoscopy , Pleural Diseases/surgery , Bronchial Fistula/surgery , Optical Fibers , Lung Abscess/complications , Critical Illness , Drainage , Pleural Diseases/complications , Pleural Diseases/therapy , Bronchial Fistula/complications , Bronchial Fistula/therapy , Shock, Septic/complications , Respiratory Distress Syndrome/complications , Treatment OutcomeSubject(s)
Humans , Male , Middle Aged , Stents , Bronchoscopy/methods , Bronchial Fistula/therapy , Bronchial Fistula/etiologyABSTRACT
Management of a persistent bronchopleural fistula (BPF) can be a therapeutic challenge. The etiological factors responsible for BPF include pulmonary tuberculosis, post-thoracic resection surgeries, trauma, malignancy, necrotising infections and rupture of lung abscess. The immediate management of BPF is drainage of the pleural cavity with insertion of an intercostal drainage tube. Patients with BPF may also require surgical intervention in the form of a wedge resection or lobectomy or muscle flap surgery. We report a case of a peripheral BPF secondary to a bacterial infection, which was successfully managed by the instillation of gelfoam via flexible bronchoscopy.
Subject(s)
Bronchial Fistula/therapy , Bronchoscopy , Gelatin Sponge, Absorbable/therapeutic use , Hemostatics/therapeutic use , Humans , Male , Middle Aged , Pleural Diseases/therapyABSTRACT
Las fístulas broncopleurales posoperatorias asociadas o no a empiema constituyen una fuente importante de morbimortalidad en pacientes que han sufrido resecciones pulmonares, principalmente cuando se tratan enfermedades malignas. El objetivo de este artículo es revisar los resultados obtenidos en el tratamiento de 6 pacientes tratados entre 1997 y 2003. La operación previa fue neumonectomía derecha en 5 pacientes y lobectomía superior derecha en uno. Las causas de la operación fueron traumatismo, tumores benignos y malignos y tuberculosis. En los 6 pacientes se utilizó mioplastia con el dorsal ancho para la obliteración de la cavidad pleural remanente. Las técnicas complementarias comprendieron el uso de colgajos pediculados de músculo intercostal (3 pacientes), mioplastia con el músculo pectoral mayor y toracoplastia parcial en un paciente cada una. La complicación más frecuente fue la fuga aérea mantenida por más de 10 días. Todos los pacientes mantenían el cierre bronquial al año de la operación(AU)
The postoperative bronchopleural fistulas associated or not with empyema are an important source of morbimortality in patients that have suffered from pulmonary resections, mainly when malignant diseases are treated. The purpose of this article is to review the results obtained in the treatment of six patients from 1997 to 2003. The previous operation was right pneumonectomy in five patients and upper right lobectomy in one. The causes of the operation were traumatism, benign and malignant tumors and tuberculosis. In the six patients, it was used myoplasty with the wide dorsal for the obliteration of the remaining pleural cavity. The complementary techniques comprised the use of pedicled flaps of intercostal muscle (3 patients), myoplasty with the pectoralis major and partial thoracoplasty in a patient, each one. The most frequent complication was the aerial leakage maintained for more than ten days. All the patients kept the bronchial closure a year after the operation(AU)
Subject(s)
Humans , Male , Female , Adult , Pneumonectomy/methods , Bronchial Fistula/diagnosis , Bronchial Fistula/therapy , Pleural Cavity/pathology , Thoracoplasty/adverse effects , Indicators of Morbidity and MortalityABSTRACT
É relatado um caso de fístula de coto brônquico após pneumectomia associada a fístula pleurocutânea e empiema pleural crônico. O paciente foi submetido a aplicaçäo de cola biológica através de videobroncofibroscopia para fechamento da fístula, sob anestesia local. Houve controle precoce do empiema e da fístula pleurocutânea.
Subject(s)
Humans , Male , Middle Aged , Bronchoscopy , Catheterization, Peripheral/methods , Empyema, Pleural/etiology , Fibrin Tissue Adhesive , Bronchial Fistula/therapyABSTRACT
One hundred and eight cases of empyema with and without broncho pulmonary fistula (BPF) were studied to analyse the efficacy of conservative management (aspiration/s and/or ICD). It was successful in 87.04% cases. Among those treated with intercostal drainage, the tube was removed within 2 months in 61.22%, 5 months in 71.42%, and 24 months in 85.71% cases. Only 14.29% cases showed persistent air leak even after 2 years of closed drainage. It was concluded that all cases of simple empyema and most cases of empyema with BPF can be managed successfully with conservative methods including aspirations and closed intercostal tube drainage.
Subject(s)
Adolescent , Adult , Bronchial Fistula/therapy , Child , Child, Preschool , Drainage , Empyema, Pleural/therapy , Female , Fistula/therapy , Humans , Inhalation , Intubation, Intratracheal , Male , Middle Aged , Pleural Diseases/therapyABSTRACT
E relatado um caso de fístula brônquica com lesäo diafragmática e comunicaçäo com a cavidade retroperitoneal, em decorrência de ferimento causado por arma de fogo
Subject(s)
Humans , Male , Adult , Bronchial Fistula/therapy , Thoracic Injuries/complications , Wounds, Gunshot/complications , Diaphragm/injuries , Bronchial Fistula/etiology , Bronchial Fistula , Thoracic Injuries/therapy , Wounds, Gunshot/therapyABSTRACT
As fístulas bilio-brônquicas säo complicaçöes raras decorrentes de afecçöes do trato biliar. Näo obstante, constituem um problema complexo e de difícil resoluçäo cirúrgica, acompanhadas de alta morbidade e mortalidade. Säo relatados aqui 2 casos de fístula bilio-brônquica tratados com drenagem biliar percutânea, que consideramos ser uma forma eficiente e perfeitamente capaz de substituir a cirurgia no manejo deste tipo de complicaçäo
Subject(s)
Humans , Male , Child , Drainage/rehabilitation , Biliary Fistula/therapy , Bronchial Fistula/therapy , BrazilABSTRACT
Em virtude das dificuldades de manutençäo de ventilaçäo artificial em pacientes com fístula broncopleural (FBP) e da promessa representada pelos sistemas de ventilaçäo de alta freqüência em jatos (VAFJ), teve-se por objetivo estudar a eficácia das trocas gasosas do sistema de VAFJ (Takaoka-995) em modelo experimental de FBP de tal magnitude que näo respondesse aos sistemas clássicos ciclados a pressäo e a volume. Assim, foram estudados 16 cäes mestiços com pulmöes normais em que se provocava FBP unilateral. Em quatro animais foram testados respiradores ciclados a volume e a pressäo, indo todos a óbito em 20 a 30 minutos e os demais 12 cäes serviram de base para o estudo das trocas gasosas durante VAFJ. Todos os animais foram anestesiados, intubados, curarizados, tendo suas veias jugular interna, femoral e artéria femoral canulizadas para obtençäo de amostras de sangue, e administraçäo de fluidos. Após controle inicial (controle), foi realizada lobectomia superior esquerda, deixando-se o coto brônquico fechado (pós-lobectomia). A seguir abria-se o coto brônquico e drenava-se sob água, obtendo-se amostras aos 30 minutos (30min FBP) e 90 minutos (90min FBP). A VAFJ era mantida com freqüência de 200/minuto e a relaçäo de tempo inspiratório/expiratório 1/2, para manter a PaCO2 entre 30 e 40mmHg. Baseados nos resultados obtidos conclui-se que o sistema de VAFJ conseguiu manter a ventilaçäo alveolar e as trocas gasosas, apesar de ter havido aumento das pressöes em vias aéreas em modelo experimental de FBP no qual a ventilaçäo mecânica clássica se mostrou inviável
Subject(s)
Dogs , Animals , Pleural Diseases/therapy , Bronchial Fistula/therapy , Pulmonary Gas Exchange , Respiration, Artificial , Respiratory InsufficiencyABSTRACT
A fistula nefrobronquica e uma doença rara e, na maioria dos casos, representa uma complicaçao de abscesso perineal. Nao e facil suspeitar desta lesao, emvirtude de o quadro clinico predominante ser de natureza pulmonar. Enfatiza-se o fato de abscesso periee