Hemodynamic, ventilatory and gasometric evaluation of an experimental bronchopleural fistula

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. .

Semiología broncoscópica. Descripción de dos nuevos signos / Bronchoscopic signs: Description of two new signs

Se describen dos nuevos signos endoscópicos que podrán resultar de utilidad para mejorar el rendimiento diagnóstico de la broncoscopia. Un ensayo semiológico sobre circunstancias anatómicas y funcionales particulares, que declaran la existencia de una afección cercana, pero fuera del alcance de observación del broncoscopista. Estos dos signos son el “signo de la burbuja” y el “signo del agujero negro”. El signo de la burbuja se observa cuando no hay flujo del aire en un subsegmento bronquial que conduce a una masa pulmonar periférica. Esto se manifiesta por la ausencia de burbujas móviles cuando se inyecta una solución salina en el subsegmento bronquial. El signo del agujero negro consiste en una penumbra circular observada en el extremo de un bronquio que se comunica con una cavidad. Se describen las formas de presentación e interpretación de estos signos y también se ofrece una explicación acerca de su fisiopatología.

The paper describes two new endoscopic signs which can be useful in the use of diagnostic bronchoscopy. This is an essay on particular anatomic and functional circumstances suggesting the presence of a pathology which cannot be seen by the bronchoscopist. These two signs are the Bubble Sign and the Black Hole Sign. The Bubble Sign is observed when the airflow is absent in a subsegmental bronchus leading to a peripheral pulmonary mass. This can be shown by the lack of mobile bubbles when a subsegmental bronchus is flooded with saline solution. The Black Hole Sign consists in the circular penumbra observed at the end of a bronchus which communicates with a cavity. The paper describes the presentation and interpretation of these signs and offers an explanation about their physiopathology.