Abstract
A 59-yr-old man with bullous lung disease developed a refractory bronchopleural fistula involving the right upper lobe. Despite independent lung and high-frequency jet ventilation, a large air leak persisted. Following the introduction of a bronchial blocker into the right upper lobe bronchus via the tracheal lumen of a left-sided endobronchial tube, oxygenation and ventilation improved, and the airleak was reduced by 90%. The presence of pneumonia led to an inexorably downhill course with death from overwhelming sepsis.
Résumé
Un homme de 59 ans, avec une maladie pulmonaire bulleuse, a développé une fistule bronchopleurale réfractaire en regard du lobe supérieur droit. Une large fuite d’air persistait malgré une ventilation à haute fréquence type « jet » et une ventilation indépendante aux deux poumons. Suite à l’introduction d’un bloqueur bronchial dans la bronche de lobe supérieur droit, en passant par la lumière trachéale d ’un tube endotrachéal gauche, l’oxygénation et la ventilation se sont améliorées et la fuite d’air a été réduite de 90%. La présence d’une pneumonie a causé une détérioration inexorable, causant le décès suite à une septicémie fulgurante.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
Abbreviations
- RR:
-
respiratory rate
- bpm:
-
breaths per minute
- VT :
-
tidal volume
- Paw :
-
airway pressure
- PEEP:
-
positive end expiratory pressure
- CPAP:
-
continuous positive airway pressure
- HFJV:
-
high frequency jet ventilation
- PSI:
-
pounds per square inch
- I:E:
-
inspiratory:expiratory
References
Wendt M, Hachenberg T, Winde G, Lawin P. Differential ventilation with low-flow CPAP and CPPV in the treatment of unilateral lung disease. Intensive Care Med 1989; 15: 209–11.
Rubio JJ, Algora-Weber A, Dominguez-de Villota E, Chamorro C. Prolonged high frequency ventilation in a patient with a bronchopleural fistula. An alternative mode of ventilation. Intensive Care Med 1986; 12: 161–3.
Phillips YY, Lonigan RM, Joyner LR. A simple technique for managing a bronchopleural fistula while maintaining positive pressure ventilation. Crit Care Med 1979; 7: 351–5.
Pierson DJ, Horton CA, Bates PW. Persistent bronchopleural air leak during mechanical ventilation. A review of 39 cases. Chest 1986; 90: 321–3.
Ratliff JL, Hill JD, Tucker H, Fallat R. Endobronchial control of bronchopleural fistulae. Chest 1977; 71: 98–9.
Ray C, Miodownik S, Carlon G, Groeger J, Howland WS. Pneumatic to electric analog for high frequency jet ventilation of disrupted airways. Crit Care Med 1984; 12: 711–12.
Carlon GC, Kahn RC, Howland WS, Ray C Jr,Turnbull AD. Clinical experience with high frequency jet ventilation. Crit Care Med 1981; 9: 1–6.
Turnbull AD, Carlon GC, Howland WS, Beattie EJ. High frequency jet ventilation in major airway or pulmonary disruption. Ann Thorac Surg 1981; 32: 468–74.
Ritz R, Benson M, Bishop MJ. Measuring gas leakage from bronchopleural fistulas during high frequency jet ventilation. Crit Care Med 1984; 12: 836–7.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Otruba, Z., Oxorn, D. Lobar bronchial blockade in bronchopleural fistula. Can J Anaesth 39, 176–178 (1992). https://doi.org/10.1007/BF03008652
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF03008652