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A5589 - Endobronchial Occlusion with One-Way Endobronchial Valve in the Treatment of a 13 Year Old Critically Ill Young Man with Bronchopleural Fistula on Mechanical Ventilation
Author Block: A. Chadha1, A. Wilson2, M. Zgoda3; 1Pediatric Pulmonary Medicine, Carolina Healthcare System, Charlotte, NC, United States, 2Pediatric Critical Care Medicine, Seattle Children's Hospital, Seattle, WA, United States, 3Pulmonary and Critical Care Medicine, Carolinas Healthcare System, Charlotte, NC, United States.
Introduction:Bronchopleural fistula (BPF) is a rare complication arising in several pulmonary conditions. Within pediatrics BPF commonly is associated with pulmonary infection. BPF carries high morbidity and mortality and leads to prolonged hospitalizations (1). Combined chronic mechanical ventilation and BPF can further complicate management. Management strategies include surgery, prolonged chest tube placement, ventilator manipulation and diagnostic and therapeutic bronchoscopy (2).
Case Report:We report the case of a previously healthy 13-year-old male who presented with consolidated bacterial pneumonia that required intubation for management of respiratory failure.
Despite employing the standard of care of pneumonia with sepsis the patient later required HFOV and V-V ECMO. Patient underwent bronchoscopy with BAL cultures positive for methicillin sensitive Staphylococcus aureus. While on V-V ECMO and mechanical ventilation a pneumothorax developed and his management was complicated by BPF/persistent air leak syndrome. Additional complications prevented surgical intervention for BPF.
Bronchoscopic intervention utilizing the Spiration IPV (Redwood, WA) endobronchial valve was considered under the IRB approved humanitarian device exemption with the aid of adult pulmonary. The Olympus sizing balloon was used to isolate the persistent air leak by serial balloon occlusion. The posterior basal segment of the right lower lobe was identified as the source of the bronchopleural fistula. A 7mm Spiration IPV endobronchial valve was deployed. Zero air leak was immediately appreciated following deployment of the valve.
Sixteen days post valve placement the chest tube was removed. Twenty-five days post valve placement patient was liberated from mechanical ventilation. The endobronchial valve was removed four months post placement without any perceivable adverse sequela. The patient was decannulated five and a half months post valve placement. To date, the patient is doing well free from chronic respiratory symptoms.
Discussion: Endobronchial valves, commonly used in the adult population with 48% resolution of the air leak syndrome (3-4), but their use has been limited to case reports or series within the pediatric literature (5). In this case, we describe the use of an endobronchial valve to achieve resolution of BPF as well as expedited liberation from chronic mechanical ventilation and ultimate decannulation. This case further supports consideration of endobronchial valves as an alternative therapy for select patients with BPF in centers with expertise and availability of multidisciplinary care.