Page 87 - ECBIP 2021_Program

MODERATED e-POSTER SESSION 09:
Miscellaneous and Rare Diseases
PP63
Introduction: Persistent air leak (PAL) associated with alveolopleural fistula (PAF) is an entity of difficult clinical management and associated with high morbidity and mortality.The aim of the study was to evaluate the usefulness of different techniques for the identification and localization of PAL for its endoscopic treatment.
Material And Methods: From January 2016 to February 2021, all patients with persistent air leak (> 7 days) due to PAF were prospectively studied. The protocol included endothoracic drainage, medical treatment, quantification of leakage by Cerfolio graduation or digital drainage if available, CT and bronchoscopy with balloon occlusion test (BOT), leak provocation test with segmental injection of O2 (SIOT) and / or selective bronchography (SB). Once the leak was identified, endoscopic treatment with endobronchial valves was considered.
Results: 33 patients with a mean age of 64.42 + 11 years (range 44-94) were studied, in which 39 bronchoscopies were performed for diagnosis,treatment or retreatment for PAL.The most frequent etiologies were 19 cases of secondary pneumothorax associated with empyema, 7 due to associated pneumothorax without pleural infection, 4 postoperative, 2 barotrauma and 2 iatrogenic. In all of them, CT was performed prior to bronchoscopy and leakage was identified in 11 patients (33%). 21 bronchoscopies were performed with deep sedation (mean dose of propofol 407 mg) and 18 cases in the operating room with general anesthesia. In 8 cases, the leak was intermittent and could not be quantified due to prebronchoscopy cessation of flow.The mean leak immediately before sedation was 1209 ml/min and after sedation or general anesthesia 270 ml/ml. In 12 cases, the leak ceased completely with sedation or despite temporary mechanical ventilation. BOT was performed in six cases, which was positive in 83%, ISOT in 21 cases with a positive result in 81%, and SB in 26 cases with a positive result in 66%.The combination of ISOT with SB allowed the diagnosis of 25/26 cases 96%.There were three serious complications associated with the endoscopic technique that were completely resolved.
Conclusions: The bronchoscopic diagnosis of PAL is hampered by the reduction in flow caused by postural changes and changes in the ventilatory pattern during bronchoscopy. The combination of techniques such as BOT, ISOT or SB allows the detection of most continuous or intermittent fistulas with persistent air leak.
BRONCHOSCOPIC DIAGNOSIS OF PERSISTENT AIR LEAK DUE TO ALVEOLOPLEURAL FISTULA
Carlos Disdier, Blanca de Vega, Santisago Juarros, Isabel Ramos, Anabel García-Onieva, Sofia Jaurrieta, Marta Belver, María José Chourio, Eduardo Solis, Ester Rodriguez Pulmonary Department. Hospital Clinico Universitario De Valladolid, Valladolid, Spain
ECBIP 2021 87
6th European Congress
for Bronchology and Interventional Pulmonology
OCTOBER ECBIP 15 - 17
ATHENS - GREECE 2021
Book of Abstracts