Hemodynamic, ventilatory and gasometric evaluation of an experimental bronchopleural fistula

Douglas Guimaraes De Oliveira,Antonio Luis Eiras Falcão,Carolina Kosour,Marcos Mello Moreira,Desanka Dragosavac,Gabriel Franco De Souza,Luiz Claudio Martins,Maria Gabriela Cavicchia Toneloto,Joaquim Murray Bustorff-Silva

doi:10.1590/s0102-86502015001000001

Abstract

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.

Highlights

Bronchopleural fistulas (BPFs) are a frequent cause of complications in the ICU, being associated with high morbidity and mortality, especially when secondary to invasive mechanical ventilation
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
A resection of the lingula was performed in order to create a BPF with an output exceeding 50% of the inspired volume

Summary

Introduction

Bronchopleural fistulas (BPFs) are a frequent cause of complications in the ICU, being associated with high morbidity and mortality, especially when secondary to invasive mechanical ventilation. It manifests initially as a tension pneumothorax that, after drainage, results in persistent air leak. Among its several etiologies the most important are pneumonia, radiotherapy, tumours, tuberculosis, lung surgeries, trauma and, inside ICU’s it is frequently associated to prolonged positive pressure ventilation and barotrauma. Regardless of its etiology, BPFs are very hard to treat, mainly because most of the patients will need mechanical ventilation to keep their oxygenation status stable and this in turn will tend to hamper the closure of the BPF. When the air leak is severe morbidity is very high and mortality can reach 18% up to 50%10-16

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Conclusion