Feasibility of a novel diagnostic technique for persistent air leak by endobronchial CO2 insufflation
V. Ruiz*a (Dr), I. Carboni Bissoa (Dr), F. Rosciania (Dr), M. Las Herasa (Dr)
a Hospital Italiano de Buenos Aires, Buenos Aires City, ARGENTINA
Background: Persistent air leaks (PAL) and bronchopleural fistula (BPF) are seen after lung surgeries. Chest computed tomography has been described to be performed for identification of BPF. However, this method does not allow measuring its magnitude nor performing therapeutic interventions. A diagnostic tool could be endobronchial carbon dioxide (CO2) insufflation with concomitant monitoring of pleural gasses by capnography at pleural drainage tubes.
Case report: A 64-years-old woman, with pulmonary fibrosis, presented pneumothorax during unilateral lung transplantation. Due to anastomotic leakage suspicion, direct CO2 insufflation was applied to bronchial stump suture. An increase in the capnography curve was observed. Medical treatment was performed and the procedure was repeated after 10 days, confirming its resolution.
The second case, a 44-years-old woman, with previous uterine myomatosis, presented septic shock during hysterectomy post-operative care. She developed severe acute respiratory distress syndrome requiring veno-venous extracorporeal membrane oxygenation. She presented unilateral pneumothorax, so a bronchoscopy was performed: a positive CO2 curve and an increase in capnography were observed into the apicoposterior (B2-B2) and anterior (B3) segments. Given the location and the critical condition of the patient, conservative treatment was taken.
Conclusion: An endobronchial CO2 insufflation technique with direct bronchoscopic visualization is presented as a feasible alternative to previously reported methods, though further studies are required to determine safety settings.
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Disclosure of funding source(s): none