From the Guidelines
Treatment for Bronchopleural Fistula
Treatment for bronchopleural fistula typically involves a multidisciplinary approach, including surgical intervention, antimicrobial therapy, and supportive care.
- Initial management may include broad-spectrum antibiotics and chest tube placement with potential escalation to surgical repair.
- In some cases, fibrin sealants or methacrylate adhesive may be applied to promote closure of the fistula, as seen in the use of methacrylate adhesive delivered through a catheter placed through the working channel of a bronchoscope 1.
- The use of methacrylate adhesive may be a reasonable alternative to operative closure when the operative risk is great 1, highlighting the need for a personalized approach based on the patient's condition and risk factors.
- Surgical intervention, such as thoracotomy or video-assisted thoracic surgery, may be necessary to close the fistula, especially in cases where conservative management fails or is not feasible.
From the Research
Treatment Options for Bronchopleural Fistula
The treatment for bronchopleural fistula (BPF) can vary depending on the size of the fistula, the underlying cause, and the patient's overall health. Some treatment options include:
- Control of active infection and adequate drainage of the hemithorax, as the first step in managing BPF 2
- Definitive surgical repair, which should be accomplished expeditiously to minimize the number of procedures performed 2
- Bronchoscopic methods, such as the use of endobronchial valves, which can be used to close the fistula in cases of small fistulae or high surgical risk 2, 3
- Endobronchial one-way valve (EBV) placement, which has been shown to be a safe and effective treatment for BPF, with an effective rate of 73.1% 3
- Surgical approaches, such as open window thoracostomy, which can be used to treat postoperative BPF and pyothorax 4
- Treatment protocols, such as the use of CT scan with 3D reconstruction to detect BPF and evaluate the location and volume of empyema cavity, and the use of multiple pedicled muscle flaps to fill the empyema cavity 5
- Multidisciplinary approaches, such as the use of minimally invasive techniques, including image-guided embolization and the placement of multiple endobronchial valves, to control multiple fistulae 6
Considerations for Treatment
When treating BPF, it is important to consider the following: