April A Grant1,2, Edward B Lineen1,2, Alan Klima3, Rodrigo Vianna4,5, Matthias Loebe5,6, Ali Ghodsizad5,6. 1. Division of Trauma and Surgical Critical Care, Dewitt Daughtry Family Department of Surgery, University of Miami, Leonard M. Miller School of Medicine, Miami, Florida. 2. Jackson Health System and Ryder Trauma Center, Miami, Florida. 3. Comprehensive Care Services, Inc, Livonia, Michigan. 4. Division of Liver, Intestinal and Multivisceral Transplant, Leonard M Miller School of Medicine, University of Miami, Miami, Florida. 5. Division of Heart and Lung Transplant and Mechanical Circulatory Support, Miami, Florida. 6. Division of Cardiothoracic Surgery, Dewitt Daughtry Family Department of Surgery, Leonard M Miller School of Medicine, University of Miami, Miami, Florida.
Abstract
INTRODUCTION: A refractory bronchopleural fistula leading to respiratory failure in a trauma patient is one of the most challenging pathologies to manage in one of the most challenging patient populations. Modern equipment and techniques have decreased and perhaps even eliminated the need for anticoagulation with ECMO, and it is finding an important niche in saving this patient population from refractory hypoxia. We review here our experience with three refractory traumatic bronchopleural fistulae utilizing venovenous ECMO as the primary treatment modality. MATERIAL AND METHODS: Retrospective chart review of three cases of refractory traumatic bronchopleural fistula treated primarily with ECMO and an ultra-lung protective strategy. RESULTS: The use of an ultra-lung protective strategy with ECMO allowed sealing of all three bronchopleural fistula. CONCLUSIONS: Traumatic bronchopleural fistulae require careful thought and early utilization of lung protective strategies to facilitate healing of the injured lung.
INTRODUCTION: A refractory bronchopleural fistula leading to respiratory failure in a traumapatient is one of the most challenging pathologies to manage in one of the most challenging patient populations. Modern equipment and techniques have decreased and perhaps even eliminated the need for anticoagulation with ECMO, and it is finding an important niche in saving this patient population from refractory hypoxia. We review here our experience with three refractory traumatic bronchopleural fistulae utilizing venovenous ECMO as the primary treatment modality. MATERIAL AND METHODS: Retrospective chart review of three cases of refractory traumatic bronchopleural fistula treated primarily with ECMO and an ultra-lung protective strategy. RESULTS: The use of an ultra-lung protective strategy with ECMO allowed sealing of all three bronchopleural fistula. CONCLUSIONS:Traumatic bronchopleural fistulae require careful thought and early utilization of lung protective strategies to facilitate healing of the injured lung.
Authors: Mazen F Odish; Jenny Yang; George Cheng; Cassia Yi; Eugene Golts; Michael Madani; Travis Pollema; Robert L Owens Journal: Crit Care Explor Date: 2021-05-14