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Bronchoscopic ethanolamine injection therapy in patients with persistent air leak from chest tube drainage.

Lim AL, Kim CH, Hwang YI, Lee CY, Choi JH, Shin T, Park YB, Jang SH, Park SM, Kim DG, Lee MG, Hyun IG, Jung KS, Shin HS - Tuberc Respir Dis (Seoul) (2012)

Bottom Line: A total of 15 patients were enrolled; 14 cases of spontaneous pneumothorax [idiopathic 9, chronic obstructive pulmonary disease (COPD) 3, post-tuberculosis 2] and one case of empyema associated with broncho-pleural fistula.Some adverse reactions, such as fever, chest pain and increased radiographic opacities occurred transiently, but resolved without any further events.With success, the time from the procedure to discharge was about 3 days (median).

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Hallym University College of Medicine, Seoul, Korea.

ABSTRACT

Background: Chest tube drainage (CTD) is an indication for the treatment of pneumothorax, hemothroax and is used after a thoracic surgery. But, in the case of incomplete lung expansion, and/or persistent air leak from CTD, medical or surgical thoracoscopy or, if that is unavailable, limited thoracotomy, should be considered. We evaluate the efficacy of bronchoscopic injection of ethanolamine to control the persistent air leak in patients with CTD.

Methods: Patients who had persistent or prolonged air leak from CTD were included, consecutively. We directly injected 1.0 mL solution of 5% ethanolamine oleate into a subsegmental or its distal bronchus, where it is a probable air leakage site, 1 to 21 times using an injection needle through a fiberoptic bronchoscope.

Results: A total of 15 patients were enrolled; 14 cases of spontaneous pneumothorax [idiopathic 9, chronic obstructive pulmonary disease (COPD) 3, post-tuberculosis 2] and one case of empyema associated with broncho-pleural fistula. Of these, five were patients with persistent air leak from CTD, just after a surgical therapy, wedge resection with plication for blebs or bullae. With an ethanolamine injection therapy, 12 were successful but three (idiopathic, COPD and post-tuberculosis) failed, and were followed by a surgery (2 cases) or pleurodesis (1 case). Some adverse reactions, such as fever, chest pain and increased radiographic opacities occurred transiently, but resolved without any further events. With success, the time from the procedure to discharge was about 3 days (median).

Conclusion: Bronchoscopic ethanolamine injection therapy may be partially useful in controlling air leakage, and reducing the hospital stay in patients with persistent air leak from CTD.

No MeSH data available.


Related in: MedlinePlus

Case 1. A 75-year-old male patient who had past history of tuberculosis. Spontaneous pneumothorax, recurrent (A), 2 and 3 days after ethanolamine injection therapy (B, C).
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Figure 1: Case 1. A 75-year-old male patient who had past history of tuberculosis. Spontaneous pneumothorax, recurrent (A), 2 and 3 days after ethanolamine injection therapy (B, C).

Mentions: In Figure 1 (case 1), a recurrent large pneumothorax in left side occurred in a 75-year-old male patient who had been on the outpatient department for post-tuberculous bronchiectasis and emphysematous lung. Despite chest tube drainage, the lung was not expanded fully and a large amount of air leak via the chest tube was persistent until 7 days later. Thus, a surgical treatment was required. However, as his sputum acid-fast bacillus smear and post-bronchodilator forced expiratory volume in one second was shown to be positive and only 630 mL (27% of predicted value) respectively, he had a high risk for surgical treatment. Thus, the patient underwent bronchoscopic ethanolamine injection therapy total three times. Thereafter, air leak was halted and the lung was fully expanded, and so the chest tube was successfully removed. The patient was discharged from the hospital with anti-tuberculous medications (Figure 1). It has been known that air leak from spontaneous pneumothorax that occurs in the case of emphysema-like changes caused by tuberculous destroyed lung and COPD is resulted from the rupture of bulla8. Thus, air leak site or any abnormalities resulting probably into air leak should be corrected to prevent further recurrences. Currently, thoracoscopic treatment for emphysema-like changes (blebs or bullae) and pleurodesis have been commonly used9,10. In some cases, wedge resection with bullae placation is preferred depending on thoracic surgeons. If the air leak persist more than 4 days even in the first episode of spontaneous pneumothorax, a surgical treatment should be considered11. However, if the patient had a high risk of anesthesia or surgery due to underlying illness or poor pulmonary function, other therapeutic modalities should be alternatively selected, but there are no effective treatments until now.


Bronchoscopic ethanolamine injection therapy in patients with persistent air leak from chest tube drainage.

Lim AL, Kim CH, Hwang YI, Lee CY, Choi JH, Shin T, Park YB, Jang SH, Park SM, Kim DG, Lee MG, Hyun IG, Jung KS, Shin HS - Tuberc Respir Dis (Seoul) (2012)

Case 1. A 75-year-old male patient who had past history of tuberculosis. Spontaneous pneumothorax, recurrent (A), 2 and 3 days after ethanolamine injection therapy (B, C).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3475465&req=5

Figure 1: Case 1. A 75-year-old male patient who had past history of tuberculosis. Spontaneous pneumothorax, recurrent (A), 2 and 3 days after ethanolamine injection therapy (B, C).
Mentions: In Figure 1 (case 1), a recurrent large pneumothorax in left side occurred in a 75-year-old male patient who had been on the outpatient department for post-tuberculous bronchiectasis and emphysematous lung. Despite chest tube drainage, the lung was not expanded fully and a large amount of air leak via the chest tube was persistent until 7 days later. Thus, a surgical treatment was required. However, as his sputum acid-fast bacillus smear and post-bronchodilator forced expiratory volume in one second was shown to be positive and only 630 mL (27% of predicted value) respectively, he had a high risk for surgical treatment. Thus, the patient underwent bronchoscopic ethanolamine injection therapy total three times. Thereafter, air leak was halted and the lung was fully expanded, and so the chest tube was successfully removed. The patient was discharged from the hospital with anti-tuberculous medications (Figure 1). It has been known that air leak from spontaneous pneumothorax that occurs in the case of emphysema-like changes caused by tuberculous destroyed lung and COPD is resulted from the rupture of bulla8. Thus, air leak site or any abnormalities resulting probably into air leak should be corrected to prevent further recurrences. Currently, thoracoscopic treatment for emphysema-like changes (blebs or bullae) and pleurodesis have been commonly used9,10. In some cases, wedge resection with bullae placation is preferred depending on thoracic surgeons. If the air leak persist more than 4 days even in the first episode of spontaneous pneumothorax, a surgical treatment should be considered11. However, if the patient had a high risk of anesthesia or surgery due to underlying illness or poor pulmonary function, other therapeutic modalities should be alternatively selected, but there are no effective treatments until now.

Bottom Line: A total of 15 patients were enrolled; 14 cases of spontaneous pneumothorax [idiopathic 9, chronic obstructive pulmonary disease (COPD) 3, post-tuberculosis 2] and one case of empyema associated with broncho-pleural fistula.Some adverse reactions, such as fever, chest pain and increased radiographic opacities occurred transiently, but resolved without any further events.With success, the time from the procedure to discharge was about 3 days (median).

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Hallym University College of Medicine, Seoul, Korea.

ABSTRACT

Background: Chest tube drainage (CTD) is an indication for the treatment of pneumothorax, hemothroax and is used after a thoracic surgery. But, in the case of incomplete lung expansion, and/or persistent air leak from CTD, medical or surgical thoracoscopy or, if that is unavailable, limited thoracotomy, should be considered. We evaluate the efficacy of bronchoscopic injection of ethanolamine to control the persistent air leak in patients with CTD.

Methods: Patients who had persistent or prolonged air leak from CTD were included, consecutively. We directly injected 1.0 mL solution of 5% ethanolamine oleate into a subsegmental or its distal bronchus, where it is a probable air leakage site, 1 to 21 times using an injection needle through a fiberoptic bronchoscope.

Results: A total of 15 patients were enrolled; 14 cases of spontaneous pneumothorax [idiopathic 9, chronic obstructive pulmonary disease (COPD) 3, post-tuberculosis 2] and one case of empyema associated with broncho-pleural fistula. Of these, five were patients with persistent air leak from CTD, just after a surgical therapy, wedge resection with plication for blebs or bullae. With an ethanolamine injection therapy, 12 were successful but three (idiopathic, COPD and post-tuberculosis) failed, and were followed by a surgery (2 cases) or pleurodesis (1 case). Some adverse reactions, such as fever, chest pain and increased radiographic opacities occurred transiently, but resolved without any further events. With success, the time from the procedure to discharge was about 3 days (median).

Conclusion: Bronchoscopic ethanolamine injection therapy may be partially useful in controlling air leakage, and reducing the hospital stay in patients with persistent air leak from CTD.

No MeSH data available.


Related in: MedlinePlus