High flow bronchopleural fistula effective bronchoscopic closure in a patient with acute respiratory distress syndrome

Abstract

Background: Bronchopleural fistula (BPF) secondary to surgery or infections implies a therapeutic challenge, either expectant or surgical treatment. Nowadays, the endoscopic closure procedure is performed more often. 

Objective: Case-report of a child presenting a successful endoscopic closure of a bronchopleural fistula during acute respiratory distress syndrome (ARDS). 

Case-report: A 14 year-old boy with previous left lower lobectomy due to chronic bronchiectasis, who developed a central BPF after transthoracic drainage of a lingular abscess, associated to mechanical ventilation failure, septic shock and ARDS. The BPF was sealed through bronchoscopy with Tetracycline and Gelfoam, with great decrease of BPF high flow until definitive closure 3 weeks after the procedure. 

Conclusion: BPF development after pulmonary abscess drainage could be effectively treated with bronchoscopic closure during ARDS in a critically ill child, avoiding higher surgical risks.