The Role of Bronchoscopic Interventions in the Management of Pneumothorax in Interstitial Lung Disease.
The Role of Bronchoscopic Interventions in the Management of Pneumothorax in Interstitial Lung Disease.
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DOI：
10.1097/lbr.0000000000000731
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发表时间：
2021-07-01
影响因子：
3.3
通讯作者：
Gomez Manjarres DC
中科院分区：
文献类型：
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作者：
Valentin R;Patel DC;Jantz MA;Mehta HJ;Mehrad B;Gomez Manjarres DC
方法在机构批准(IRB201801716)后，我们对佛罗里达大学斯汉兹医院2012年10月1日至2019年6月30日收治的所有确诊为ILD并继发性气胸的患者进行了单中心回顾分析，这些患者接受了支气管镜干预，作为持续空气泄漏管理的一部分。螺旋阀系统(奥林巴斯公司，中央山谷，宾夕法尼亚州)和合成水凝胶CoSeal(美国巴克斯特国际公司，迪尔菲尔德，伊利诺伊州)用于研究。持续性漏气定义为插入胸管后持续48小时的漏气，或第一次介入后持续24小时的漏气。主要终点是治疗成功，定义为在同一住院期间拔除胸管而没有气胸复发。次要终点是气胸复发和手术并发症，包括主要并发症，即死亡和急性缺氧性呼吸衰竭，以及瓣膜移位或移位等轻微并发症。数据在Prism(版本8，Mac，GraphPad，加利福尼亚州圣地亚哥)中进行分析。所有变量均采用描述性统计进行分析。结果我们确定了14名ILD继发性气胸患者，他们在研究期间住院16次(总共16次)(表1)。第一次干预是4次胸膜手术，12次支气管镜手术。在接受初次胸膜介入治疗的患者中，所有患者都需要随后的支气管镜检查以解决空气泄漏问题，而在初次接受支气管镜检查的患者中，有8例(67%)需要进行额外的支气管镜检查或胸膜干预(图1)。共放置40个气管内瓣膜，中位数为3个/次(四分位数范围：2~5)，共19次应用水凝胶，中位数为2次(四分位数范围：1~3)。
METHODSAfter institutional approval (IRB201801716), we performed a single center retrospective analysis of all patients with a diagnosis of ILD and secondary pneumothorax admitted to the University of Florida Health-Shands Hospital from October 1, 2012 to June 30, 2019 who underwent bronchoscopic intervention as part of the management of persistent air leak. Spiration valve system (Olympus Inc., Center Valley, PA) and synthetic hydrogel CoSeal (US Baxter International Inc., Deerfield, IL) were used for the study. Persistent air leak was defined as air leak after chest tube insertion lasting> 48 hours, or> 24 hours after first intervention. Primary endpoint was treatment success defined as chest-tube removal without recurrence of pneumothorax during the same hospitalization. Secondary endpoints were recurrence of pneumothorax and procedural complications including major complications, that is death and acute hypoxic respiratory failure, and minor complications as valve displacement or migration. Data were analyzed in Prism (version 8 for Mac, GraphPad, San Diego, CA). All variables were analyzed using descriptive statistics.RESULTSWe identified 14 patients with ILD and secondary pneumothorax who were hospitalized 16 times (total of 16 encounters) over the study period (Table 1). The first intervention was a pleural procedure in 4 encounters, and a bronchoscopic procedure in 12 encounters. Among the encounters that underwent initial pleural intervention, all required subsequent bronchoscopic procedure to achieve air leak resolution, and among the encounters with initial bronchoscopic intervention 8 (67%) required additional either bronchoscopic or pleural intervention (Fig. 1). A total of 40 endobronchial valves were deployed with a median of 3 valves per procedure (interquartile range: 2 to 5), and a total of 19 hydrogel applications were performed with a median of 2 applications (interquartile range: 1 to 3) per procedure.