Clinical Challenges in Thoracic Surgery: Management of Bronchopleural Fistula after Pneumonectomy
Behind The Knife: The Surgery Podcast
Behind The Knife: The Surgery Podcast
4.8 • 1.4K Ratings
🗓️ 16 December 2024
⏱️ 38 minutes
🧾️ Download transcript
Summary
Hosts:
Chloe E. Hanson, M.D., PGY3
Brian E. Louie, MD, Thoracic Attending
Peter T. White, MD, Thoracic Attending
Learning Objectives:
- What is a bronchopleural fistula (BPF) and what different ways do they present?
- Describe the acute management of an early BPF.
- Describe the differences in operative considerations between an early and late BPF.
- Describe different options for closure of a pneumonectomy space.
- Sugarbaker's Adult Chest Surgery, 3e Sugarbaker DJ, Bueno R, Burt BM, Groth SS, Loor G, Wolf AS, Williams M, Adams A. Sugarbaker D.J., & Bueno R, & Burt B.M., & Groth S.S., & Loor G, & Wolf A.S., & Williams M, & Adams A(Eds.),Eds. David J. Sugarbaker, et al. https://shc.amegroups.org/article/view/3787/html
- Dal Agnol G, Vieira A, Oliveira R, Ugalde Figueroa PA. Surgical approaches for bronchopleural fistula. Shanghai Chest 2017;1:14.
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Transcript
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| 0:00.0 | Behind the Night, THE SURgery Podcast, relevant and engaging content designed to help you dominate the day. Hello and welcome back to another clinical challenge in thoracic surgery with your Swedish |
| 0:26.9 | Thoracic Surgery team. |
| 0:28.7 | I'm Chloe Hansen. |
| 0:29.7 | I'm a third year general surgery resident currently in my research year here at Swedish, and |
| 0:33.6 | I'm joined by my esteemed attending, Dr. Brian Louis and Dr. Peter White. |
| 0:38.8 | Howdy-do. |
| 0:40.6 | Hey, great to see you again. |
| 0:46.0 | Today, we will be talking about the management of bronchoporil fistulas after pneumonectomy, |
| 0:51.3 | which is one of the most dreaded complications after lung resection due to its high morbidity and mortality. |
| 0:53.2 | Thanks, Chloe. |
| 0:56.3 | Let's dive right into a case. Let's just imagine you're on our service and you're called post-operatively to see one of our pneumectomy patients who the nurses |
| 1:01.6 | tell you has a new onset productive cough. The patient is 65, a male who's post-up day four |
| 1:08.3 | after undergoing a right pneumectomy by a serratus anterior sparing |
| 1:12.4 | post-ilateral thloricotomy, and they buttressed the, or they covered the stump with an intercostal |
| 1:17.5 | muscle flap at the time of surgery. This is for a bulky squamous cell carcinoma with the right |
| 1:21.9 | main stem that extended down the bronchus intermedias. On your way over, you briefly review |
| 1:26.7 | a spas medical history, |
| 1:27.8 | which includes a history of smoking, COPD, and until today, his post-operative course has been |
| 1:32.5 | unremarkable in the chest tube we took out on post-up date too. On arrival, you find the patient |
| 1:37.5 | sitting up in bed. He's aggressively coughing and obvious distressed. He says his coughing fit came on |
| 1:43.2 | acutely, and he's been productive of a large |
| 1:45.5 | volume of clear reddish fluid. His blood pressure is stable. He's adding 92% of remair, |
... |
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