Treatment for Collapsed Lung in Critically III Patients: Selective Intrabronchial Air Insufflation Using the Fiberoptic Bronchoscope

doi:10.1378/chest.97.2.435

Chest

Volume 97, Issue 2, February 1990, Pages 435-438

https://doi.org/10.1378/chest.97.2.435 Get rights and content

A new, simpler method to re-expand collapsed lungs was introduced in 14 procedures in 12 critically ill patients. To close the bronchus, we wedge the fiberoptic bronchoscope into each segment or subsegment of the collapsed lung instead of using a balloon cuff. Room air was then insufflated into the atelectatic alveoli after repetitive sputum suctioning and bronchial washing with normal saline solution. Complete re-expansion was achieved in 12 of the 14 procedures and partial in two. The average alveolar-arterial oxygen pressure difference (P[A-a]O₂) declined from 217.5 before the procedure to 200.3, 150.0 and 152.2, respectively at 30 minutes, 12 hours and 24 hours after. There were no complications.

(Chest 1990; 97:435–38)

Section snippets

MATERIALS AND METHODS

Twelve patients were admitted to the medical or surgical ICU for the different critical conditions (Table 1). The duration of lung collapse ranged from 24 to 120 hours. All had received intensive respiratory care since admission to prevent atelectasis. When the lung collapsed, another 24 hours of respiratory therapy was performed before the fiberoptic bronchoscopic procedure.

A fiberoptic bronchoscope was used. A three-way adaptor was connected to the suction channel of the bronchoscope. One

RESULTS

After 12 of the 14 procedures, the chest x-ray film showed complete reexpansion; in the remaining two, case 5 and the secondary procedure in case 12, the x-ray film showed partial re-expansion. In case 5 the collapsed lung reexpanded completely after six days of continuous, intensive, pulmonary care. In case 12, a third bronchoscopic procedure was performed with immediate full re-expansion (Table 1).

Case 1 and case 6 died of septic shock 24 and 26 hours after the bronchoscopic procedure. Their

DISCUSSION

Collapsed lung is one of the important problems in critically ill patients, and the clinical condition may worsen rapidly. Treatment with a therapeutic fiberoptic bronchoscopic procedure at the bedside was introduced and good results were reported in many studies.6, 7, 8, 9 This therapeutic procedure includes repetitive sputum suctioning and bronchial washing with normal saline solution; complete or partial re-expansion of atelectasis was attained in 60 to 90 percent of the cases.1, 6, 7, 8, 9,

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Citation Excerpt :
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Fiberoptic bronchoscopy has become a commonplace procedure in ICUs. Despite the fact that one of the most common indications for bronchoscopy is the presence of retained secretions and atelectasis, there is little research dedicated to its safety and utility in this clinical situation. This article presents a case of an intubated trauma victim who had undergone numerous bronchoscopic procedures, with varying degrees of success, for retained secretions and atelectasis. This review then seeks to answer the following three main questions regarding bronchoscopy in critically ill patients: (1) Is bronchoscopy effective in resolving atelectasis? (2) Is bronchoscopy superior to other means of resolving atelectasis? (3) Is bronchoscopy safe in critically ill patients? The patient was a 28-year-old man with no significant medical history who presented to the emergency department after his car was hit by a dump truck. He was found to have multiple leg fractures and a splenic rupture, and he was taken to the operating room for an exploratory laparotomy, splenectomy, and reduction of his fractures. He was then brought to the surgical ICU intubated, sedated, and receiving mechanical ventilation. Over the next 6 h, he developed progressive hypoxemia and diffuse, bilateral alveolar infiltrates on a chest radiograph (CXR). Four days postoperatively, a routine CXR revealed total atelectasis of his right upper lobe (RUL). Emergent bronchoscopy was performed, and a large mucus plug obscuring the RUL bronchus was removed. Follow-up CXR demonstrated resolution of the atelectasis. The next day, RUL atelectasis was again seen on his CXR. A repeat bronchoscopic examination and BAL failed to reveal any plug. A follow-up CXR showed continued atelectasis. Over the next week, the patient underwent daily bronchoscopy for atelectasis with variable degrees of improvement. Over the next 3 weeks, his pulmonary status improved until he was eventually extubated, and 1 month after hospital admission he was discharged to rehabilitation.

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: Manuscript received February 28; revision accepted July 6.

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Chest

Treatment for Collapsed Lung in Critically III Patients: Selective Intrabronchial Air Insufflation Using the Fiberoptic Bronchoscope

Section snippets

MATERIALS AND METHODS

RESULTS

DISCUSSION

Ann Thorac Surg

Chest

Chest

Chest

Bedside bronchofiberoscopy for atelectasis and lung abscess

JAMA

Treatment of postoperative pulmonary atelectasis by active inflation of the atelectatic lobe(s) through an endobronchial tube

Acta Anesth Scand

Treatment of pulmonary atelectasis by active inflation using the endobronchial procedure

Jap J Thorac Surg Tokyo