Bronchopleural fistula management in a pediatric patient requiring extracorporeal membrane oxygenation

Author:

Yang Margaret1ORCID,Derespina Kim1,Grant Chantal2,Vicencio Alfin2,Murthy Raghav3,Kaushik Shubhi1

Affiliation:

1. Division of Pediatric Critical Care Medicine, Department of Pediatrics, Mount Sinai Kravis Children’s Hospital, New York City, NY, USA

2. Division of Pediatric Pulmonology, Department of Pediatrics, Mount Sinai Kravis Children’s Hospital, New York City, NY, USA

3. Division of Pediatric Cardiac Surgery, Department of Cardiovascular Surgery, Mount Sinai Icahn School of Medicine, New York City, NY, USA

Abstract

Bronchopleural fistula (BPF) is a connection between the bronchus and pleural cavity. It is associated with high morbidity and mortality and management of BPF has not been well described in the pediatric population. We describe a 2-year-old girl who presented with fever and increased work of breathing, found to have atypical hemolytic uremic syndrome and Streptococcus necrotizing pneumonia with development of persistent air leak due to bronchopleural fistulas requiring extracorporeal membrane oxygenation (ECMO). Three endobronchial valves were placed with successful resolution of bronchopleural fistulas. She required tracheostomy for chronic respiratory failure and endobronchial valves were eventually removed. Approximately 3.5 months after discharge to acute care rehabilitation, tracheostomy was successfully decannulated. This case highlights the successful use of endobronchial valves for resolution of BPF while on ECMO as well as the importance of further studies on optimal candidates, timing and duration of intervention in addition to sequelae of endobronchial valve placement.

Publisher

SAGE Publications

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