Transbronchoscopic selective bronchial occlusion for intractable pneumothorax

The aim of this study was to evaluate the efficacy, complications and safety of the application of transbronchoscopic balloon detection (TBD) and selective bronchial occlusion (SBO) to intractable pneumothorax.

Forty patients with pneumothorax, who had experienced more than 7 days of chest tube drainage without closure of the pleural fistula, underwent TBD and SBO. In 10 patients, oxygenation and pulse rates were recorded. A thoracic CT scan was performed 10 days after SBO.

The bronchi leading to the pleural fistula were located by TBD in 34 of 40 patients (85%). The air leakages ceased after the first occlusion in 30 patients, and five of these 30 patients underwent a second occlusion due to recurrence of pneumothorax 72 h after the first occlusion. In three of these patients, air leakages ceased after the second occlusion, while the remaining two patients underwent thoracoscopy. In total, 28 of 40 patients (70%) were cured using SBO. During TBD/SBO, the lowest SaO2 was 89.0 +/- 2.8%, the mean SaO2 was 93.4 +/- 2. 6% and the percentage of time during the procedure that SaO2 was <90% was 10.7 +/- 17.5%. Ten days after SBO, thoracic CT scans were performed on 10 patients and no obstructive atelectasis was detected in any patient.

These results indicate that TBD and SBO are safe and effective procedures for treating patients with intractable pneumothorax.