Localization and treatment of bronchopleural fistula through capnography

Bronchopleural fistula (BPF) is a feared complication in the setting of pneumonectomy, lobectomy, and pulmonary infection. The development of BPFs significantly increases morbidity and mortality, and their treatment is complicated, multifaceted, and variable in success. Recently, the use of fibrin glues, acrylic glues, and endobronchial valves through bronchoscopy has allowed for minimally invasive treatment, sparing the patient surgical intervention. Results in the literature for these modalities have been mostly positive in a variety of clinical scenarios. Regardless of the therapeutic interventions used, proper diagnosis and localization of these fistulas is essential. These modalities have traditionally included installation of methylene blue in the pleural space, balloon occlusion, and ventilation scintigraphy. Here, we report the successful localization and treatment of a BPF through the use of localized bronchoscopic capnography in a 30-year-old woman with a complicated BPF. Initial attempts to localize the fistula with Fogarty catheter balloon occlusion were unsuccessful, as multiple segments were involved. Ultimately, with a capnographic catheter, the precise segments could be identified and subsequently occluded with acrylic glue. Air leak and pneumothorax resolved, chest tubes were removed without complication, and the patient was discharged 2 days after the procedure.