Bronchopleural fistula management in a pediatric patient requiring extracorporeal membrane oxygenation

Area of Science:

• Pediatric Pulmonology
• Critical Care Medicine
• Thoracic Surgery

Background:

• Bronchopleural fistula (BPF) presents a significant management challenge in pediatric patients, often associated with high morbidity and mortality.
• Limited established protocols exist for pediatric BPF management, necessitating case-based approaches.

Purpose of the Study:

• To describe the successful application of endobronchial valves in managing persistent bronchopleural fistulas in a pediatric patient on extracorporeal membrane oxygenation (ECMO).
• To highlight the potential of endobronchial valve therapy as a treatment option for pediatric BPF, even in complex critical care scenarios.

Main Methods:

• A case report of a 2-year-old girl with atypical hemolytic uremic syndrome and necrotizing pneumonia leading to bronchopleural fistulas and requiring ECMO.
• Intervention involved the placement of three endobronchial valves to manage the persistent air leak.
• Post-intervention management included tracheostomy for respiratory failure, subsequent valve removal, and rehabilitation.

Main Results:

• Successful resolution of bronchopleural fistulas was achieved with endobronchial valve placement while the patient was on ECMO.
• The patient was decannulated from tracheostomy after 3.5 months in acute care rehabilitation.
• This case demonstrates a viable therapeutic option for pediatric BPF in a critical care setting.

Conclusions:

• Endobronchial valves can be effectively used to resolve bronchopleural fistulas in pediatric patients, including those requiring ECMO.
• Further research is warranted to determine optimal patient selection, timing, and duration for endobronchial valve interventions in pediatric BPF.
• Understanding the long-term sequelae of endobronchial valve placement in children is crucial for refining treatment strategies.