29. Pleural Disease Part 2: Hemothorax & BPF with Dr. Michal Sobieszczyk, MD
Jul 15, 2024
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Dr. Michal Sobieszczyk discusses hemothorax & bronchopleural fistulas. Small vs large chest tubes, endobronchial valves for air leaks, and managing pleural diseases are covered in detail. Insightful discussion on patient management and treatment options.
Appropriate chest tube management is crucial for hemothorax, with 15 French pigtail tubes being effective.
Collaboration with thoracic surgeons and individualized approaches are key in addressing bronchopleural fistulas.
Deep dives
Management of Pneumothorax and Hemothorax
When dealing with pneumothorax, minimizing positive pressure and transitioning to water seal can prevent tension pneumothorax. External interventions may include blood patch application or talc pleurodesis. Thoracic surgery consultation can be vital in unresolved cases. For hemothorax, appropriate chest tube management is crucial, with the size impacting outcomes; 15 French pigtail chest tubes can be effective. Depending on patient stability, different chest tube sizes may be suitable. For unresolved cases, additional interventions or thoracic surgical input may be necessary to prevent complications like empyema or fibrothorax.
Thoracic Interventions for Persistent Air Leaks
Addressing bronchopleural fistula involves a preventative approach by reducing positive pressure and initiating water seal. External interventions like blood patch application or talc pleurodesis can be effective in managing persistent air leaks. Internal interventions, such as endobronchial valves or blockers, offer options to address the issue. In extreme cases, VV ECMO can provide relief for severe leaks. Collaboration with thoracic surgeons may optimize treatment outcomes, emphasizing the importance of an individualized approach.
Strategies for Persistent Bronchopleural Fistula
Persistent bronchopleural fistula lasting over seven days warrants attention, with strategies focused on optimizing positive pressure and transitioning to water seal. External interventions, including blood patching or talc pleurodesis, can aid in closure. Internal interventions like endobronchial valve placement or blockage offer targeted solutions. In challenging cases, multidisciplinary approaches involving thoracic surgery or VV ECMO may be necessary for comprehensive management. Customized care plans are essential for successful resolution.
Podcast Wrap-Up and Acknowledgments
The podcast discusses managing pneumothorax, hemothorax, and bronchopleural fistula intricately, emphasizing tailored interventions for optimal outcomes. Practical insights on tube management, external and internal interventions, and collaborative care underscore the complexity and significance of thoracic conditions. Acknowledgments to sponsors, team members, and the production team highlight the collective efforts in delivering educational content. Disclaimers reinforce educational intent and urge caution in medical decision-making based on podcast information.
On this episode - part 2/2 if you will - we continue our discussion of pleural disease with a focus on hemothorax & management of bronchopleural fistulas. Small tube or large tube? When do you call in the reinforcements? What about endobronchial valves for persistent air leaks? Learn the answers to these questions - and so much more -n with Dr. Mike Sobieszczyk our expert interventionalist!