SESSION TITLE: What's New in the ICU
SESSION TYPE: Affiliate Case Report Slide
PRESENTED ON: Tuesday, October 29, 2013 at 07:30 AM - 09:00 AM
INTRODUCTION: Intra-Bronchial Valve (IBV®) is a removable endoscopically-placed device that limits airflow to distal segments while it allows proximal secretion drainage. It is currently used as non-surgical treatment for bronchial-pleural fistulas and lung volume reduction (LVR) in emphysema. The patient described is a single-lung transplant that underwent mechanical ventilation for respiratory failure due to a community acquired viral infection. Subsequently, patient was difficult-to-wean from mechanical ventilation. The patient had IBV®s placed in her native right emphysematous lung. This intervention represents a novel application to the patient’s weaning from mechanical ventilation.
CASE PRESENTATION: 61 year-old-lady with a history of single left-lung transplant due to emphysema was admitted to the intensive care unit with respiratory failure. Physical examination was remarkable for limited breath sounds worse in the right hemithorax. Laboratory tests showed lymphopenia. Chest Contrast-Tomography revealed right emphysematous lung impinging the left with lingular and left lower lobe ground glass opacities. Patient had a lingular bronchoalveolar lavage. It yielded respiratory syncytial virus (RSV). After aerosolized ribavirin and tracheostomy, the patient received 10 IBV®s in the right upper -middle lobes. Subsequently, peak and plateau pressures decreased with the ability to pass spontaneous breathing trials.
DISCUSSION: The case displays a unique situation in which IBV®s placed on the patient’s right native lung assisted in the ability to be liberated from mechanical ventilation. This is the second reported occurrence in which IBV® valves were used on prolonged mechanical ventilation. Lung volume reduction surgery (LVRS) has been demonstrated to improve quality-of-life and survival in a sub-population of emphysema patients. Considering single lung transplantation in emphysema, graft dysfunction can be caused by native lung hyperinflation. Two case series describe successful elective LVRS with native lung hyperinflation.1,2 IBV® is a removable device that acts as one-way valve to allow air-secretion flow proximally. A case series showed that IBV® in non-lung transplant patients with respiratory failure aided in weaning.3
CONCLUSIONS: This is the first published case of IBV® in the setting of respiratory failure-mechanical ventilation in lung transplant.
Reference #1: Reece TB, et al. J Thorac Cardiovasc Surg 2008; 135:931-937
Reference #2: Wilson H, et al. Eur J Cardiothorac Surg 2012; 42:410-413
Reference #3: Mahajan AK,et al. J Bronchology Interv Pulmonol 2012; 19:137-141
DISCLOSURE: The following authors have nothing to disclose: Enrique Ortiz-Diaz, Diana Guerra, Neeraj Sinha, Ramachandra Sista
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