Disorders of the Pleura: Disorders of the Pleura |

Management of Bronchopleural Fistula With the Nutritional Supplement-Juven, Vitamins A, and C, Zinc Gluconate, and Folic Acid FREE TO VIEW

Rajeev Narang, MBBS; Devina Narang, BS; Shreya Narang, BS; George Udeani, Phar
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Corpus Christi Medical Center, Corpus Christi, TX

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):567A. doi:10.1016/j.chest.2016.08.656
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SESSION TITLE: Disorders of the Pleura

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM

PURPOSE: Bronchopleural fistula is a common clinical problem encountered by pulmonologists and CV surgeons. Majority of bronchopleural fistula close by themselves within few days with properly placed tube thoracostomy and suction .Some patient can have persistent leak leading to prolonged hospitization. Surgical options, such as lung stapling, use of fibrin glue administered bronchoscopically and endobronchial valves are sometimes needed to help some of these patient with varying results. Surgical options are expensive and can have significant morbidity and even mortality. We propose using concepts proven to be efficacious in wound healing, can be applied in managing these difficult patients. Nutritional supplements that have been found to be useful in wound healing including juven (an arginine-based amnio acid), vitamin A, vitamin C, zinc gluconate, and folic acid can also be applied in managing these patients.

METHODS: This study was a retrospective chart review of patients with bronchopleural fistula. Patient with persistent air leak forty eight hours after insertion of chest tube were analysed in a retrospective review. Some patients based on author's clinical experience were prescribed above mentioned nutritional supplements.Based on review of charts, author was able to identify patients who received: Juven, 1 packet daily, vitamin A 10,000 units once daily, vitamin C 500 mg once daily, folic acid 1 mg once daily, and zinc gluconate 220 mg once daily (Non-Standard Intervention ) versus those who those who did not receive these agents (Standard Intervention ) These two group of patient were compared to each other . The parameter which was monitiored was number of days with chest tube in standard and non standard group. Patient who died from any cause in either group were not included in analysis There were 11 patients in the non-standard intervention group, and 10 patients in the standard intervention group. Descriptive statistics was carried out to determine means, and standard deviations for both groups. Mann Whitney U test (one-tailed, significance level of 0.05) was conducted to determine the level significance for both groups.

RESULTS: Mean length of stay on chest tube for the Standard Intervention was 10.9, with a standard deviation of 6.1 days. In the Non-Standard Intervention , mean duration on chest tube was 6.4, with a standard deviation of 2.3 days. The Z-score was -1.7252, with a p-value of 0.0418, thus significant at p≤ 0.05. The U-value was 30. The critical U at p≤ 0.05 was 31. Thus the result was significant at p≤ 0.05.

CONCLUSIONS: Time to chest tube removal in BF fistula patients managed with Juven, 1 packet twice daily, vitamin A 10,000 units once daily, vitamin C 500 mg once daily, folic acid 1 mg once daily, and zinc gluconate 220 mg once daily was shorter than in the group where these agents were not used.

CLINICAL IMPLICATIONS: It seems that that this inexpensive safe intervention,when combined with standard treatment, can shorten the duration of bronchopleural fistula thus decreasing length of stay and cost of caring for these patients. The shorter hospital length of stay can decrease risk of hospital acquired infections.

DISCLOSURE: The following authors have nothing to disclose: Rajeev Narang, Devina Narang, Shreya Narang, George Udeani

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