Transbronchoscopic selective bronchial occlusion for intractable pneumothorax

Background and objective: The aim of this study was to evaluate the efficacy, complications and safety of the application of transbronchoscopic balloon detection (TBD) and selective bronchial occlusion (SBO) to intractable pneumothorax. Methods: Forty patients with pneumothorax, who had experienced more than 7 days of chest tube drainage without closure of the pleural fistula, underwent TBD and SBO. In 10 patients, oxygenation and pulse rates were recorded. A thoracic CT scan was performed 10 days after SBO. Results: The bronchi leading to the pleural fistula were located by TBD in 34 of 40 patients (85%). The air leakages ceased after the first occlusion in 30 patients, and five of these 30 patients underwent a second occlusion due to recurrence of pneumothorax 72 h after the first occlusion. In three of these patients, air leakages ceased after the second occlusion, while the remaining two patients underwent thoracoscopy. In total, 28 of 40 patients (70%) were cured using SBO. During TBD/SBO, the lowest SaO2 was 89.0 ± 2.8%, the mean SaO2 was 93.4 ± 2. 6% and the percentage of time during the procedure that SaO2 was <90% was 10.7 ± 17.5%. Ten days after SBO, thoracic CT scans were performed on 10 patients and no obstructive atelectasis was detected in any patient. Conclusions: These results indicate that TBD and SBO are safe and effective procedures for treating patients with intractable pneumothorax.