Evaluation of Bronchoscopic Lung Insufflation in the Management of Patients with Lung Collapse

Abstract
Background: Pulmonary atelectasis is one of the most commonly encountered abnormalities in chest radiographs. Flexible Bronchoscopy (FB) has been of great help in the management of many pulmonary conditions. Bronchoscopic insufflation of atelectatic portions of the lung can be safe and effective in treating acute lung collapse which is refractory to conventional therapy.
Aim of Study: To evaluate the safety and effectiveness of bronchoscopic lung insufflation in the management of Egyptian patients with lung collapse.
Subjects and Methods: An experimental cross-sectional study was carried out on 40 patients admitted in Al-Hussein and Sayed Galal Al-Azhar University Hospitals in the period from March 2016 to March 2018. Patients with acute partial or complete lung collapse that failed to re-expand with con-ventional methods (physiotherapy or lung recruitment ma-noeuvers) or those with rapidly aggravated collapse were included. The patients, after failed conventional methods, were categorized into two groups: Group 1: Included thirty-six patients managed by bronchoscopic toilet and suction only. (Thirty patients with success bronchoscopic suction and six patients whom collapse failed to expand with bronchoscopic suction). Group 2: Include ten patients managed by broncho-scopic insufflation technique either immediately in cases of rapidly aggravated collapse (four patients) or after failed initial bronchoscopic toilet and suction (six patients).
Results: Thoracic and upper abdominal operations caused significant numbers of postoperative lung collapse with lower lobes mostly affected. The mean value of PaO2 was signifi-cantly improved after the bronchoscopic insufflation procedure (74.3±10.4 vs. 60.9±9.7mmHg, p<0.001). The success rate of bronchoscopic insufflation was 80% in the first 24 hours with no significant procedure-related complications. Recur-rence of collapse within 2 weeks follow-up was noted in pre-existing pulmonary disease, but was significant in smokers (p=0.022). Late intervention after 72 hours was associated with failed lung expansion.
Conclusion: Bronchoscopic insufflation was highly suc-cessful in treating lung collapse and improving lung oxygen-ation without significant complications.