CHEST Guidelines-Management-of-Alveolar-Pleural-Fistula

Management-of-Alveolar-Pleural-Fistula_chest

Pdf Summary

This editorial discusses recent advancements and findings related to the management of pulmonary embolism (PE) and alveolar-pleural fistula (APF) or bronchopleural fistula (BPF), two critical medical issues with significant impact on patient care. <br /><br />For PE, a study has revealed that 45% of patients could be categorized as low-risk using high-sensitivity cardiac troponin I (hs-cTnI) levels, indicating potential clinical benefits. Despite this, caution is advised as the study's small number of adverse outcomes and lack of hs-cTnI measurements in some patients, notably those with active malignancy, could limit its general applicability. The study raises questions about whether combining a panel of cardiac biomarkers could improve the accuracy of classifying patients as low-risk, stressing the need for additional research. Confirmation of these findings might lead to significant changes in clinical practices, potentially allowing some patients with acute PE to be managed as outpatients.<br /><br />The editorial also focuses on APF/BPF management, highlighting that these conditions are complex to treat surgically, with high morbidity and mortality. Traditional surgical and bronchoscopic interventions, such as pleurodesis and the use of airway occluding devices, have shown limited success. The use of Watanabe spigots and other bronchoscopic methods, like endobronchial valves and synthetic hydrogels such as CoSeal, are explored. CoSeal, a novel synthetic hydrogel, has shown promising results in stopping air leaks in the majority of cases within a short time frame, due to its "auto-reversibility" and ease of use. However, larger trials are necessary to confirm its effectiveness across various clinical scenarios.<br /><br />Overall, these discussions emphasize the evolving landscape of treatment for PE and APF/BPF, indicating potential shifts in clinical strategy pending further research and validation.

Keywords

pulmonary embolism

alveolar-pleural fistula

bronchopleural fistula

cardiac troponin I

biomarkers

outpatient management

Watanabe spigots

endobronchial valves

synthetic hydrogels

CoSeal