2015 年 37 巻 4 号 p. 441-444
Background. It is often difficult to treat patients with intractable pneumothorax and invasive therapies such as pleurodesis and surgical procedures are required. Non-invasive therapy such as endoscopic bronchial occlusion (EBO) is preferred for patients with respiratory failure and poor general health status. Case. An emergency resection of the jejunum was performed in a 54-year-old woman with strangulated ileus. She was admitted to the intensive care unit with respiratory failure and acute respiratory distress syndrome. On day 6, she had right pneumothorax. Her continuous positive airway pressure and pressure support (PS) changed as follows: PS 15 cm H_2O and positive end-expiratory pressure of 5 cm H_2O with FiO_2 1.0 (PaO_2 82.1 mmHg, PaCO_2 70.6 mmHg). The pressure setting was limited because air leakage had increased. We could not perform invasive therapy because of her poor condition. On day 13, we performed EBO with an Endobronchial Watanabe Spigot (EWS) because of persistent air leaks and continued oxygenation failure. EWS was applied to bronchi in lobes B^4 and B^5 with a flexible bronchoscope. After EBO, there was a decrease in the amount of leakage and the patient's oxygen needs decreased. Concerning the cause of air leaks after EBO, interlobar collateral ventilation is involved and completely stopping air leakage may not always be necessary. Eight days later, the EWS in B^4 had migrated and was removed because of no change in air leakage. To prevent recurrence, the chest tube was removed on day 67 after pleurodesis. We expected that the therapy of EWS would successfully reduce air leakage and ensure more effective pleurodesis. The EWS at B^5 was not removed because of a high risk of recurrence and observed emphysematous changes. Conclusion. EWS can be an effective treatment option in inoperable cases requiring mechanical ventilation.
