The Use of Bronchoscopic Oxygen Insufflation to Isolate Persistent Air Leaks in Secondary Pneumothorax Due to COPD

The development of a persistent air-leak due to secondary pneumothorax in patients with COPD is a difficult problem. Treatment options can include surgery, pleurodesis, and various endoscopic techniques. The use of one-way valves has been reported in patients with broncho-pleural and alveolo-pleural fistulae arising after surgical resection as well as after secondary pneumothorax. Isolating the source of the leak is of paramount importance in determining where to place the one-way valves. This can be problematic in patients who only demonstrate air-leak with expiration or forced expiration. We report the use of bronchoscopic oxygen insufflation in isolating the air-leak in three patients with persistent leak only present with expiration and forced expiration.