Waiting for pneumothorax to resolve to remove chest tube and begin treatment

[Keepthefaith]

My mother has been diagnosed with NSCLC. She is currently in the hospital with bilateral chest tubes to drain pleural fluid. Her right lung has a small pneumothorax (air leak) which is presenting a problem- her thoracic surgeon says that he cannot remove her chest tube and replace with PleurX catheter (pigtail) with the pneumothorax present. This is holding up her treatment as her oncologists do not want to administer chemo while she still has the chest tube (due to risk of infection). Has anyone ever been in this situation? If so, how long did you wait and/or what did you do to resolve the pneumothorax if it didn't go away on its own? Unfortunately my mom is not a candidate for pleurodesis.

Her pulmonolgist has referred her to an interventional pulmonary specialist to perform a procedure to "seal" the pneumothorax by way of introducing a type of bio-sealant (like a human concrete or glue) via bronchoscopy to resolve the pneumothorax. Has anyone ever been in this situation or had this type of procedure? I am trying to learn more information about it and would also like to seek out a professional 2nd opinion, but first wanted to ask if anyone in this group has actually had this procedure done before.

[Tom Galli]

Keepthefaith,

 

Welcome here.

 

You pose difficult questions for your mother who has a difficult case.  I've never had bilateral chest tubes but have had as many as three (at on time) on one side of my chest.  I've also never had a pneumothorax (collapsed lung) but have had many discussions with my surgeon and pulmonologist about procedures I've where a pneumothorax was a distinct possibility.  My doctors were also considering using a bio-sealant to bolster a weak area in my bronchus stump suture repair but I never actually had one.

 

So, I don't have actual experience with everything facing your mother but I have some domaine knowledge that might be helpful.

 

My thoracic surgeon had what appeared to me a step-by-step approach to chest tubes and collapsed lungs (my characterization).  It went like this.  Get rid of the fluid first (chest tube) then deal with all other problems second.  It is kind of a hydraulics problem.  Two things fill the pleural cavity: body fluid and air.  My surgeon's actions seemed to indicated he needed to deal with the fluid first.  That may be the approach your surgeon is taking with your mother.  It is a good question to ask.

 

Tubes and chemotherapy in my experience do not mix.  Chemo reduces white blood count and a chest tube allows access to bacteria and other nasty stuff to tissue not well supplied with blood vessels.  So if these invaders gain a lodgment in your mom's pleural tissue, they can multiply before her immune system detects them and attacks them.  This is my explanation and I'm not a microbiologist nor an infectious disease specialist, but from all of the procedures I've been through, chemo and invasive procedures generally did not mix in my treatment history.

 

I was a candidate for bronchoscopy application of a bio-sealant mixed with bone fragments to bolster a weak area in my bronchus stump sutures.  The area turned out to be too large so they inserted two stents using a bronchoscopy.  If this procedure is performed on your mother, I think it would need to be done after the chest tubes drain the pleural fluid.  Again, this is a good question to ask. 

 

Second opinions are always helpful but make sure you are asking the right questions.  It seems to me the question you are interested in asking is: can your mother's cancer treatment (chemotherapy) begin while she is encumbered with chest tubes and is dealing with a collapsed lung (lungs)?  

 

I hope I've helped.  More questions?  Ask away.

 

Stay the course.

 

Tom