Video-assisted medical thoracoscopy performed with a single-use bronchoscope: Case report of a critically ill patient with pleural empyema

Current guidelines recommend VATS as the first-line treatment for stage II empyema. Patients with concomitant cardiorespiratory failure are considered ineligible for guideline-recommended management. Alternative treatment options are needed. This case report pertains to an obese man in his early 60 s with respiratory failure and decompensated heart failure. He developed an emphyema, which was refractory to the standard antibiotic therapy, thoracocentesis and other chest drainage. As patient was disqualified from surgical treatment, new approach was implemented. Minimally invasive approach of introducing a single-use bronchoscope through an existing chest drain (FOB-VAMT) was performed with support of non-invasive ventilation and analgosedation. Patient's condition improved significantly after the procedure. He remains under regular follow-up at the Pulmonology Outpatient Clinic 2 years after implemented treatment. This case reports that FOB-VAMT may provide an effective therapeutic option for patients disqualified from standard VATS and endotracheal intubation.