Possibilities of using hyperbaric oxygenation in bronchial suture ischemia after lung resection

INTRODUCTION. Bronchial suture ischemia and necrosis is a serious complication following lung resection. Traditional treatments are often ineffective. Hyperbaric oxygen therapy may be useful as an adjuvant therapy for bronchial suture ischemia following lung resection.

The OBJECTIVE was to study the potential of hyperbaric oxygenation in patients with ischemic changes in the bronchial suture after oncothoracic surgery with systematic mediastinal lymph node dissection.

METHODS AND MATERIALS. A study was conducted involving 174 patients with bronchial raphe ischemia/necrosis following oncothoracic surgery with systematic mediastinal lymph node dissection. All patients underwent HBO sessions. The clinical course of each patient, treatment outcomes, and any adverse effects were analyzed. Treatment outcomes were compared between groups, including those with ischemic and necrotic changes in the bronchial raphe zone.

RESULTS. Ischemia/necrosis was detected after surgery on day 6 [4–7], and HBO was started on day 8 [6–10]. The median duration of HBO was 8 [6–10] sessions. In 127 (93.4 %) patients, HBO allowed to significantly improve the endoscopic picture with subsequent healing of the bronchial suture, in 9 (6.6 %) patients, there was worsening of ischemic changes, which required further surgical intervention. Mortality was higher in the group of necrotic changes of the bronchial suture and amounted to 9 people (23.7 %), than in the ischemia group – 7 patients (5.1 %) (p<0.001). The cumulative 100-day survival probability (according to the Kaplan – Meier curve) in patients with ischemic changes was 94.9 %, and in patients with necrotic changes of the bronchial suture – 76.3 %.

CONCLUSIONS. The obtained clinical data confirm the effectiveness and demonstrate the potential of using HBO to improve bronchial suture healing after lung resection, particularly in cases of tissue ischemia.

1. Plaksin S. A., Farshatova L. I., Lisichkin A. L. Isсhemic change in bronchus stump after lung cancer resection. Grekov’s Bulletin of Surgery. 2020;179(3):33–39. (In Russ.). https://doi.org/10.24884/0042-4625-2020-179-3-33-39

2. Endoh M., Oizumi H., Kato H. et al. Hyperbaric oxygen therapy for postoperative ischemic bronchitis after resection of lung cancer. J Thorac Dis. 2018;10(11):6176–6183. https://doi.org/10.21037/jtd.2018.10.45. PMID: 30622789; PMCID: PMC6297444.

3. Skrzypczak P. J., Kasprzyk M., Piwkowski C. The review of the management and prevention methods of bronchopleural fistula in thoracic surgery. J Thorac Dis. 2023;15(10):5268–5271. https://doi.org/10.21037/jtd-23-1231. PMID: 37969259; PMCID: PMC10636441.

4. Gritsiuta A. I., Stovall A., Petrov R. V. Surgical strategies in the management of postoperative bronchopleural fistula: a narrative review. AME Surg J. 2025;5:10. https://doi.org/10.21037/asj-24-55.

5. Furukawa M., Coster J. N., Hage C. A. et al. Hyperbaric oxygen therapy for extensive bronchial necrosis and dehiscence after lung transplantation. JTCVS Tech. 2023;19(4):166–168. https://doi.org/10.1016/j.xjtc.2023.04.005. PMID: 37324345; PMCID: PMC10268486.

6. Mathieu D., Marroni A., Kot J. Tenth European Consensus Conference on Hyperbaric Medicine: recommendations for accepted and nonaccepted clinical indications and practice of hyperbaric oxygen treatment. Diving Hyperb Med. 2017;47(1):24–32. https://doi.org/10.28920/dhm47.1.24-32.

7. Licker M., Spiliopoulos A., Frey J. G. et al. Risk factors for early mortality and major complications following pneumonectomy for non-small cell carcinoma of the lung. Chest. 2002;121(6):1890–7. https://doi.org/10.1378/chest.121.6.1890. PMID: 12065354.

8. Peng Z., Mei J., Liu C. et al. Risk factors and outcomes of bronchopleural fistula after bronchoplasty in patients with non-small cell lung cancer: a retrospective multivariate analysis. Transl Lung Cancer Res. 2022;11(5):744–756. https://doi.org/10.21037/tlcr-22-272.

9. Skrzypczak P., Kasprzyk M., Gabryel P. et al. Methods of bronchial stump buttressing in post-pneumonectomy bronchopleural fistula prevention: a systematic review. Pol Przegl Chir. 2024;96(6):70–84. https://doi.org/10.5604/01.3001.0054.6636.

10. Satoh Y., Okumura S., Nakagawa K. et al. Postoperative ischemic change in bronchial stumps after primary lung cancer resection. Eur J Cardiothorac Surg. 2006;30(1):172–6. https://doi.org/10.1016/j.ejcts.2006.03.047. Epub 2006 May 26. PMID: 16730184.

11. Benhamed L., Bellier J., Fournier C. et al. Postoperative ischemic bronchitis after lymph node dissection and primary lung cancer resection. Ann Thorac Surg. 2011;91(2):355–9. https://doi.org/10.1016/j.athoracsur.2010.09.021. PMID: 21256268.

12. Buckley C.J., Cooper J.S. Hyperbaric Oxygen Effects on Angiogenesis. 2023 Sep 4. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan. PMID: 29494092.

13. Karaś R., Binduga U. E., Januszewicz P. et al. Review of Hyperbaric Oxygen Therapy as an Adjunctive Intervention for Metabolic Disorders. Antioxidants. 2025;14:1443. https://doi.org/10.3390/antiox14121443.

14. Krylov V. V., Kolchina E. Y. Possibilities of using hyperbaric oxygen therapy at different stages of cardiac surgery. Journal of Clinical Practice. 2022;13(2):88–97. https://doi.org/10.17816/clinpract104667.

15. Dickhoff C., Daniels J. M., van den Brink A. et al. Does hyperbaric oxygen therapy prevent airway anastomosis from breakdown? Ann Thorac Surg. 2015;99(2):682–5. https://doi.org/10.1016/j.athoracsur.2014.03.055. PMID: 25639406.

16. Plafki C., Peters P., Almeling M. et al. Complications and side effects of hyperbaric oxygen therapy. Aviation Space and Environmental Medicine.2000;71(2):119–124.

17. Zhang Y., Zhou Y., Jia Y. et al. Adverse effects of hyperbaric oxygen therapy: a systematic review and meta-analysis. Front. Med. 2023;10:1160774. https://doi.org/10.3389/fmed.2023.1160774.

18. Goel M. K., Khanna P., Kishore J. Understanding survival analysis: Kaplan-Meier estimate. Int J Ayurveda Res. 2010;1(4):274–8. https://doi.org/10.4103/0974-7788.76794. PMID: 21455458; PMCID: PMC3059453.

19. Rich J. T., Neely J. G., Paniello R. C. et al. A practical guide to understanding Kaplan-Meier curves. Otolaryngol Head Neck Surg. 2010; 143(3):331–6. https://doi.org/10.1016/j.otohns.2010.05.007. PMID: 20723767; PMCID: PMC3932959.

20. Bland J. M., Altman D. G. The logrank test. BMJ. 2004;328(7447):1073. https://doi.org/10.1136/bmj.328.7447.1073. PMID: 15117797; PMCID: PMC403858.