Chapter 27 - Management of bronchopleural fistula

Summary

Bronchopleural fistula (BPF) occurs during mechanical ventilation in two general circumstances: as a localized lung or airway lesion (for example, following trauma or surgery; complicating central line placement) or as a complication of diffuse lung disease (for example, ARDS, Pneumocystis carinii pneumonia). Bronchopleural fistula could clinically present as acute, subacute and delayed or chronic forms. The first priority in managing a major pleural space infection is to protect the healthy lung parenchyma. Bronchoscopy should be carried out as soon as possible to diagnose the fistula. Mechanical ventilation may be required in patients. The air escaping through the BPF delays healing of the tract. It accounts for a significant loss of tidal volume, jeopardizing the minute ventilation and oxygenation as this is an area of low resistance. Ventilatory support should provide adequate inflation for the uninvolved areas of lung and assure adequate gas exchange.