How is bronchopleural fistula treated?
Direct surgical repair of chronic bronchopleural fistula may be achieved in most patients after adequate pleural drainage by suture closure and aggressive transposition of vascularized pedicle flaps. Omentum is particularly effective in buttressing the closure of bronchopleural fistulas.
What is bronchopleural fistula?
DEFINITION. Bronchopleural fistula refers to fistula between major, lobar, or segmental bronchus and the pleural space. Alveolar pleural fistula (APF) is a communication between the lung parenchyma (distal to the level of the subsegmental bronchus) and the pleural space.
How do you identify a bronchopleural fistula?
When the fistula appears after removal of a chest tube, the diagnosis of bronchopleural fistula is made on the basis of fever, purulent sputum, and a new air-fluid level in the pleural cavity on the chest radiograph. The diagnosis is confirmed by bronchoscopic examination.
Can anesthesia cause pneumothorax?
Pneumothorax during general anesthesia is a rare event, but can potentially be life threatening, especially if it develops into tension pneumothorax [11]. The major risk factor for developing pneumothorax during general anesthesia is positive pressure ventilation [12].
How do you ventilate a patient with a bronchopleural fistula?
Strategies aimed at decreasing peak inspiratory pressure, using lower tidal volumes, lowering positive end-expiratory pressure, decreasing the inspiratory time, and decreasing the respiratory rate, while minimizing negative intrapleural pressure decreases airflow across the bronchopleural fistula.
Can a chest tube cause a bronchopleural fistula?
Bronchopleural fistula (BPF) is a sinus tract between the bronchus and the pleural space that may result from a necrotizing pneumonia/empyema (anaerobic, pyogenic, tuberculous, or fungal), lung neoplasms, and blunt and penetrating lung injuries or may occur as a complication of procedures such as lung biopsy, chest …
When do you suspect bronchopleural fistula?
If a fistula appears in nonsurgical cases or in delayed postoperative period, the diagnosis should be suspected when fever, productive cough, and new or increasing air-fluid levels are seen on the chest radiograph in the pleural space.
How does intubation cause pneumothorax?
High positive pressures during mechanical ventilation led to pneumothorax and pneumomediastinum, and the mechanism was primarily the dissection of air along the perivascular sheaths of the pulmonary arteries, presumably due to rupture of perivascular alveoli.
How do you handle an air leak in a chest tube?
If bubbling disappears when you clamp the tubing, suspect an air leak at the insertion site or from within the chest wall. Assess the insertion site; if you detect a leak, apply petroleum gauze and a sterile occlusive dressing to seal it off.
What does an air leak in a chest tube mean?
Once a chest tube is inserted, air bubbling into the chest drainage system indicates an air leak. The flow of air through the fistulous tract into the pleural space delays healing and inhibits lung expansion.
How does bronchopleural fistula develop?
A bronchopleural fistula (BPF) is a fistula between the pleural space and the lung. It can develop following pneumonectomy, lung ablation, post-traumatically, or with certain types of infection.
What is A bronchopleural fistula?
Definition. A bronchopleural fistula is a connection from the bronchial tree to the pleural space. Miller cites three ways this can occur: rupture of a bronchus, bulla, cyst, or abscess erosion due to carcinoma or inflammatory disease stump dehiscence status post pneumonectomy Ventilator management is difficult because positive pressure…
What are the treatment options for bronchopleural fistula (BPF)?
Bronchoscopic intervention is a viable first option in small bronchopleural fistulas that are less than 5 mm in diameter. Endoscopic closure of a BPF is of lower cost, has a reduced rate of trauma, and can be performed in critically ill patients.
When is repeat bronchoscopy indicated for fistula?
Repeat bronchoscopy is not routine and only performed if fistula recurrence or a complication is suspected. If valves or stents are used, a chest CT scan and bronchoscopy are repeated at six weeks to assess for complications.
What are the surgical options for the closure of fistula?
Surgical closure of the fistula is done by an anterior, trans-pericardial approach thoracotomy with muscle flap to fill the pleural space or with a muscle flap coverage of the fistula with a limited thoracoplasty.
