Bronchopleural Fistula

A bronchopleural fistula is an air leak in the lungs that persists for more than 24 hours after a pneumothorax (collapsed lung) develops. Bronchopleural fistula most commonly occurs when a bronchial stump doesn't heal after pulmonary resections or when there's an infection of the pleural area. It can also be caused when there's not enough ventilation, the ventilator isn't cycling properly, the patient's not getting enough ventilation, or when there's been an ongoing bout with pneumothorax. If a patient has been on mechanical ventilation, bronchopleural fistula is known to occur late in the illness.

Bronchopleural fistula can be deadly to mesothelioma patients and other patients who have incurred bronchopleural fistula for reasons unrelated to chest trauma. The condition should be tended to immediately, as it can cause empyema. If a fistula occurs, a drain in the chest should be installed to allow air to flow properly. Ventilation should also be improved, as the goal is to diminish the leak and maintain proper oxygenation of the patient. If the bronchopleural fistula is severe, a higher frequency ventilation mechanism should be used.

Doctors may use bronchoscopy to identify the approximate location of the leak and to keep leaks localized by inserting a balloon catheter into the suction channel and through distal airways. If the fistula cannot be managed or controlled, surgery may be necessary, and can include a thoracoplasty, stabilization of the intercostals and pectoralis muscles, stapling of the bronchial stump, and decortication. The main goal of such surgery is to stop the air leak completely.

'Bronchopleural Fistula' Sources:
  1. Rippe, Irwin, Fink, Cerra, Intensive Care Medicine, 1999.




 

 

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