Resp - Bronchopleural Fistula Flashcards
Define an air leak
Any extrusion of air from a normally gas flled cavity such as gthe airway/sinus, GI
Classift Air leaks
Cerfolio Class: Continuous - throughout resp cycle - seen in MV with BPFInspExp (common after pulmonary surgery)Forced expirationAnatomical classification - central or peripheral
What is a BPF
Abnormal communication betweeh bronchial tree and the pleural spaceLeads to air leak, persistant and failure to inflate lungSmall ones - heal with conservative TxLarger - wont
Causes of a BPF
Commonly following pulmonary resection (pneumonectomy > lobectomy)Risks
Right sided proceduresPleural/pulmonary infectionPre-op steroid/radiation/DMMalignancyMV > 24 hours
Other causestraumaARDSInfectionsNecrotising lung diseaseIatrogenic - lines/drainsMechanical vent
Features of BPF
DyspnoeaHypotensionSub cut emphysemaCough with prurelenceTracheal shiftPersistant air leakBubbing in the drain
Diagnosis of BPF
CXR - increased pleural airspace fluid level tension PtxBronch - confirms location, bubbles on washing methylene blue into drainCT chest - characterise the BPFOthers - VQ scan
Why is BPF different from PTx
BPF is direct communciation between central bronchial tree and pleuraPneumothorax - peripheral between ruptured bleb and cavity
Physiological issues with BPF
Cant apply PEEPLoss of tidal volumeCant expand lungInapprorpirate cyclingDELAYED WEAN
Management
PrinciplesResus General Conservative measuresVentilatory strategyLarge leak management
Resus of BPF
Supportive care and monitorImagingTreat the life threatening - PTx Dehiscience of stump Pulmonary flooding and drainage
Conservative measures
Large bore drainSuction to pleural if neededAbx and drainage
Ventilation strategy
Minimise distension and volume Reduce PEEP, Tv, Insp time and RR Allow permissive CO2GET TO SPONTANEOUS VENT SOONSTOP MECHANICAL VENT ASAPThis will encourage healing
Options for large leaks
Other vent modes - HFV/Oscillate??DLT and two vent ventilation, lung isolationBronchoscopic repair if <8mmSealantsSurgery - thoracoplasy, stump staple, pleural abrasionECMO
