4] Inadequate drainage, persistence of BPF and/or non-expansion of the lung even after antibiotic therapy and intercostal drainage were referred to cardiothoracic surgeon and decortication and/or decortication with closure of bronchopleural
fistula using intercostal muscle flap were performed in selected cases.
However, when there is a preexistent pneumothorax, the adequate use of HFJV probably helps to reduce the air leak through the bronchopleural
fistula because a lower elevation in the airway pressure, associated with a good compromise on the oxygenation.
The paper describes the case of a 63-year-old female patient, who was referred to Mayo Clinic for treatment of a large bronchopleural
A true bronchopleural
fistula (BPF) refers to communication between the pleural space and bronchial tree while a parenchymal-pleural fistula (PPF) is between pleura and parenchymal lung (Figure 19).
fistula which required prolonged intercostal drainage developed in 4 patients.
2,3) Abscess formation is driven by chronic inflammation of the pleural space, initially causing an empyema, which triggers development of a bronchopleural
fistula allowing exudative material to enter the chest wall.
In general the pleura thickens gradually in post-primary TB and it can even lead to tuberculosis empyema and bronchopleural
fistula is a life threatening complication after pneumonectomy with an incidence of about 2-5% and a mortality rate of up to 50%.
Table 1 Contraindications to VHI or MHI Conditions Acute pulmonary oedemas Severe bronchospasm Haemoptysis Documented cystic lung changes (bullae or blebs) Subcutaneous emphysema Undrained pneumothoraces or intercostal catheter with air leak Obstructing airway tumour or lung tumour Bronchopleural
fistula Patients requiring nitric oxide or prostaglandins infusions Coagulopathic conditions Physiological parameters Respiratory PEEP (>10 cm[H.
His condition was complicated by pneumotho-races and bronchopleural
fistula formation secondary to barotrauma during mechanical ventilation.
In another of his studies, five of nine children with the condition developed bronchopleural
fistulae after chest tube placement (Pediatr.
For closure of the bronchus, in order to diminish the risk of a bronchopleural
fistula, he cut the cartilage of the bronchial stump at several points to prevent their spring-like action, and then used interrupted silk sutures to effect its closure.