Bronchopleural fistula - NYSORA

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Bronchopleural fistula

Learning objectives

  • Describe bronchopleural fistula, its causes, symptoms, and diagnosis
  • Manage patients with a bronchopleural fistula

Definition & mechanisms

  • A bronchopleural fistula (BPF) is a pathologic connection between the bronchus and the pleural space
  • Potentially serious complication following pneumonectomy or other pulmonary resection
  • Can be classified as acute, subacute, and chronic
    • Acute: Caused by surgical dehiscence, potentially life-threatening, requires prompt surgical intervention
    • Subacute & chronic: Mainly associated with infection, subacute more severe

Causes

  • Breakdown of suture/staple line following lung resection
  • Rupture of a cavity (cyst, abscess, bulla, bleb)  
  • Erosion of the bronchial wall by infection (empyema, pneumonia, tuberculosis) 
  • Erosion of the bronchial wall by neoplasm  
  • Penetrating trauma  
  • Pulmonary infarction  
  • Persistent spontaneous pneumothorax
  • Chemotherapy or radiotherapy
  • Iatrogenic

Signs & symptoms

Acute BPFDyspnea
Hypotension
Subcutaneous emphysema
Cough with expectoration of purulent fluid
Tracheal or mediastinal shift
Persistent air leak
Reduction or disappearance of pleural effusion on chest radiograph
Subacute BPFWasting
Malaise
Fever
Chronic BPFInfectious processes
Fibrosis of the pleural space

Diagnosis

  • Instillation of methylene blue into the pleural space
  • Bronchography
  • Bronchoscopy
  • CT
  • Capnography

Management

Bronchopleural fistula, bpf, radiography, bronchoscopy, tidal volume, blood gas, resuscitations, oxygen, chest tube, lung isolation, volatile, iv, double-lumen tube, fiberoptic guidance, one-lung ventilation, normothermia, invasive arterial pressure, central venous pressure, arterial blood gas, urine, extubation, bronchial suctioning, bronchodilators, physiotherapy, sputum, recurrence

Suggested reading

  • Salik I, Vashisht R, Abramowicz AE. Bronchopleural Fistula. [Updated 2022 May 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK534765/
  • Kiyota Y, Topulos GP, Hartigan PM. Bronchopleural fistula. In: Aglio LS, Lekowski RW, Urman RD, eds. Essential Clinical Anesthesia Review: Keywords, Questions and Answers for the Boards. Cambridge: Cambridge University Press; 2015:518-519. 
  • Pollard BJ, Kitchen, G. Handbook of Clinical Anaesthesia. Fourth Edition. CRC Press. 2018. 978-1-4987-6289-2.

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