Can a chest tube cause a bronchopleural fistula?
A bronchopleural fistula are often discovered when a chest tube is unable to be removed following lung surgery due to a persistent air leak. There may be continuous bubbling, or instead, an air leak may be present only during inspiration or expiration.
How do you ventilate a patient with bronchopleural fistula?
The goal of mechanical ventilation is to minimize flow across the fistula by keeping airway pressure below the critical opening pressure of the fistula.
- Minimize PEEP.
- Short inspiratory time.
- Low tidal volumes.
- Ideally spontaneous breathing (likely not feasible in this case)
- Permissive hypercapnia.
What is differential lung ventilation?
Differential lung ventilation (DLV) is used to salvage ventilatory support in severe unilateral lung disease in the critical care setting. However, DLV with a double-lumen tube is associated with serious complications such as tube displacement during ventilatory management.
What is alveolar pleural fistula?
An alveolopleural fistula (APF) is a pathologic communication between the pulmonary parenchyma distal to a segmental bronchus (alveoli) and the pleural space. It presents as a pneumothorax and if it persists beyond five days is labeled as a prolonged air leak (PAL).
How is pneumatocele treated?
Medical care for pneumatocele is treatment of the underlying condition. In most circumstances, this involves administration of broad-spectrum antibiotics to treat the pneumonia. Therapy should be directed against the most common bacterial organisms in children, including S aureus and S pneumoniae.
Does a pneumatocele go away?
These lesions are asymptomatic and transient in most patients and disappear by about 6 weeks. They usually do not require any specific treatment or intervention. Surgical intervention is only necessary when pneumatoceles cause cardiopulmonary compromise or rupture into the pleural space.