List Archives

Wed, 9 Jan 2002 23:00:24 EST

BPF is reserved for a Bronchial fistula that occurs after resection in which 
a lobar or mainstem bronchus is oversewn or stapled and breaks down not a 
peripheral lung injury, as the management is completely different, as is the 
outcome, survival and connotation.  In an otherwise stable patient, a leak 
should heal in several days, it often will not in a patient on the vent or on 
steroids.  Sometimes suction may actually increase the size and duration of 
an airleak, this is well documented in LVR patients.  It is OK to accept a 
small airspace if it decreases the size of the leak.  Injection of sclerotic 
agent thru the tube is only successful 40-50 % of the time.  An otherwise 
healthy patient hanging out in the hospital because of an airleak should be 
considered for VATS after about a week or so.  You also need to broch to r/o 
bronchial injury, this may not present initially.  It can present late as a 
delayed leak, persistent leak or even bronchial stricture.  I am a thoracic 
surgeon by the way, as well as a trauma surgeon and Intensivist.  BWolfer

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