Resp - Viva-BPF Flashcards
What is a BPF
Abnormal communication between bronchial tree and pleural space
Causes an air leak
How does a BPF manifest
Persistent air leak or failure to re-inflate despite chest tube drainage for 24 hours
Continuous PTx/emphysema
How does the size of a BPF matter
Small - tear and puncture - heal quickly with conservative
Larger ones in a main bronchus wont
What is an air leak
An excursion of air from a normally gas filled cavity such as upper airway, sinuses, GI tract etc
Types of airleak
Cerfolio Classification
Continuous - throughout resp cycle (seen in BPF and MV)
Inspiratory only
Expiration only
Forced exp only (cough)
Class of BPF
Central - connections between trachea/lobar and pleura
Peripheral (distal airway) and pleura
Causes of BPF
Post pulmonary resection 4-10% pneumontectomy, 0.5% lobectomy
Right sided procedures more at risk Uncontrolled pleural infection (necrotic lung), Pre-op steroids, radiation chemo Cancer MV for more than 24 hours
Trauma/ARDS
Pneumonia/TB
Line placement, lung biopsy - iatrogenic
Persistent PTx
Features of BPF
Self limiting to life threatening PTx
Dypsnoea Hypotension Subcut emphysema Cough and pruluence Shift trachea/mediastinum Persistent leak in MV Bubbling constantly drain
Diagnosis
CXR - increased pleural airspace, air/fluid level, Tension
Bronch - Localise BPF , bubbles on washing
Methylene blue appears in the drain
CT chest - of choice,
Other - VQ scan, Xenon in pleural space
How does it differ from PTx
BPF - direct communication between central bronchial tree and pleural
PTx - peripheral communication between a ruptured bleb or alveolar duct
Physiological consequences of BPF
Continuous air leak - wont heal
Can’t apply PEEP Loss of tidal volume, can’t maintain alveolar vent Failure to re-expand lung Inappropriate cycling Delayed wean
Management
Resus and initial management -
Supportive care, imaging, treat Tension
Bronchial stump dehiscence - re-suture and re-enforce
Pulmonary flood - control airway, postural drain with affected side down
General
CHEST DRAIN
Suction if needed
Control infection Abx plus drain
Vent
Minimise alveolar distension and minute volume
Low PEEP, low TV, low Insp Time, and RR
Permissive hypercapnoea and lower SaO2
Encourage spontaneous breathing Get off MV as soon as practical
Large/persistent leaks
Consider high frequency vent or oscillator
Independent ventilation Two vents or DLT/bronchial blocker
Bronchoscope repair (not if >8mm) Bronch can apply sealants, gel foam, fibrin
Surgery - thoracoplasty, stump staple, pleural abrasion
ECMO
ICU specific consequence
Can’t wean Hypoxia Hypercapnoea Can’t use PEEP or expand lung Sedative and paralysis +++ More operations and transfers off unit DLT High mortality/morbidity
