Bronchopleural Fistula

Bronchopleural Fistula

It is described as a connection between the pleural space and the bronchial tree. 24 hours after a pneumothorax, a continuous air leak is clinically observed.

The problem is a severe side effect of lung cancer surgery. Bronchopleural fistulas can also develop as a result of tuberculosis, severe lung infections, pneumothoraxes, chemotherapy, or radiation treatment for lung cancer.

Risk factor

• Radiation
• Surgery

Causes

• Post- operative complication of pulmonary resection.
• Lung necrosis complicating infection persistent spontaneous pneumothorax, chemotherapy or radiotherapy, and tuberculosis.

Clinical presentation

• Acute
  • When acute, BPF can be life-threatening condition due to tension pneumothorax or asphyxiation from pulmonary flooding. The characterized by
    • Sudden appearance of dyspnea, hypotension.
    • Coughing with expectoration of purulent material or fluid.
    • Shifting of the trachea and mediastinum
    • Persistence of the air leak in the absence of a technical problem, or decrease or disappearance of pleural effusion on the chest radiography.

• Sub- Acute
  • The sub- acute presentation is more insidious and is characterized by
    • Wasting
    • Malaise
    • Fever and minimally productive cough.

• Chronic
  • There is fibrosis of the pleural space and mediastinum preventing the mediastinal shift.

• Delayed
  • When the fistula appears in nonsurgical cases or in the delayed postoperative period, the diagnosis should be suspected when fever, productive cough, and new or increasing air fluid levels are seen on the chest radiograph in the pleural space.

Diagnosis

• Plain film
• CT scan
• Scintigraphy

Management of BPF

• Control of active infection and adequate drainage of the hemothorax.
• Treatment options of BPF include surgical procedure as well as medical therapy and in particular the use of bronchoscopy and different glues, coils, and sealants.
• Proper nutrition is required frequently required.
• Chest tube management
• Mechanical ventilation
• Surgery

Post-operative Management

• If the patient smokes, counsel them on the advantages of quitting.
• If the patient stops smoking, atelectasis and secretion buildup in the lungs may be reduced.
• To eliminate secretion without placing undue strain on the site of the incision.
• How to breathe diaphragmatically
• Expectations before, during, and following lung operation.

Nursing Management

• Observe the critical sign
• Examine the patient's wounds and any connected drainage systems.
• Drainage should be regularly inspected for quality and leakage.
• Provide drugs to reduce the agony
• The patient's respiratory pattern should be improved, a high fowler position offered,
• To reduce secretion and, if necessary, suction the patient's airways, administer humidified oxygen.
• Frequently monitor the patient's respiratory health
• Preserving sufficient ventilation
• It's crucial to practice aggressive lung hygiene to avoid complications.
• Maintain a closed drainage system and functional chest tubes.
• At first, check the chest tube output every hour.
• Examine the incision or chest tube site for indications of infection.
• Maintain dietary status

References

• archive.is/2Q5bs
• book-med.info/fistula/50983