ATS Breathe Easy At The Bedside: Episode 4 – Bronchopleural Fistula Management in Positive Pressure Ventilation
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Sep 12, 2023 The podcast discusses the management of bronchopleural fistulas in positive pressure ventilation, emphasizing the importance of treating the patient rather than just the image. Various strategies such as water sealing, tube placement, and pleuridesis agents are discussed. Surgical options are considered as a last resort due to associated risks.
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Air Leak Grading (1–4)
- Grade air leaks from 1 (forced exhalation) to 4 (continuous) by observing bubbling during respiratory phases.
- Continuous leaks are the largest and usually take the longest to resolve.
Prefer Water Seal To Promote Healing
- Consider switching a draining chest tube to water seal rather than keeping continuous suction to reduce flow through the fistula.
- Accept a small pneumothorax if the patient is clinically stable to encourage faster fistula healing.
Simple Way To Set Water Seal
- A simple way to set water seal is to remove wall suction from the collection system; it will switch to water seal.
- Ask an experienced nurse to show you at the bedside if you are unsure.