Ventilatory management in a child with bilateral bronchopleural fistula: A challenge for the intensivist

Abstract

Pneumatoceles have been described as a complication of staphylococcal pneumonia in children. But the management of large (>1 cm) bilateral bronchopleural fistula (BPF) in a child on positive pressure ventilation is a challenge for the intensivist. Bronchoscopy is an efficient method to close small BPFs (1-3 mm); independent lung ventilation cannot be used in patients with bilateral lung involvements; high frequency ventilation is of limited value in patients with distal and parenchymal disease; surgical management is deferred in patients with severe hypoxia and active chest infection. Extracorporeal membrane oxygenation is the only treatment modality left but its availability is limited to a few centers only.