ABSTRACT
The term bronchopleural fistula (BPF) can be loosely defined as persistent leakage of gas from the airways into the
pleural space. A true BPF, however, is located in the central airways, whereas leaks
located peripherally are better described by the term parenchymal-pleural fistula (PPF). The presence of a persistent leak in a mechanically ventilated patient is
a worrisome prognostic sign independent of the precise origin, yet it is important
to distinguish BPF from PPF in this population. Fundamental differences in the pathogenesis
and natural history of these two entities dictate divergent approaches to management.
This review compares and contrasts the evaluation and management of BPF and PPF in
patients receiving mechanical ventilation, and provides an overview of the many nonsurgical
interventions used to manage persistent leaks.
KEYWORD
Bronchopleural fistula - persistent air leak - pneumothorax - mechanical ventilation
- lung resection - barotrauma - complications
