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High frequency ventilation (HFV) is a generic term applied to several types of ventilation: high frequency positive pressure ventilation, high frequency jet ven­tilation, and high frequency oscillation ventilation. Complete discussion of the general principles of HFV and specific details of different types and applications of HFV have been detailed elsewhere. Despite mechanical differences in the […]

As with the chest tube, the resistance to flow of gases is an integral consideration in the choice of the drainage system connected with the chest tube in a patient with a BPF. The size of air leak and the flow that the drainage device can accommodate are necessary considerations when choosing the drainage system. […]

Patients with chest trauma, adult respiratory dis­tress syndrome (ARDS)-related barotrauma, and pa­tients undergoing invasive chest procedures, including thoracotomy and central line placement, are general categories of patients in whom the potential for the development of a BPF exists and who are fre­quently encountered by the critical care specialist. A chest tube placed to manage a […]

The pulmonologist and intensivist will frequently be called on to advise on the management and therapy of both nonsurgical and surgically related BPFs. Given the incidence of barotrauma and BPFs in the mechan­ically ventilated patient, knowledge of the care of patients with BPFs is requisite for the critical care specialist. Management and definitive therapy of […]

Bronchopleural fistulas (BPFs), communications be­tween the bronchial tree and the pleural space, continue to present a formidable management and therapeutic challenge. A review of BPF is presented and includes discussion of the causes of BPF, clinical presentation, and management with emphasis on currently available medical techniques. Medical man­agement includes appropriate chest tube placement, selection of […]

The postoperative differential diagnoses for lung radiolucencies include pneumatoceles, bronchopleu­ral fistulas, pneumothorax, and elevation of hemidia- phragms with superimposition of abdominal contents. Lung torsion can occur but usually presents as opaci­fication due to infarction and atelectasis. Pneumatoceles are thin-walled cystic structures that develop secondarily to pneumonia. Though they are unusual in adults, they have been […]

An 80-year-old retired male railroad worker was referred for evaluation of a chronic cough and a persistent left lower lobe infiltrate. One month prior to presentation, he was hospitalized for a pneumonia and a parapneumonic effusion. Thoracentesis at that time yielded sterile fluid with negative cytologic findings. He complained of progressive dyspnea, worse at night. […]

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