Persistent air leaks in patients receiving mechanical ventilation

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.