Pressure-flow behavior of a bronchopleural fistula during mechanical ventilation with positive pressure

We examined the mechanical behavior of a bronchopleural fistula created by sectioning a small subpleural bronchus in seven anesthetized lambs. The pressure across the fistula was measured as the difference between the pressure recorded by a retrograde bronchial catheter inserted in the vicinity of the fistula and the outflow pressure at the fistula exit. The effective resistance of the fistula (Rf) was computed by dividing this pressure difference by the gas flow through the fistula measured at the outlet of an intrapleural tube adjacent to the fistula. Rf increased by 114 +/- 25% (SE) when we inflated the lungs in a stepwise manner from a tracheal pressure of 2-20 cmH2O. Rf also increased when inflation pressure varied continuously; this increase, however, was less evident when we decreased the inflation time from 1.0 to 0.2 s. The relationship between Rf and lung volume was similar during the stepwise inflations and deflations but showed marked hysteresis during the continuous inflation-deflation maneuvers, when Rf was greater during deflation than inflation. Our results suggest that the fistula behaves as a compliant pathway whose relevant transmural pressure is the transmural pressure at or near the fistula's exit. We attribute the increase in Rf during inflation to decreases in transmural pressure caused by convective and dissipative losses inside the fistula and by the stress applied by the chest wall on the outer surface of the fistula.