Management of bronchopleural fistula with differential lung ventilation and extracorporeal membrane oxygenation

Bronchopleural fistulas (BPF) represent an unusual but clinically significant condition in pediatric patients. We report the case of a 15-year-old adolescent who developed septic shock and multiple organ failure secondary to a methicillin-resistant Staphylococcus aureus infection, complicated by necrotizing pneumonia and high-output BPF. The patient was supported with veno-venous extracorporeal membrane oxygenation and differential lung ventilation using a double-lumen endobronchial tube. This strategy enabled the control of positive pressure in the affected lung, promoting fistula closure and subsequent respiratory recovery. This case highlights the value of a multimodal approach in complex situations, emphasizing the synergistic use of extracorporeal membrane oxygenation (ECMO) and differential ventilation as a therapeutic option for refractory BPF in pediatric patients.