Young patient with pneumonia complicated by bronchopleural fistula

We present the case of a 19 year old female presenting to the Emergency Department with signs of pneumonia and sepsis, with her clinical status deteriorating rapidly to septic shock and respiratory failure. Her pneumonia was complicated by formation of an empyema and a bronchopleural fistula. Bronch...

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Bibliographic Details
Published in:The American journal of emergency medicine 2021-08, Vol.46, p.797.e3-797.e5
Main Authors: Fariduddin, Maria Mohammed, Wang, Kai, Birjees, Ayesha, Syed, Wajihuddin
Format: Article
Language:English
Subjects:
Blood pressure
Bronchopleural fistula
Bronchus
Chest tubes
Emergency medical care
Empyema
Extracorporeal membrane oxygenation
Fistula
Fistulae
Intubation
Lung diseases
Oxygen saturation
Patients
Pneumonia
Pneumothorax
Respiratory failure
Sepsis
Septic shock
Staphylococcus aureus pneumonia
Thoracic surgery
Trauma
Ventilators
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Description
Summary:We present the case of a 19 year old female presenting to the Emergency Department with signs of pneumonia and sepsis, with her clinical status deteriorating rapidly to septic shock and respiratory failure. Her pneumonia was complicated by formation of an empyema and a bronchopleural fistula. Bronchopleural fistula (BPF) is a fistula between pleural space and a bronchus. It is an uncommon complication of lung surgery, endobronchial interventions or chest trauma. They are sometimes formed secondary to postoperative pneumonia. Management of BPF requires surgical or bronchoscopic intervention with supportive care. Since a BPF can cause physiological tension pneumothorax, it can lead to significant worsening of respiratory status of these patients. Ventilator settings need to be adjusted to reduce the Positive end expiratory pressure and tidal volume to support these patients. With this case we highlight the importance of recognizing and diagnosing a BPF and timely management of a BPF in the emergency setting to help patients get to the definitive treatment of the fistula.
ISSN:0735-6757
1532-8171
DOI:10.1016/j.ajem.2021.01.057