Bpf And Empyema

BPF and Empyema • Causes: after pulmonary resection for carcinoma, traumatic rupture of a bronchus or bulla ( barotrauma or PEEP), penetrating chest wound, or spontaneous drainage into the bronchial tree of an empyema cavity or lung cyst • PPV→ contamination of the healthy lung, loss of air with ↓ alveolar ventilation and CO2 retention, and potential tension Pneumothorax • In case of empyema with BPF drain the empyema under LA with chest tube under suction, then do a CXR, then may fix the BPF under GA • GA options ( the main target is to avoid PPV) o Awake intubation with DLT o Gas induction and maintaining spontaneous ventilation o RSI • Keep FiO2 always 1, and avoid N2O • For non-surgical management: DLT and resting the affected lung, or use of HFJV • Keep a high index of suspicion for tension Pneumothorax

Lung Cysts and Bullae • bronchogenic, postinfective, infantile, or emphysematous • COPD Pt with CO2 retention and ↓ respiratory reserve •