CV-EMCrit Wee - Mastering Persistent Air Leaks: Navigating the Management of Pleural Fistulae from Conservative Care to VV ECMO

This podcast addresses the complexities of persistent air leaks, defining it as an air leak lasting beyond three to seven days and distinguishing between bronchopleural and alveolar pleural fistulas. The discussion covers quantification methods, including bubble column assessment and advanced systems like Medela, alongside the Serfolio classification based on respiratory phase. Etiologies are divided into surgical (lung resections) and medical (secondary spontaneous pneumothorax). Management strategies emphasize a "drain, wait, watch, and escalate" approach, favoring smaller chest tubes and early transition to water seal to promote healing. Escalation steps include blood patch pleurodesis, surgical intervention (VATS), bronchoscopic management with endobronchial valves, and VV ECMO for severe cases requiring ultra-lung protective ventilation.