Emergency thoracotomy for acquired bronchopleural fistula in the premature infant with respiratory distress.

Pneumothorax is a common complication of ventilator therapy and usually responds to tube thoracostomy. Persistent pneumothorax with a large air leak may indicate the presence of a bronchopleural fistula (mean weight 1360 g) with (BPF) required FIO2 of 1.0, a peak inspiratory pressure of 33 cm H2O and were hypoxemic (x pH 7.19) despite insertion of multiple chest tubes. Four patients treated nonoperatively died while nine of ten survived emergency thoracotomy and suture of BPF. BPF was probably related to suction catheter trauma. These observations suggest that emergency thoracotomy may be a life-saving procedure in selected infants requiring ventilator support who demonstrate a large air leak, persistent pneumothorax, and progressive hypoxia that is unresponsive to chest tube insertion.