Managing a major traumatic bronchopleural fistula in a resource scarce community

A case of penetrating chest trauma owing to bull horn goring injury was managed surgically. Postoperative respiratory distress and severe hypoxia was managed initially by conventional modes of ventilatory assistance. We were unable to correct non resolving hypoxaemia through usual course of tracheal intubation and positive pressure ventilation. Large amount of persistent air leak at the intercostal chest tube drainage site arose the suspicion of associated severe traumatic bronchopleural fistula and led to try out alternative methods of respiratory support. An early tracheostomy was planned due to lack of facility for high frequency jet ventilation, which provided two-pronged benefits of a lowered airway resistance to breathing and avoided the need for positive pressure breaths.