Bronchopleural fistulae (BPF) can present a significant therapeutic dilemma in the maintenance of ade- quate alveolar ventilation. The challenge presented by bronchopleural fistulae relates to keeping airway pressures at or below the critical opening pressure of the fistula in order to promote fistula healing, yet still providing adequate alveolar ventilation for sufficient gas exchange. Occasionally, independent lung ventilation alone or in combination with other less conventional ventilatory strategies is required. We report the case of a patient with a massive bronchopleural fistula fol- lowing thoracic surgery and present a strategy of management for this challenging clinical problem.
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