Abstract
Purpose
To describe the use of high frequency oscillatory ventilation (HFOV) in the management of a high output bronchopleural fistula (BPF).
Clinical features
A 55-yr-old female developed a BPF after thoracotomy and decortication of an empyema. The patient deteriorated on the second postoperative day (pH 7.10 PCO2 89) requiring 100% oxygen and mechanical ventilation. After initial improvement, deterioration occurred by 24 hr with conventional positive pressure ventilation (volume or pressure limited) because of decreased pulmonary compliance and bilateral diffuse airspace disease (acute respiratory distress syndrome), persistent increased peak and plateau airway pressures, a prolonged inspired oxygen concentration greater than 0.6, and inability to apply positive end expiratory pressures because of an increased BPF leak (530 mL · breaths−1). HFOV was initiated and maintained for 28 days until resolution of the airspace disease and decreased leak through the BPF to 100 mL · breaths−1.
Conclusion
We report the successful use of HFOV in a patient with high output BPF We suggest that HFOV is a useful technique in patients with a BPF when conventional positive pressure ventilation fails.
Objectif
Décrire l’usage de la ventilation oscillatoire à haute fréquence (VOHF) dans la prise en charge d’une fistule bronchopleurale (FBP) à débit élevé.
Éléments cliniques
Une FBP s’est développée chez une femme de 55 ans à la suite d’une thoracotomie et de la décortication d’un empyème. L’état de la patiente s’est détérioré au deuxième jour postopératoire (pH 7,10 PCO2 89) et a nécessité l’utilisation d’oxygène à 100 % et de ventilation mécanique. Une amélioration initiale a été notée, suivie d’une détérioration, 24 h après l’instauration de la ventilation traditionnelle à pression positive (pression ou volume limité), causée par une baisse de la compliance pulmonaire et un trouble alvéolaire diffus (syndrome de détresse respiratoire aiguë), la hausse de la pression de pointe et de la pression plateau des voies aériennes, la persistance d’une concentration d’oxygène inspirée plus grande que 0,6 et l’incapacité d’appliquer des pressions positives expiratoires à cause des fuites par la FBP (530 mL · respirations−1). La VOHF a été installée et maintenue pendant 28 jours jusqu’à la résolution du trouble respiratoire et la diminution de la fuite à 100 mL · respirations−1.
Conclusion
L’efficacité de la VOHF chez une patiente qui présentait une FBP à débit élevé semble donc indiquer son utilité devant l’échec de la ventilation traditionnelle à pression positive en présence d’une FBP.
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Ha, D.V., Johnson, D. High frequency oscillatory ventilation in the management of a high output bronchopleural fistula: a case report. Can J Anesth 51, 78–83 (2004). https://doi.org/10.1007/BF03018553
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DOI: https://doi.org/10.1007/BF03018553