High frequency ventilation combined with spontaneous breathing during bronchopleural fistula repair: a case report

• Published in: Canadian journal of anesthesia 2009, Vol.56 (1), p.52-56
• Main Authors: Poulin, Véronique, Vaillancourt, Rosaire, Somma, Jacques, Gagné, Nathalie, Bussières, Jean S.
• Format: Article
• Language: English
• Subjects: Adult; Anesthesia; Anesthesia, General - methods; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthesiology; Biological and medical sciences; Bronchial Fistula - etiology; Bronchial Fistula - surgery; Bronchoscopy; Bronchoscopy - methods; Cancer; Cardiology; Case reports; Case Reports/Case Series; Chemotherapy; Critical Care Medicine; Edema; Female; General anesthesia; High-Frequency Ventilation - methods; Humans; Infections; Intensive; Intervention; Magnetic resonance imaging; Medical personnel; Medical sciences; Medicine; Medicine & Public Health; Metastasis; Pain Medicine; Pediatrics; Pleural Diseases - etiology; Pleural Diseases - surgery; Pneumology/Respiratory System; Pneumonectomy; Pneumonectomy - adverse effects; Prostheses; Respiration; Thoracic surgery; Thoracic Surgery, Video-Assisted - methods
• ISSN: 0832-610X; 1496-8975
• DOI: 10.1007/s12630-008-9010-9

Purpose We report the addition of high frequency oscillatory ventilation (HFOV), combined with spontaneous breathing under general anesthesia, during an uncommon technique to occlude a late post-pneumonectomy bronchopleural fistula. Clinical features A 41-year-old woman underwent an extended right pneumonectomy with chest wall resection and prosthetic reconstruction for a large adenocarcinoma of the upper lobe (T3N0M0). Her postoperative recovery was satisfactory, and she subsequently received adjuvant chemotherapy. Four months later, however, she was readmitted for investigation of confusion and pink expectorations. On cerebral magnetic resonance imaging, a frontal metastasis with surrounding edema was discovered, as well as a possible secondary lesion in the occipital lobe. In view of the comorbidities, thoracoscopy was planned as an interim measure, with the goal being to debride the fistula and to seal the prosthetic plug. During this case, a HFOV system was used to allow an addition of 2.5 L·min −1 of minute ventilation to the patient’s spontaneous respiration, while maintaining eucapnia without increasing airway pressure. Conclusions With the addition of high frequency ventilation under general anesthesia in a patient with a persistent bronchopleural fistula, the PaCO 2 level was adequately controlled during the simultaneous use of fibreoptic bronchoscopy and video assisted thoracoscopy to facilitate a successful surgical repair.