Independent lung ventilation in the management of traumatic bronchopleural fistula

Independent lung ventilation (ILV) is a technique for managing patients with unilateral lung disease or injury who have failed conventional mechanical ventilation. A 20-year-old man sustained severe ballistic injuries to the chest and abdomen. Damage control laparotomy controlled the patient's...

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Bibliographic Details
Published in:The American surgeon 2006-06, Vol.72 (6), p.530-533
Main Authors: CHEATHAM, Michael L, PROMES, John T
Format: Article
Language:English
Subjects:
Adult
Airway management
Biological and medical sciences
Bronchial Fistula - etiology
Bronchial Fistula - therapy
Case studies
General aspects
Humans
Hypoventilation - etiology
Hypoventilation - therapy
Hypoxia - etiology
Hypoxia - therapy
Lungs
Male
Medical sciences
Pleural Diseases - etiology
Pleural Diseases - therapy
Positive-Pressure Respiration - methods
Pulmonary Atelectasis - etiology
Pulmonary Atelectasis - therapy
Respiratory distress syndrome
Respiratory therapy
Thoracic Injuries - complications
Trauma
Ventilators
Wounds, Gunshot - complications
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Summary:Independent lung ventilation (ILV) is a technique for managing patients with unilateral lung disease or injury who have failed conventional mechanical ventilation. A 20-year-old man sustained severe ballistic injuries to the chest and abdomen. Damage control laparotomy controlled the patient's initial hemorrhage, however, an evolving cavitary pulmonary lesion subsequently developed into a high-volume bronchopleural fistula. Progressive atelectasis of the damaged lung resulted in profound hypoxemia and hypercarbia refractory to conventional mechanical ventilation. Synchronous ILV was initiated using a double-lumen endotracheal tube and two ventilators titrated to optimize the patient's oxygenation and ventilation and minimize ventilator-induced lung injury. Intensive ILV over the next 17 days resulted in recruitment of the atelectatic right lung, resolution of the bronchopleural fistula, and significant improvement in oxygenation and pulmonary compliance. This appears to be the longest reported use of ILV for traumatic lung injury.
ISSN:0003-1348
1555-9823
DOI:10.1177/000313480607200614