The Science Journal of the American Association for Respiratory Care
Introduction: A 27 year old male, unrestrained driver was involved in a head-on motor vehicle accident, and required surgical repair of a torn right bronchus intermedius. Initially, the patient was ventilated using a 7200ae ventilator in the Pressure Control Ventilation (PCV) mode with eight cm H2O of set PEEP. On post operative day two he developed a right bronchopleural fistula and a large left pulmonary contusion. By post operative day five, the right chest tube leak had increased and the chest x-ray demonstrated bilateral infiltrates. The patient's pulmonary status gradually worsened over the next few days, despite aggressive pulmonary hygiene and tracheostomy, and by post operative day nine he had developed left lung ?white out?, a Cdyn 15cc/cmH20 and a P/F ratio 100. Attempts to utilize high inspiratory pressures and PEEP levels increased the right chest tube leak. Method: The decision was made to initiate Independent Lung Ventilation (ILV) utilizing a left Robertshaw double-lumen endotracheal tube and two 7200ae ventilators in the PCV mode. An attempt was made to synchronize the two ventilators by utilizing the same rate and a fixed inspiratory time, but this proved impractical and asynchronous ventilation was instituted. Two End-Tidal CO2 monitors were used to follow alveolar ventilation and observe for signs of airway obstruction. The right lung was ventilated using low inspiratory pressures and set PEEP. The left lung was ventilated using high inspiratory pressures and set PEEP.
Results: Within eight hours after the institution of ILV, the P/F ratio improved to 250, the Cdyn increased to 30cc/cmH20, and the right chest tube leak decreased significantly. ILV was maintained for seven days. Subsequently, the patient was returned to conventional ventilation via a single-lumen tracheostomy tube and decannulated several days later. In conclusion: Bronchopleural fistula can be successfully treated with Independent Lung Ventilation utilizing two asynchronous 7200ae ventilators in the PCV mode.