The Science Journal of the American Association for Respiratory Care

2012 OPEN FORUM Abstracts


Rory A. Mullin1, Nicholas Russo2, Robert L. Chatburn1; 1Respiratory Institute, Cleveland Clinic, Cleveland, OH; 2Anesthsia Institute, Cleveland Clinic, Cleveland, OH

INTRODUCTION: Independent lung ventilation (ILV) has been described for use in patients with non-homogenous lung injury. The theory behind ILV is to protect a non-injured lung from excessive strain while also maintaining ventilation. Mid-Frequency ventilation (MFV) has been described as a means to provide potential lung protective benefits similar to high frequency ventilation using a conventional ventilator (Respir Care 2008;53(12):1669-1677). We describe a case of acute lung injury leading to pulmonary hemmorhage treated with ILV and MFV. CASE SUMMARY: A 69 year old man was admitted for liver transplant. During sugery, the patient developed hemoptysis and right pnuemothorax. A right tube thoracostomy was performed and the right lung was isolated with a double lumen endotracheal tube. An emergent bronchoscopy was performed on the right lung but we were unable to identify a source of bleeding. Blood gases on arrival to the ICU was pH = 7.18 PCO2 = 74 mmHg PO2 = 82 mmHg. ILV was started and the left lung was maintained on conventional ventilatory settings (PC-CMV rate 24 breaths/min, TI 1.25s, VT ~400 mL, PEEP 8 cm H2O, FiO2 100%). The right lung was set up with MFV (PC-IMV rate 80 breaths/min, TI 0.43s, VT approximately 80 mL, PEEP +15, FiO2 100%). The resulting blood gas showed: pH = 7.39, PCO2 = 46 mmHg, PO2 = 105 mmHg. The right lung hemoptysis stopped, allowing interventional radiology opportunity to identify a source of bleeding. No pulmonary source was identified. The next day, we were able to wean the patient to conventional ventilation on both lungs and he remained on conventional ventilation throughout the rest of his admission.. The patient had a long complicated post-operative course and eventually succumbed to renal and hepatic failure. DISCUSSION: This patientÂ’s complicated coagulopathy likely contributed to the hemoptysis. On arrival to the ICU, our goal was to keep the right lung isolated while still maintaining ventilation and oxygenation. The first thought was for high-frequency ventilation on the right lung for lung protection, however the equipment was not immediately available. Stabilizing an injury by reducing the change in ventilatory pressures was our primary goal. We targeted a mean airway pressure, much like high frequency ventilation. Ultimately, the patient was safely ventilated using ILV and MFV. Sponsored Research - None