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

Abstract

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 LÁmin -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. RésuméObjectif Nous rapportons l'ajout du mode de ventilation ah aute fre´quence par oscillation (VHFO) a`la respiration spontane´e sous anesthe´sie ge´ne´rale pendant une technique peu commune visant a`re´aliser l'occlusion d'une fistule bronchopleurale survenue a`la suite d'une pneumonectomie. É léments Cliniques Une patiente de 41 ans a subi une pneumonectomie droite extensive avec re´section de la paroi thoracique et reconstruction prothe´tique en traitement d'un important ade´nocarcinome du lobe supe´rieur (T3N0M0). Sa re´cupe´ration postope´ratoire fut satisfaisante et elle reçut par la suite une chimiothe´rapie adjuvante. Cependant, quatre mois plus tard, elle fut re´admise al 'hôpital pour un examen approfondi de troubles de confusion et d'expectorations rose´es. La re´sonance magne´tique ce´re´brale re´ve´la une me´tastase frontale entoure´e d'un oede`me, ainsi qu'une le´sion secondaire potentielle au niveau du lobe occipital. E´tant donne´les comorbidite´s, une thoracoscopie a e´te´pre´vue comme mesure inte´rimaire, et dont l'objectif e´tait de de´brider la fistule et sceller le bouchon prothe´tique. Pendant cette

High-Frequency Oscillatory Ventilation in an Infant With Necrotizing Pneumonia and Bronchopleural Fistula

“…4 Poulin et al reported similar results in a 41-year-old female with lung cancer who developed bronchopleural fistula following pneumonectomy. 12 Creel et al reported a case series of 11 children (age range 3-15 y) with community-acquired MRSA pneumonia admitted to a pediatric intensive care unit over a 6-year period; however, they did not report any cases of bronchopleural fistula or use of HFOV. 13 We believe our patient was an unusual case of an infant with community-acquired MRSA pneumonia complicated by empyema and bronchopleural fistula.…”

The anesthesia of trachea and bronchus surgery

“…Inadequate ventilation may occur because an air leak. Awake fiberoptic intubation with double-lumen or single-lumen ETTs, spontaneous ventilation until lung isolation, thoracic epidural anesthesia with IV sedation and HFJV may be used in patients with bronchopleural fistula (69).…”