Independent Lung Ventilation Using High-frequency Ventilation in the Management of a Bronchopleural Fistula

High frequency oscillatory ventilation in the management of a high output bronchopleural fistula: a case report

“…3 Although the incidence of BPF is low, anesthesiologists may encounter patients with a BPF during resuscitation for acute respiratory failure or in patients requiring surgery for BPF closure itself. [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] C Ca as se e r re ep po or rt t A 55-yr-old woman with colon carcinoma underwent a left hemicolectomy. Six months later, metatastic disease involving the liver was noted which required a cholecystectomy and right hemihepatectomy.…”

“…There have been many case successful reports of independent lung ventilation with a double lumen endotracheal tube. [15][16][17] In these cases the unaffected lung had no pathology and unilateral conventional ventilation was sufficient for gas exchange. The affected lung with the BPF was ventilated via high frequency jet ventilation (HFJV) or independently ventilated with conventional positive pressure at a lower mean airway pressure.…”

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

“…Several therapeutic options have been reported for the management of bronchopleural fistulas in adults, including independent lung ventilation, 16,17 interventional bronchoscopy, and closure of the bronchopleural fistula with various devices or materials, [18][19][20] but those approaches were technically not possible in our patient. [18][19][20] Our patient was not a candidate for lobectomy, because the necrotizing pneumonia process was not limited to one lobe.…”

Management options for the complicated pleural space

“…Ventilator strategies utilizing reduced tidal volumes, PEEP, and inspiratory times are used to limit air flow through a BPF and promote healing [81][82][83][84]. Additional alternative methods of ventilation have also been tried including selective intubation of the healthy lung, double lumen intubation with independent ventilation, high-frequency oscillatory ventilation, high-frequency jet ventilation, and extracorporeal support methods [81,82,85,86]. Differential lung ventilation with either selective mainstem bronchial intubation or double lumen intubation reduces or eliminates air flow to the lung with the BPF but requires the unaffected lung to be healthy enough to support ventilation and oxygenation.…”