A 23-year-old man with left lung atelectasis treated with a targeted segmental recruitment maneuver: a case report

Abstract

Background: Lung atelectasis are nonventilated parts of lung tissue and occur as a result of the collapse of the pulmonary parenchyma (alveoli). Various therapeutic procedures for inflating the collapsed pulmonary parenchyma, such as bronchial aspiration and/or standard recruitment maneuvers, are not always successful. Case presentation: We report a case of a 23-year-old Croatian man with a parapharyngeal abscess on the left side of the neck with spreading of infection in the mediastinum and left side of the thorax and consequent major atelectasis of the left lung. The patient was mechanically ventilated. We decided to apply a new method in which a pulmonary artery catheter was placed (guided by bronchoscope) on the entrance to the lower left bronchus. The pulmonary artery catheter balloon was inflated to achieve bronchial closure. Using another respirator, we ventilated the affected lobe separately with continuously high pressure of 30 cmH 2 O. After 30 minutes, we removed the pulmonary artery catheter from the lower left bronchus and placed it in the upper left bronchus and repeated the procedure. Our method allowed a significantly longer duration (30 minutes) of continuously high pressure of 30 cmH 2 O separately to only one of the total of five lobes of the lungs while the other four lobes were simultaneously ventilated continuously with protective ventilation mode. Conclusion: Use of a pulmonary artery catheter and two respirators in our patient's case proved to be a successful method for recruiting the atelectatic lung while maintaining protective ventilation of the lung segments without atelectasis.

Segmental Lung Recruitment in Patients with Bilateral COVID-19 Pneumonia Complicated by Acute Respiratory Distress Syndrome: A Case Report

“…Computed tomography (CT) and ultrasound along the ARDS showed atelectasis mainly in the lower lung segments. At this stage of the disease, segmental lung recruitment was performed, which has already been described in the literature as a minimally invasive innovative procedure that could prevent the use of more invasive procedures, such as extracorporeal membrane oxygenator (ECMO) or even thoracic surgery [ 11 ]. Segmental lung recruitment increased the PaO 2 /FiO 2 ratio in patients, indicating the success of the procedure itself and suggesting an increase in the lung area through which gas diffusion occurred.…”

“…All four patients experienced clinical deterioration of respiratory parameters, and enhanced segmental lung recruitment of the lower segments of both lungs, and the middle segment of the right lung, was performed, according to the previously described technique in [ 11 ]. In brief, patients were additionally analgosedated for the procedure by administering an intravenous infusion of sufentanyl up to 0.075 microg/kg/h (Alatamedics, Zagreb, Croatia), and they received the neuromuscular blocker rocuornim bormid (Organon, Kloosterstraat, The Netherlands) at a dose of 0.6 mg/kg.…”

“…Hodgson et al [ 9 ] showed that a gradual increase in positive end-expiratory pressure (PEEP) during the recruitment maneuver is safe and can improve oxygenation in patients with ARDS, while another study showed increased mortality in a group of patients with ARDS treated with the recruitment maneuver [ 10 ]. A segmental lung recruitment maneuver with independent pulmonary ventilation was described in our previous case report as a successful recruitment maneuver in patients with lobar pneumonia [ 11 ]. In this case report, a segmental recruitment maneuver was used for four patients with severe bilateral COVID-19 pneumonia complicated by ARDS and atelectasis as secondary problems, which, unfortunately, are often responsible for a fatal outcome.…”

Imaging Criteria in the Diagnosis of Atelectasis

“…Middle lobe: Atelectasis at this level causes the major fissure to shift upwards, while the minor fissure is deviated inferiorly (Protić et al, 2020).…”