Re-expansion pulmonary oedema - differential lung ventilation comes to the rescue

Abstract

Re-expansion pulmonary oedema (REPE) is a rare complication following re-inflation of a chronically collapsed lung, which is often fatal. We present a case of a 22-year-old male who presented to the hospital with severe respiratory distress and a history of blunt abdominal trauma 3 months back. He was diagnosed to have left sided diaphragmatic hernia with a mediastinal shift to the right, and was posted for emergency repair of the same. After surgical decompression of the left hemi-thorax and reduction of the abdominal contents, re-expansion of the left lung was achieved, following which patient developed REPE. A left sided double lumen tube was then inserted to prevent flooding and cross contamination of the right lung and ventilation of both lungs was maintained intraoperatively. Post-operatively, REPE was successfully managed by differential lung ventilation with a lung salvage strategy to the left lung and a lung protective strategy to the right lung.

Independent lung ventilation: Implementation strategies and review of literature

“…Management of patients on ILV, outside of ventilation strategies, should be guided by the patient’s needs and not influenced by institution of ILV. Though paralysis was thought to be necessary for institution of ILV, use of ILV without paralysis is reported[4]. However, DLT is more stimulating to the airway than a single lumen tube and might require more sedation for patient tolerance and comfort.…”

“…Independent lung ventilation (ILV), though infrequently used in the critical care setting, has been reported by various authors as a rescue strategy for patients with unilateral lung pathology. These are mostly confined to case reports or small case series, but span a variety of patient populations, including medical[1-3], surgical[4-6], pediatric[7-10], and trauma[3,11]. ILV involves anatomical as well as physiological separation of each lung into separate units, and the success of implementation depends on the experience of the critical care team with ILV.…”