The traumatic acute lung injury treated with intermittent flow expiratory ventilation.

Abstract

A case of respiratory failure caused by severe bilateral pulmonary contusion and right lower lobe rupture is reported. The patient was treated by using newly developed systems of intermittent flow expiratory ventilation (IFEV). The original IFEV has been reported as a new technique to augment of CO2 removal during mechanical ventilation1). A 16-year-old male sustained acute respiratory failure due to pulmonary contusion and rupture. He underwent thoracotomy for removal of the ruptured right lower lobe. After surgery, he needed mechanical ventilation with high PEEP and high fraction of inspired oxygen for oxygenation failure during the initial 7 days after admission. After 4 days of ventilation, chest X-ray and CT scan demonstrated cavitation of 5 cm in diameter in the left lower lobe. On day 12, massive sudden air leakage from a left chest drainage tube occurred as a result of rupture of the cavitation. He underwent thoracotomy again for removal of the ruptured left lower lobe. After the second operation, ventilatory failure due to polycystic changes and pneumonia occurred. IFEV was introduced to augment CO2 removal. After the start of IFEV, PaCO2 was dramatically reduced from 97mmHg to 79mmHg, and PaO2 was also improved. However, pulmonary infection could not be controlled, and he died due to respiratory failure on day 44.