Critical Care and Shock

Asynchronous Independent Lung Ventilation in the Management of Bronchopleural Fistula

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Ventilation of lungs with parenchymal injury which can be caused by either disease or trauma has always been a difficult task for both respiratory therapists and physicians. There have been great many advances made in mechanical ventilators and ventilator modes over last decade. This has included the introduction of modes such as High Frequency Oscillator Ventilation (HFOV) [1] and Airway Pressure Release Ventilation (APRV).
Coupled with these new modes has also been a better understanding of how to best recruit and stabilize the lungs [2] and how to best use therapist driven protocols which may help to decrease the percentage of Acute Lung Injury (ALI) that we see today. Sometimes as respiratory care practitioners, we are exposed to trauma patients, which may present with massive amounts of parenchymal damage to the lungs, which we may have to modify on how to ventilate and oxygenate these patients. Some patients may have such severe unilateral lung pathology, that it will be difficult to oxygenation and ventilate, we should make a better effort to avoid high peak pressures and thus decrease the risk of barotrauma to uninjured lung tissue. In such a case, we may wish to consider asynchronous independent lung ventilation with one of these new modes.