Critical Care and Shock

Successful recruitment in severe unilateral pneumonia using airway pressure release ventilation and lateral decubitus position



We report a case of post-operative, severe, unilateral pneumonia in a tetraplegic in whom there was difficulty in ventilating and recruiting the affected lung. Airway pressure release ventilation (APRV) was applied to create a pan-inspiratory recruitment effort and the patient was positioned with the affected lung non-dependent to facilitate drainage of secretions. This resulted in a dramatic improvement in recruitment and gas exchange, allowing ventilatory requirements to be weaned rapidly. We highlight the difficulties in lung recruitment for unilateral lung disease and discuss how APRV may be the ideal technique in such situations.