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Nitric oxide and high frequency jet ventilation in a patient with bilateral bronchopleural fistulae and ARDS

From the Department of Anesthesiology, Program in Critical Care, London Health Sciences Centre, 339 Windermere Road, London, Ontario N6A 5A5 Canada.

Address correspondence to: Lorne Porayko MD. Phone: 519-663-3363; Fax: 519-663-3079; E-mail: lporayko{at}yahoo.com

Purpose: To describe a method of delivering nitric oxide during high frequency jet ventilation.

Clinical Features: A 63-yr-old man underwent reduction pneumoplasty for bullous emphysema. Postoperatively, ventilation was inadequate, secondary to bilateral high output bronchopleural fistulae. High frequency jet ventilation was initiated and achieved adequate ventilation (pH>7.2). Over the following 24 hr, progressive hypoxemia (Sa0₂ < 86%) developed along with the acute respiratory distress syndrome. Nitric oxide was delivered by continuous flow at the patient Y-connector during combined high frequency jet and conventional ventilation (two conventional low volume breaths/minute). Substantial improvement in oxygenation (FiO₂ 0.8 0.5, SaO₂ > 92%) was noted initially and was sustained over 72 hr. Subsequently, the patient was weaned to conventional ventilation without difficulty. Mechanical ventilation was discontinued on postoperative day sixteen.

Conclusion: The simultaneous use of nitric oxide and high-frequency jet ventilation was used safely and effectively in this patient as a method of support for acute respiratory distress syndrome with co-existing large bilateral bronchopleural fistulae.

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