This Article Résumé de cet Article Full Text Full Text (PDF) Submit a scholarly reply Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Ratzenhofer-Komenda, B. Articles by Smolle-Jüttner, F. M. Search for Related Content PubMed PubMed Citation Articles by Ratzenhofer-Komenda, B. Articles by Smolle-Jüttner, F. M. Related Collections Cardiothoracic Anesthesia, Respiration and Airway

Differential lung ventilation and emergency hyperbaric oxygenation for repair of a tracheal tear

Beatrice Ratzenhofer-Komenda, MD^*, Anton Offner, MD^*, Fritz Kaltenböck, MD^*, Alfred Maier, MD, Hans Pinter, MD, Gerhard Prause, MD^* and Freyja M. Smolle-Jüttner, MD

^* From the Departments of Anesthesiology and Critical Care Medicine, and
Thoracic and Hyperbaric Surgery, University Medical School of Graz, Graz, Austria.

Beatrice Ratzenhofer-Komenda MD, Department of Anesthesiology and Critical Care Medicine, University Hospital, LKH - Universitätskliniken Graz, Auenbrugger Platz 29, A-8036 Graz, Austria. Phone: +43-316-385-3359; Fax: +43-316-385-3847; E-mail: beatrice.ratzenhofer{at}kfunigraz.ac.at

Purpose: To report the anaesthetic management of a case of tracheal rupture, using different types of ventilation and additional hyperbaric oxygenation (HBO).

Clinical features: An 8 cm postintubation tracheal tear was repaired in a 66-yr-old woman with acute myocardial reinfarction, mediastinal and subcutaneous emphysema, cardiac failure and unrecognized lymphoma. Intraoperative monitoring included dual oximetry: arterial (SaO₂) and mixed venous saturations (SvO₂). Maintenance of free surgical access and a series of life-threatening events like dislocation of the jet catheter required many ventilation modes. An episode of supraventricular tachycardia was interrupted by cardioversion. Differential lung ventilation with a combination of conventional and high-frequency jet ventilation (HFJV) modes preserved oxygenation (PO₂ 139.2 mmHg, PCO₂ 42.4 mmHg, FiO₂ 1.0) until acute tube obstruction and decrease of saturation values (SaO₂ 58%, SvO₂ 45%) required emergency HBO: immediate cardiac and respiratory stabilization was provided by double-lung HFJV and apneic oxygenation under hyperbaric conditions at 2.5 atmospheres absolute for 35 min (SaO₂ 100%).

The patient recovered from surgery but died of non-Hodgkin lymphoma.

Conclusion: The combination of different ventilation modes including HFJV and the additional use of HBO resulted in sufficient oxygenation during tracheal repair.