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High frequency oscillatory ventilation in the management of a high output bronchopleural fistula: a case report

[L’utilisation de la ventilation oscillatoire à haute fréquence dans la prise en charge d’une fistule bronchopleurale à débit élevé : une étude de cas]

Duc V. Ha, MD^* and David Johnson, MD^*,

^* From the Department of Anesthesia, University of Saskatchewan, Saskatoon, Saskatchewan;
and the Division of Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada.

Address correspondence to: Dr. Duc V. Ha, Department of Anesthesiology, Royal University Hospital, 103 Hospital Drive, University of Saskatchewan, Saskatoon, Saskatchewan S7N 0W8, Canada. Phone: 306-655-1193; Fax 306-655-1279; E-mail: ducvinhha{at}hotmail.com

Purpose: To describe the use of high frequency oscillatory ventilation (HFOV) in the management of a high output bronchopleural fistula (BPF).

Clinical features: A 55-yr-old female developed a BPF after thoracotomy and decortication of an empyema. The patient deteriorated on the second postoperative day (pH 7.10 PCO₂ 89) requiring 100% oxygen and mechanical ventilation. After initial improvement, deterioration occurred by 24 hr with conventional positive pressure ventilation (volume or pressure limited) because of decreased pulmonary compliance and bilateral diffuse airspace disease (acute respiratory distress syndrome), persistent increased peak and plateau airway pressures, a prolonged inspired oxygen concentration greater than 0.6, and inability to apply positive end expiratory pressures because of an increased BPF leak (530 mL•breaths^-1). HFOV was initiated and maintained for 28 days until resolution of the airspace disease and decreased leak through the BPF to 100 mL•breaths^-1.

Conclusion: We report the successful use of HFOV in a patient with high output BPF. We suggest that HFOV is a useful technique in patients with a BPF when conventional positive pressure ventilation fails.