Abstract
BackgroundLung atelectasis are nonventilated parts of lung tissue and occur as a result of the collapse of the pulmonary parenchyma (alveoli). Various therapeutic procedures for inflating the collapsed pulmonary parenchyma, such as bronchial aspiration and/or standard recruitment maneuvers, are not always successful.Case presentationWe report a case of a 23-year-old Croatian man with a parapharyngeal abscess on the left side of the neck with spreading of infection in the mediastinum and left side of the thorax and consequent major atelectasis of the left lung. The patient was mechanically ventilated. We decided to apply a new method in which a pulmonary artery catheter was placed (guided by bronchoscope) on the entrance to the lower left bronchus. The pulmonary artery catheter balloon was inflated to achieve bronchial closure. Using another respirator, we ventilated the affected lobe separately with continuously high pressure of 30 cmH2O. After 30 minutes, we removed the pulmonary artery catheter from the lower left bronchus and placed it in the upper left bronchus and repeated the procedure. Our method allowed a significantly longer duration (30 minutes) of continuously high pressure of 30 cmH2O separately to only one of the total of five lobes of the lungs while the other four lobes were simultaneously ventilated continuously with protective ventilation mode.ConclusionUse of a pulmonary artery catheter and two respirators in our patient’s case proved to be a successful method for recruiting the atelectatic lung while maintaining protective ventilation of the lung segments without atelectasis.
Highlights
Lung atelectasis are nonventilated parts of lung tissue and occur as a result of the collapse of the pulmonary parenchyma
Case presentation A 23-year-old Croatian man without any significant past medical history was admitted to our intensive care unit (ICU) due to a parapharyngeal abscess on the left side of the neck with spreading of infection in the mediastinum and the left side of the thorax
In the postoperative period in the ICU, the patient was sedated and mechanically ventilated with antibiotic therapy according to microbiological findings
Summary
Lung atelectasis are nonventilated parts of lung tissue and occur as a result of the collapse of the pulmonary parenchyma (alveoli). Due to atelectasis of the left lung that persisted during the second week of treatment in the ICU, bronchoscopy with bronchoaspiration and recruitment maneuvers were performed several times. We performed lung ultrasound, which showed atelectasis of the major part of the left lower lobe and the posterior part of the upper lobe on the 34th day of the patient’s stay in the ICU. Our trial, which we named “targeted segmental recruitment,” was one of the last attempts to avoid the proposed life-threatening surgical reduction of the lung parenchyma in our young patient His Acute Physiology and Chronic Health Evaluation II (APACHE II) score upon admission was 7, and his Sequential Organ Failure Assessment (SOFA) score upon admission was 6. After 48 hours (36th day of treatment), a CT scan of the thorax was performed, indicating significantly better ventilation of the left lung (Fig. 2).
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