Abstract
IntroductionIndependent lung ventilation is a form of protective ventilation strategy used in adult asymmetric acute lung injury, where the application of conventional mechanical ventilation can produce ventilator-induced lung injury and ventilation-perfusion mismatch. Only a few experiences have been published on the use of independent lung ventilation in newborn patients.Case presentationWe present a case of independent lung ventilation in a 16-day-old infant of 3.5 kg body weight who had an asymmetric lung injury due to respiratory syncytial virus bronchiolitis. We used independent lung ventilation applying conventional protective pressure controlled ventilation to the less-compromised lung, with a respiratory frequency proportional to the age of the patient, and a pressure controlled high-frequency ventilation to the atelectatic lung. This was done because a single tube conventional ventilation protective strategy would have exposed the less-compromised lung to a high mean airways pressure. The target of independent lung ventilation is to provide adequate gas exchange at a safe mean airways pressure level and to expand the atelectatic lung. Independent lung ventilation was accomplished for 24 hours. Daily chest radiograph and gas exchange were used to evaluate the efficacy of independent lung ventilation. Extubation was performed after 48 hours of conventional single-tube mechanical ventilation following independent lung ventilation.ConclusionThis case report demonstrates the feasibility of independent lung ventilation with two separate tubes in neonates as a treatment of an asymmetric acute lung injury.
Highlights
Independent lung ventilation is a form of protective ventilation strategy used in adult asymmetric acute lung injury, where the application of conventional mechanical ventilation can produce ventilator-induced lung injury and ventilation-perfusion mismatch
We report the case of a 16-day-old infant, ventilated with two different tubes and different ventilation strategies to treat a severe respiratory syncytial virus bronchiolitis with asymmetric lung injury, which had been unresponsive to conventional pharmacological therapy and single-tube mechanical ventilation
Diagnosis of respiratory syncytial virus (RSV) bronchiolitis was quickly made through the detection of RSV antigen on pharyngeal secretion using an enzyme-linked immuno-absorbent assay (ELISA) method [2]
Summary
Independent lung ventilation is a form of protective ventilation strategy used in adult asymmetric acute lung injury, where the application of conventional mechanical ventilation can produce ventilator-induced lung injury and ventilation-perfusion mismatch. Pressure controlled high-frequency ventilation (HFPPV) is a form of protective ventilation that uses high respiratory rates (150 breaths per minute) with small tidal volume, allowing low mean airway pressure to theoretically reduce ventilation induced lung injury (VILI).
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