Prolonged (continuous) prone position ventilation in a patient with a large mediastinal mass

Abstract

: We report a case of a twenty-two years old woman with a large anterior mediastinal mass admitted to the ICU with severe airway obstruction and bronchospasm after a percutaneous biopsy of the mediastinal mass and left thoracentesis. Mechanical ventilation was optimized and high dose steroid therapy, bronchodilators and sevoflurane were prescribed; severe hypoxemia persisted (PaO2/FiO2 85), therefore she was ventilated in prone position. After 12 days of mechanical ventilation, of which six of them were in continuous prone position (156 h), the patient was successfully extubated. Prone position helped to treat increased airway resistance and collapse, therefor clinicians must be aware that maintenance of spontaneous ventilation and avoidance of general anesthesia are of paramount importance to prevent cardiopulmonary collapse in patients with large anterior mediastinal masses. Prolonged continuous prone position ventilation should be considered as “rescue therapy” in such cases.