Republication of “Ultrasonographic Appearance of Lung Sliding in a Patient With a Bronchopleural Fistula on a High-Frequency Oscillator Ventilator”

David John Wallace,Penny Sappington,Samuel Tisherman,Michael Stone

doi:10.1177/8756479320924842

Abstract

The patient with a bronchopleural fistula and acute respiratory distress syndrome can present a therapeutic challenge for the treating clinician. In this case, the authors describe the use of bedside thoracic sonography to show real-time improvement in a pneumothorax after initiation of high-frequency oscillatory ventilation. Sonography may have a role in the evaluation of ventilator strategies in the future, although validation of this application is still needed.

Highlights

The patient with a bronchopleural fistula (BPF) and acute respiratory distress syndrome (ARDS) can present a therapeutic challenge for the treating clinician
We describe the use of bedside thoracic sonography to show real-time improvement in a pneumothorax after initiation of high-frequency oscillatory ventilation (HFOV)
A 19-year-old man was admitted to the trauma intensive care unit (ICU) after a high-speed motor vehicle accident where he was ejected through the windshield

Summary

Introduction

The patient with a bronchopleural fistula (BPF) and acute respiratory distress syndrome (ARDS) can present a therapeutic challenge for the treating clinician. In this case, we describe the use of bedside thoracic sonography to show real-time improvement in a pneumothorax after initiation of high-frequency oscillatory ventilation (HFOV). The patient was intubated in the field by paramedics for airway protection His initial chest x-ray demonstrated bilateral hemopneumothoraxes, and bilateral tube thoracostomies were performed in the emergency department. Computed tomography (CT) of the abdomen demonstrated splenic and liver lacerations Hypotension following his abdominal CT scan resulted in immediate transfer to the operating room, where splenectomy and liver packing were performed. Additional injuries included a left femoral neck fracture and a right clavicle fracture

Methods

Discussion

Conclusion