We present a case of independent lung ventilation in an adult with asymmetric acute lung injury. We applied a conventional protective ventilatory strategy to the more homogeneously infiltrated lung and high-frequency oscillatory ventilation to the almost totally collapsed lung, because a conventional protective strategy exposed this lung to plateau pressure more than 30 cm H2O, whereas high-frequency oscillatory ventilation provided sufficient gas exchange at safer pressure levels. Analysis of a lung computed tomography scan was used to evaluate the efficacy of the ventilatory strategy.
IMPLICATIONS: This case report demonstrates the feasibility and safety of independent lung ventilation set with high-frequency oscillation ventilation (HFO) in an adult acute respiratory distress syndrome patient with markedly asymmetric lung disease. HFO was initiated, set, and successfully discontinued on the basis of computed tomography analysis.
*Dipartimento di Discipline Medico-Chirurgiche, Sezione di Anestesia e Rianimazione, Università di Torino, Ospedale S. Giovanni Battista-Molinette, Torino, Italy; †Sezione di Chirurgia Toracica, Università di Torino, Ospedale S. Luigi, Torino, Italy; and ‡Servizio di Radiologia d’urgenza, Ospedale S. Giovanni Battista-Molinette, Torino, Italy
Accepted for publication November 5, 2004.
Address correspondence and reprint requests to V. Marco Ranieri, MD, Dipartimento di Discipline Medico-Chirurgiche, Sezione di Anestesiologia e Rianimazione, Università di Torino, Ospedale S. Giovanni Battista, Corso Dogliotti 14, 10126 Torino, Italy. Address e-mail to firstname.lastname@example.org.