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2016, Number 3

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Rev Mex Anest 2016; 39 (3)

Rescue from an unexpected massive leak of the respiratory volume

Blanco-Pajón MJ, Pérez-Osorio MG

Language: Spanish
References: 25
Page: 219-226
PDF size: 312.87 Kb.


ABSTRACT

The bronchopleural fistula with a major unexpected airleak in a patient with mechanic ventilation represents a grave situation due to the ventilation and lung oxygenation difficulty. The jet manual ventilation is a technique that allows introducing oxygen into the airways through jets generating laminar flows that travel the trachea and bronchus at high speed allowing it to get to the alveolar tissue. Although its best known use is the administration through the cricothyroid membrane for the «I can’t ventilate-I can’t intubate» grave situation (jet transtracheal ventilation) it has been used as an anesthetic ventilation technique in some special surgeries when the conventional ventilation is not possible or very difficult (rigid bronchoscopy, traqueobronchial resections, larynx microsurgery). However, in all these reported uses there is a distal integrity from the airways to the jet. We report its use through a one lumen tracheal tube to rescue unexpected impossibility for conventional ventilation during one pleural decortication in a three year old girl for a sudden bronchopleural fistula formation of great leak. We discussed the probable reasons for the success in this case and suggest this technique as an alternative to similar situations.


REFERENCES

  1. Janz MA, Antony VB. Pleural disease in intensive care unit. In: Gabrielli A, Layon J, Mihae Yu. Civetta Taylor and Kirby’s Critical Care. 4th Edition, Philadelphia, PA, Lipincott Williams and Wilkins, 2009; pp. 2171-2188.

  2. Lois M, Noppen M. Bronchopleural fistulas: an overview of the problem with especial focus on the endoscopic management. Chest. 2005;128:3955-3965.

  3. Singhal S, Ferraris VA, Bridges CR, Clough ER, Mitchel JD, Fernando HC, et al. Management of alveolar airleaks after pulmonary resection. Ann Thorac Surg. 2010;89:1327-1335.

  4. Marín GDJ, Echeverry P, Sánchez AM, Angel AM. Neumotórax secundario a ventilación jet transtraqueal en un paciente pediátrico. Rev Colomb Anestesiol. 2004;34:95-200.

  5. Evans E, Biro P, Bedforth N. Jet ventilation. Contin Educ Anaesth Crit Care Pain. 2007;7:2-5.

  6. Benumof JL, Scheller MS. The importance of transtracheal jet ventilation in the management of the difficult airway. Anesthesiology. 1989;71:769-678.

  7. Spoerel WE, Narayanan PS, Singh NP. Transtracheal ventilation. Br J Anaesth. 1971;43:932-939.

  8. Valverde CML, Tercedor SA, Polo GA, Guerrero LF, Almazán DA. Un caso de “dificultad de ventilación-dificultad de intubación” resuelto con ventilación jet transtraqueal. Rev Esp Anestesiol Reanim. 2003;50:534-538.

  9. Monnier PH, Ravussin P. Percutaneus transtracheal ventilation for laser endoscopic treatment of laryngeal and subglotic lision. Clin Otholaryngology. 1988;13:209-217.

  10. Espoerel WE, Greenway RE. Technique of ventilation during endoralyngeal surgery under general anesthesia. Can Anaesth Soc J. 1973;20:369-377.

  11. García RM, Juste CJ, Belda NFJ. Manejo de la vía aérea en la cirugía traqueobronquial. En: Moreno BR, Ramasco RF. Manual de anestesia y medicina preoperatoria en cirugía torácica. Barcelona, Ergon, 2009; pp. 203-211.

  12. Baraka AS, Siddik SS, Taha SK, Jalbout MI, Massou FM. Low frequency jet ventilation for stent insertion in a patient with tracheal stenosis. Can J Anesth. 2001;48:701-704.

  13. Slinger PD, Campos JH. Anesthesia for thoracic surgery. In: Miller RD. Miller’s anesthesia. Seventh Edition, Philadelphia, PA, Churchill Livingstone Elsevier, 2010; pp. 1819-1887.

  14. Wilson WC, Benumof JL. Anesthesia en cirugía torácica. En: Miller RD. Miller anestesia, Sexta ed., Madrid, Elsevier, 2005; pp. 1847-1939.

  15. Branoub M, Kraensler EJ. Anesthesia for pulmonary and mediastinal surgery. In: Estafanous FG, Barash PG, Reves JG. Cardiac anesthesia principles and clinical practice. Second Ed. Philadelphia PA, Lippincott Williams and Wilkins, 2001; pp. 701-766.

  16. Sanders RD. Two ventilating attachments for bronchoscopes. Del Med J. 1967;39:170-175.

  17. Pathak V, Welsby I, Mahmood K, Wahidi M, Maclntyre N, Shofer S. Ventilation and anesthetic approaches for rigid bronchoscopy. Ann Am Soc Thorac Soc. 2014;11:628-634.

  18. Li S, Liu Y, Tan F, Chen J, Chen L. Efficacy of manual jet ventilation using Manujet III for bronchoscopyc airway foreign body removal in children. Int J Pediatr Otorhinolaryngol. 2010;74:1401-1404.

  19. Vourc’h G, Fischler M, Michon F, Melchior JC, Seigneur F. High frequency jet ventilation v. manual jet ventilation during bronchoscopy in patients with tracheo-bronchial stenosis. Br J Anaesth. 1983;55:969-972.

  20. Borland LM, Reilly JS. Jet ventilation for laser laryngeal surgery in children. Modification of the Saunders jet ventilation technique. Int J Pediatr Otorhinolaryngol. 1987;14:65-71.

  21. Scamman FL, McCabe BF. Supraglottic jet ventilation for laser surgery of the larynx in children. Ann Otol Rhinol Laryngol. 1986;95:142-145.

  22. Tobias MA, Nassar WY, Richards DC. Naso--tracheal jet ventilation for micro-laryngeal procedures. Anaesthesia. 1977;32:359-362.

  23. Patel RG. Percutaneous transtracheal jet ventilation: a safe, quick, and temporary way to provide oxygenation and ventilation when conventional methods are unsuccessful. Chest. 1999;116:1689-1694.

  24. Navarro MH, Causade LS, Zúñiga RS, Ronco MR, García BC, Sánchez DI. Presencia de fístula broncopleural en niños con patología pulmonar. Descripción de nueve casos clínicos. Rev Chil Pediatr. 2002;73:595-601.

  25. Baumann M, Sahn S. Medical management and therapy of bronchopleural fistulas in the mechanically ventilated patient. Chest. 1990;97:721-728.




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