title: On the possible role of positive end-expiratory pressure ventilation in the treatment of chylothorax caused by blunt chest trauma.
abstract: Recent reports on the treatment of chylothorax postulate a benefit to ventilator therapy, especially using positive end-expiratory pressure (PEEP). This report describes the use of mechanical ventilation with PEEP in the management of a 24-year-old male motorcyclist who sustained a ligamentous Chance fracture of the thoracic spine at the T6-7 level with bilateral traumatic chylothorax. Treatment of the chylothorax consisted of high PEEP ventilation, bilateral chest tube thoracostomies, and total parenteral nutrition. The chylothoraces resolved within 4 days of treatment and mechanical ventilation was stopped. Ventilator therapy of traumatic chylothorax and the physiologic grounds for its use are discussed. A review of the literature and experimental evidence seem to suggest that ventilator treatment of traumatic chylothoraces is effective.
authors.affiliation: Department of Surgery, University of Marburg, Germany.
authors.forename: E
authors.initials: E
authors.lastname: Lindhorst
authors.forename: H A
authors.initials: HA
authors.lastname: Miller
authors.forename: G A
authors.initials: GA
authors.lastname: Taylor
authors.forename: L
authors.initials: L
authors.lastname: Gotzen
mesh_terms: D000063:Accidents, Traffic; D000328:Adult; D015505:Chest Tubes; D002916:Chylothorax / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008297:Male; D009049:Motorcycles; D011175:Positive-Pressure Respiration / Q000379:methods*; D011859:Radiography; D016103:Spinal Fractures / Q000150:complications*; D013904:Thoracic Vertebrae / Q000293:injuries*