Differential lung ventilation and emergency hyperbaric oxygenation for repair of a tracheal tear.
OBJECTIVE
To report the anaesthetic management of a case of tracheal rupture, using different types of ventilation and additional hyperbaric oxygenation (HBO).


METHODS
An 8 cm postintubation tracheal tear was repaired in a 66-yr-old woman with acute myocardial reinfarction, mediastinal and subcutaneous emphysema, cardiac failure and unrecognized lymphoma. Intraoperative monitoring included dual oximetry: arterial (SaO2) and mixed venous saturations (SvO2). Maintenance of free surgical access and a series of life-threatening events like dislocation of the jet catheter required many ventilation modes. An episode of supraventricular tachycardia was interrupted by cardioversion. Differential lung ventilation with a combination of conventional and high-frequency jet ventilation (HFJV) modes preserved oxygenation (PO2 139.2 mm Hg, PCO2 42.4 mm Hg, FiO2 1.0) until acute tube obstruction and decrease of saturation values (SaO2 58%, SvO2 45%) required emergency HBO: immediate cardiac and respiratory stabilization was provided by double-lung HFJV and apneic oxygenation under hyperbaric conditions at 2.5 atmospheres absolute for 35 min (SaO2 100%). The patient recovered from surgery but died of non-Hodgkin lymphoma.


CONCLUSIONS
The combination of different ventilation modes including HFJV and the additional use of HBO resulted in sufficient oxygenation during tracheal repair.
Ratzenhofer-Komenda
B
B
Department of Anesthesiology, University Medical School of Graz, Austria. beatrice.ratzenhofer@kfunigraz.ac.at
Offner
A
A
Kaltenböck
F
F
Maier
A
A
Pinter
H
H
Prause
G
G
Smolle-Jüttner
F M
FM
D000368:Aged; D005260:Female; D006611:High-Frequency Jet Ventilation; D006801:Humans; D006931:Hyperbaric Oxygenation; D007442:Intubation, Intratracheal / Q000009:adverse effects; D012121:Respiration, Artificial; D014132:Trachea / Q000293:injuries / Q000601:surgery*