Supplemental jet ventilation in a case of ARDS complicated by bronchopleural fistulae.
OBJECTIVE
To present a case of unusual ventilatory strategy in a 17 year old girl with the acute respiratory distress syndrome (ARDS) complicated by bilateral bronchopleural fistulae.


METHODS
The patient was ventilated with a combination of conventional pressure control ventilation (PCV) and high frequency jet ventilation (HFJV) for 133 and 110 days, respectively.


RESULTS
Despite prolonged hypoxia, extensive barotrauma and nosocomial infections, she survived without significant impairment of respiratory function. Two years later she was healthy and independent with only mildly reduced respiratory reserve.


CONCLUSIONS
The combination of PCV and HFJV was beneficial in this case of ARDS complicated by bronchopleural fistulae. The case also highlights the utility of HFJV in the desperately hypoxic patient with extensive airway disruption.
Intensive Care Unit, Fremantle Hospital, Fremantle, Western Australia. david.simes@health.wa.gov.au
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Simes