title: Prone position to treat bronchopleural fistula in post-operative acute lung injury.
abstract: OBJECTIVE
  Prone position is used to treat patients with acute lung injury or acute respiratory distress syndrome because it improves gas exchange and respiratory mechanics. When broncho-pleural fistula occurring, the clinical impact of prone position is limited; however, its use could be tried when the fistula is small or other potential treatments are not possible.
  
  
  METHODS
  A 45-year-old man with oesophageal cancer submitted to a total oesophagectomy with intrathoracic transposition of the stomach developed post-operatively respiratory failure and pneumothorax, which were worsened by unilateral pleural rupture and severe subcutaneous emphysema produced after an attempt to introduce through anterior chest wall a second drainage tube.
  
  
  RESULTS
  Prone position associated with lung protective strategy was implemented during 16-18 h daily and after the change of position PaO2/FiO2 increased of 35% and PaCO2-PetCO2 decreased about 40%; at 4th day under treatment, the subcutaneous emphysema and pneumothorax could not be detected either clinically or radiologically. On the 6th day the lung lesion could not be observed under the CT-scan.
  
  
  CONCLUSIONS
  In a patient that underwent a major thoracic surgery the addition of prone positioning to protective lung ventilation rendered possible not only the healing of the acute lung injury, but also the quick repair of a lung rupture owing to a thoracic drainage attempt.
authors: Department of Anesthesiology, University of Trieste, Trieste, Italy. v.antonaglia@libero.it
authors: Vittorio
authors: V
authors: Antonaglia
authors: Umberto
authors: U
authors: Lucangelo
authors: Walter A
authors: WA
authors: Zin
mesh_terms: D000208:Acute Disease; D001983:Bronchial Fistula / Q000209:etiology / Q000628:therapy*; D004938:Esophageal Neoplasms / Q000601:surgery; D006801:Humans; D055370:Lung Injury; D008297:Male; D008875:Middle Aged; D010995:Pleural Diseases / Q000209:etiology / Q000628:therapy*; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy*; D016684:Prone Position; D016156:Respiratory Tract Fistula / Q000209:etiology / Q000628:therapy*
references: Am J Respir Crit Care Med. 2002 May 15;165(10):1359-63
references: 12016096
references: Crit Care Med. 2003 Apr;31(4 Suppl):S285-95
references: 12682454
references: Am J Respir Crit Care Med. 2000 May;161(5):1660-5
references: 10806172
references: Chest. 1988 Nov;94(5):1122
references: 3180887
references: Thorax. 1983 Sep;38(9):696-7
references: 6684807
references: Respir Care Clin N Am. 2003 Sep;9(3):343-62
references: 14690070
references: Am J Respir Crit Care Med. 1998 Jun;157(6 Pt 1):1721-5
references: 9620897
references: Crit Care Med. 2000 Feb;28(2):295-303
references: 10708156
references: Chest. 2004 Jul;126(1):249-58
references: 15249468
references: Chest. 1990 Mar;97(3):721-8
references: 2407455
references: Chest. 1992 Aug;102(2):568-72
references: 1643949
references: Anesth Analg. 1981 Feb;60(2):118-9
references: 7469082
references: J Anesth. 2001;15(3):125-31
references: 14566508
references: Thorac Cardiovasc Surg. 2003 Apr;51(2):106-8
references: 12730823
references: J Trauma. 2005 Aug;59(2):333-41; discussion 341-3
references: 16294072
references: Am J Respir Crit Care Med. 2006 Jul 15;174(2):187-97
references: 16645177
references: Intensive Care Med. 2000 Oct;26(10):1434-40
references: 11126253
references: Anesthesiology. 1986 Jun;64(6):739-46
references: 3521393
references: Anesth Analg. 1987 Sep;66(9):833-8
references: 3304022
references: Ann Thorac Surg. 2003 Sep;76(3):903-8
references: 12963226