title: Independent lung ventilation combined with HFOV for a patient suffering from tracheo-gastric roll fistula.
abstract: This case report describes the difficult respiratory management of an esophageal cancer patient with acute respiratory distress syndrome (ARDS) and systemic inflammatory response syndrome (SIRS) caused by a postoperative tracheogastric roll fistula. A single-lumen tracheal tube could not seal the fistula, and therefore a double-lumen tracheal tube (DLT) for the left side was used. Although the proximal cuff of the DLT failed to seal the fistula, independent lung ventilation (ILV) improved blood gas levels. During right thoracotomy, the left lung was ventilated conventionally with 5 cmH2O positive end-expiratory pressure (PEEP), and in addition, high-frequency oscillation ventilation (HFOV) to the right lung was employed. This combination allowed the maintenance of adequate oxygenation, and the HFOV to the right lung decreased the PaCO2 level during surgery without interruption of the surgical field. These techniques provided the opportunity to successfully remove a necrotic gastric roll and achieve closure of the fistula using an intercostal muscle flap. This report documents and discusses the difficulty of performing appropriate anesthetic management of a patient with these complex complications after esophageal surgery.
authors.affiliation: Department of Anesthesiology, Juntendo University Shizuoka Hospital, 1129 Nagaoka, Izunokuni, Shizuoka 410-2295, Japan.
authors.forename: Maki
authors.initials: M
authors.lastname: Ichinose
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Sakai
authors.forename: Ikuo
authors.initials: I
authors.lastname: Miyazaki
authors.forename: Akihiro
authors.initials: A
authors.lastname: Muraoka
authors.forename: Miyuki
authors.initials: M
authors.lastname: Aizawa
authors.forename: Kaigen
authors.initials: K
authors.lastname: Igarashi
authors.forename: Atsushi
authors.initials: A
authors.lastname: Okazaki
mesh_terms: D000758:Anesthesia / Q000379:methods*; D004938:Esophageal Neoplasms / Q000601:surgery*; D017809:Fatal Outcome; D005747:Gastric Fistula / Q000209:etiology / Q000601:surgery*; D006612:High-Frequency Ventilation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery; D012128:Respiratory Distress Syndrome / Q000150:complications; D016156:Respiratory Tract Fistula / Q000209:etiology / Q000601:surgery*; D018746:Systemic Inflammatory Response Syndrome / Q000150:complications; D014133:Tracheal Diseases / Q000209:etiology / Q000601:surgery*