title: [A case of respiratory insufficiency after resection of the aortic aneurysm and replacement with a synthetic conduit which recovered by airway pressure release ventilation].
abstract: We experienced a patient with respiratory insufficiency after resection of the aortic aneurysm and replacement with a synthetic conduit which recovered by airway pressure release ventilation (APRV) dramatically. A 44-year-old man diagnosed as aortic aneurysm of the descending thoracic aorta was admitted to our hospital and an operation was scheduled. The operation lasted for 19 hours and the time of general anesthesia was 23 hours. The immediate post-operative chest x-ray showed atelectasis of the right upper lobe, elevated right diaphragm and poor aeration of the lungs. A volume-limited mechanical ventilation was used for this patient postoperatively in ICU. But accumulation of carbon dioxide and poor oxygenation were observed. We started APRV by Bennet 840 (Tyco Healthcare, Tokyo). Specifically, we used Bilevel mode (PEEP 20/3 cmH20/3, inspiratory time 3.2 seconds, respiratory rate 15 times per minute, pressure support 20 cm H2O, FI(O2) 1.0). Promptly accumulation of carbon dioxide was improved and atelectasis of the right upper lobe vanished. Additionally, oxygenation was improved. He was weaned from a ventilator on postoperative day 5. We have demonstrated that APRV is an important tool that should be used to improve severe respiratory insufficiency.
authors.affiliation: Intensive Care Unit, Osaka Medical College Hospital, Takatsuki 569-8686.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Shimoyama
authors.forename: Nozomi
authors.initials: N
authors.lastname: Majima
authors.forename: Noriko
authors.initials: N
authors.lastname: Kadono
authors.forename: Masayuki
authors.initials: M
authors.lastname: Ito
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Agui
authors.forename: Osamu
authors.initials: O
authors.lastname: Umegaki
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Minami
mesh_terms: D000328:Adult; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D045422:Continuous Positive Airway Pressure / Q000379:methods; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D012131:Respiratory Insufficiency / Q000209:etiology* / Q000628:therapy*