A 22-year-old man was admitted to a district general hospital with chest injuries, a ruptured spleen and limb fractures, sustained in a road traffic accident. After an emergency splenectomy, the patient developed unilateral pulmonary oedema with hypoxaemia which was resistant to both conventional controlled mechanical ventilation (CMV) and independent lung ventilation (ILV). He was transferred to a specialist cardiothoracic unit where high frequency jet ventilation (HFJV) also failed to achieve adequate oxygenation. Combined high frequency ventilation (CHFV), using high frequency pulses from a Bromsgrove Penlon Jet ventilator superimposed onto small tidal volumes from an Engstrom Erica improved oxygenation rapidly to allow decreases in inspired oxygen fraction (FiO2), peak airway pressure (PAWP) and positive end expiratory pressure (PEEP). Progressive weaning from ventilatory support was then possible over five days. CHFV is a valuable technique in the treatment of acute catastrophic lung injury and needs wider recognition.
The role of ventilatory support in acute lung injury is supportive, whilst the damage to alveolar-capillary membranes resolves and alveolar stability is restored. The optimum mode of support varies with individual patients, but none can reliably prevent progression of acute lung injury and high frequency ventilation (HFV) has been disappointing in this respect.
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