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BJA Advance Access published online on July 26, 2004
British Journal of Anaesthesia, doi:10.1093/bja/aeh231
© 2004 by The Board of Management and Trustees of the British Journal of Anaesthesia
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Accepted May 27, 2004

Case Report

High-frequency oscillatory ventilation and an interventional lung assist device to treat hypoxaemia and hypercapnia

M. David 1* W. Heinrichs 1

1 Department of Anaesthesiology, Johannes Gutenberg-University, Mainz, Germany

* To whom correspondence should be addressed. E-mail: david{at}mail.uni-mainz.de.


  Abstract

A male patient accidentally aspirated paraffin oil when performing as a fire-eater. Severe acute respiratory distress syndrome (PaO2/FIO2 ratio 10.7 kPa) developed within 24 h. Conventional pressure-controlled ventilation (PCV) with high airway pressures and low tidal volumes failed to improve oxygenation. Hypercapnia (PaCO2 12 kPa) with severe acidosis (pH<7.20) ensued. Treatment with high-frequency oscillatory ventilation (HFOV) and a higher adjusted airway pressure (35 cm H2O) improved the PaO2/FIO2 ratio within 1 h from 10.7 to 22.9 kPa, but the hypercapnia and acidosis continued. Stepwise reduction of the mean airway pressure (26 cm H2O), and oscillating frequencies (3.5 Hz), as well as increasing the oscillating amplitudes (95 cm H2O) resulted in an unchanged PaCO2, but oxygenation worsened. The new pumpless extracorporeal interventional lung assist device (ILA, NovaLungR, Hechingen, Germany) was therefore used for carbon dioxide elimination to enable a less aggressive ventilation strategy. PaCO2 normalized after initiation of ILA. HFOV with a mean airway pressure of 32 cm H2O was maintained, but with a higher oscillatory frequency (9 Hz) and very low oscillatory amplitude (25 cm H2O). After 6 days, the patient was transferred to a conventional ventilator, and ILA was discontinued after 13 days without complications.

Keywords: complications, acute respiratory distress syndrome; lung, extracorporeal assist; ventilation, high-frequency oscillatory.
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