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CRITICAL CARE AND TRAUMA

Independent High-Frequency Oscillatory Ventilation in the Management of Asymmetric Acute Lung Injury

Pierpaolo Terragni, MD^*, Giulio L. Rosboch, MD^*, Eleonora Corno, MD^*, Eleonora Menaldo, MD^*, Andrea Tealdi, MD^*, Piero Borasio, MD, Ottavio Davini, MD, Aurelio G. Viale, MD^*, and V. Marco Ranieri, MD^*

*Dipartimento di Discipline Medico-Chirurgiche, Sezione di Anestesia e Rianimazione, Università di Torino, Ospedale S. Giovanni Battista-Molinette, Torino, Italy; Sezione di Chirurgia Toracica, Università di Torino, Ospedale S. Luigi, Torino, Italy; and Servizio di Radiologia d’urgenza, Ospedale S. Giovanni Battista-Molinette, Torino, Italy

Address correspondence and reprint requests to V. Marco Ranieri, MD, Dipartimento di Discipline Medico-Chirurgiche, Sezione di Anestesiologia e Rianimazione, Università di Torino, Ospedale S. Giovanni Battista, Corso Dogliotti 14, 10126 Torino, Italy. Address e-mail to marco.ranieri{at}unito.it.

We present a case of independent lung ventilation in an adult with asymmetric acute lung injury. We applied a conventional protective ventilatory strategy to the more homogeneously infiltrated lung and high-frequency oscillatory ventilation to the almost totally collapsed lung, because a conventional protective strategy exposed this lung to plateau pressure more than 30 cm H₂O, whereas high-frequency oscillatory ventilation provided sufficient gas exchange at safer pressure levels. Analysis of a lung computed tomography scan was used to evaluate the efficacy of the ventilatory strategy.