Nitric oxide and high frequency jet ventilation in a patient with bilateral bronchopleural fistulae and ARDS

Purpose: To describe a method of delivering nitric oxide during high freque ncy jet ventilation. Clinical Features: A 63-yr-old man underwent reduction pneumoplasty for bullous emphysema. Postoperatively, ventilation was inade quate, secondary to bilateral high output bronchopleural fistulae, High fre quency jet ventilation was initiated and achieved adequate ventilation (pH > 7.2). Over the following 24 hr, progressive hypoxemia (SaO(2) < 86%) deve loped along with the acute respiratory distress syndrome. Nitric oxide was delivered by continuous flow at the patient Y-connector during combined hig h frequency jet and conventional ventilation (two conventional low volume b reaths/minute). Sustantial improvement in oxygenation (FiO(2) 0.8 0.5, SaO( 2) > 92%) was noted initially and was sustained over 72 hr. Subsequently, t he patient was weaned to conventional ventilation without difficulty. Mecha nical ventilation was discontinued on postoperative day sixteen. Conclusion : The simultaneous use of nitric oxide and high-frequency jet ventilation w as used safely and effectively in this patient as a method of support for a cute respiratory distress syndrome with co-existing large bilateral broncho pleural fistulae.