Jet Ventilation II

This is a continuation of the last blog. When we got a chest X-ray, we found that the operative side was whited out and the non-operative side was hyperinflated. When the patient's cancer invaded the bronchus, it destroyed the muscular layer that normally keeps the bronchus open. After the pulmonologist cored out the tumor to open it up, the airway was open but easily collapsible. When we ventilated with positive pressure - that is, when the ventilator (or a hand-squeezed-mask) delivered pressurized air to the lung, the pressure would hold that bronchus open. But when the patient was breathing on his own, utilizing negative pressure ventilation, it would collapse. When you or I take a breath in, our diaphragm drops down, the lungs open up, and the negative pressure in our chest draws air from the environment in. But for this patient, the negative pressure caused the flimsy walls of the tumor-riddled bronchus to collapse. That lung didn't aerate, and because we kept asking the patient to take deep breaths, all that air went into his good lung. Hence the X-ray, a whited-out affected side and a hyperinflated contralateral side.

We had to re-anesthetize the patient. After I intubated him, the pulmonologist went in with a bronchoscope and placed a stent - a wire frame that would keep the affected bronchus open. After deploying the stent and cleaning out the lungs, we woke the patient up once again, and this time, his breathing was unlabored, his oxygenation much improved. He was discharged to home the following day.