The benefit of mechanical ventilation with biphasic PEEP mode for a patient with ARDS caused by aspiration pneumonia

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  • Sato Yoko
    Department of Anesthesiology, Tokyo Woman's Medical University
  • Ninomiya Marie
    Department of Anesthesiology, Tokyo Woman's Medical University Medical Center East
  • Saito Mariko
    Department of Anesthesiology, Tokyo Woman's Medical University Medical Center East
  • Sato Toshiro
    Department of Medical Engineering, Tokyo Woman's Medical University Medical Center East
  • Nakagaki Asako
    Department of Medical Engineering, Tokyo Woman's Medical University Medical Center East
  • Nomura Minoru
    Department of Anesthesiology, Tokyo Woman's Medical University
  • Ozaki Makoto
    Department of Anesthesiology, Tokyo Woman's Medical University
  • Kotani Toru
    Department of Anesthesiology, Tokyo Woman's Medical University Medical Center East

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  • ２相性のＰＥＥＰモードによる呼吸管理が効果的であった誤嚥性肺炎によるＡＲＤＳの１例

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Abstract

We report a case of successful mechanical ventilation with BIPAP mode in an ARDS patient. An 84-year-old man with pulmonary emphysema who had undergone total gastrectomy one month earlier suffered respiratory failure at home five days after discharge due to aspiration pneumonia. The patient was mechanically ventilated with pressure-controlled ventilation with an 840 ventilator (Tyco Healthcare, USA) and the oxygenation improved temporarily. However, septic shock caused by aspiration pneumonia due to MRSA developed and patient-ventilator dyssynchrony, characterized by tachypnea, double inspiration, and hiccup-like inspiration, was observed. Additionally, the dead-space fraction was more than 70%. Ventilatory modes, including CPAP (+PS), SIMV, and A/C, could not but only BIPAP was able to improve oxygenation. The patient was successfully weaned from mechanical ventilation three months later. It is speculated that the better response of BIPAP to the patient's own irregular pattern in both inspiration and expiration re-established the patientventilator synchrony and led to the increase in minute ventilation and the alveolar recruitment followed by improvement of oxygenation.

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