Airway pressure release ventilation. The ventilatory strategy in chest trauma

Abstract

Introduction: Thoracic trauma is an important cause of morbidity and mortality. The costal volet with pulmonary contusion overshadows the prognosis
Objective: To present a ventilatory strategy to stabilize the chest wall, correct hypoxemia and protect the lung parenchyma.
Clinical case: A patient with costal volet, bilateral pneumothorax and pulmonary contusion that produced a respiratory distress; required mechanical ventilation. Given the need to stabilize the thoracic wall and recruit the lung parenchyma, it was ventilated with release of airway pressures. A thoracotomy was required to definitively resolve the lung lesion and thoracoplasty was performed. The patient withdrew without sequelae after 21 days of hospitalization.
Conclusions: The APRV is proposed as a strategy that facilitates the stability of the thoracic wall, the alveolar recruitment, theoretically offers advantages in pulmonary protection and in the systemic inflammatory response. In this particular case the expected objectives were achieved with the use of this modality as a bridge for corrective surgery.