Unilateral high frequency jet ventilation. Reduction of leak in bronchopleural fistula

A young alcoholic presented with severe bilateral bronchopneumonia, which required prolonged treatment with intermittent positive pressure ventilation. High airway pressures were necessary for effective gas exchange. A recurrent tension pneumothorax led to a persistent bronchopleural fistula which resulted in hypercarbia and hypoxaemia despite the use of large minute volumes. Surgical resection was not considered feasible because of extensive local infection. Asynchronous independent lung ventilation was instituted, using a double-lumen endobronchial tube. A considerable leak still occurred through the bronchopleural fistula, and it was only when high frequency jet ventilation was substituted to the fistula-containing lung that the leak was virtually abolished, while improving gas exchange. High frequency jet ventilation in bronchopleural fistula is of potential benefit.