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Case Reports and Images in Medicine

 
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Case Report
 
Independent lung ventilation in the management of pneumothorax
Muna Beg1, Pantea Mahtosh1, Sudhir Rajan1, Hekmat Nasiri1, Vincent Liu1,2
1Kaiser Permanente Santa Clara Medical Center, Homestead Campus, 3rd floor, Department 384, 710 Lawrence Expressway, Santa Clara, CA 95051, USA.
2Kaiser Permanente Division of Research 2000 Broadway Oakland, CA 94612, USA.

Article ID: 100003Z09MB2015
doi:10.5348/Z09-2015-3-CR-3

Address correspondence to:
Muna Beg
MD, 1-562-481-4328, Kaiser Permanente Santa Clara Medical Center
Graduate Medical Education Department, Homestead Campus
3rd floor, Department 384, 710 Lawrence Expressway, Santa Clara, CA 95051
USA

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How to cite this article:
Beg M, Mahtosh P, Rajan S, Nasiri H, Liu V. Independent lung ventilation in the management of pneumothorax. J Case Rep Images Med 2015;1:10–13.


Abstract
Introduction: Independent lung ventilation (ILV) with double lumen endotracheal tube (DLT) or endobroncial blockade has a known role in managing pneumothorax or by isolating the diseased lung. We report a case in which ILV was used along with a bronchial blocker for treatment of severe persistent pneumothorax (PTX).
Case Report: We report a 66-year-old female admitted with septic shock and respiratory failure from right lobar pneumonia who developed a right-sided pneumothorax. Despite the placement of two chest tubes, the patient had persistent acidosis and air leak. She required independent lung ventilation with a double lumen endotracheal tube and a bronchial blocker. This isolated the right lower lobe airleak and provided lung protective concordant positive pressure ventilation to the right middle and upper lobes.
Conclusion: Persistent air leaks in an intubated patient can be challenging. Our case highlights the concept of anatomical lung separation. With this clinicians can to allow provide isolation of the diseased lung, while using other subsegments to maintain adequate gas exchange.

Keywords: Double lumen endotracheal tube, Endobroncial blockade, Independent lung ventilation, Pneumothorax


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Author Contributions
Muna Beg – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Pantea Mahtosh – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Sudhir Rajan – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Hekmat Nasiri – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Vincent Liu – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2015 Muna Beg et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.



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