We experienced a patient with
respiratory insufficiency after resection of the
aortic aneurysm and replacement with a synthetic conduit which recovered by
airway pressure release ventilation (APRV) dramatically. A 44-year-old man diagnosed as
aortic aneurysm of the descending thoracic aorta was admitted to our hospital and an operation was scheduled. The operation lasted for 19 hours and the time of
general anesthesia was 23 hours. The immediate post-operative chest x-ray showed
atelectasis of the right upper lobe, elevated right diaphragm and poor aeration of the lungs. A volume-limited
mechanical ventilation was used for this patient postoperatively in ICU. But accumulation of
carbon dioxide and poor oxygenation were observed. We started APRV by Bennet 840 (Tyco Healthcare, Tokyo). Specifically, we used Bilevel mode (PEEP 20/3 cmH20/3, inspiratory time 3.2 seconds, respiratory rate 15 times per minute, pressure support 20 cm H2O, FI(O2) 1.0). Promptly accumulation of
carbon dioxide was improved and
atelectasis of the right upper lobe vanished. Additionally, oxygenation was improved. He was weaned from a
ventilator on postoperative day 5. We have demonstrated that APRV is an important tool that should be used to improve severe
respiratory insufficiency.