The patient with a bronchopleural fistula and acute respiratory distress syndrome can present a therapeutic challenge for the treating clinician. In this case, the authors describe the use of bedside thoracic sonography to show real-time improvement in a pneumothorax after initiation of high-frequency oscillatory ventilation. Sonography may have a role in the evaluation of ventilator strategies in the future, although validation of this application is still needed.
Gryminski J. , Krakowka P., Lypacewicz G.: The diagnosis of pleural effusion by ultrasonic and radiologic techniques. Chest1976;70:33-37.
2.
Lichtenstein DA, Menu Y.: A bedside ultrasound sign ruling out pneumothorax in the critically ill: lung sliding. Chest1995;108:1345-1348.
3.
Targhetta R. , Bourgeois JM, Chavagneux R., Balmes P.: Diagnosis of pneumothorax by ultrasound immediately after ultrasonically guided aspiration biopsy. Chest1992; 101:855-856.
4.
Wernecke K., Galanski M., Peters PE, Hansen J.: Pneumothorax: evaluation by ultrasound-preliminary results. J Thorac Imaging1987;2:76-78.
5.
Soldati G., Testa A., Silva FR, Carbone L., Portale G., Silveri NG: Chest ultrasonography in lung contusion. Chest2006;130: 533-538.
6.
Lichtenstein D., Mezière G., Biderman P., Gepner A.: The "lung point": an ultrasound sign specific to pneumothorax. Intensive Care Med2000;26:1434-1440.
7.
Bouhemad B., Zhang M., Lu Q., Rouby J-J.: Clinical review: bedside lung ultrasound in critical care practice. Crit Care (Lond) 2007;11:205.
8.
Cunningham J. , Kirkpatrick AW, Nicolaou S., et al: Enhanced recognition of "lung sliding" with power color Doppler imaging in the diagnosis of pneumothorax. J Trauma2002; 52:769-771.
9.
Baumann MH, Sahn SA: Medical management and therapy of bronchopleural fistulas in the mechanically ventilated patient. Chest1990;97:721-728.
10.
Lois M., Noppen M.: Bronchopleural fistulas: an overview of the problem with special focus on endoscopic management. Chest2005;128:3955-3965.
11.
Bernard GR, Artigas A., Brigham KL, et al: Report of the American-European Consensus conference on acute respiratory distress syndrome: definitions, mechanisms, relevant outcomes, and clinical trial coordination. Consensus Committee. J Crit Care1994;9:72-81.
12.
Esan A., Hess D., Raoof S., George L.: Severe hypoxemic respiratory failure: Part 1. Ventilator strategies. Chest2010; 137:1203-1216.
13.
Brower R., Ware L., Berthiaume Y., Matthay M.: Treatment of ARDS. Chest2001;120:1347.
14.
Stawicki SP , Goyal M., Sarani B.: High-frequency oscillatory ventilation (HFOV) and airway pressure release ventilation (APRV): a practical guide. J Intensive Care Med2009;24: 215-229.
15.
Fort P., Farmer C., Westerman J., et al: High-frequency oscillatory ventilation for adult respiratory distress syndrome: a pilot study. Crit Care Med1997;25:937-947.
16.
Mehta S., Lapinsky SE, Hallett DC, et al: Prospective trial of high-frequency oscillation in adults with acute respiratory distress syndrome. Crit Care Med2001;29:1360-1369.
17.
Derdak S., Mehta S., Stewart TE, et al: High-frequency oscillatory ventilation for acute respiratory distress syndrome in adults: a randomized, controlled trial. Am J Respir Crit Care Med2002;166:801-808.
18.
Lichtenstein D., Mezière G., Biderman P., Gepner A.: The comet-tail artifact: an ultrasound sign ruling out pneumothorax. Intensive Care Med1999;25:383-388.
