[Bronchiectasis treated with negative extra-thoracic pressure ventilation].

A 25-year old man with 5-year history of bronchiectasis was admitted to the ICU complaining of severe shortness of breath. He had a respiratory rate of 40 to 50 breath/min. On 0.5 l/min of oxygen with nasal cannula, arterial blood pH was 7.39, Paco2 52.3 mmHg, Pao2 45.0 mmHg. Then, on 1 l/min of oxygen, Pao2 was unchanged, but Paco2 increased to 58 mmHg. As his consciousness was so clear, we applied to him the negative extra-thoracic pressure ventilator which was designed by the authors. Negative extra-thoracic pressure ventilation (NETPV) was maintained at a IMV rate of 30 breath/min, peak negative extra-thoracic pressure of -20 to -30 cmH2O, and an inspiratory/expiratory ratio of 1:2. During NETPV, his respiratory rate and oxygen consumption were decreased and Pao2 was increased compared with his spontaneous breathing. He made a recovery from dyspnea, especially, he was able to take a deep breath. When NETPV was applied to him, pulmonary artery and arterial catheterizations revealed that central venous pressure was slightly decreased, cardiac index unchanged or slightly decreased, heart rate, systemic blood pressure, and pulmonary arterial pressure unchanged compared with spontaneous breathing. The patient was able to read books and maintained communication in his voice with his family and the medical staff. After 3 days of the treatment with NETPV, a marked improvement was noted and the patient was discharged from the ICU. NETPV has the benefits as follows. First, it is very easy for both a patient and a doctor to assist his breathing because an endotracheal intubation is not necessary.(ABSTRACT TRUNCATED AT 250 WORDS)