Short-term asynchronous ventilation and differential positive end-expiratory pressure in the treatment of aspiration pneumonia. A case report.

Synchronous and asynchronous differential lung ventilation, with or without the application of selective positive end-expiratory pressure (PEEP), has been described. Short-term asynchronous ventilation with differential PEEP as a treatment modality for unilateral lung disease has not been well documented. We report on a 43-year-old accident victim with multiple trauma who developed a severe left-sided aspiration pneumonia which failed to respond to conventional therapy including the application of PEEP. A left-sided double-lumen endotracheal tube was passed and 15 cm and 5 cm H2O PEEP was applied to the left and right lungs respectively. Asynchronous ventilation using two Ambu bags coupled with vigorous physiotherapy and endobronchial suctioning for 40 minutes resulted in a dramatic improvement in both the appearance on chest radiography and arterial blood gas values.