Rubini F, Nava S, Callegari G, Fracchia C, Ambrosino N
IRCCS, Centro Medico di Riabilitazione, Fondazione Clinica del Lavoro, Pavia.
Minerva Anestesiol. 1994 Mar;60(3):139-42.
In patients who underwent lung transplantation one of the primary determinants of patient survival is infection. Contributing factors in the development of pneumonia include immunosuppression and alterations in the natural lung defense mechanism induced by transplantation. We describe a case of a Pneumocystis carinii pneumonia occurring in the recipient of single lung transplantation for interstitial lung disease four months after surgery. The patient developed severe acute respiratory failure (ARF) requiring mechanical ventilation. Because of the increased infectious risk, tracheal intubation was avoided and pressure support ventilation was performed by the nasal route (NPSV) with PEEP (PS: 16 cm H2O PEEP: 8 cm H2O). NPSV and PEEP were applied 20-22 hours/day in the first 4 days, thereafter 2 to 6 hours 3 times a day, together with medical therapy. This treatment was performed for 15 days. This mode of ventilation was well tolerated and was successful. We conclude that NPSV may be useful in the treatment of ARF in patients with lung transplantation, particularly to avoid invasive mechanical ventilation related infectious complications.
