2006 Volume 13 Issue 3 Pages 243-247
We report a case of successful mechanical ventilation with BIPAP mode in an ARDS patient. An 84-year-old man with pulmonary emphysema who had undergone total gastrectomy one month earlier suffered respiratory failure at home five days after discharge due to aspiration pneumonia. The patient was mechanically ventilated with pressure-controlled ventilation with an 840 ventilator (Tyco Healthcare, USA) and the oxygenation improved temporarily. However, septic shock caused by aspiration pneumonia due to MRSA developed and patient-ventilator dyssynchrony, characterized by tachypnea, double inspiration, and hiccup-like inspiration, was observed. Additionally, the dead-space fraction was more than 70%. Ventilatory modes, including CPAP (+PS), SIMV, and A/C, could not but only BIPAP was able to improve oxygenation. The patient was successfully weaned from mechanical ventilation three months later. It is speculated that the better response of BIPAP to the patient's own irregular pattern in both inspiration and expiration re-established the patientventilator synchrony and led to the increase in minute ventilation and the alveolar recruitment followed by improvement of oxygenation.
