Abstract
A 24-year-old female patient who developed bronchiolitis obliterans organizing pneumonia (BOOP) in association with graft-versus-host disease following bone marrow transplantation for acute lymphoid leukemia at the age of 21. Extreme pulmonary overinflation was exacerbated by BOOP, and mechanical ventilation was initiated to treat worsening dyspnea and hypercapnia. As the patient had responded poorly to steroids and weaning from ventilation was considered difficult, pressure control ventilation with permissive hypercapnia was used to prevent barotrauma. Due to markedly reduced lung compliance, PaCO2 remained at levels higher than recommended in the literature, ranging between 80 and 120mmHg during the course of the ventilation. As oxygenation was normal and no dysfunction was observed in other organs, ventilation was maintained with minimal sedation and an emphasis on the level of consciousness as a treatment index despite PaCO2 levels above 80mmHg. The results of this strategy, which enabled the patient to communicate throughout the 87-day ventilation period, demonstrate a possible approach to preserving quality of life in long-term mechanical ventilation.
