Abstract
We treated a case of acute respiratory failure due to a postoperative fistula between right main bronchus and mediastinal abscess by drainage and extracorporeal membrane oxygenation. The patient was a 54-year-old male who underwent esophagotomy for esophageal cancer. On the 5th postoperative day, P/F ratio decreased to 47 because of a large amount of intratracheal pus. As differential lung ventilation failed to improve it, veno-venous extracorporeal membrane oxygenation was started at 2.2l·min-1. The ventilator settings during the extracorporeal support were adjusted to maintain percutaneous oxygen saturation not less than 95% with FIO2≤60%. Bronchofiberscopy on the 9th postoperative day recognized a fistula communicating right main bronchus and mediastinal abscess. A 7.5Fr catheter was inserted into the abscess cavity through the tracheal tube and a fistula, and an 18Fr drainage tube was percutaneously inserted. Respiratory failure was improved in accordance with a reduction of pus. The patient was successfully weaned from the extracorporeal support on the 13th day, and then from a ventilator on the 40th day.
