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1 Department of Medicine, Surgery, and Thoracic and Cardiovascular Surgery, U.S. Naval Hospital, National Naval Medical Center, Bethesda
Positive pressure ventilation is possible in the presence of a large air leak if a volume-cycled ventilator and adequate pleural suction are used. The ventilator, the lungs, and the pleural suction apparatus are an interdependent system and cause a number of difficult problems in respiratory management. Although seemingly contraindicated, the addition of PEEP improved oxygenation in our patient when his course was complicated by the adult respiratory distress syndrome. Guiding principles based on an analysis of a complex situation were developed which can be useful in the future care of patients this difficult problem.
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