PMC7229276_01
Clinical course after the patient's admission to the emergency department.. NAD = noradrenaline; AVP = arginine vasopressin; DOB = dobutamine; Cdyna (both) = dynamic compliance in both lungs; Cdyna (left) = dynamic compliance in the left lung; Cdyna (right) = dynamic compliance in the right lung; MAP = mean arterial pressure.
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fig1
The treatment course is shown in Fig. 1.
Chest radiograph obtained after intubation.. Infiltrative shadows are evident in the right middle and lower lung, but no abnormality is seen in the left lung.
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fig2
No abnormality was seen in the left lung (Fig. 2, Fig. 3).
Chest radiograph obtained after replacement of the single-lumen endotracheal tube with the double-lumen endotracheal tube.
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fig4
The ILV was started 6 hours after the patient's arrival, and immediately thereafter arterial blood gas analysis showed improved oxygenation, with a PaO2 of 103 mmHg (FiO2: right 1.0, left 0.6), which allowed for a gradual decrease in the amount of oxygen delivered (Fig. 4).
Chest radiograph obtained on hospital day 2 shows a reduction in the right lung infiltrates.
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fig5
Arterial blood gas analysis was repeated at 25 hours and at 45 hours, showing the PaO2 to be 75 mmHg (FiO2: right 0.5, left 0.5) and 94 mmHg (FiO2: right 0.5, left 0.4), respectively (Fig. 5).
Chest radiographs obtained on hospital day 4, i.e., after replacement of the double-lumen endotracheal tube with a single-lumen endotracheal tube, shows a reduction in the right lung infiltrates and no collapse of the right lung.
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fig6
The DLT was replaced with an SLT on hospital day 4 because there was no collapse of the right (affected) lung and no deterioration in oxygenation even when one ventilator was used for both lungs (Fig. 6).