Independent lung ventilation using dual ventilators for unilateral reexpansion pulmonary edema after mediastinal tumor resection: a case report

BACKGROUND: Reexpansion pulmonary edema following pulmonary and mediastinal surgery presents a complex clinical challenge. Independent lung ventilation (ILV), which facilitates the application of distinct positive end-expiratory pressures (PEEP) and tidal volumes to each lung, may serve as an alternative therapeutic approach for managing reexpansion pulmonary edema. CASE PRESENTATION: A 58-year-old female patient presented with a giant space-occupying lesion measuring 17.1*11.2*19.2 cm in the left lung and underwent mediastinal tumor resection under general anesthesia. Intraoperatively, following the resection of the tumor and the invaded upper lobe of the left lung, the left lung was manually reopened, resulting in the development of reexpansion pulmonary edema (RPE). To prevent exudate from the left lung from infiltrating the right lung and to avoid barotrauma to the right lung due to excessive airway pressure, a dual ventilator mechanical ventilation strategy was employed. This approach utilized a double-lumen endotracheal tube, allowing for differential ventilation modes tailored to each lung. CONCLUSION: The mechanical ventilation treatment involving double-lumen bronchial intubation with various ventilation modes serves as an effective ventilatory support for managing reexpansion pulmonary edema.