<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>2448-8909</journal-id>
<journal-title><![CDATA[Medicina crítica (Colegio Mexicano de Medicina Crítica)]]></journal-title>
<abbrev-journal-title><![CDATA[Med. crít. (Col. Mex. Med. Crít.)]]></abbrev-journal-title>
<issn>2448-8909</issn>
<publisher>
<publisher-name><![CDATA[Colegio Mexicano de Medicina Crítica A.C.]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S2448-89092024000500349</article-id>
<article-id pub-id-type="doi">10.35366/118231</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Uso de ventilación mecánica independiente asincrónica en paciente con fuga de aire masiva asociado a rotura bronquial bilateral: presentación de un caso]]></article-title>
<article-title xml:lang="en"><![CDATA[Asynchronous mechanical ventilation for the management of massive air leak in bilateral bronchial injury: a case report]]></article-title>
<article-title xml:lang="pt"><![CDATA[Uso de ventilação mecânica independente assíncrona em um paciente com vazamento maciço de ar associado à ruptura brônquica bilateral: relato de caso]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Villagrana-Márquez]]></surname>
<given-names><![CDATA[Saúl Antonio]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Centro Médico Excel  ]]></institution>
<addr-line><![CDATA[Tijuana Baja California]]></addr-line>
<country>México</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>00</month>
<year>2024</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>00</month>
<year>2024</year>
</pub-date>
<volume>38</volume>
<numero>5</numero>
<fpage>349</fpage>
<lpage>352</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_arttext&amp;pid=S2448-89092024000500349&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_abstract&amp;pid=S2448-89092024000500349&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_pdf&amp;pid=S2448-89092024000500349&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen:  Introducción:  el manejo médico de la fuga aérea masiva suele ser problemático y sobre todo al presentarse daño en ambos bronquios principales. Se puede optar como estrategia el uso de ventilación mecánica independiente (dos ventiladores) asincrónica tratando de sobrepasar o incluso ferulizar la lesión bronquial con un tubo endotraqueal de doble lumen de manera provisional para su resolución quirúrgica.  Presentación del caso:  se describe caso clínico de paciente con fuga aérea masiva por lesión en ambos bronquios secundarios a mediastinitis descendente necrotizante por Staphylococcus aureus. Se implementó intubación selectiva con tubo bilumen y ventilación independiente con dos ventiladores de manera asincrónica. Análisis: esta ventilación involucra separación tanto anatómica como fisiológica, además de la implementación de diferentes parámetros en cada pulmón. Las indicaciones más comunes para este tipo de ventilación incluyen: lesión pulmonar inducida por neumonía, fuga aérea masiva por fístula broncopleural, hemorragia pulmonar y contusión pulmonar.  Conclusión:  la ventilación asincrónica puede proporcionar al paciente protección pulmonar necesaria y además el manejo del PaCO2 sin el uso de ECMO.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract:  Introduction:  the medical management of massive air leak is often challenging, particularly when damage occurs in both main bronchi. An alternative strategy is to employ asynchronous mechanical ventilation (using two ventilators) to attempt to surpass or even splint the bronchial injury provisionally with a double-lumen endotracheal tube for subsequent surgical resolution.  Case report:  we present a clinical case of a patient with massive air leak due to injury in both secondary bronchi resulting from descending necrotizing mediastinitis caused by Staphylococcus aureus. Selective intubation with a double-lumen tube and independent ventilation using two ventilators asynchronously was implemented. This ventilation approach involves both anatomical and physiological separation, along with the adjustment of different parameters for each lung. Common indications for this type of ventilation include pneumonia-induced lung injury, massive air leak from bronchopleural fistula, pulmonary hemorrhage, and pulmonary contusion.  Conclusion:  asynchronous ventilation can provide the necessary lung protection for the patient and effectively manage PaCO2 levels without the use of ECMO.]]></p></abstract>
<abstract abstract-type="short" xml:lang="pt"><p><![CDATA[Resumo:  Introdução:  o manejo médico de um vazamento maciço de ar é muitas vezes problemático, especialmente quando ambos os brônquios principais estão danificados. Como estratégia, a ventilação mecânica assíncrona e independente (dois ventiladores) pode ser usada como uma tentativa de contornar ou até mesmo de imobilizar a lesão brônquica com um tubo endotraqueal de duplo lúmen provisoriamente para resolução cirúrgica.  Revisão do caso:  descreve-se um caso clínico de um paciente com vazamento maciça de ar devido a lesões em ambos os brônquios, secundárias à mediastinite descendente necrosante causada por Staphylococcus aureus. A intubação seletiva com tubo de bilúmen e a ventilação independente com dois ventiladores foram implementadas de forma assíncrona. Análise: essa ventilação envolve a separação anatômica e fisiológica, bem como a implementação de diferentes parâmetros em cada pulmão. As indicações comuns para esse tipo de ventilação incluem lesão pulmonar induzida por pneumonia, vazamento maciço de ar devido a fístula broncopleural, hemorragia pulmonar e contusão pulmonar.  Conclusão:  a ventilação assíncrona pode proporcionar ao paciente a proteção pulmonar e o manejo da PaCO2 necessários sem o uso de ECMO.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[fuga aérea masiva]]></kwd>
<kwd lng="es"><![CDATA[ventilación asincrónica]]></kwd>
<kwd lng="es"><![CDATA[Staphylococcus aureus]]></kwd>
<kwd lng="en"><![CDATA[massive air leak]]></kwd>
<kwd lng="en"><![CDATA[asynchronous ventilation]]></kwd>
<kwd lng="en"><![CDATA[Staphylococcus aureus]]></kwd>
<kwd lng="pt"><![CDATA[vazamento maciço de ar]]></kwd>
<kwd lng="pt"><![CDATA[ventilação assíncrona]]></kwd>
<kwd lng="pt"><![CDATA[Staphylococcus aureus]]></kwd>
</kwd-group>
</article-meta>
</front><back>
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