Non-surgical management of giant lung bullae during mechanical ventilation.

Giant lung bullae have a large impact on respiratory mechanics1,2 and make ventilator management difficult in patients undergoing mechanical ventilation. The pathogenesis of lung bullae is varied. COPD-related emphysematous bullae are the most common type of lung bullae, whereas ventilator-associated lung bullae are rare. Treatment considerations include therapy for underlying disease, ventilation strategies to prevent progression of the bullous lung disease, and indications for surgical or bronchoscopic intervention. Although there are some treatment recommendations for COPD-related lung bullae,3,4 the role and timing of bullectomy for new-onset lung bullae during mechanical ventilation remain unclear. We describe our experience of treating a patient with severe bullous lung disease that developed during mechanical ventilation. We used ventilator management alone, without surgical intervention, to successfully treat the patient.