Manual trans-tracheal high frequency positive pressure ventilation for left main bronchus and carinal mass surgical resection in a child

Inflammatory myofibroblastic tumor (IMT), also called pseudo-tumor, is a very rare condition and accounts for less than 1% of primary lung tumor. It is most common benign tumor of lung in children. This case is reported with the objective of highlighting the role of manual trans-tracheal high frequency positive pressure ventilation (HFPPV) in facilitating surgical resection with maintenance of adequate oxygenation and a little compromised ventilation. A 9-year boy, weighing 21 kg, was diagnosed as a case of IMT of left main bronchus on biopsy and was successfully treated by surgical excision through left thoracotomy. HFPPV through improvised technique was used for ventilation and oxygenation during surgery. Total Intravenous anaesthesia with propofol infusion and increments of fentanyl was used during HFPPV. After the completion of the surgery, conventional positive pressure ventilation (PPV) was continued through the endotracheal tube (ETT) to check any bronchial stump leak. After the surgery, patient was weaned and extubated in the operating room. Hospital course remained uneventful and the patient was discharged after 6 days. HFPPV with manually improvised technique is applicable in carinal surgery for optimization of oxygenation, ventilation, and uninterrupted surgical resection.