ABSTRACT
OBJECTIVE: To report the first case of the use of asynchronous independent lung high-frequency oscillatory ventilation (AIL-HFOV) in the management of acute hypoxemic respiratory failure in a large pediatric patient with markedly asymmetric lung disease. DESIGN: Case study. SETTING: Tertiary pediatric intensive care unit in a pediatric teaching hospital. PATIENT: A 17-yr-old, 87-kg male patient with trisomy 21 and with respiratory failure and progressive hypoxemia because of pneumonia. INTERVENTIONS: Intubation with a 37-Fr double-lumen endobronchial tube and ventilation with two oscillatory ventilators for a total of 16 days. MEASUREMENTS AND MAIN RESULTS: Hemodynamic data were obtained using a pulmonary artery catheter. Adequate oxygenation and ventilation were readily achieved after institution of AIL-HFOV. The F(IO2)/PaO2 ratio increased from 52 to 224, and the shunt fraction decreased from 40 to 9 after 30 mins of AIL-HFOV. F(IO2) was rapidly reduced from 1.0 to 0.4 on the right lung and to 0.6 on the left lung. Mean arterial pressure was maintained, the cardiac index increased from 3.5 to 5.4 L/min/m2, the systemic vascular resistance index decreased from 1513 to 1225 dyne x sec/cm5 x m2, and the pulmonary vascular resistance index decreased from 723 to 428 dyne x sec/cm5 x m2 without the need for additional fluid boluses or increases in inotropic support. No airleaks developed during the entire hospital stay. CONCLUSIONS: AIL-HFOV improved oxygenation and hemodynamic performance in this large patient. This case demonstrates that it is feasible to use two high-frequency oscillatory ventilators to independently ventilate the lungs of a large patient with markedly asymmetric lung disease. We believe that AIL-HFOV deserves future study and development for the treatment of large patients with acute hypoxemic respiratory failure and asymmetric lung disease when other choices are limited.
Subject(s)
Hypoxia/therapy , Respiratory Insufficiency/therapy , Acute Disease , Adolescent , Feasibility Studies , High-Frequency Ventilation , Humans , Hypoxia/etiology , Male , Respiratory Insufficiency/complicationsABSTRACT
OBJECTIVES: To describe severe myocardial manifestations in two infants with respiratory syncytial virus infection and to review published literature reporting cardiac involvement in patients with respiratory syncytial virus disease. DESIGN: Case report and literature review. SETTING: Tertiary care pediatric intensive care unit (ICU). PATIENTS: Two infants admitted to the pediatric ICU for dysrhythmias and severe myocardial dysfunction and infected with respiratory syncytial virus. INTERVENTIONS: Conventional cardiovascular, antidysrhythmic, and respiratory support, as well as extracorporeal membrane oxygenation and high-frequency oscillatory ventilation. MEASUREMENTS AND MAIN RESULTS: Both patients had respiratory syncytial virus infections and clinical evidence of severe myocarditis, with dysrhythmias, cardiomegaly, and cardiogenic shock. Both infants survived their hospitalizations. To our knowledge, these two patients are the first reported cases of myocarditis in infants with respiratory syncytial virus infection. CONCLUSIONS: Severe myocardial dysfunction and dysrhythmias may accompany respiratory syncytial virus infection in some infants and may be reversible with aggressive supportive therapy.
Subject(s)
Anti-Arrhythmia Agents/therapeutic use , Arrhythmias, Cardiac/therapy , Extracorporeal Membrane Oxygenation , High-Frequency Ventilation , Myocarditis/etiology , Respiratory Syncytial Virus Infections/complications , Arrhythmias, Cardiac/etiology , Cardiopulmonary Resuscitation , Critical Care , Electrocardiography , Female , Humans , Infant , Intensive Care Units, Pediatric , Male , Respiratory Syncytial Virus Infections/therapy , Treatment OutcomeABSTRACT
OBJECTIVE: To assess the hemodynamic effects of high mean proximal airway pressures (Paw) during high-frequency oscillatory ventilation (HFOV) in non-neonatal pediatrics patients with severe respiratory failure. DESIGN: Prospective and retrospective study. SETTING: Pediatric ICU in a university-affiliated hospital. PATIENTS: 8 non-neonatal pediatric patients with severe respiratory failure ventilated with HFOV at our institution between July 1991 and February 1994. All patients had a pulmonary artery catheter. INTERVENTIONS: HFOV. MEASUREMENTS AND RESULTS: Higher Paw was required during HFOV to obtain adequate lung expansion during the first 24 h (median 20.9 cmH2O, range 16.9-30.0 cmH2O in CMV, versus median 30.0 cmH2O, range 21.0-33.0 cmH2O in HFOV, p = 0.008), resulting in improved oxygenation as evaluated by alveolar-arterial oxygen difference (median of 557.2 mmHg, range 360.4-607.8 mmHg in CMV, versus median of 410.5 mmHg, range 282.9-550.2 mmHg after 24 h of HFOV, p = 0.03). The only observed effect on the cardiovascular system was a decrease in heart rate (median of 162, range 129-178 in CMV, versus median of 142, range 104-195 after 24 h of HFOV, p = 0.03). Oxygen delivery, cardiac index, mean systemic arterial blood pressure, and pulmonary and systemic vascular resistances did not change significantly before and after HFOV in the patients as a group, although in one case a decrease in cardiac index and oxygen delivery was observed. CONCLUSIONS: High-Paw HFOV must be used cautiously, but seems to have no discernible adverse effects on the cardiovascular system in most patients.
