High-frequency oscillatory ventilation in children with acute lower respiratory infection with refractory hypercapnia. A clinical case

Abstract

Bronchiolitis is a frequent pathology that affects the lower airways of young children, increasing inspiratory and expiratory resistance as well as reducing lung compliance. We report the case of a 9-month-old previously healthy girl, with rhinovirus bronchiolitis, who was referred to intensive care due to respiratory distress during the previous 24 hours, and clinical ventilatory insufficiency refractory to medical treatment. Invasive mechanical ventilation was initiated, with hypercapnia refractory to different ventilatory strategies. After 20 hours, high-frequency oscillatory ventilation was started, using high pressure deltas and low respiratory rates as a strategy, being effective in the treatment of hypercapnia. This outcome is based on the fact that a certain constant mean pressure in the airway would open and maintain the airways permeable, reduce pulmonary hyperinflation and optimize ventilation, through the mechanisms involved high-frequency oscillatory ventilation.