High-frequency oscillatory ventilation in children with acute lower respiratory infection with refractory hypercapnia. A clinical case
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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.
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References
2. Bardach A, Rey-Ares L, Cafferata ML, et al. Systematic review and meta-analysis of respiratory syncytial virus infection epidemiology in Latin America. Rev Med Virol. 2014; 24:76-89.
3. Meissner HC. Viral bronchiolitis in children. N Engl J Med. 2016; 374(1):62–72. doi: 10.1056
4. Comité de Neumonología, Comité de Infectología, Comité de Medicina Interna Pediátrica, Comité de Pediatría Ambulatoria, Colaboradores. Recomendaciones para el manejo de las infecciones respiratorias agudas bajas en menores de 2 años. Actualización 2021. Arch Argent Pediatr 2021; 119(4): S171-S197.
5. Cruces P, González-Dambrauskas S, Quilodrán J, et al. Respiratory mechanics in infants with severe bronchiolitis on controlled mechanical ventilation. BMC Pulm Med. 2017; 17(1):129.
6. Andreolio C, Piva JP, Bruno F, et al. Airway Resistance and Respiratory Compliance in Children with Acute Viral Bronchiolitis Requiring Mechanical Ventilation Support. Indian J Crit Care Med. 2021 Jan; 25(1):88-93.
7. Taffarel P, Jorro Baron F, Bonetto G, y col. Actualización en ventilación de alta frecuencia oscilatoria en pacientes pediátricos con insuficiencia respiratoria aguda. Revista Argentina de Terapia Intensiva. 34, 1 (abr. 2017), 53-62.
8. Pediatric Acute Lung Injury Consensus Conference Group. Pediatric acute respiratory distress syndrome: consensus recommendations from the pediatric acute lung injury consensus conference. Pediatr Crit Care Med 2015; 16(5): 428-439
9. Selandari J, Taffarel P y García M. Ventilación de alta frecuencia oscilatoria (capitulo 11). Manual de Emergencias y Cuidados Críticos en Pediatría / Gladys Itatí… et al; editado por Moreno G, Ioster T. 3ª edición. Ciudad Autónoma de Buenos Aires: Sociedad Argentina de Pediatria, 2020. 1172 páginas. ISBN 978-987-3715-44-0
10. Slee-Wijffels FY, van der Vaart KR, Twisk JW, et al. High-frequency oscillatory ventilation in children: a single-center experience of 53 cases. Crit Care 9, R274 (2005). https://doi.org/10.1186/cc3520
11. Donoso A, Cruces P, Valenzuela J, y col. Ventilación de alta frecuencia oscilatoria es eficaz en el tratamiento de hipercapnia grave refractaria. Revista chilena de medicina intensiva. 2006; vol 21(2): 101-107 166.
12. Miyaji M, Kawaguch A, Pringle C, et al. High-Frequency Oscillatory Ventilation as a Rescue Mode for Refractory Hypercarbia in Children. Tokyo Women's Medical University Journal. March 2022. https://doi.org/10.24488/twmuj.2021016
13. Sharma K, Von Hack-Prestinary I, Vidal R. High-frequency oscillatory ventilation as a rescue for severe asthma crisis in a child. SAGE Open Medical Case Reports. January 2020. doi:10.1177/2050313X20957454
14. Demoule, A., Brochard, L., Dres, M. et al. How to ventilate obstructive and asthmatic patients. Intensive Care Med 46, 2436–2449 (2020). https://doi.org/10.1007/s00134- 020-06291-0
15. Oyágüez Ugidos P, Reyes Domínguez S, Modesto Alapont V, et al. Mechanical ventilation in chronic obstructive pulmonary disease (COPD) exacerbations (Chapter 31). Handbook of Pediatric and Neonatal Mechanical Ventilation. Tesela Ediciones, Las Palmas de Gran Canaria, 2021. ISBN 978-84-124534-0-9