| 11 th Annual Pediatric Critical Care Colloquium |
| Session/Time | Poster/Thu, 4:30 - 6:30 PM |
| Title | Bronchopleural Fistula (BPF) Treated with Asynchronous Lung Ventilation |
| Author | Andrus, LR Frankel, W Rhine, K Van Meurs, M Derish, JV DiCarlo, LH Mathers, G Hammer |
| Affiliation | Dept of Pediatrics, Stanford U. School of Medicine |
| Introduction | We report. a case of an II year old female who presented with severe trachei6s, required mechanical ventilation (MV), developed a broncho-pleural fistula (BPF), and ARDS. Because of b 'er progressive respiratory failure she was placed on va ECMO and asynchronous lung ventilation (ALV) to permit her BPF to resolve |
| Method | A chaxt review of this patient revealed that she was treated with ECMO following a 5 day history of fever, increasing oxy-en requirement for a pneumonia, and eventually ventilator support. Quickly her luna diseased progressed to severe ARDS (O.I. > I 10, map 42 cm H20), and PaO2 of 38 tor-r in an FiO2 of I.O. She was transferred to our institution for consideration of ECMO. She was placed on va ECMO soon after arrival. Her ECMO run was complicated by a hemothroax, necessitating, a suraical exploration of her chest while on ECIYIO, repeat d flexible bronchoscopies to clear airway secretions an-d the use of ALV to apply lower airway pressures to the side with the BPF. |
| Result | The patient required a total of 21 days of ECMO. We were unable to obtain resolution of her BPF while on ECIMO, so it was decided to attempt to use a technique of ALV to provide differential pressures to each lun-. Unfortunately, the BPF continued despite lower mean airway pressures to the affected luna usina conventional ventilation (CMV). Once we instituted HFIV to the affected luna in combination with CMV to the other lun- rapid resolution of the BPF occurred which enabled her to be weaned from ECMO. She continued on MV for a total of 57 days. She was discharged after an additional 43 days. |
| Conclusion | Necrotizing tracheo-bronchitis can evolve into a severe respiratory injury which necessitates (MV), complicated by persistent air leak and require tube thoracostomy. If the air leak persists, then one may be dealing with a larger defect in the pleural lining - BPF. The varous treatment options include reduction of ventilatory pressures at the expense of worsening blood gases, pleurodesis, and unconventional forms of mechanical ventilatory support such as High Frequency Ventilation. We report that ECMO, HFJV, ALV may provide life saving support in the older pediatric patient with BPF and refractory respiratory failure. |
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