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Chapter 26 - Respiratory Insufficiency on Maximal Support

Is That It?

Published online by Cambridge University Press:  17 December 2021

By
Federico Minen  and
Jon Lillie
Edited by
Shelley Riphagen  and
Sam Fosker
Shelley Riphagen
Affiliation:
Evelina Children’s Hospital, London and South Thames Retrieval Service
Sam Fosker
Affiliation:
Evelina Children’s Hospital, London
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Summary

An 8-week-old baby girl born prematurely had been transferred and admitted to PICU after presenting to her local hospital with respiratory failure due to bronchiolitis. She was born at 30 weeks gestational age in good condition and had a straightforward course without any complications of prematurity. She was discharged home at 36 weeks weighing 2 kg. After 2 weeks at home, she developed respiratory symptoms, was brought to A&E and then admitted to her local PICU where she was intubated and ventilated for RSV bronchiolitis. By 5 days after PICU admission she had improved to such an extent that ventilation could be weaned to minimal support. Over the next 24 hours, however, she deteriorated rapidly with evolving four quadrant opacification on CXR (Figure 26.1), necessitating escalation of ventilation and cardiovascular support. Ventilation was further escalated to high frequency ventilation (HFOV). Piperacillin-tazobactam and gentamicin had been started.

Type
Chapter
Information
Cases in Paediatric Critical Care Transfer and Retrieval Medicine , pp. 141 - 147
Publisher: Cambridge University Press
Print publication year: 2022

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References

Further Reading

Ferreira Cruz, F, Ball, L, Macedo Rocco, PR, et al. Ventilator-induced lung injury during controlled ventilation in patients with acute respiratory distress syndrome: less is probably better. Expert Rev Respir Med 2018;;12(5):403–14.Google Scholar
Griffiths, MJD, McAuley, DF, Perkins, GD, et al. Guidelines on the management of acute respiratory distress syndrome. BMJ Open Respir Res 2019;6(1):e000420.Google Scholar
Khemani, RG, Smith, L, Lopez-Fernandez, YM, et al. Paediatric acute respiratory distress syndrome incidence and epidemiology (PARDIE): an international, observational study. Lancet Respir Med. 2019;7(2):115–28.Google Scholar
Lillie, J, Boot, L, Speggiorin, S, et al. Factors behind decline of venovenous extracorporeal membrane oxygenation to support neonatal respiratory failure. Pediatr Crit Care Med 2020;21(8):e502–4.CrossRefGoogle ScholarPubMed
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):428–39.Google Scholar
ELSO Guidelines for Neonatal Respiratory Failure 2017. www.elso.org/Portals/0/ELSOGuidelinesNeonatalRespiratoryFailurev1_4.pdfGoogle Scholar
Guidance for the emergency transfer of blood and components with patients between hospitals (NHSBT Appropriate use of blood group & National laboratory managers’ group of the national blood transfusion committee); www.transfusionguidelines.org/document-library/documents/transfer-of-blood-appendices-eoe-rtc-v3c-doc/download-file/Transfer%20of%20Blood%20Appendices%20EoE%20RTC%20%20V3C.doc.Google Scholar

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