Pulmonary Procedures |

Use of Biphasic Cuirass Ventilation During Bronchoscopy in a Critically Ill Infant FREE TO VIEW

Sonal Malhotra, MD; Dr. Robert Kaslovsky, MD
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Albany Medical Center, Enid, OK

Chest. 2014;146(4_MeetingAbstracts):786A. doi:10.1378/chest.1994815
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SESSION TITLE: Bronchology/Interventional Student/Resident Case Report Posters II

SESSION TYPE: Medical Student/Resident Case Report

PRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PM

INTRODUCTION: Spinal muscular atrophy type 1 (SMA-1) presents in infancy with progressive weakness of the lower motor neurons, often leading to early death secondary to respiratory complications. Because of an impaired cough reflex and poor airway clearance, pediatric patients with SMA-1 are at risk for severe lower-respiratory tract complications during respiratory infections. The introduction of noninvasive ventilation (NIV) has been shown to reduce hospitalizations and intensive care admissions thus improving the prognoses of these children. (1)

CASE PRESENTATION: We report on a 2-month-old patient with SMA-1 who was transferred to our facility with a 1-week history of upper respiratory symptoms of cough and congestion. Upon arrival she continued to have tachypnea in spite of respiratory support with high-flow nasal cannula. Chest radiography showed right middle and lower lobe atelectasis with a “bell shaped” chest and nasal swab for viral PCR was positive for Coronavirus. Because of continued respiratory distress, complicated by underlying hypotonia, we decided not to intubate. Instead, BCV delivered by the Hayek® RTX ventilator was initiated. Although aggressive interventions were employed, the patient had no significant improvement and required flexible bronchoscopy while on BCV. Despite her small size and the presence of the bronchoscope in her airways, the patient tolerated the procedure with no desaturations. Unlike similar procedures done by passing a scope through an endotracheal tube, complications such as hypoxia and occlusion of the airway did not occur. In the subsequent week, four more bronchoscopic procedures were necessary utilizing similar techniques to successfully re-inflate the right lung while still on BCV.

DISCUSSION: Bronchoscopy and bronchoaveolar lavage in patients with respiratory distress is often complicated by hypoxemia (2). To our knowledge, this is the first report of successful flexible bronchoscopy and lavage in an infant utilizing BCV instead of positive pressure ventilation. Although our case report focuses on an infant, we were able to successfully perform the same procedure utilizing BCV with similar outcomes in an adolescent with chronic respiratory failure and atelectasis.

CONCLUSIONS: There have been no other publications on the use of BCV during flexible bronchoscopy. Further studies are needed to confirm the safety and efficacy of BCV-supported bronchoscopy in infants and children.

Reference #1: Keating, JM, Collins, N, Bush, A, Chatwin, M. High Frequency Chest Wall Oscillation in a Non-Invasive Ventilation Dependent Patient with Type 1 Spinal Muscular Atrophy. Resp Care 2011;56:1840-1843

Reference #2: Murgu, SD, Pecson, J, and Colt, HG. Bronchoscopy During Noninvasive Ventilation: Indication and Technique. Resp Care 2010; 55(5):595-600

DISCLOSURE: The following authors have nothing to disclose: Sonal Malhotra, Dr. Robert Kaslovsky

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