Introduction
Pediatric patients with congenital heart disease suffer from respiratory problems
owing to increased airway mucin production, intrinsic airway instability, tracheomalacia,
bronchomalacia or due to extrinsic compression of airway caused by dilated pulmonary
artery, left atrium or aorta, in the conditions like vascular rings, truncus arteriosus,
total anomalous pulmonary venous connection, tetralogy of Fallot with absent pulmonary
valve, etc. These can prolong ventilatory dependency of the patients Our aim was to
use a holistic alternative approach to open collapsed lung in pediatric patients with
congenital heart disease using simple and innovative lung recruitment technique.
Methods
From January 2020 to March 2021, four preoperative pediatric cardiac patients having
collapsed left lung, due to compression of left main bronchus, undergoing corrective
cardiac surgery were subjected to lung recruitment technique by using elective endobronchial
intubation and suctioning with chest physiotherapy in the form of vibration and percussion
along with intermittent ventilation with 100% oxygen.
Results
All four patients’ collapsed lungs were opened up successfully post procedure, which
was confirmed by immediate chest X rays and were successfully weaned off ventilator
within 24-48 hours as per PICU protocol. One patient, who was extubated within 24
hours, had opposite lung collapse after extubation, which was managed with chest physiotherapy.
Another patient had relative bradycardia (HR- 108/min) and desaturation (spo2-66%)
during procedure, which was improved immediately after withdrawing tube and instituting
two lung ventilations with 100% oxygen.
Discussion
Generally, flexible fibreoptic bronchoscope (FOB) is used in such type of scenario,
but there are limitations of it, like non-availability of neonatal size, expertise
in technique, premature and small infants, who require less than 3.5 mm size endotracheal
tube, where negotiation of FOB from endotracheal tube (ETT) is not possible. This
lung recruitment technique helps in improvement in lung mechanics and early weaning
and shorten the duration of mechanical ventilation. It is relatively easier and safer
technique one can use.
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Copyright
© 2021 Published by Elsevier Inc.
