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Lung isolation in a child with unilateral necrotizing Clostridium perfringens pneumonia
Ken M Brady1, Z Leah Harris, Gregory B Hammer
1Department of Anesthesiology/Critical Care Medicine and Pediatrics, Johns Hopkins Hospital, Baltimore, MD, USA.
Insights
This case report details using an endobronchial blocker for lung isolation and selective continuous positive airway pressure in a pediatric patient with severe necrotizing pneumonia. This novel approach successfully aerated the lung, avoiding surgery.
Area of Science:
- Pediatric critical care medicine
- Pulmonary medicine
- Infectious diseases
Background:
- Sickle cell disease patients are susceptible to severe pulmonary complications, including necrotizing pneumonia.
- Managing unilateral lung disease in pediatrics can be challenging, especially with airway limitations.
Observation:
- A 12-year-old male with sickle cell disease developed necrotizing pneumonia in the left lung.
- Conventional treatments failed to resolve persistent atelectasis, and the patient's airway was too small for standard double-lumen endotracheal tubes.
Findings:
- An endobronchial blocker was used for lung isolation and selective continuous positive airway pressure (CPAP) to the affected left lung for 48 hours.
- This intervention led to substantial lung aeration within 48 hours, avoiding the need for lung resection.
Implications:
- This case highlights a novel and successful application of endobronchial blockers for selective ventilation in pediatric patients with complex airway anatomy.
- The technique offers a viable alternative to surgical intervention in select cases of severe unilateral pneumonia.
Objective:
To describe lung isolation and the selective application of continuous positive airway pressure using an endobronchial blocker in a patient with sickle cell disease and unilateral necrotizing Clostridium perfringens pneumonia.
Design:
Case report.
Setting:
Pediatric intensive care unit.
Patient:
A 12-yr-old male with sickle cell disease developed persistent necrotizing pneumonia of the left lung following exchange transfusion for acute chest syndrome and hyper-hemolytic syndrome.
Interventions:
An endobronchial blocker was placed into the left main stem bronchus for lung isolation and application of continuous positive airway pressure to the left lung for 48 hrs.
Measurements And Main Results:
After 14 days of persistent atelectasis of the left lung despite thorascopic decortication and multiple bronchoscopies, our patient had substantial lung aeration within 48 hrs of continuous positive airway pressure applied via the endobronchial blocker. Lung resection was avoided and the patient was successfully extubated 2 days after removal of the blocker.
Conclusions:
This case report demonstrates a therapeutic application of prolonged lung isolation and differential ventilation in a patient with an airway too small for commercially available double-lumen endotracheal tubes. The apparent success of this intervention suggests the feasibility of selective ventilation in pediatric patients and highlights a novel application of the bronchial blocker.
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