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Neurally adjusted ventilatory assist and lung transplant in a child: A case report
Vincenzo Vitale1, Zaccaria Ricci, Stefano Morelli
1Department of Pediatric Cardiology and Cardiac Surgery, Intensive Care Unit, Bambino Gesù Hospital, Rome, Italy. ezio.vitale@tin.it
Insights
Neurally adjusted ventilatory assist (NAVA) successfully weaned a cystic fibrosis patient off mechanical ventilation post-lung transplant. NAVA prevented ventilator dyssynchrony and gastric issues, improving outcomes.
Area of Science:
- Pediatric critical care medicine
- Respiratory therapy
- Transplant surgery
Background:
- Cystic fibrosis (CF) patients undergoing lung transplantation often face challenges with mechanical ventilation weaning.
- Post-lung transplant complications such as infection, pneumothorax, and ventilator dyssynchrony can impede successful weaning.
- Ventilator dyssynchrony can lead to gastric distension, nausea, and vomiting, further complicating patient recovery.
Observation:
- A 15-year-old male with a history of CF and prior surgeries, including a right pneumonectomy, underwent single-lung transplantation.
- Following transplantation, the patient experienced difficulties weaning from mechanical ventilation despite pressure-support ventilation.
- The patient exhibited significant ventilator asynchrony, leading to gastric distension and associated symptoms.
Findings:
- Neurally adjusted ventilatory assist (NAVA) was implemented to address patient-ventilator dyssynchrony.
- NAVA effectively minimized overassistance and prevented asynchronous breathing patterns.
- The application of NAVA facilitated successful weaning from mechanical ventilation.
Implications:
- NAVA offers a viable strategy for managing complex pediatric patients requiring mechanical ventilation post-lung transplantation.
- This approach can mitigate risks associated with ventilator dyssynchrony, improving patient tolerance and recovery.
- Successful weaning using NAVA highlights its potential role in optimizing care for CF patients after solid organ transplantation.
Objective:
To report the successful application of neurally adjusted ventilatory assist to a child with cystic fibrosis who underwent single-lung transplantation.
Design:
Case report.
Setting:
Pediatric cardiac intensive care unit.
Patient:
A 15-yr-old male with cystic fibrosis was admitted to our pediatric cardiac intensive care unit after single-lung transplantation. The child had previously received two bowel resections at the age of 1 yr, right pneumonectomy at the age of 3 yrs, and endoscopic percutaneus gastrostomy at the age of 10 yrs. After transplant, the child failed several attempts of weaning off mechanical ventilation with pressure-support ventilation, due to infection, pneumothorax, and ventilator asynchrony that caused gastric distension and numerous episodes of nausea and vomiting.
Intervention:
Use of neurally adjusted ventilatory assist to avoid patient-ventilator dyssynchrony and consequent gastric distension.
Conclusions:
The utilization of neurally adjusted ventilatory assist allowed to limit the risk of overassistance and prevent patient-ventilator asynchrony and to successfully wean the child off mechanical ventilation after single-lung transplant.
