Bronchoscopy with N-acetylcysteine lavage in severe respiratory failure from pertussis infection

Area of Science:

• Pediatrics
• Pulmonology
• Infectious Diseases

Background:

• Pertussis (whooping cough) poses a significant risk of mortality and severe morbidity in infants.
• Severe cases can lead to pneumonia, respiratory failure, and pulmonary hypertension, often requiring advanced support like extracorporeal membrane oxygenation (ECMO).
• ECMO for pertussis-related respiratory failure has a higher mortality rate compared to other pediatric conditions.

Observation:

• A 2-month-old infant presented with severe respiratory failure and pulmonary hypertension, meeting ECMO criteria.
• The patient's condition was refractory to standard therapies for pediatric hypoxemic respiratory failure, including open lung strategies, prone positioning, intratracheal surfactant, and inhaled nitric oxide.
• Airway obstruction due to inflammatory debris and thick secretions was identified as a critical factor.

Findings:

• Repeated therapeutic bronchoscopy with N-acetylcysteine instillation successfully cleared inspissated secretions and relieved airway obstruction.
• This intervention led to gradual resolution of respiratory failure and pulmonary hypertension.
• The infant recovered with minimal long-term sequelae, avoiding the need for ECMO.

Implications:

• Repeated bronchoscopy with N-acetylcysteine offers a viable alternative treatment for severe, refractory pertussis in infants.
• This approach may be particularly beneficial when airway obstruction is the primary driver of respiratory failure.
• Further research into less invasive methods for managing severe pertussis-induced airway obstruction is warranted.