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Add-on treatment with nebulized hypertonic saline in a child with plastic bronchitis after the Glenn procedure

Grzegorz Lis1, Ewa Cichocka-Jarosz2, Urszula Jedynak-Wasowicz2

  • 1Jagiellonian University, Medical College, Department of Pediatrics, Chair of Pediatrics, Cracow, Poland, Professor. Department of Pediatrics, Chair of Pediatrics, Jagiellonian University Medical College, Cracow, Poland.

Jornal Brasileiro De Pneumologia : Publicacao Oficial Da Sociedade Brasileira De Pneumologia E Tisilogia
|March 15, 2014
PubMed

Insights

Plastic bronchitis (PB) is a rare airway obstruction. Prompt recognition and treatment, including nebulized saline, are crucial for children, especially after Fontan-type surgery, to reduce high mortality risks.

Area of Science:

  • Pediatric Cardiology
  • Pulmonology
  • Critical Care Medicine

Background:

  • Plastic bronchitis (PB) is a rare but serious condition causing airway obstruction.
  • It is associated with high mortality rates, up to 50%, in children post-Fontan-type cardiac surgery.
  • Respiratory tract infections can precipitate PB in susceptible patients.

Observation:

  • A case of an 18-month-old female with PB following pneumonia is presented.
  • The patient had a history of Glenn procedure for a functionally univentricular heart.
  • Fiberoptic bronchoscopy confirmed complete left bronchus obstruction by mucoid casts.

Findings:

  • Pharmacotherapy included glucocorticosteroids, azithromycin, and enalapril maleate.
  • Nebulized 3% NaCl solution demonstrated significant benefit in managing the mucoid casts.
  • Early identification and intervention are key to improving outcomes.

Implications:

  • Physicians should maintain a high index of suspicion for PB in children undergoing Fontan-type procedures.
  • Respiratory infections serve as a critical trigger, necessitating vigilant monitoring.
  • Aggressive management, including nebulized hypertonic saline, may be beneficial in pediatric PB cases.

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