1
|
Olguin Ciancio M, Cambra FJ, Pons-Odena M. Tracheal opening manoeuvre (PEEP-20) in a patient with bronchopulmonary dysplasia and severe tracheobronchomalacia with neurally adjusted ventilatory assist (NAVA). BMJ Case Rep 2020; 13:13/1/e229471. [PMID: 31969395 DOI: 10.1136/bcr-2019-229471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Bronchopulmonary dysplasia (BPD) is occasionally associated with tracheobronchomalacia, and it is this combination that can lead to serious outcomes. The most severe cases require tracheostomies, ventilatory support and eventually even tracheal stents or surgery. Ventilation in patients with tracheomalacia is complicated without a good patient-ventilator synchrony; the neurally adjusted ventilatory assist (NAVA) mode is potentially beneficial in these cases. This case report presents a patient affected by BPD and severe tracheobronchomalacia who was tracheostomised and ventilated 24 hours a day and who suffered from episodes of airway collapse despite using the NAVA mode. It was necessary to increase the positive end-expiratory pressure to 20 cmH2O (the PEEP-20 manoeuvre) for several minutes during an episode; this allowed the trachea to remain open and allowed us to optimise the patient's ventilation. This strategy has previously been described in a patient with tracheomalacia, reducing the frequency and need for sedation in the following episodes.
Collapse
Affiliation(s)
| | - Francisco José Cambra
- Pediatric Intensive Care Unit, Hospital Sant Joan de Deu, Esplugues de Llobregat, Spain.,Critical Care Research Group, Institut de Recerca Sant Joan de Déu, Santa Rosa 39-57. 08950 Esplugues de Llobregat, Spain
| | - Martí Pons-Odena
- Pediatric Intensive Care Unit, Hospital Sant Joan de Deu, Esplugues de Llobregat, Spain .,Critical Care Research Group, Institut de Recerca Sant Joan de Déu, Santa Rosa 39-57. 08950 Esplugues de Llobregat, Spain
| |
Collapse
|
2
|
Andronikou S, Chopra M, Langton-Hewer S, Maier P, Green J, Norbury E, Price S, Smail M. Technique, pitfalls, quality, radiation dose and findings of dynamic 4-dimensional computed tomography for airway imaging in infants and children. Pediatr Radiol 2019; 49:678-686. [PMID: 30683962 PMCID: PMC6459803 DOI: 10.1007/s00247-018-04338-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 11/21/2018] [Accepted: 12/19/2018] [Indexed: 02/07/2023]
Abstract
This retrospective review of 33 children's dynamic 4-dimensional (4-D) computed tomography (CT) images of the airways, performed using volume scanning on a 320-detector array without anaesthesia (free-breathing) and 1.4-s continuous scanning, was undertaken to report technique, pitfalls, quality, radiation doses and findings. Tracheobronchomalacia (airway diameter collapse >28%) was recorded. Age-matched routine chest CT scans and bronchograms acted as benchmarks for comparing effective dose. Pitfalls included failure to administer intravenous contrast, pull back endotracheal tubes and/or remove nasogastric tubes. Twenty-two studies (67%) were diagnostic. Motion artefact was present in 16 (48%). Mean effective dose: dynamic 4-D CT 1.0 mSv; routine CT chest, 1.0 mSv, and bronchograms, 1.4 mSv. Dynamic 4-D CT showed tracheobronchomalacia in 20 patients (61%) and cardiovascular abnormalities in 12 (36%). Fourteen children (70%) with tracheobronchomalacia were managed successfully by optimising conservative management, 5 (25%) underwent surgical interventions and 1 (5%) died from the presenting disorder.
Collapse
Affiliation(s)
- Savvas Andronikou
- Department of Paediatric Radiology, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, UK. .,Department of Paediatric Radiology, University of Bristol, Bristol, UK. .,Department of Pediatric Radiology, Section of Pulmonary Imaging, Children's Hospital of Philadelphia, 3NW 39, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.
| | - Mark Chopra
- Department of Paediatric Radiology, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Simon Langton-Hewer
- Department of Paediatric Pulmonology, Bristol Royal Hospital for Children, Bristol, UK
| | - Pia Maier
- Department of Pediatric Radiology, Section of Pulmonary Imaging, Children’s Hospital of Philadelphia, 3NW 39, 3401 Civic Center Blvd., Philadelphia, PA 19104 USA
| | - Jon Green
- Department of Paediatric Radiology, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Emma Norbury
- Department of Paediatric Radiology, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Sarah Price
- Radiation Science Services, Medical Physics & Bioengineering, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Mary Smail
- Radiation Science Services, Medical Physics & Bioengineering, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| |
Collapse
|