Independent lung ventilation in a newborn with asymmetric acute lung injury due to respiratory syncytial virus: a case report

<p>Abstract</p> <p>Introduction</p> <p>Independent lung ventilation is a form of protective ventilation strategy used in adult asymmetric acute lung injury, where the application of conventional mechanical ventilation can produce ventilator-induced lung injury and ventilation-perfusion mismatch. Only a few experiences have been published on the use of independent lung ventilation in newborn patients.</p> <p>Case presentation</p> <p>We present a case of independent lung ventilation in a 16-day-old infant of 3.5 kg body weight who had an asymmetric lung injury due to respiratory syncytial virus bronchiolitis. We used independent lung ventilation applying conventional protective pressure controlled ventilation to the less-compromised lung, with a respiratory frequency proportional to the age of the patient, and a pressure controlled high-frequency ventilation to the atelectatic lung. This was done because a single tube conventional ventilation protective strategy would have exposed the less-compromised lung to a high mean airways pressure. The target of independent lung ventilation is to provide adequate gas exchange at a safe mean airways pressure level and to expand the atelectatic lung. Independent lung ventilation was accomplished for 24 hours. Daily chest radiograph and gas exchange were used to evaluate the efficacy of independent lung ventilation. Extubation was performed after 48 hours of conventional single-tube mechanical ventilation following independent lung ventilation.</p> <p>Conclusion</p> <p>This case report demonstrates the feasibility of independent lung ventilation with two separate tubes in neonates as a treatment of an asymmetric acute lung injury.</p

The role of mean platelet volume in the early detection of acute bronchiolitis: A prospective study

Introduction and objectiv

The management of acute bronchiolitis in infants

Bronchiolitis is a seasonal viral lower respiratory tract illness common in infancy and a major cause of hospitalization in this age group. The course is often self-limiting but drawn out over 2-4 weeks. Investigations are of limited value and the diagnosis is essentially clinical. Mainstay of management is supportive care to maintain oxygenation and hydration. Historically, clinical trials have shown little or no significant benefit of pharmacological therapy in bronchiolitis. Commonly used pharmacological agents include nebulized hypertonic saline, bronchodilators, epinephrine and corticosteroids, oral or inhaled; though their role remains controversial. Recent studies point towards a beneficial effect of nebulized hypertonic saline on clinical severity and length of hospitalization. There also seems to be a promising role of nebulized epinephrine in reducing the need for hospitalization. Home oxygen is increasingly being used in patients with uncomplicated bronchiolitis and on-going hypoxia as an effective way to decrease both hospital admissions and the length of hospital stay.</p