Weaning to extubation directly from high-frequency oscillatory ventilation in an infant with cystic lung disease and persistent air leak: a strategy for lung protection.
We report the successful weaning and extubation of an infant from a SensorMedics 3100A high-frequency oscillator without returning to conventional ventilation. A 7-week-old term infant with respiratory syncytial virus bronchiolitis complicated by cystic pulmonary lesions repeatedly failed attempts to return to conventional ventilation from high-frequency oscillatory ventilation (HFOV) for weaning, because of recurrent pneumothoraces. A computed tomography of the chest revealed multiple well defined cysts of various sizes involving both lungs. Therefore, weaning to extubation from HFOV was proposed as a way of preventing further air leak. The weaning strategy consisted of a technique we refer to as "sprinting." Using this method, the patient was successfully extubated directly from HFOV, with no complications. A follow-up computed tomography of the chest showed marked improvement in the size of the cystic lesions. The patient was discharged home with no need for home oxygen therapy.
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Division of Respiratory Medicine, Montreal Children's Hospital, McGill University Health Center, 2300 Tupper, Montreal, Quebec, Canada H3H 1P3.
Mullahoo
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Liben
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D006612:High-Frequency Ventilation; D006801:Humans; D007223:Infant; D008297:Male; D011030:Pneumothorax / Q000209:etiology; D018357:Respiratory Syncytial Virus Infections / Q000628:therapy*; D015300:Ventilator Weaning / Q000379:methods*