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.
Division of Respiratory Medicine, Montreal Children's Hospital, McGill University Health Center, 2300 Tupper, Montreal, Quebec, Canada H3H 1P3.
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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*