title: The use of a mobile computed tomography scanner in the pediatric intensive care unit to evaluate airway stenting and lung volumes with varying levels of positive end-expiratory pressure.
abstract: OBJECTIVE
  Presentation of a case report describing the use of a mobile computed tomography (CT) scanner in the pediatric intensive care unit (PICU) to radiographically evaluate tracheobronchial stenting and lung volumes while using different levels of positive end-expiratory pressure (PEEP) and positioning in a critically ill infant.
  
  
  METHODS
  Case report of a single patient.
  
  
  METHODS
  Pediatric intensive care unit in a University Hospital.
  
  
  METHODS
  A 6-month-old premature infant with bronchopulmonary dysplasia, tracheobronchomalacia, and progressive respiratory failure.
  
  
  METHODS
  CT scans of the chest were performed by using a mobile CT scanner in the PICU. Serial CT scans were performed at PEEP levels of 5, 10, 15, and 20 cm H(2)O in both the supine and prone position. Scheduled medical care and standard monitoring were continued during the course of the CT scans.
  
  
  RESULTS
  Identical anatomic levels demonstrating the trachea, bronchi, and lung parenchyma were compared while different levels of PEEP and supine or prone positioning were used. From these comparisons, the level of PEEP in which lung volumes were optimized was radiographically determined. No significant changes in large airway caliber were observed. There was no difference noted between prone and supine positioning. CT scans were completed with minimal disruption to the patient's care.
  
  
  CONCLUSIONS
  Mobile CT scanners can be used in the PICU for the diagnostic evaluation of critically ill children. This option allows for the continuation of medical therapies and monitoring in the intensive care setting while avoiding the potential complications of transporting a critically ill child to the radiology department. The use of mobile CT scanners may disrupt PICU routine and is more expensive than use of fixed CT scanners. Mobile CT scanners may be useful in radiographically determining the optimal level of PEEP in infants with tracheobronchomalacia and bronchopulmonary dysplasia.
authors.affiliation: Department of Pediatrics, Division of Pediatric Critical Care and Pulmonary Medicine, Georgetown University Medical Center, Washington, DC, USA. jhertzog@nemours.org
authors.forename: J H
authors.initials: JH
authors.lastname: Hertzog
authors.forename: R J
authors.initials: RJ
authors.lastname: Cartie
authors.forename: G J
authors.initials: GJ
authors.lastname: Hauser
authors.forename: H J
authors.initials: HJ
authors.lastname: Dalton
authors.forename: K
authors.initials: K
authors.lastname: Cleary