title: Treatment of cardiogenic pulmonary oedema by helmet-delivered non-invasive pressure support ventilation in children with scorpion sting envenomation.
abstract: BACKGROUND
  The aim of this study was to evaluate the feasibility of non-invasive positive pressure ventilation through a new interface helmet in the treatment of cardiogenic pulmonary oedema due to scorpion sting envenomation in children.
  
  
  METHODS
  Three patients presented with fever, and respiratory distress following scorpion sting. Their cardiac enzymes were abnormal. Electrocardiogram (ECG) of 3 patients showed features of myocardial strain with ST elevation. Bedside chest X-ray taken in emergency showed marked bilateral infiltrates suggestive of pulmonary oedema. M-mode, two-dimensional colour-flow Doppler echocardiogram showed left ventricular dysfunction.
  
  
  RESULTS
  At paediatric intensive care unit admission, they were treated with antivenom, prazosin (0.03 mg/kg/dose), dopamine (15 mcg/kg/ min), dobutamine (10 mcg/kg/min) and nitroprussid (1 mcg/kg/min). Epinephrine (0.1 mcg/kg/ min) were added later. They were hypoxic and dyspnoeic. A slight sedation was induced with ketamine and/or midazolam. Non-invasive pressure support ventilation (NPSV) was delivered via the helmet by means of an intensive care unit ventilator. We evaluated the effect of NPSV delivered by helmet on oxygenation, respiratory rate, haemodynamics, complications and outcome. An improvement of oxygenation was observed within 2 hours of treatment.The helmet was well tolerated by all the children. No complications occurred in the 3 patients.
  
  
  CONCLUSIONS
  This new approach of delivering NPSV through a helmet allows the successful treatment of cardiogenic pulmonary oedema in children with scorpion sting envenomation, assuring a good tolerance without complications. Future studies are needed before recommending the extensive application of this technique in all cases of cardiogenic pulmonary oedema due to scorpion sting envenomation.
authors.affiliation: Department of Pediatric Intensive Care, Cukurova University, Faculty of Medicine, Adana, Turkey. dyildizdas@cu.edu.tr
authors.forename: Dincer
authors.initials: D
authors.lastname: Yildizdas
authors.forename: H Levent
authors.initials: HL
authors.lastname: Yilmaz
authors.forename: Sevcan
authors.initials: S
authors.lastname: Erdem
mesh_terms: D000818:Animals; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011175:Positive-Pressure Respiration / Q000295:instrumentation* / Q000379:methods; D011654:Pulmonary Edema / Q000209:etiology / Q000628:therapy*; D012131:Respiratory Insufficiency / Q000209:etiology / Q000628:therapy*; D065008:Scorpion Stings / Q000150:complications* / Q000628:therapy; D012605:Scorpions; D018487:Ventricular Dysfunction, Left / Q000209:etiology / Q000628:therapy*