Therapeutic application of helium-oxygen and mechanical ventilation in a child with acute myelogenous leukemia and airway obstruction.
Children with mediastinal masses can have a variety of disparate clinical presentations, including chest pain, superior vena cava syndrome, Horner syndrome, pericardial effusion, and cardiac tamponade. Nonetheless, respiratory symptoms are present in 80% of children at presentation and are the most common presenting symptom. Management of respiratory failure due to mediastinal masses is challenging because intubation-with the accompanying sedation and paralysis-is likely to worsen the respiratory failure. For this reason, any new treatments for this condition are welcome. We report the case of an intubated 2-year-old girl with respiratory failure from a mediastinal mass who was successfully weaned from mechanical ventilatory support through the use of a 70%:30% helium-oxygen admixture (heliox). We then review mediastinal masses and the biophysical rationale for use of heliox in airway narrowing.
Bigham
Michael T
MT
Division of Critical Care Medicine, Akron Children's Hospital, Akron, OH 44308, USA. michael.bigham@chmca.org
Nowak
Jeffrey E
JE
Wheeler
Derek S
DS
D000280:Administration, Inhalation; D000402:Airway Obstruction / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D001999:Bronchoscopy; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006371:Helium / Q000008:administration & dosage*; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D010100:Oxygen / Q000008:administration & dosage*; D012121:Respiration, Artificial / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed
D006371:Helium; D010100:Oxygen