title: Perfluorodecalin lavage of a longstanding lung atelectasis in a child with spinal muscle atrophy.
abstract: OBJECTIVE
  Persistent lung atelectasis is difficult to treat and perfluorochemical (PFC) liquid may be an option for bronchioalveolar lavage (BAL).
  
  
  METHODS
  A 4-year-old girl with spinal muscle atrophy was admitted in respiratory failure. On admission, the X-ray confirmed the persistence of total right-sided lung atelectasis, which had been present for 14 months. She was endotracheally intubated and ventilated from the day of admission. BAL with normal saline was performed twice without improvement. Following failed extubation and being dependent on continuous respiratory support, a trial of BAL using PFC liquid (Perfluorodecalin HP) was carried out. The PFC was delivered through the endotracheal tube on three consecutive days. A loading dose of 3 ml/kg was administered, followed by a varying dose in order to more effectively lavage the lungs. She tolerated the procedure well the first 2 days, although there were no clinical signs of improvement in the atelectasis. Intentionally, higher inflation pressures were applied after PFC instillation on day 3. Chest X-ray then showed hazy infiltrates on her left lung and she required more ventilatory support. However, lung infiltrates cleared over the next 3 days. A tracheotomy was done 6 days after the last PFC instillation. She had a slow recovery and was successfully decanulated. Clinical improvement of lung function was seen including less need of BiPAP and oxygen. A chest CT scan showed then functional lung tissue appearing in the previous total atelectatic right lung.
  
  
  CONCLUSIONS
  Lavage with PFC can safely be performed with a therapeutic effect in a child with unilateral total lung atelectasis.
authors: Department of Pediatrics, Pediatric Intensive Care Unit, Oslo University Hospital, Oslo, Norway.
authors: Thore
authors: T
authors: Henrichsen
authors: Paal H H
authors: PH
authors: Lindenskov
authors: Thomas H
authors: TH
authors: Shaffer
authors: Ruth J V
authors: RJ
authors: Loekke
authors: Drude
authors: D
authors: Fugelseth
authors: Rolf
authors: R
authors: Lindemann
mesh_terms: D018893:Bronchoalveolar Lavage; D002675:Child, Preschool; D002908:Chronic Disease; D005260:Female; D005466:Fluorocarbons / Q000627:therapeutic use*; D006801:Humans; D001261:Pulmonary Atelectasis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000628:therapy; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000628:therapy; D014897:Spinal Muscular Atrophies of Childhood / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000628:therapy; D014057:Tomography, X-Ray Computed; D014132:Trachea / Q000000981:diagnostic imaging / Q000601:surgery; D016896:Treatment Outcome
chemical_list: D005466:Fluorocarbons; C008805:perfluorodecalin