title: Bronchoscopy with N-acetylcysteine lavage in severe respiratory failure from pertussis infection.
abstract: Pertussis is an illness that causes significant morbidity and mortality, especially in infants younger than 3 months old. In the most severe cases, it can cause pneumonia, respiratory failure, acute respiratory distress syndrome, pulmonary hypertension, and death. There are reports of using rescue extracorporeal membrane oxygenation (ECMO) as a rescue therapy. However, the mortality of ECMO with pertussis is higher than with other causes of pediatric respiratory failure. We report here the case of a 2-month-old boy with severe respiratory failure and pulmonary hypertension who satisfied ECMO criteria but was successfully treated with repeated bronchoscopy with instillation of N-acetylcysteine. Our patient's respiratory failure was refractory to multiple therapies that have shown benefit in pediatric hypoxemic respiratory failure, including open lung strategies, prone positioning, intratracheal surfactant, and inhaled nitric oxide. Although pulmonary hypertension is a key factor in most cases of fatal pertussis, the adverse effects of hyperinflation and air leaks were more important in this patient's clinical course. Because bronchiolar obstruction from inflammatory, mucous, and airway epithelial debris can be seen in severe pertussis, a regimen of repeated therapeutic bronchoscopy was initiated, and thick, inspissated secretions were retrieved. The patient's airway obstruction gradually resolved, and he eventually recovered with minimal sequelae.
authors.affiliation: Critical Care Medicine, Children's Hospital of Michigan, 3901 Beaubien Ave, Detroit, MI 48201. asarnai@med.wayne.edu.
authors.forename: Angela F
authors.initials: AF
authors.lastname: Mata
authors.forename: Ajit A
authors.initials: AA
authors.lastname: Sarnaik
mesh_terms: D000111:Acetylcysteine / Q000008:administration & dosage*; D001999:Bronchoscopy / Q000379:methods*; D006801:Humans; D007223:Infant; D008297:Male; D012141:Respiratory Tract Infections / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D012720:Severity of Illness Index; D007507:Therapeutic Irrigation / Q000379:methods; D014917:Whooping Cough / Q000150:complications / Q000175:diagnosis / Q000628:therapy*
chemical_list: D000111:Acetylcysteine
keywords: bronchoscopy; extracorporeal membrane oxygenation; pertussis; respiratory distress syndrome; respiratory insufficiency