Clinical case of a high-frequency mechanical lung ventilation atypical using in the treatment of an infant with congenital lung disease

Abstract

A small number of controlled studies have been conducted using high-frequency mechanical lung ventilation (HFMLV) in the treatment process. In the literature, complications associated with the use of HFMLV, in particular, the development of air leak syndrome, are described. This technique is usually successfully used in the treatment of homogeneous and symmetrical lung tissue lesions. Every year, the number of congenital malformations in children that can be accompanied by inhomogeneous lesions of the lungs increases, accordingly, the number of clinical cases that do not correspond to the classic picture of the disease increases, so they cannot be treated according to unified clinical protocols. The objective of the article is to help choose optimal modes of mechanical lung ventilation in non-standard situations, which will make it possible to improve the course of the disease, reduce the number of complications and prevent hypoxic-ischemic damage to the central nervous system as a consequence of chronic or acute hypoxia, which is combined with the phenomena of secondary ischemia. A baby was hospitalized in the department of the National Children’s Specialized Hospital «Ohmatdyt» with the main diagnosis of «hypoplasia, dysplasia of the lung» and concomitant «broncho-pulmonary dysplasia that occurred in the perinatal period. The ductus arteriosus is open. Pulmonary hypertension? Anemia. Seizure syndrome. Primary immunodeficiency? Complication: respiratory failure 3, mixed type». After surgical intervention in the scope of an atypical lobectomy, the child was ventilated using strict parameters of mechanical lung ventilation, which was accompanied by a gradual deterioration of the general condition and the condition of the lungs, caused not only by a congenital malformation of the lungs, but also by immunodeficiency (of unknown etiology), anemia, convulsive syndrome and the presence polyresistant strains of bacteria in bacterial cultures of sputum. Against the background of surgical (mechanical) trauma to the lung tissue and the presence of a bacterial disease of the lung parenchyma with a concomitant complication in the form of a tension pneumothorax, HFMLV was used as a «therapy of despair», despite the limited amount of scientific data on the effectiveness of treatment of inhomogeneous lung tissue lesions using HFMLV. During the treatment, a complication in the form of pneumothorax occurred as expected. The use of constant adequate monitoring of respiratory functions and timely elimination of complications made it possible to stabilize the child’s condition: the need for oxygen decreased, the condition of the lung parenchyma improved, the positive dynamics of the disease made it possible to carry out gradual weaning from artificial lung ventilation and the transition to spontaneous effective breathing with minimal oxygen support. Therefore, HFMLV can be not only a «therapy of despair». With proper and timely use, it can help reduce the frequency of complications associated with mechanical ventilation of the lungs.It can also be used as a separate technique, if the dynamics of the disease can be predicted, provided that the hospital has expert class respiratory function monitoring and experienced specialists.

Keywords

• high-frequency mechanical lung ventilation; lung hypoplasia; acute respiratory distress syndrome; congenital malformation of the lungs; inhomogeneous lung damage; pneumothorax; bronchopulmonary dysplasia; «therapy of despair»; hypoxic-ischemic damage to the central nervous system.