Abstract
BackgroundWe describe a pediatric patient who suffered from critical abdominal distention caused by a combination of humidified, high-flow nasal cannula (HHFNC) oxygen therapy and nasal airway.Case presentationA 21-month-old boy with a history of chronic lung disease was admitted to the intensive care unit (ICU). Immediately after admission, his airway was established using a tracheal tube and mechanical ventilation was started. Five days after the commencement of mechanical ventilation, finally, his trachea was extubated. Immediately after extubation, HHFNC therapy at 20 L/min with an FiO2 of 0.35 was applied. However, severe stridor was observed, then a nasal airway was placed in the left nostril. However, he became restless. Critical abdominal distention was observed. A subsequent chest X-ray revealed that the nasal airway was placed too deeply, and the gastrointestinal air was severely accumulated. Immediately, the nasal airway was removed, and HHFNC flow was reduced to 10 L/min. Frequent suctioning and continuous gastric drainage were required, which achieved gradual improvement of respiratory condition.ConclusionsWe need to recognize that HHFNC therapy is one of the positive pressure ventilation system. Therefore, HHFNC therapy might cause the similar adverse events to noninvasive pressure ventilation.
Highlights
We describe a pediatric patient who suffered from critical abdominal distention caused by a combination of humidified, high-flow nasal cannula (HHFNC) oxygen therapy and nasal airway.Case presentation: A 21-month-old boy with a history of chronic lung disease was admitted to the intensive care unit (ICU)
We need to recognize that HHFNC therapy is one of the positive pressure ventilation system
It has been reported that HHFNC is equivalent to more traditional non-invasive ventilation support, such as continuous or bi-level positive airway pressure (CPAP or Bi-level positive airway pressure (BiPAP)) [3, 4]
Summary
It is supposed that the deeply inserted nasal airway caused critical abdominal distention by insufflating the HHFNC flow into the gastrointestinal rather than the respiratory tract. In the early stage before the development of critical abdominal distention, the HHFNC flow might have partially supported his breathing; it is likely that the HHFNC flow gradually became ineffective for supporting his breathing because of aerophagia His gastroesophageal reflux might have worsened the situation because aerophagia is possibly accelerated by noninvasive positive airway pressure in patients with gastroesophageal reflux [5]. A linear relationship between flow and pressures measured in the pharynx (pressure = − 0.375 + 0.138 × flow) with the closed-mouth condition was reported According to this model, 2.4 cm H2O of positive pressure was generated in our patient at that time. HHFNC therapy might cause the similar adverse events to noninvasive pressure ventilation This time, we would like to underline that critical abdominal overdistention could happen by HHFNC therapy
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