ABSTRACT 390

Abstract

Background and aims: Mechanical ventilation using protective strategy is used to minimize the ventilator-induced lung injury, however prone positioning and pulmonary recruitment maneuver are necessary in some cases. Aims: To describe a case report of a child acute respiratory distress syndrome (ARDS). Methods: The information was obtained from medical charts after parents written autorization. Results: We reported the case of 11years old female child with mild asthma had admitted in PICU and because of dyspnea and hypoxemia, started noninvasive ventilation, but patient did not tolerate it, subsequently Heliox was unsuccessfull as well. 2ndday antibiotics started. Progressive worsening dyspnea /hypoxemia resulted in intubation. Afterwards, PaO2/FiO2 83 (Peep 13cmH2O FiO20,9), driving pressure 32cmH2O Vt 6mL/kg (pH7,20 PaCO2 62mmHg). On the 4thday CT demonstrated presence of regional lung attenuation of a dependent area (Figure 1), it was accomplished pulmonary recruitment maneuver (driving pressure 15cmH2O, IT2sec, RR10cpm, FiO21,0, Peep20, 25, 30,35,40cmH2O, 2minutes in each Peep level) (Figure 2). Decremental Peep titration was done, searching an ideal Peep 18cmH2O, enabling a decrease of the FiO20,45, SpO293%, driving pressure 15cmH2O, Vt6mL/kg associated prone positioning. 6th day there was a new clinical worsening episode (PaO2/FiO2 121), accomplished another pulmonary recruitment maneuver at the bedside (driving pressure 15cmH2O, PEEP 25cmHO), after 2hours PaO2/FiO2 185. On the two following days, the ventilatory parameters was decreased. 9thday extubation was done successfully, she was discharged home after 11days.FigureConclusions: This case report demonstrated the ventilatory protective strategy was insufficient to manage ARDS, so the pulmonary recruitment maneuver and prone positioning were the strategies that conduced a less harmful ventilation and improved the gas exchange.