ABSTRACT 471

Abstract

Background and aims: Prolonged mechanical ventilation (PMV) after cardiac surgery occur in young children in pediatric critical care units (PICU). Age, pulmonar vascular resistance (PVR), previous lung disease, congestive heart failure, concomitant congenital syndrome are preoperative factors that associated with failed extubation after cardiac surgery. Aims: Non-invasive ventilation (NIV) is a supportive therapy that improves weaning. Methods: A 2 year-old boy with tricuspit atresia and pulmonar stenosis, had a history of Glenn procedure and right sided diaphragmatic paralysis, following second operation for pulmonary arter reconstruction, the patient failed extubation. NIV was applied through the oronasal mask using a pressure control mode. Initially, peak inspiratory positive pressure was set at 20 cmH2O, PEEP at 10 cm H2O. At the beginning, the patient required minimal sedation and this allowed him to efficient and comfort ventilation by the way of close contact between his face and mask. Results: He well tolerated NIV, dobutamin was tappered slowly and was stopped in two days. NIV weaned and discontinued in two day time. Conclusions: NIV is a supportive therapy that improves mortality. It may also be used in patients recently extubated in intensive care units (ICUs), after operation, and to aid weaning from mechanical ventilation. Here, NIV was used in a case with diaphragm paralysis after pediatric cardiac surgery. Cardiac function is also a key point of extubation success. Dobutamin increase cardiac function and may help patient in weaning procedure. Weaning in this particular patient population NIV and low dose inotropic agent may decreased the rate of failed extubation.