ONE LUNG LUCY: PEDIATRIC ARDS IN A CHILD WITH LUNG AGENESIS

Abstract

TYPE: Case Report TOPIC: Critical Care INTRODUCTION: Pediatric acute respiratory distress syndrome (PARDS) is a relatively common clinical problem in the PICU. However, ARDS in a pediatric patient with one lung is unique and not well defined. We present such a case and highlight challenges in management. CASE PRESENTATION: Our patient is a 14month old girl who presented to the ER in acute hypoxemic respiratory failure secondary to RSV bronchiolitis. Her past medical history is significant for left lung agenesis and supracardiac total anomalous pulmonary venous return (surgically repaired). She was admitted to the PICU and subsequently developed severe ARDS, with peak OI of 28. Single lung protective strategy was initially applied with the use of lower tidal volumes of 5-6 ml/kg and a PEEP of 6. Inhaled NO was employed and she was subsequently placed on tidal volumes of 8ml/kg and PEEP of 8 with subsequent improved lung compliance. She was successfully extubated after 2 weeks of MV. DISCUSSION: The Pediatric Acute Lung Injury Consensus Conference (PALICC) developed pediatric-specific definitions for ARDS and recommendations regarding treatment. Recommendations regarding management of patients with one lung who develop ARDS are lacking. One lung ventilation is a standard approach to facilitate surgical exposure for pulmonary and other thoracic surgeries, however it is not known whether ventilation strategies suggested by the anesthesia literature is applicable to PARDS. CONCLUSIONS: Our case presented challenges in providing adequate ventilation and oxygenation while minimizing further lung injury in a patient with one lung PARDS. Further study is needed to elucidate the optimum mechanical ventilation strategy. DISCLOSURE: Nothing to declare. KEYWORD: One Lung ARDS