Use of esophageal balloon manometry in the management of pediatric acute respiratory distress syndrome

There is paucity of literature regarding the use of esophageal balloon manometry in the management of Pediatric Acute Respiratory Distress Syndrome. We describe our first ever experience of successful usage of esophageal balloon pressure manometry in a child with acute respiratory distress syndrome. This is a six-year-old girl who presented with shortness of breath and fever and was found to be in severe acute respiratory distress syndrome due to septic shock secondary to group A streptococcus. The patient was managed using an esophageal balloon manometry for positive end-expiratory pressure titration. She was liberated from invasive mechanical ventilation on day 7 of hospital course. Esophageal balloon manometry guided positive end-expiratory pressure for 103 out of 155 hours of ventilation with no obvious sequelae. Our case shows the feasibility of transpulmonary pressure measurements in pediatric patients. This practice may be useful to optimize management in pediatric acute respiratory distress syndrome to improve outcomes.