Premium
Use of airway pressure release ventilation in a child with refractory hepatopulmonary syndrome after liver transplantation
Author(s) -
Jenkins Julia K.,
Gebergzabher Yodit D.,
Island Eddie R.,
Habashi Nader,
Hauser Gabriel J.
Publication year - 2013
Publication title -
pediatric transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.457
H-Index - 69
eISSN - 1399-3046
pISSN - 1397-3142
DOI - 10.1111/petr.12058
Subject(s) - medicine , hypoxemia , liver transplantation , refractory (planetary science) , hepatopulmonary syndrome , transplantation , liver disease , mechanical ventilation , surgery , anesthesia , gastroenterology , physics , astrobiology
HPS is a life‐threatening condition in patients with end‐stage liver disease, in which intrapulmonary vascular dilatations result in intrapulmonary shunts and hypoxemia. The only successful treatment is liver transplantation. Hypoxemia may be severe prior to transplantation; however, it can worsen or become refractory after liver transplantation and result in increased post‐operative mortality. Here, we present the case of a 10‐month‐old female infant with progressive end‐stage liver disease and severe HPS , who developed refractory hypoxemia after a successful liver transplantation. After 19 days of unsuccessful attempts to reverse the hypoxemia using conventional mechanical ventilation and HFOV, the patient responded dramatically to APRV , with rapid improvement in her P a O 2 and sharp decline in her OI . She was able to begin weaning from APRV two days later and was extubated within seven days. APRV was successful in treating refractory hypoxemia in this patient with severe HPS after liver transplantation, possibly by modifying distribution of pulmonary blood flow. Although we cannot rule out coincidental natural resolution of the HPS , APRV could be a useful rescue therapy in patients with HPS and refractory hypoxemia.