Open AccessSevere pediatric acute respiratory distress syndrome due to scrub typhus: Successful ventilation with airway pressure release ventilation mode after becoming refractory to protective ventilation
Author(s) -
Sudha Chandelia,
Sarika Jain
Publication year - 2017
Publication title -
indian journal of critical care medicine/indian journal of critical care medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.317
H-Index - 30
eISSN - 1998-359X
pISSN - 0972-5229
DOI - 10.4103/ijccm.ijccm_38_17
Subject(s) - medicine , ards , mechanical ventilation , ventilation (architecture) , hypoxemia , anesthesia , continuous positive airway pressure , respiratory distress , intensive care medicine , refractory (planetary science) , lung , mechanical engineering , physics , obstructive sleep apnea , astrobiology , engineering
Scrub typhus can affect lungs from mild illness like pneumonitis to a severe illness like acute respiratory distress syndrome (ARDS). Such patients may be very challenging to treat when their hypoxemia becomes severe and refractory to treatment. Main treatment is supportive in terms of mechanical ventilation. In adult ARDS, low tidal volume (TV) ventilation has been recommended, but there is no consensus on most effective ventilation mode in children. We present a case of a 12-year-old girl who developed severe ARDS (PO 2 /FiO 2 ratio - 58), refractory to low TV ventilation. There was a rapid improvement in oxygenation on the application of airway pressure release ventilation (APRV) mode within ½ h. She was successfully ventilated and weaned off the ventilator over 5 days. This case highlights the utility of APRV mode of ventilation as a rescue therapy for severe refractory ARDS in children.