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Paediatric pulmonary haemorrhage: Independent lung ventilation as effective strategy in management.

Murkute A, Angadi U, Jain P, Sharique T, Hegde R - Indian J Crit Care Med (2014)

Bottom Line: Pulmonary haemorrhage is an uncommon symptom in paediatrics with the etiology varying among the series by age, location, and the diagnostic tests employed.Once airway protection and volume resuscitation are ensured, localization of the anatomic site of bleeding, isolation of the involved airway, control of haemorrhage and treatment of the underlying cause of becomes essential.In localized persistent bleeding, airway control may be achieved by lung isolation with double lumen endotracheal tube and synchronous independent lung ventilation.

View Article: PubMed Central - PubMed

Affiliation: Department of Paediatric Critical Care, Narayana Health, Bommasandra, Bengaluru, Karnataka, India.

ABSTRACT
Pulmonary haemorrhage is an uncommon symptom in paediatrics with the etiology varying among the series by age, location, and the diagnostic tests employed. Once airway protection and volume resuscitation are ensured, localization of the anatomic site of bleeding, isolation of the involved airway, control of haemorrhage and treatment of the underlying cause of becomes essential. In localized persistent bleeding, airway control may be achieved by lung isolation with double lumen endotracheal tube and synchronous independent lung ventilation.

No MeSH data available.


Related in: MedlinePlus

Chest X-ray showing double-lumen tube in situ with improved right lung aeration
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Figure 1: Chest X-ray showing double-lumen tube in situ with improved right lung aeration

Mentions: An 8-year-old male child presented to us with a history of multiple bouts of massive hemoptysis and increasing dyspnea of 3-day duration. He had undergone bidirectional Glenn shunt at the age of 8 months for tricuspid atresia. He had an uneventful course till the present presentation. He was intubated and was mechanically ventilated in view of severe respiratory distress. His hemodynamics was supported with inotropes, and broad spectrum antibiotics were started. Initial workup showed normal blood counts with normal platelet count. Chest X-ray showed multiple heterogeneous opacities in right lung suggestive of hemorrhage [Figure 1]. In view of massive bleed from airway that was not controlled with positive pressure ventilation, he was taken up for an emergency angiography and collateral of 2.5 mm arising from left subclavian artery was occluded by coil embolization; following which there was temporary cessation of bleeding. However the next day, there was recurrence massive bleed from endobronchial tube. This time he underwent bronchoscopy that showed friable mucosa of right main bronchus and also computed tomography (CT) thorax [Figure 2] which showed multiple tiny collaterals arising from the aorta that could not be embolized. Decision of bronchial artery embolization was deferred because of deteriorating general condition with recurrent bleeds.


Paediatric pulmonary haemorrhage: Independent lung ventilation as effective strategy in management.

Murkute A, Angadi U, Jain P, Sharique T, Hegde R - Indian J Crit Care Med (2014)

Chest X-ray showing double-lumen tube in situ with improved right lung aeration
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4195201&req=5

Figure 1: Chest X-ray showing double-lumen tube in situ with improved right lung aeration
Mentions: An 8-year-old male child presented to us with a history of multiple bouts of massive hemoptysis and increasing dyspnea of 3-day duration. He had undergone bidirectional Glenn shunt at the age of 8 months for tricuspid atresia. He had an uneventful course till the present presentation. He was intubated and was mechanically ventilated in view of severe respiratory distress. His hemodynamics was supported with inotropes, and broad spectrum antibiotics were started. Initial workup showed normal blood counts with normal platelet count. Chest X-ray showed multiple heterogeneous opacities in right lung suggestive of hemorrhage [Figure 1]. In view of massive bleed from airway that was not controlled with positive pressure ventilation, he was taken up for an emergency angiography and collateral of 2.5 mm arising from left subclavian artery was occluded by coil embolization; following which there was temporary cessation of bleeding. However the next day, there was recurrence massive bleed from endobronchial tube. This time he underwent bronchoscopy that showed friable mucosa of right main bronchus and also computed tomography (CT) thorax [Figure 2] which showed multiple tiny collaterals arising from the aorta that could not be embolized. Decision of bronchial artery embolization was deferred because of deteriorating general condition with recurrent bleeds.

Bottom Line: Pulmonary haemorrhage is an uncommon symptom in paediatrics with the etiology varying among the series by age, location, and the diagnostic tests employed.Once airway protection and volume resuscitation are ensured, localization of the anatomic site of bleeding, isolation of the involved airway, control of haemorrhage and treatment of the underlying cause of becomes essential.In localized persistent bleeding, airway control may be achieved by lung isolation with double lumen endotracheal tube and synchronous independent lung ventilation.

View Article: PubMed Central - PubMed

Affiliation: Department of Paediatric Critical Care, Narayana Health, Bommasandra, Bengaluru, Karnataka, India.

ABSTRACT
Pulmonary haemorrhage is an uncommon symptom in paediatrics with the etiology varying among the series by age, location, and the diagnostic tests employed. Once airway protection and volume resuscitation are ensured, localization of the anatomic site of bleeding, isolation of the involved airway, control of haemorrhage and treatment of the underlying cause of becomes essential. In localized persistent bleeding, airway control may be achieved by lung isolation with double lumen endotracheal tube and synchronous independent lung ventilation.

No MeSH data available.


Related in: MedlinePlus