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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 relatively normal lung fields at the time of discharge
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Figure 3: Chest X-ray showing relatively normal lung fields at the time of discharge

Mentions: In view of recurrent bleeding and inability to maintain optimum saturations, left side double-lumen endotracheal tube was inserted under bronchoscopic guidance. ILV was initiated by two separate ventilators. Right lung (bleeding) was put on the pressure controlled ventilation and left lung relatively normal, was managed with volume controlled ventilation. Both ventilators were time cycled with same settings and effort was made for maximum synchronization. With complete isolation of bleeding right lung from the left side and effective toileting of the right bronchus, bleeding gradually came down. The child was put back to a single conventional ventilator after 4 days and was extubated subsequently 2 days later, after confirming complete cessation of bleeding by bronchoscopy. The child was observed inward for few days and in the absence of any recurrence of bleeding, he was discharged in healthy condition [Figure 3]. There was no history suggestive of the pulmonary bleed during follow up visits.


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 relatively normal lung fields at the time of discharge
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Chest X-ray showing relatively normal lung fields at the time of discharge
Mentions: In view of recurrent bleeding and inability to maintain optimum saturations, left side double-lumen endotracheal tube was inserted under bronchoscopic guidance. ILV was initiated by two separate ventilators. Right lung (bleeding) was put on the pressure controlled ventilation and left lung relatively normal, was managed with volume controlled ventilation. Both ventilators were time cycled with same settings and effort was made for maximum synchronization. With complete isolation of bleeding right lung from the left side and effective toileting of the right bronchus, bleeding gradually came down. The child was put back to a single conventional ventilator after 4 days and was extubated subsequently 2 days later, after confirming complete cessation of bleeding by bronchoscopy. The child was observed inward for few days and in the absence of any recurrence of bleeding, he was discharged in healthy condition [Figure 3]. There was no history suggestive of the pulmonary bleed during follow up visits.

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