The Turkish Journal of Pediatrics
2014 , Vol 56 , Num 1
Successful noninvasive mechanical ventilation in a child on prolonged and life-threatening invasive mechanical ventilation after Fontan operation
Divisions of 1Pediatric Intensive Care Unit, 2Pediatric Cardiology, Department of Pediatrics and Department of 3Pediatric
Surgery, and 4Cardiovascular Surgery, Ankara University School of Medicine, Ankara, Turkey.
E-mail: dryamanayhan@yahoo.com.tr
For many decades, the primary treatment of acute respiratory failure has
been mechanical ventilation. Intubation and mechanical ventilation carry
complications such as upper respiratory system trauma, barotrauma, volutrauma,
oxytrauma, atelectrauma, and nosocomial infection, and they increase mortality.
Noninvasive mechanical ventilation (NIMV) applied to a specially selected
group of patients has more advantages than invasive ventilation, especially the
decreased number of complications. We present a three-year-old girl who had
prolonged invasive mechanical ventilation (IMV) and weaning failure due to
severe tracheal bleeding after Fontan operation. She could not be extubated
for 20 days after admission to our Pediatric Intensive Care Unit (PICU)
because of life-threatening airway bleedings from within the endotracheal
tube. Owing to the severe bleedings during endotracheal aspirations, it was
decided to change her mechanical ventilation to NIMV. NIMV was performed
successfully for 12 days without difficulty, and she was discharged from
the hospital on the 55th postoperative day with normal clinical findings.
Noninvasive ventilation has an increasing use in critically ill children. NIMV
should be considered in prolonged mechanical ventilation and weaning failure
from IMV in critically ill children.
Keywords :
noninvasive mechanical ventilation, Fontan operation, prolonged invasive
mechanical ventilation, children.