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ID 117796
Title Alternative
Transpulmonary pressure-guided PEEP titration for mechanical ventilation in pediatric patient with refractory hypoxia due to abdominal compartment syndrome induced by neuroblastoma : a case report.
致死的低酸素血症をきたした神経芽細胞腫Stage4Sの一乳児症例
Author
Nakano, Yuki Tokushima University
Momota, Kazuki Tokushima University
Akimoto, Yusuke Tokushima University
Keywords
Neuroblastoma
Abdominal compartment syndrome
Transpulmonary pressure
Content Type
Journal Article
Description
Background : Neuroblastoma is the most common extracranial solid tumor of childhood. Although the prognosis of neuroblastoma is relatively good, newborns less than two months of age with stage 4S neuroblastoma may present with aggressive hypoxia and restrictive respiratory impairment due to abdominal compartment syndrome.
Case presentation : Two-month-old girl, height of 63 cm and body weight of 10 kg. She was diagnosed as neuroblastoma with Stage 4S. Because she was suffered from refractory hypoxemia and restrictive respiratory impairment due to abdominal compartment syndrome induced by multiple liver metastasis and massive ascites, she was transferred to our ICU. Her trachea was intubated and ventilated with assist/controlled mode, driving pressure 22 cmH2O, positive end-expiratory pressure(PEEP)8 cmH2O, fraction of inspiratory oxygen(FIO2)1.0, but tidal volume was obtained only 3.2 mL/kg and PaO2/FIO2 ratio of 55 mmHg. Therefore, we insert esophageal sensor and monitored esophageal pressure to performed transpulmonary pressure guided PEEP titration. When we changed PEEP from 8 to 15 cmH2O so that the end-expiratory transpulmonary pressure achieving 0 to 5 cmH2O, her oxygenation(PaO2/FIO2 ratio : 55 to 178 mmHg)and respiratory compliance(1.4 to 3.0 mL/cmH2O)were dramatically improved. Her respiratory condition was further stabilized by ascites puncture and radiotherapy, and the patient was extubated successfully on the 25th ICU day.
Conclusions : Although pediatric neuroblastoma with stage 4S may induce severe respiratory efficiency, the responsiveness of treatment for neuroblastoma is promising. Multimodal treatments including optimal ventilator management such as transpulmonary pressure -guided PEEP titration contributes to improved patient’s prognosis.
Journal Title
Shikoku Acta Medica
ISSN
00373699
NCID
AN00102041
Publisher
徳島医学会
Volume
78
Issue
3-4
Start Page
115
End Page
120
Sort Key
115
Published Date
2022-08-25
FullText File
language
jpn
TextVersion
Publisher
departments
University Hospital
Medical Sciences