Pulmonary

Abstract

Intensive Care Unit with pneumonia and progressive respiratory Insufficiency. She was intubated and ventilated by pressure regulated volume controlled ventilation (Servo 300C, Siemens, Solna, Sweden). Maximum conditions were Inspiratory Minute Volume 3.2 I, PEEP 10 cm H 2 O and 100% 0,. Chest X-ray showed bilateral interstitial Consolidation. Material obtained by broncho-alveolar lavage showed Pneumocystls Carinii. HIV-serology (Elisa and Western blott) and p24-antigen were positive, confirming the diagnosis Of pediatric AIDS. She was then treated with high dose Co-trimoxazole, Penthamidine, zidovudlne and steroids iv. Because of chest X-ray features, high need for 0, (100%, pao, 56 mm Hg), not responding to elevation of PEEP (max 10 Cm H 2 O) and Pao,/FiO, <200 (56)."' Acute Respiratory Distress Syndrome (ARDS) was diagnosed. Because conventional ventilation (CV) failure, HFO -V (3100A, Sensor Medics,Yorba Linda, Ca) was Initiated. Starting Mean Airway Pressure (MAP) of 19 cm H,0 was based on MAP of the cv, oscillatory pressure amplitude (dP) of 47 was, at initial frequency of 7.5 Hz, adjusted until chest wall vibrations were visible. It was required to raise MAP to 26 Cm H,0 and OP to 66 before optimal lung volume and ventilation were achieved and need for 0, reduced within hours. This was monitored by frequent blood-gas analysis and chest X-rays. MAP and dP could slowly be reduced. After a good response the first day, gradually 0,demand reduced and the patient could be weaned from the ventilation. MAP, OP, Fi0, and Oxygenation Index (MAP x PaO,/FiO,I are shown in table 1. Chest X-ray follow-up showed gradually Improving lung features, with marked improvement of aereatlon. After 10 days HFO-V she Could be succesfully detubated when a MAP Of 10 Cm H,0 was achieved.