A Vasudevan, N Mahesh
acute lung injury, ards., cerebral palsy, laryngospasm, negative pressure pulmonary edema, pulmonary aspiration
A Vasudevan, N Mahesh. Acute respiratory distress syndrome in a child with cerebral palsy. The Internet Journal of Anesthesiology. 2008 Volume 20 Number 2.
Pulmonary edema can occur following airway obstruction. These reports are usually put under the category of
A 8year old girl, weighing 8 kg (malnourished) with spastic cerebral palsy was scheduled for hip adductor release. She had past history of recurrent chest infections and tonic posturing. On examination drooling of saliva, mild scoliosis and spasticity were present. Chest X-ray showed apparently normal lungs.
Child was premedicated with Famotidine 10mg, Metoclopromide 5mg and Midazolam 4mg
The child had recurrent episodes of arterial oxygen desaturation with appearance of bright red frothy secretions in the tracheal tube. High PEEP (10 to 12 cmH2O) was required to maintain arterial oxygen saturation in the next few days. Laboratory investigations showed normal renal and liver functions including normal plasma proteins. The child improved over the next few days and was successfully extubated on the seventh postoperative day.
There have been many reports of pulmonary edema following upper airway obstruction, usually put under the category of
The high negative intrapleural pressure is the main precipitating event in the development of edema following upper airway obstruction. Damage to alveolar-capillary membrane by hypoxia, acute aspiration of gatric contents or pre-existing lung pathology could worsen the problem leading to ARDS8. It is essential to differentiate ALI/ARDS from simple negative pressure pulmonary edema, since the management has to be more aggressive with the former. Even though the initial clinical picture is similar, presence of blood in the lung secretions, bilateral diffuse ‘fluffy’ infiltrates on chest radiography and persistently low PaO2:FIO2 should help differentiate ALI/ARDS from negative pressure pulmonary edema. Early detection and aggressive management may help reduce the morbidity and mortality in these patients.
Dr Vasudevan A, No-2, Type-IV, JIPMER campus, Dhanvantri nagar, Puducherry, India- 605006. Email: firstname.lastname@example.org