Tài liệu Mechanical Ventilation for children with Lung Disease: ALI, ARDS, and Hypoxemic Respiratory

Mechanical Ventilation for

children with Lung Disease

ALI, ARDS, and Hypoxemic Respiratory

Failure.

How should I manage these patients in

the OR?

Roby Khemani MD MsCI

USC Keck School of Medicine

Childrens Hospital Los Angeles

Case Presentation

• 9 year old male with Leukemia with respiratory

failure from Adenovirus pneumonia.

• 3 days into ICU course develops acute upper GI

bleed.

• Several attempts at endoscopic control of

bleeding unsuccessful.

• Has received 8 units of PRBCs over past 24 hours

and still having ongoing losses.

• Surgical team wishes to take child to OR for

exploratory laparatomy to control bleeding.

Current Support

• Conventional Mechanical Ventilation

– SIMV Pressure Control + Pressure Support

• Rate 20; Peak Inspiratory Pressure 32; PEEP 12; FiO2 0.6

• Last ABG; 7.28/62/60/+3

• Lung Disease Severity Indicators

– PaO2

/FiO2 Ratio : 100

– Oxygenation Index (MAP *FiO2

/PaO2

) *100 = 19

• Fentanyl, Midazolam, Octreotide Infusions

• No inotropes or Vasopressors

Questions?

• How do I identify who is at high risk for

worsening lung injury or poor outcome?

• What type of ventilator management strategy

should I employ for this patient in the

operating room?

• Any other adjuvant therapies/management I

should be considering when managing this

patient interoperatively