Authors: Pachl J, Broz L, Kripner J, Fric M, Roubik K, Zabrodsky V, Waldauf P, Bakalar B, Horakova O, Jandova J, Koenigova R.
Pachl J, Broz L, Kripner J, Fric M, Roubik K, Zabrodsky V, Waldauf P, Bakalar B, Horakova O, Jandova J, Koenigova R. Initial Optimal Continuous Distension Pressure in Prone HFOV in a Paediatric Burn: Case Report. Burns 2004; 30(2); 192-196
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The case report presents the treatment of a severe extrapulmonary ARDS (OI = 50) in a critically burnt 13-month old child. High frequency oscillatory ventilation was initiated in the prone position after a failure of the prone conventional ventilation. It led to a dramatic improvement in oxygenation. The initial effective continuous distension pressure reached a level as high as 4.0 kPa without any signs of deterioration in the cardiovascular parameters. Oxygenation improvement displayed staircase shape characteristics during the course of therapy in both the prone and supine positions. The effective optimal level of CDP was titrated during one week of HFOV application. CDP was identified as higher for the prone position than for the supine one. The child was switched to conventional ventilation at a CDP level of 1.2 kPa. The wounds (35% of his TBSA grade II a-b) healed completely without the need of surgical intervention.
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