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VOLUME 21 , ISSUE 5 ( May, 2017 ) > List of Articles

CASE REPORT

Severe pediatric acute respiratory distress syndrome due to scrub typhus: Successful ventilation with airway pressure release ventilation mode after becoming refractory to protective ventilation

Keywords : Acute respiratory distress syndrome, airway pressure release ventilation, pediatric, scrub typhus

Citation Information : Severe pediatric acute respiratory distress syndrome due to scrub typhus: Successful ventilation with airway pressure release ventilation mode after becoming refractory to protective ventilation. Indian J Crit Care Med 2017; 21 (5):326-328.

DOI: 10.4103/ijccm.IJCCM_38_17

License: CC BY-ND 3.0

Published Online: 01-06-2018

Copyright Statement:  Copyright © 2017; The Author(s).


Abstract

Scrub typhus can affect lungs from mild illness like pneumonitis to a severe illness like acute respiratory distress syndrome (ARDS). Such patients may be very challenging to treat when their hypoxemia becomes severe and refractory to treatment. Main treatment is supportive in terms of mechanical ventilation. In adult ARDS, low tidal volume (TV) ventilation has been recommended, but there is no consensus on most effective ventilation mode in children. We present a case of a 12-year-old girl who developed severe ARDS (PO 2 /FiO 2 ratio - 58), refractory to low TV ventilation. There was a rapid improvement in oxygenation on the application of airway pressure release ventilation (APRV) mode within ½ h. She was successfully ventilated and weaned off the ventilator over 5 days. This case highlights the utility of APRV mode of ventilation as a rescue therapy for severe refractory ARDS in children.


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  1. Gupta P, Gurjar U, Sharma BS, Gupta ML. Complication profile of scrub typhus and its association with total leucocyte count. Int J Contemp Pediatr 2017;4:96-9.
  2. Thomas R, Puranik P, Kalal B, Britto C, Kamalesh S, Rego S, et al. Five-year analysis of rickettsial fevers in children in South India: Clinical manifestations and complications. J Infect Dev Ctries 2016;10:657-61.
  3. Wang CC, Liu SF, Liu JW, Chung YH, Su MC, Lin MC. Acute respiratory distress syndrome in scrub typhus. Am J Trop Med Hyg 2007;76:1148-52.
  4. Walker DH. Rickettsiae and rickettsial infections: The current state of knowledge. Clin Infect Dis 2007;45 Suppl 1:S39-44.
  5. Park JS, Jee YK, Lee KY, Kim KY, Myong NH, Seo PW. Acute respiratory distress syndrome associated with scrub typhus: Diffuse alveolar damage without pulmonary vasculitis. J Korean Med Sci 2000;15:343-5.
  6. Kollisch-Singule M, Emr B, Smith B, Ruiz C, Roy S, Meng Q, et al. Airway pressure release ventilation reduces conducting airway micro-strain in lung injury. J Am Coll Surg 2014;219:968-76.
  7. Roy S, Habashi N, Sadowitz B, Andrews P, Ge L, Wang G, et al. Early airway pressure release ventilation prevents ARDS-a novel preventive approach to lung injury. Shock 2013;39:28-38.
  8. Emr B, Gatto LA, Roy S, Satalin J, Ghosh A, Snyder K, et al. Airway pressure release ventilation prevents ventilator-induced lung injury in normal lungs. JAMA Surg 2013;148:1005-12.
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