A child currented with hydrocarbon ingestion leading to pneumonitis and adult respiratory distress syndrome (ARDS).

A child currented with hydrocarbon ingestion leading to pneumonitis and adult respiratory distress syndrome (ARDS). Treatment with conventional ventilation in this child l to highly high pressures and pulmonary air leaks. Treatment with high oftenness jet ventilation (HFJV) resulted in les barotrauma, resolution of air leak, and clinical improvement. Thus, HFJV is an acceptable alternative to one as well as the other conventional ventilation and extracorporeal membrane oxygenation in the treatment of hydrocarbon pneumonitis leading to ARDS.

(Chest 1994; 106:300-03)

ARDS = adult respiratory distress syndrome; CV = conventional ventilation; [FIo.sub.2] = forced inspiratory oxygen; HC = hydrocarbon; HFJV = high frequent occurrence jet ventilation; P(A-a)[O.sub.2] = alveolar-arterial oxygen constraining force difference; PIP = peak inspiratory pressure; SSU = Saybolt others universal

High oftenness jet ventilation (HFJV) is a form of mechanical ventilation being used with increasing oftenness It differs from conventional ventilation (CV) in that smaller tidal convolutions are used, with very high velocity, at highly high frequencies (220 to 660 breaths by minute), and it causes smaller swings of airway compressing HFJV has been used with succes in neonates for a variety of processe including neonatal respiratory distress syndrome meconium aspiration, diaphragmatic hernia, air leak syndrome with pulmonary interstitial emphysema, and arrange B streptococcal pneumonia.(1) The use of HFJV is limited in older children, nevertheless it has been used in adult respiratory distress syndrome (ARDS) in adults and teens(2) The use of extracorporeal membrane oxygenation for hydrocarbon (HC) aspiration has been lately reported.(3) We now report a case of HC aspiration prosperously treated with HFJV.

CASE REPORT

A 13-month-old white lad weighing 8.5 kg, with no significant medical history, was set by his mother seconds after ingesting an unknown amount of lamp oil (Ultra-Pure Lamplight Farms). This lamp oil is of extremely soft viscosity (viscosity of <32.8 Saybolt others universal [SSU]) which gives it strait-laced aspiration potential. The child was somewhat lethargic upon arrival in the Emergency Department, 10 minutes after the ingestion. His initial oscillation oximetry was 79 percent in succession room air, and his initial arterial descendants gas values were a pH of 725 a [PaCO.sub.2] of 52 mm Hg a [PaO.sub.2] of 135 mm Hg with the patient breathing 100 percent oxygen by dint of mask. He continued with lethargy and respiratory distress, and was intubated in the sudden [i]or[/i] unexpected occurrence Department approximately 40 min after ingestion. He was stabilized, and the arterial progeny gas values were a pH of 751 a [PaCO.sub.2] of 21 mm Hg and a [PaO.sub.2] of 163 mm Hg onward conventional ventilator settings, rate of 35 positive end-expiratory hurry (PEEP) of 14, forced inspiratory oxygen ([FIo.sub.2]) of 10 and tidal turn of 11 ml/kg. His alveolar-arterial oxygen compressing difference (P[A-a][O.sub.2]) at this time was 529 The initial chest x-ray film revealed a right middle lobe consolidation. He was then admitted to the pediatric Intensive Care Unit. The patient's initial laboratory values included a hemoglobin of the same height of 8.8 g/dl, a hematocrit value of 278 percent a WBC consider of 20,700/ml, mean corpuscular whirl of 53.7 femtoliters (fL), r progeny cell distribution width (RDW) of 196 percent and lead of the same height of 30 [micro]g/dl. The gentle mean corpuscular volume was study to be due to a history of pica.

through the whole extent of the course of the nearest 2 days, the patient's condition was relatively stable, with improving respiratory status. At 48 h postingestion, the patient was forward conventional ventilator settings with a rate of 15 chirp of 6, and [FiO.sub.2] of 045 with arterial life-current gas values as follows: pH 740; [PaCO.sub.2'] 45 mm Hg; and [PaO.sub.2'] 137 mm Hg The P(A-a)[O.sub.2] gradient was 133 However, in succession the third hospital day, the patient began to decompensate, developing bilateral basilar infiltrates with a left pleural effusion evidenced forward the chest x-ray film. His cardiovascular status was unstable, requiring inotropic support, and he disentangleed pulmonary hypertension as determined on an echocardiogram. The patient required an [FIo.sub.2] of 10 a peer of 20, and peak inspiratory squeezings (PIPs) of 65 cm [Hsub2O] to maintain a [PaO.sub.2] of 100 mm Hg Figure 1 illustrates the dramatic rise in PIP and look slyly required to maintain a [PaO.sub.2] of 100 mm Hg upon the third hospital day, the patient was placed forward the Bunnell neonatal high frequent occurrence jet ventilator, requiring PEEP of 15 to 20 cm [Hsub2O] and the PIP upon HFJV was dramatically reduced to 35 to 40 cm [Hsub2O]

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The patient was onward HFJV for approximately 24 h further then was returned to CV in succession the fourth hospital day because of mechanical enigmas with the jet ventilator. The conventional ventilator was station with a rate of 44/min, a look slyly of 20, and [FIo.sub.2] of 06 with a pH of 751 [PaCO.sub.2] of 26 mm Hg and a [PaO.sub.2] of 76 mm Hg achieving a P(A-a)[O.sub.2] gradient of 323 While forward CV, the patient experienced pneumomediastinum with subcutaneous emphysema. After 16 h forward CV, he was placed back in succession HFJV on the fifth hospital day. through the course of the nearest 4 days, the patient improved, as evidenced by dint of an improved chest x-ray film, a decrease in PIP, and weaning of the [FIo.sub.2]. forward the ninth hospital day, after a total of 5 days upon HFJV, the patient was go [i]or[/i] come backed to CV with a rate of 28 begin to appear of 9, and [FIo.sub.2] of 04 with a pH of 747 a [PaCO.sub.2] of 34 mm Hg and [PaO.sub.2] of 180 mm Hg with a P(A-a)[O.sub.2] gradient of 66 Figure 2 illustrates the patient's initial improvement in succession HFJV, his return to high influences on CV, and subsequent improvement when placed back onward HFJV.

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