Perfluorodecalin lavage of a longstanding lung atelectasis in a child with spinal muscle atrophy

• Published in: Pediatric pulmonology 2012-04, Vol.47 (4), p.415-419
• Main Authors: Henrichsen, Thore, Lindenskov, Paal HH, Shaffer, Thomas H, Loekke, Ruth JV, Fugelseth, Drude, Lindemann, Rolf
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; bronchioalveolar lavage; Bronchoalveolar Lavage; child; Child, Preschool; Chronic Disease; Diseases of striated muscles. Neuromuscular diseases; Female; Fluorocarbons - therapeutic use; General aspects; Humans; lung atelectasis; Medical sciences; Neurology; perfluorochemical liquids; Pneumology; Pulmonary Atelectasis - diagnostic imaging; Pulmonary Atelectasis - drug therapy; Pulmonary Atelectasis - therapy; Respiration, Artificial; Respiratory Insufficiency - diagnostic imaging; Respiratory Insufficiency - drug therapy; Respiratory Insufficiency - therapy; spinal muscle atrophy; Spinal Muscular Atrophies of Childhood - diagnostic imaging; Spinal Muscular Atrophies of Childhood - drug therapy; Spinal Muscular Atrophies of Childhood - therapy; Tomography, X-Ray Computed; Trachea - diagnostic imaging; Trachea - surgery; Treatment Outcome
• ISSN: 8755-6863; 1099-0496
• DOI: 10.1002/ppul.21565

Objective Persistent lung atelectasis is difficult to treat and perfluorochemical (PFC) liquid may be an option for bronchioalveolar lavage (BAL). Case report A 4‐year‐old girl with spinal muscle atrophy was admitted in respiratory failure. On admission, the X‐ray confirmed the persistence of total right‐sided lung atelectasis, which had been present for 14 months. She was endotracheally intubated and ventilated from the day of admission. BAL with normal saline was performed twice without improvement. Following failed extubation and being dependent on continuous respiratory support, a trial of BAL using PFC liquid (Perfluorodecalin HP) was carried out. The PFC was delivered through the endotracheal tube on three consecutive days. A loading dose of 3 ml/kg was administered, followed by a varying dose in order to more effectively lavage the lungs. She tolerated the procedure well the first 2 days, although there were no clinical signs of improvement in the atelectasis. Intentionally, higher inflation pressures were applied after PFC instillation on day 3. Chest X‐ray then showed hazy infiltrates on her left lung and she required more ventilatory support. However, lung infiltrates cleared over the next 3 days. A tracheotomy was done 6 days after the last PFC instillation. She had a slow recovery and was successfully decanulated. Clinical improvement of lung function was seen including less need of BiPAP and oxygen. A chest CT scan showed then functional lung tissue appearing in the previous total atelectatic right lung. Conclusion Lavage with PFC can safely be performed with a therapeutic effect in a child with unilateral total lung atelectasis. Pediatr Pulmonol. 2012; 47:415–419. © 2011 Wiley Periodicals, Inc.