The Science Journal of the American Association for Respiratory Care

1999 OPEN FORUM Abstracts

A Promethean Adjunct to Ventilating an Infant with Severe Tracheobronchomalacia Using Helium-Oxygen Mixtures: A Case Report.

M Rogers, R Scott, L Langga, T Malinowski, D Deming, A Hopper, Loma Linda University Medical Center and Children's Hospital Loma Linda, California.

Introduction: There is scant information about the use of helium-oxygen mixtures (heliox) in the neonatal patient with chronic lung disease. We present a case report of a mechanically ventilated premature infant receiving heliox to reduce airway resistance secondary to tracheobronchomalacia. Case summary: A 27 week estimated gestational age, male infant, delivered via Cesarean section, required mechanical ventilation for respiratory distress. The infant was transferred to our neonatal intensive care unit at 30 days of age for patent ductus arteriosus ligation and ventilator management. Over the next eight months, the infant developed seizures, multiple episodes of sepsis, bronchopulmonary dysplasia with failure to wean from continuous mechanical ventilation. Severe tracheobronchomalacia was diagnosed by bronchoscopy. The patient had severe desaturations and ventilator asynchrony with agitation and airway collapse. Heliox gas therapy (FIHe of 0.65) was initiated. There was an immediate and significant clinical improvement in ventilation with a decrease in PaCO2 from 110 mmHg to 50 mmHg and an increase in pH from 7.17 to 7.47. The infant continued to receive heliox for five days. The intervention with heliox allowed the patient's blood gases and work of breathing to stabilize. Discussion: Mechanical ventilation of an infant with complex obstructive airway disease is a challenge. Tracheobronchomalacia is characterized by a decrease in airway tone and structure, which leads to airway obstruction. Heliox is effective in reducing the symptoms of upper and lower airway obstruction because of its low density and high kinematic viscosity. Both functions work to reduce the collapse of tracheal tissues and enhance carbon dioxide clearance. This case study suggests heliox is a viable bridge in the episodic, exacerbation of airway collapse in a mechanically ventilated infant with tracheobronchomalacia.

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