Samenvatting

Case
A four year old girl, with a previous history of asthma, was admitted on the paediatric ward of a non-university hospital with respiratory distress and fever. Laboratory work-up showed no elevated inflammatory markers and the thorax radiograph revealed a pneumonia of the right lower lobe. Non-invasive ventilator support with high-flow nasal cannula was started at rate 30L/min (=2L/kg/min). Frequent inhalation of salbutamol and intravenous corticosteroids were administered for 24 hours and then interrupted. The respiratory distress and fever persisted, the repeated blood test revealed increasing signs of infection and the radiograph showed growing infiltrates for which intravenous antibiotics were started. In the following days she showed respiratory improvement so the flow and inhalation therapy could be reduced. The third day of hospitalisation she developed an increasing swelling of the neck. Thorax radiograph was repeated on day four and revealed extensive subcutaneous emphysema near the neck, thorax and left arm as well as a pneumopericardium for which a transfer to our university hospital was performed. Low flow oxygen therapy, corticosteroids, magnesium sulphate and more frequent inhalation therapy were used. A CT thorax confirmed subcutaneous emphysema, pneumomediastinum and -pericardium, intrapulmonary air leakage peri-vascular and pneumonia. Spontaneous resolution was observed in the following days.

Conclusion
We present a case of a girl with subcutaneous emphysema due to mediastinal pneumothorax due to bronchial obstruction and respiratory distress treated with HHFNC. The lack of studies using higher flow rates and the available case reports of serious air leakage in children treated with HHFNC indicate that caution must be exercised and the underlying lung disease, asthma or other, needs to be treated as well. Uncomplicated pneumomediastinum and subcutaneous emphysema can be managed conservatively with analgesia and avoidance of maneuvers that increase pulmonary pressure.

Originele taal-2English
StatusUnpublished - 2021
Evenement49ste jaarlijkse congres van de BVK - online meeting, Belgium
Duur: 18 mrt 202119 mrt 2021

Conference

Conference49ste jaarlijkse congres van de BVK
LandBelgium
Periode18/03/2119/03/21

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