Ökkeş Özgür MART, Dinçer YILDIZDAŞ, Özden ÖZGÜR HOROZ, Faruk EKİNCİ, Merve MISIRLIOĞLU

Solunum sinsityal virüsü ile ilişkili bronşiyolite bağlı solunum sıkıntısı gelişen trakeostomili bir çocuk olguda Heliox tedavisi kullanımı

Helyum-oksijen gaz karışımı olan Heliox, obstrüktif akciğer hastalığını tedavi etmek için uzun yıllardır kullanılmaktadır. Heliox’un azot-oksijen karışımlarına göre daha düşük yoğunluğu ve daha yüksek viskozitesi nedeniyle, obstrüktif durumlarda hava yolu direncini önemli ölçüde azaltabilir. Akut bronşiyolitli bebeklerde yüksek akış nazal kanül ile birlikte kullanıldığında, heliox kullanımının gaz değişiminde iyileşmeye yol açacağı düşünülmektedir. Solunum sinsityal virüs (RSV) infant dönemindeki bronşiyolitin en önemli etkenidir. Kliniğimizde, trakeostomisi olan ve mekanik ventilatör desteği alan RSV (+) hastamıza, mekanik ventilatörde yüksek basınçlara ve bronkodilatör tedavilere rağmen, yeterli oksijenasyonu sağlayamadığımız için mekanik ventilatör ile heliox tedavisi uyguladık. Hastamıza 4 saat boyunca heliox tedavisi verildi. Heliox sonrasında hastanın mekanik ventilatör desteklerinde ve bronkodilatör ihtiyacında önemli ölçüde azalma oldu. Kan gazındaki oksijenizasyon indeksi 7.3’den 4’e, PaCO2 55 mmHg’den 40 mmHg’ye geriledi. Biz burada, RSV ile ilişkili bronşiyolite bağlı solunum sıkıntısı gelişen, diğer tedavi uygulamalarına yanıt vermeyen ve heliox tedavisi ile düzelen bir çocuk olguyu sunduk.

Use of Heliox therapy in a child with tracheostomy who developed respiratory distress due to bronchiolitis associated with respiratory syncytial virus

Keywords:

respiratory distress, child, Heliox,

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1. Welliver RC. Review of epidemiology and clinical risk factors for severe respiratory syncytial virus infection. J Pediatr. 2003;143:112–117.
2. Hall CB. Respiratory syncytial virus and parainfluenza virus. N Engl J Med 2001;344:1917–1928.
3. Wang EE, Law BJ, Stephens D. Pediatric Investigators Collaborative Network on Infections in Canada (PICNIC) prospective study of risk factors and outcomes in patients hospitalized with respiratory syncytial viral lower respiratory tract infection. Journal of Pediatrics. 1995;126:212–9.
4. Mink S, Ziesmann M, Wood LD. Mechanisms of increased maximum expiratory flow during HeO2 breathing in dogs. J Appl Physiol Respir Environ Exerc Physiol. 1979;47:490-502.
5. Paret G, Dekel B, Vardi A, Szeinberg A, Lotan D, Barzilay Z. Heliox in respiratory failure secondary to bronchiolitis: a new therapy. Pediatric Pulmonology. 1996;22:322–3.
6. Kyu HH, Pinho C, Wagner JA, et al. Global and national burden of diseases and injuries among children and adolescents between 1990 and 2013: fi ndings from the Global Burden of Disease 2013 Study. JAMA Pediatr 2016;170:267–87.
7. Stockman LJ, Curns AT, Anderson LJ, FischerLangley G: Respiratory syncytial virus-associated hospitalizations among infants and young children in the United States, 1997–2006. Pediatr Infect Dis J. 2012;31:5–9.
8. Mansbach JM, Piedra PA, Teach SJ, et al.; MARC-30 Investigators. Prospective multicenter study of viral etiology and hospital length of stay in children with severe bronchiolitis. Arch Pediatr Adolesc Med. 2012;166:700-6.
9. American Academy of Pediatrics. Diagnosis and management of bronchiolitis. Pediatrics. 2006;118:1774–93.
10. Ralston SL, Lieberthal AS, Meissner HC, et al.; American Academy of Pediatrics. Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis [published correction appears in Pediatrics. 2015;136(4):782]. Pediatrics. 2014;134:1474-1502.
11. Kallappa C, Hufton M, Millen G, Ninan TK. Use of high flow nasal cannula oxygen (HFNCO) in infants with bronchiolitis on a paediatric ward: a 3-year experience. Arch Dis Child. 2014;99:790-1.
12. Khoshoo V, Edell D. Previously healthy infants may have increased risk of aspiration during respiratory syncytial viral bronchiolitis. Pediatrics. 1999;104:1389- 90.
13. Oakley E, Borland M, Neutze J, et al.; Paediatric Research in Emergency Departments International Collaborative (PREDICT). Nasogastric hydration versus intravenous hydration for infants with bronchiolitis: a randomised trial. Lancet Respir Med. 2013;1:113-120.
14. Gadomski AM, Scribani MB. Bronchodilators for bronchiolitis. Cochrane Database Syst Rev. 2014; 6:CD001266.
15. Hartling L, Fernandes RM, Bialy L, et al. Steroids and bronchodilators for acute bronchiolitis in the first two years of life: systematic review and meta-analysis. BMJ. 2011;342:d1714.
16. Farley R, Spurling GK, Eriksson L, Del Mar CB. Antibiotics for bronchiolitis in children under two years of age. Cochrane Database Syst Rev. 2014;(10):CD005189.
17. Donlan M, Fontela PS, Puligandla PS: Use of continuous positive airway pressure (CPAP) in acute viral bronchiolitis: a systematic review. Pediatr Pulmonol 2011;46:736–46.
18. Greenough A: Role of ventilation in RSV disease: CPAP, ventilation, HFO, ECMO. Paediatr Respir Rev 2009;10:26–8.
19. Milesi C, Baleine J, Matecki S, Durand S, Combes C, Novais AR, Combonie G: Is treatment with a high flow nasal cannula effective in acute viral bronchiolitis? A physiologic study. Intensive Care Med. 2013;39:1088–94.
20. Lee JH, Rehder KJ, Williford L, Cheifetz IM, Turner DA: Use of high flow nasal cannula in critically ill infants, children, and adults: a critical review of the literature. Intensive Care Med. 2012;39:247–57.
21. Schibler A, Pham TM, Dunster KR, Foster K, Barlow A, Gibbons K, Hough JL: Reduced intubation rates for infants after introduction of high-flow nasal prong oxygen delivery. Intensive Care Med. 2011;37:847–52.
22. Mansbach JM, Piedra PA, Stevenson MD, Sullivan AF, Forgey TF, Clark S, Espinola JA, Camargo CA Jr, Investigators M: Prospective multicenter study of children with bronchiolitis requiring mechanical ventilation. Pediatrics. 2012;130:492–500.
23. Wolfson MR, Bhutani VK, Shaffer TH, Bowen FW Jr. Mechanics and energetics of breathing helium in infants with bronchopulmonary dysplasia. Journal of Pediatrics. 1984;104:752–7.
24. Barach AL. The therapeutic use of helium. JAMA. 1936;107:1273-80.
25. Martinón-Torres F. What’s weighing down heliox?. Lancet Respiratory Medicine. 2015;3:14–5.
26. Kneyber MC, van Heerde M, Twisk JW, Plötz FB, Markhors DG. Heliox reduces respiratory system resistance in respiratory syncytial virus induced respiratory failure. Critical Care 2009;13(3): R71
27. Liet JM, Ducruet T, Gupta V, Cambonie G. Heliox inhalation therapy for bronchiolitis in infants. Cochrane Database of Syst Rev. 2015;9:CD006915.
28. Seliem W, Sultan AM. Heliox delivered by high flow nasal cannula improves oxygenation in infants with respiratory syncytial virus acute bronchiolitis. J Pediatr (Rio J). 2018;94:56-61.