Negative Pressure Ventilation as a Therapy for Post-operative Complications in a Patient with Single Ventricle Physiology

• Published in: Heart, lung & circulation Vol. 20; no. 12; pp. 763 - 765
• Main Authors: Deshpande, Shriprasad R., MD, MS, Kirshbom, Paul M., MD, Maher, Kevin O., MD
• Format: Journal Article
• Language: English
• Published: Australia Elsevier B.V 01.12.2011
• Subjects: Cardiac Surgical Procedures; Cardiopulmonary interaction; Cardiovascular; Congenital heart disease; Heart Defects, Congenital - diagnostic imaging; Heart Defects, Congenital - physiopathology; Heart Defects, Congenital - surgery; Heart Ventricles - diagnostic imaging; Heart Ventricles - physiopathology; Heart Ventricles - surgery; Hemodynamics; Humans; Infant; Kawashima; Male; Negative pressure ventilation; Postoperative Complications - therapy; Radiography; Respiration, Artificial; Single ventricle pathway; Ventilators, Negative-Pressure; Single ventricle pathway; Negative pressure ventilation; Congenital heart disease; Cardiopulmonary interaction; Kawashima
• ISSN: 1443-9506; 1444-2892
• DOI: 10.1016/j.hlc.2011.03.010

Objective To report the use of negative pressure ventilation as a therapeutic rescue in a patient with post-operative complications of Kawashima procedure. Design Case report. Setting Paediatric cardiac critical care unit in a tertiary care teaching hospital. Patient Nine month-old patient with single ventricle physiology developed complications after Kawashima procedure that were worsened by use of positive pressure ventilation. Intervention Utilisation of negative pressure ventilation due to its unique cardiopulmonary interactions and haemodynamic effects. Measurements and main results There was gradual and persistent improvement in the passive diastolic pulmonary blood flow through the Kawashima circuit along with improvement in oxygenation and ventilation. The patient was successfully weaned off ventilator support and discharged to home. Conclusion Patients with single ventricle physiology depend on passive diastolic blood flow to the lungs through surgical pathways such as Fontan or Kawashima circuits. Prolonged use of positive pressure ventilation can significantly affect this forward flow and result in haemodynamic compromise. Use of negative pressure ventilation with its unique cardiopulmonary interactions can be an effective rescue as demonstrated in our case.