Re-expansion of an Atelectatic Lung through Flexible Bronchoscopy in a Child with Dermatomyositis and Celiac Disease

Summary This paper describes the utility of flexible bronchoscopy in a sick child diagnosed with dermatomyositis, celiac disease. Mucus plug is a common medical cause of lung atelectasis. Due to deteriorated respiratory condition, the child was highly febrile, cyanotic, liver 6-7 cm, palpable under the right rib arch. We described a child with dermatomyositis and lung atelectasis. Atelectasis causes difficulty breathing and decreased oxygen saturation, so the child was intubated and put on a complete mechanical ventilation. Before intubation, the number of respirations exceeded 40/min, O2 saturation on the pulse oximeter fell under 73%. Pulse rate was 173/min, blood pressure 94/37 mmHg. Before intubation, the gas analysis of blood showed: Ph below 7.30 and pCO2 9 kPa, pO2 in the blood below 4.9 kPa. After flexible bronchoscopy was performed, therapeutic and diagnostic, lung re-expansion was enabled. After performed bronchoalveolar lavage with 0.9% NaCL 1 ml per kg TT, twice repeated, corticosteroids were introduced at the site of the changed mucus membrane. Mechanical ventilation parameters: Fio2, number of respirations and inspiratory pressure decreased. Values of gas analysis: ph improvement above 7.30 Pco2 3.6kPa, pO2 in the blood 11. O2 saturation 95%, pulse rate 120/min. The five-year-old child patient was extubated five days after bronchoscopy and was transferred to the standard Pulmonology Ward. Blood derivatives were obtained on several occasions. The condition improved, methotrexat therapy was introduced, with corticosteroids once a week, 3x40 mg i.v., on other week days Pronison 5 mg 4x1. Sažetak Ovaj rad ukazuje na značaj fleksibilne bronhoskopije kod obolelog deteta sa dijagnozom dermatomyositis, coeliakia. Sluzni čep u bronhu je čest medicinski uzrok atelektaze kod ovih bolesnika. Usled pogoršanog respiratornog stanja, obolela deca mogu imati visoku temperaturu, cijanozu, uvećanu jetru do 6- 7 cm. Prikazujemo dete sa dermatomiozitisom, koje je imalo atelektazu pluća. Atelektaza pluća uzrokuje otežano disanje, smanjenje saturacije, zbog čega je obolelo dete intubirano i priključeno na totalnu mehaničku ventilaciju. Broj respiracija pre intubacije prelazio je 40 min, saturacija oksigena saturacija na oksimetru pulsa pada ispod 73%. Puls 173/min, krvni pritisak 94/37 mmHg. Pre intubacije vrednosti plinova u krvi - pH obično su ispod 7,30 i pCO2 9 kPa, pO2 u krvi ispod 4,9 kPa. Posle izvedene fleksibilne bronhoskopije, dijagnostičke i terapijske sa bronhoalveolarnom lavažom, nastupa reekspanzija pluća. Posle izvedene bronhoalveolarne lavaže sa 0,9% NaCL 1 ml/kg TT, dva puta ponovljene, uvedeni su kortikosteroidi na mestu promene na sluznici obolelog bronha. Parametri mehaničke ventilacije: FiO2, smanjen broj respiracija i vrednosti inspiratornog pritiska. Vrednosti pH arterijske krvi se popravljaju iznad 7,30 Pco2 3,6 kPa, pO2 u krvi 11. Saturacija kiseonikom 95%, puls 120/min. Petogodišnja devojčica je pet dana kasnije ekstubirana i premeštena na standardno odeljenje pulmologije. Krvni derivati su uključeni u nekoliko navrata. Stanje se poboljšalo, tako da je methotreksat uveden u terapiju, sa kortikosteroidima jednom sedmično, 3x40 mg i.v., a drugim danima u sedmici Pronison 5 mg 4x1.