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    e-Posters
SESSION 4
       P94
         SUCCESSFUL OUTCOME IN A CHILD WITH CRITICAL COVID-19 ILLNESS WITH BIPAP-HFNC IMPLEMENTATION AFTER POST-EXTUBATION RESPIRATORY FAILURE
Eleni Volakli1, Despoina Iordanidou2, Elpis Chochliourou1, Athanasios Kasimis1, Maria Katsafiloudi1, Elisavet Michailidou3, Elpis Hatziagorou1, Emmanuel Roilides1, Maria Sdougka1
1 Pediatric Intensive Care Unit, Hippokration General Hospital, Thessaloniki, Greece 2 Anesthesiology Department, Hippokration General Hospital, Thessaloniki, Greece 3 3rd Pediatric Department, Hippokration General Hospital, Thessaloniki, Greece
   Αim: To present a case of critical COVID-19 in a boy who was successfully treated with BIPAP and HFNC to overcome post-extubation respiratory failure.
Case presentation: A 13.5y boy, BW 60kg, (IBW 50kg), no comorbidities, presented to the ED with severe respiratory failure (SpO2 45%), GCS 15/15, in compensated shock. Immediate in situ intubation and transfer to OR for further stabilization, rapid PCR test positive for SARS- CoV-2. Chest Xray conclusive for critical COVID-19, with intense opacities on all pulmonary fields. Alveolar flooding was appearing up to the ET. A central and arterial line was inserted, norepinephrine infusion was started and the patient was transferred to COVID-19 PICU. IPPV was initiated {IRV 1:1.5, Tv 8ml/IBW (400+50 ml for VD HEPA filter compensation), Peak/PEEP 45/10, RR to normocapnia}. Good response to PICU and COVID-19 protocols (remdesivir/dexamentazone/colchicine). No special problems during the first two weeks of PICU stay, rectum colonization with Klebsiella pneumoniae and Acinetobacter baumanii. Managed to be extubated on d14th and put immediately on HFNC (baseflow 50 lit/min, O2 20 lit/min, FiO2 55%). 7h later he developed respiratory distress and BIPAP was initiated (IPAP 24 cmH20/EPAP 7 cmH20, O2 15 lit/min). In the parallel, a diagnosis of pancreatitis and colitis was made. Severe intestine distention was noticed, possibly complicated by BIPAP aerophagia, and efforts started to reduce IPAP. Gradual improvement, transferred to HDU on d22th with BIPAP (IPAP 14/EPAP 6/O2 15lit/min). Since d25th day HFNC reintroduced during day time. On d33th on HFNC only (baseflow 25 lit/min, O2 12 lit/min, FiO2 45%) transferred to Pediatric Ward.
Conclusions: ΒΙPAP helped our patient to overcome post-extubation respiratory failure. Positive pressures, in the presence of rhino gastric tube, could have increased aerophagia and deteriorate colon distention caused by pancreatitis and colitis. Physicians should be aware of BIPAP/HFNC capabilities as well as possible adverse effects.
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