High-frequency percussive ventilation as a lifesaving intervention in a pediatric case of life-threatening asthma: a case report and literature review.

Abstract

Introduction: Severe acute asthma exacerbation requiring mechanical ventilation, referred to as life-threatening asthma, presents significant challenges due to elevated airway resistance, dynamic hyperinflation, and impaired gas exchange. Conventional mechanical ventilation may be insufficient in these cases, necessitating alternative strategies. High-frequency percussive ventilation (HFPV) offers a promising approach by combining improved oxygenation and ventilation with effective secretion clearance.

Case study: An 11-year-old male with a history of asthma and eczema presented to the emergency department in respiratory failure with profound hypercarbia. Life-threatening asthma with cardiopulmonary arrest led to endotracheal intubation and initiation of mechanical ventilation. Despite the use of conventional settings, oxygen saturation remained critically low, and air trapping persisted. The patient was transitioned to HFPV via a VDR^®-4 ventilator.

Results: Arterial blood gases demonstrated rapid improvement within 2 hours (from pH 6.7, pCO₂ >120 mmHg to pH 7.169, pCO₂ 77.2 mmHg). After 29 hours on HFPV, the patient was transitioned to conventional ventilation, followed by tracheal extubation to high-flow nasal cannula. The patient was discharged home within 72 hours with optimized asthma management.

Conclusion: This case demonstrates the potential efficacy of HFPV in managing life-threatening pediatric asthma, achieving rapid stabilization without the use of neuromuscular blockade. Further prospective studies are needed to evaluate HFPV's potential as a rescue therapy in both specialized and non-specialized settings.