Intrapulmonary percussive ventilation for obstructive atelectasis caused by bronchial cast-like clots after pulmonary hemorrhage in a child with congenital heart disease.

Abstract

Pulmonary hemorrhage may cause persistent airway obstruction due to retained intrapulmonary blood and clot material, resulting in obstructive atelectasis that may be difficult to resolve with conventional airway-clearance strategies. We report the case of a 3-year-old boy with congenital heart disease who developed extensive obstructive atelectasis associated with bronchial cast-like clots after right pulmonary hemorrhage during angioplasty. Chest physiotherapy, postural drainage, prone positioning, and repeated bronchoscopic airway clearance did not improve aeration. Intrapulmonary percussive ventilation (IPV) was introduced after stabilization of airway bleeding as an adjunctive airway-clearance intervention, using low driving pressures with predefined safety criteria and continuous cardiopulmonary monitoring. After IPV initiation, dark blood and bronchial cast-like clots were repeatedly retrieved during bronchoscopic airway-clearance procedures, and radiographic improvement was observed over time. No rebleeding, barotrauma, or clinically meaningful changes in mean arterial pressure, central venous pressure, heart rate, or oxygen saturation were observed during IPV. This case suggests that IPV may have an adjunctive role in the management of obstructive atelectasis caused by retained clot material after pulmonary hemorrhage in a child with congenital heart disease.