Pediatrics International | 2021
Percutaneous transluminal renal angioplasty with CO2 in a child
Abstract
dynein arms of the microtubules. All of these findings were consistent with the features of PCD. To date, treatment of PCD, with its cilia dysmotility, has been poorly studied in children. To improve airway clearance, we performed IPV for the patient. This is normally used for intractable atelectasis associated with neurological impairment or cystic fibrosis. The effects of IPV are on the mobilization of secretions, the improvement in the recruitment of obstructed areas in the lungs, and the improvement in gas exchange. The patient was able to be sustained on home use of IPV once every 2 days as an airway clearance strategy. The advantage of IPV is that active cooperation is not necessary to perform the treatment. The device provides internal thoracic percussion by delivering small bursts of high-flow air, generating airway pressures to oscillate between 5 and 35 cm H2O. This process causes the airway walls to vibrate in synchrony with these oscillations. Intrapulmonary percussive ventilation is safe but may lead to pneumothorax, barotrauma, gastric distention, arrhythmia, decreased cardiac output, and an increase in intracranial pressure. Hence, contraindications for IPV include untreated pneumothorax, hemoptysis, rib fractures, and active tuberculosis. Unfortunately, few data are available to support the use of IPV with patients other than cystic fibrosis, neuromuscular children, or with patients outside of an intensive care unit setting, which highlights the importance of our findings. We considered PCD patients with recurrent atelectasis or pneumonia resistant to drugs (mucolytics, bronchodilators, or antibiotics) or respiratory rehabilitation as being indicated for the use of IPV. In summary, we presented the first case of sustained use of IPV as long-term successful treatment in a PCD patient. Intrapulmonary percussive ventilation may become the standard treatment in PCD patients as it may help avoid the need for lung transplantation.