Posted May 15, 20204 yr hi all, I had baby 36 weeks completed gestation, on admission severe respirstory distress,given surfactan , distress not setteled after 24hrs of ventilation (invasiveSIMV ). Xray still shwing complete white out, repaeat surfactant given still no improvent CT chest done its normal. Sepsis screen negative. what could be reason for complete white out and not improving lung fields? thanking you.
May 15, 20204 yr Are you able to elaborate on the chest CT and/or share images? I find it quite hard to fathom how a CXR showed total white out at the same time that a chest CT was completely normal. Also, more clinical information would be helpful: blood gases, response to surfactant, vent settings, etc.
May 15, 20204 yr Was there a transient improvement in SaO2 and FiO2 after surfactant administration, say for 2-4 hours? If so, I would consider a surfactant protein mutation such as heterogenous SPB mutation or homogenous/heterogenous ABCA3 mutation. Also SPC mutations are highly variable in their presentation(s). Homogenous SPB mutations may have a brief response to surfactant, but will inevitably return to a severe RDS clinical picture. Heterogeneous SPB mutations may be survivable if the baby is full term. Heterogeneous ABCA3 mutations are survivable if not premature while homogenous ABCA3 mutations are often fatal, even in full-term babies. Recommend searching papers by N. Nogee and A. Hamvas Another thought, the penetration of the Xrays may not have been optimized for the type of CXR; thus the CXR looks abnormal while the CT is normal. Does the "whiteness" of the stomach bubble correspond to the "whiteness" of the lung? if so, the CXR was probably under penetrated. if the stomach bubble is much blacker than the lung fields, there is a problem with the lungs.
May 16, 20204 yr Chest ultrasound might help, since air-fluid interface give a different artifact compare with full filled fluid
May 17, 20204 yr How about doing an echocardiogram to rule out total anomalous pulmonary venous return?
May 19, 20204 yr On 5/15/2020 at 3:43 PM, HickOnACrick said: homogenous/heterogenous Homozygous/heterozygous?
May 28, 20204 yr Remembers me to case of Surfactant protein Mutation. Done well After Ltx At age of 7 month. But me need more information: what Kind of Ventilation you use. Which Setting? Oscillation? NO? Echo Shows pulmonary hypertension? Please look for CMV in tracheal aspirat.
Create an account or sign in to comment