2022 Volume 41 Issue 2 Pages 80-85
In pediatric patients, sedation may be accompanied by the need for mechanical ventilation. However, with prolonged sedation, tolerance tosedative drugs may arise, complicating the case with withdrawal syndrome.
In this report, we present a case of 11-year-old boy diagnosed as acute lymphoblastic leukemia who was admitted to the intensive care unit (ICU) for continuous hemodiafiltration and plasma exchange. The patient was placed under sedation and mechanical ventilation was initiated. On day 57, the patient was weaned from continuous hemodiafiltration, and the sedative drugs were tapered. The trachea of the patient was extubated, but the patient required reintubation followed by tracheostomy. On day 75, the patient was transferred to the general ward, but he suffered from severe hypoxia presumably due to negative pressure pulmonary edema (NPPE) and was admitted to the ICU. We experienced a case of NPPE due to withdrawal syndrome in a pediatric patient under prolonged sedation. Possible mechanisms included physical obstruction due to airway secretions and functional obstruction due to ventilator desynchronization and increased inspiratory effort. Even in patients with tracheostomy, occurrenceof NPPE should be considered.
