Abstract
We report a complicated pediatric case that was difficult to wean from artificial ventilation. A 12-year-old girl with severe scoliosis and congenital muscular dystrophy showed a low vital capacity. A common cold triggered acute respiratory insufficiency with hypoxemia and hypercapnea, making artificial ventilation necessary. As she had a difficult airway, it took about 2 hours to achieve endotracheal intubation. Moreover, she performed self-extubation twice, resulting in pneumonia and pulmonary atelectasis. A vicious cycle was formed by the difficult airway, self-extubation and increased doses of sedatives. In order to break this cycle, a tracheostomy was performed. As a result, she could be weaned from artificial ventilation and attend school using a speaking cannula.
