Bridging to lung transplantation using high frequency oscillatory ventilation in pediatric non-specific interstitial pneumonitis

Abstract

This is a case report of bridging to lung transplantation using high frequency oscillatory ventilation (HFOV) in pediatric non-specific interstitial pneumonitis (IP). A 6-year-old boy was transferred to our hospital due to dry cough and oxygen desaturation. He had been treated with chemotherapy and radiation for bladder rhabdomyosarcoma until two years prior. No symptoms of tumor relapse were observed after the therapy. Chest computed tomography and lung biopsy findings revealed non-specific IP, which was probably due to the past chemotherapy. Following biopsy, the patient developed acute respiratory failure and was subsequently provided with intubation and conventional mechanical ventilator management, including continuous intravenous analgesic, muscle relaxants, and sedative drugs. However, his ventilation had not sustained an optimal PaCO₂ level, prompting initiation of HFOV. Thereafter, his ventilation improved, and he was judged to be eligible for lung transplantation due to untreatable respiratory dysfunction. With the continuation of HFOV for bridging to transplantation, living-related lung transplantation from his mother was successfully performed, and the patient was successfully discharged from the hospital. Although there is no consensus regarding HFOV eligibility in IP, this case report demonstrates the possibility of HFOV for bridging to lung transplantation in cases of IP.