The x-ray taken at arrival of the three-year-old patient with lobar pneumonia
The team struggled to ventilate her and sedation failed to reduce agitation. It was not until day 17, when the dedicated team decided to try a different ventilation mode, that the patient took a turn for the better.
The switch to Neurally Adjusted Ventilatory Assist (NAVA) created an immediate change in her lung values. Respiratory rate leaped to 50 breaths per min, which is to be expected. At the same time tidal volumes dropped to more protective levels, so the team stayed with it. The patient’s ventilator agitation reduced gradually, as did the amount of support delivered. The fraction of inspired oxygen (FiO2) dropped from 90% to 60%. This was indeed a turning point.
Seven days later, on day 24, the patient was extubated to High Flow therapy; she was finally discharged from the hospital on day 32. The child recovered her speech and movement without any obvious sequelae.