In severe pediatric acute respiratory distress syndrome, data are lacking on methods to measure and set optimal positive end-expiratory pressure. We present a 2-year-old girl with Trisomy 21 who developed severe pediatric acute respiratory distress syndrome and refractory hypoxemia from human metapneumovirus pneumonia. Esophageal manometry was utilized to measure transpulmonary pressure, and positive end-expiratory pressure was increased to 19 cm H2O, resulting in rapid improvement in oxygenation. Hemodynamics remained adequate without intervention. The patient improved and survived without sequelae. Our case suggests that transpulmonary pressure monitoring should be studied as an adjunct to improve outcomes in pediatric acute respiratory distress syndrome.
From the Departments of *Anesthesiology and Perioperative Medicine
†Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota.
Accepted for publication February 21, 2019.
The authors declare no conflicts of interest.
Address correspondence to Stephen J. Gleich, MD, Department of Anesthesiology and Perioperative Medicine, 200 1st St SW, Rochester, MN 55905. Address e-mail to email@example.com.