A52-29 Pediatric Acute Respiratory Distress Syndrome Following Lobectomy: A Case Report

Abstract Introduction In adults, acute respiratory distress syndrome (ARDS) following lobectomy has a reported prevalence of 2.9%. However, pediatric ARDS (PARDS) is rarely described, especially during the subacute postoperative period. We present a unique case of a pediatric patient who developed PARDS one month after lung resection. Case Description A 15-year-old male with chromosome 1 deletion syndrome, seizure disorder, gastrostomy tube use and recurrent aspiration pneumonia with chronic cystic lung disease presented four weeks status-post right lower lung lobectomy via thoracotomy with worsening cough and respiratory distress. Of note, the initial post-operative course was complicated by a two-week hospitalization and Pseudomonal aeruginosa respiratory infection treated with ciprofloxacin for 21 days. In the ED, he was tachypneic and saturating 82%. Chest radiograph showed bilateral opacities, and arterial blood gas revealed pH 7.2, pCO2 50, pO2 80 on 100% FiO2 via 40 L high-flow nasal cannula. Viral panel was negative. He was started on piperacillin-tazobactam and escalated to BiPAP then transferred to our PICU where he required emergent intubation for respiratory failure due to PARDS. Due to difficulty achieving adequate ventilation and poor lung compliance, he was started on Airway Pressure Release Ventilation and inhaled nitric oxide. He subsequently suffered a cardiopulmonary arrest in the setting of refractory hypoxemia and needed emergent cannulation onto veno-arterial extracorporeal membrane oxygenation (VA-ECMO) via bilateral femoral vessels. His ECMO course was complicated by Harlequin Syndrome or differential hypoxia syndrome requiring conversion to a hybrid of veno-arterial venous circuit and later venous-venous (VV) circuit. All cultures were initially negative, but on day 9 drainage noted from prior chest tube site grew Streptococcus anginosus. Subsequent lower respiratory tract cultures grew Sphingomonas paucimobilis on day 16, thought to be ventilator-acquired, and later multidrug-resistant Pseudomonas aeruginosa on day 21. Antibiotics were transitioned to meropenem and nebulized tobramycin to complete a 4-week course. Chest tube placed on day 26 for hydropneumothorax (Image 1) and empyema at prior lobectomy site. He was decannulated from VV-ECMO on day 20 and extubated on day 30. He was discharged to rehabilitation on day 55. Discussion This case highlights a complicated post-operative course after lobectomy with polymicrobial and multidrug-resistant pneumonia, PARDS, and cardiac arrest requiring ECMO. Patient’s history of recurrent aspiration pneumonia likely increased his susceptibility to resistant infection and severe postoperative complications. This case underscores the importance of careful perioperative planning, infection prevention strategies, and need for extended monitoring in medically complex patients undergoing lung resection. This abstract is funded by: None