Approach to procedural ventilation in a BPD infant undergoing hemodynamic assessment: a case report

We present the case of a five-month-old premature infant with bronchopulmonary dysplasia complicated by atrial septal defect and pulmonary hypertension. Given the patient's age and comorbid chronic respiratory failure, cardiac catheterization was deferred and pulmonary hypertension diagnosis was made by echocardiography. Unfortunately, the child developed pulmonary edema and clinical worsening with initiation of sildenafil therapy. Initial measurements on right heart catheterization suggested more pulmonary vascular disease than sequela from a left-to-right shunt, which was inconsistent with clinical picture. Real time multidisciplinary collaboration prompted adjustment of ventilation to a bronchopulmonary dysplasia approach (higher tidal volumes, adequate positive end expiratory pressure) through the anesthesia circuit. This resulted in a more clinically consistent hemodynamic profile, suggesting need for atrial septal defect closure. This intervention allowed treatment of the child's pulmonary vascular disease without further pulmonary edema, thereby decreasing morbidity and mortality risks. This case report is a good demonstration of the measured and clinical effect of disease-specific perioperative ventilation adjustments on hemodynamics in the bronchopulmonary dysplasia population. It also highlights the need for multidisciplinary team approach for optimal outcome.