Lemierre disease in the pediatric intensive care unit, clinical course, and the use of high-frequency oscillatory ventilation.

OBJECTIVE

To highlight that cavitating pneumonias may be part of Lemierre disease, caused by Fusobacterium necrophorum. Also to report on the use of high-frequency oscillatory ventilation (HFOV) among other strategies, in the treatment of such a cavitating pneumonia.

DESIGN

Case study.

SETTING

Tertiary pediatric intensive care unit in a university teaching hospital.

PATIENT

A 45-kg, 14-yr old girl.

INTERVENTIONS

Ventilation with a HFOV for 12 days, conventional ventilation for 24 days, and the concomitant use of nitric oxide.

MEASUREMENTS AND MAIN RESULTS

Oxygenation improved markedly following institution of HFOV and nitric oxide, the PaO2/FIO2 ratio increasing from 10.7 kPa on conventional ventilation to 24 kPa on HFOV and nitric oxide after an initial period of respiratory unit recruitment. Mean airway pressure decreased from 26 cm H2O to 22 cm H2O during this period, while amplitude was 80 cm H2O. After 12 days of gradual improvement on HFOV, the PaO2/FIO2 ratio increased to 27 kPa, mean airway pressure decreased to 17 cm H2O, and amplitude decreased to 65 cm H2O. Multiple chest drains for loculated pneumothoraces were required during the periods of conventional ventilation and HFOV.

CONCLUSIONS

HFOV and nitric oxide improved oxygenation through the critical period of this disease when conventional ventilation variables were considered maximal. There were eight occurrences of loculated pneumothoraces during the period of HFOV and five occurrences during conventional ventilation. We would like to remind fellow clinicians that Lemierre disease may be the cause of cavitating pneumonias.