What Would You Do?
Based on actual MetroHealth Cases
Bad bad baby:
2 y/o, 10 kg, male with acute on chronic respiratory failure. PICU attending requests help with intubation.Patient has BPD with pulmonary hypertension, now on ventilatory assistance via (nasal) BIPAP with recent pH 7.27 with PaCO2 97 and SpO2 90. Becomes cyanotic when mouth opens (loses BIPAP pressure). Parents want everything done except tracheostomy. "Impossible IV" with no IV access currently. (PICC line in X-ray planned after intubation.) ENT was planning laryngoscopy and bronchoscopy soon to evaulate possible element of upper airway obstruction. Reported to be microcephalic with "smallish" mandible.
What would you do?
(Actual management and outcome to be revealed here soon.)