Mechanical Ventilation in Acute Respiratory Distress Syndrome and Severe Scoliosis: A Case Report

Abstract

Introduction: Scoliosis is an abnormal curvature of the spine that leads to detrimental changes in the lungs. If left uncorrected, scoliosis can progress to distort the thoracic cage, causing restriction, obstruction of the small airways, and impaired ventilatory muscle function. Over time, patients develop inefficient biomechanics, increasing their work of breathing even during normal tidal breathing. With limited reserve, insults such as pneumonia can increase respiratory load, leading to respiratory failure and difficulty in weaning. Case Presentation: We present the case of an adolescent girl with respiratory failure due to pneumonia and severe scoliosis. The patient was managed in the pediatric intensive care unit for ten days. From day 1 to 5, the focus was on optimizing her pulmonary mechanics and eradicating the infectious process. From day 6 to 10, the focus shifted to strengthening her ventilatory muscles to maintain effective spontaneous ventilation and cough reflexes. Previous spirometry data were unavailable, making clinical parameters crucial in guiding the weaning process. Conclusions: This case discusses mechanical ventilation strategies to overcome intrinsic and extrinsic barriers, and perform ventilatory muscle conditioning to wean and ultimately liberate the patient from mechanical ventilation.