A Case of Neonate with Vein of Galen Malformation Refractory to Weaning Attempts from Mechanical Ventilation Managed Successfully with Noninvasive Ventilation

Abstract

Weaning of patients with vein of Galen malformations (VOGM) from mechanical ventilation can be challenging in the postprocedure period due to underlying high-output cardiac failure and the fluid overload caused by the neurointervention procedure. We present the case of a neonate with VOGM who was refractory to multiple weaning attempts from mechanical ventilation and was successfully managed with noninvasive ventilation (NIV). NIV can be safely used as a method of weaning, post mechanical ventilation in this subset of patients. The use of NIV will facilitate successful weaning and reduce the incidence of extubation failure in neonates with VOGM in cardiac failure.

Keywords

vein of Galen malformations - mechanical ventilation - noninvasive ventilation

• References

• 1 Hrishi AP, Lionel KR. Periprocedural management of vein of Galen aneurysmal malformation patients: an 11-year experience. Anesth Essays Res 2017; 11 (03) 630-635
• 2 Garcia-Monaco R, De Victor D, Mann C, Hannedouche A, Terbrugge K, Lasjaunias P. Congestive cardiac manifestations from cerebrocranial arteriovenous shunts. Endovascular management in 30 children. Childs Nerv Syst 1991; 7 (01) 48-52
• 3 Chevret L, Durand P, Alvarez H. et al. Severe cardiac failure in newborns with VGAM. Prognosis significance of hemodynamic parameters in neonates presenting with severe heart failure owing to vein of Galen arteriovenous malformation. Intensive Care Med 2002; 28 (08) 1126-1130
• 4 Garg S, Sinha S. Non-invasive ventilation in premature infants: based on evidence or habit. J Clin Neonatol 2013; 2 (04) 155-159
• 5 Davis PG, Henderson-Smart DJ. Nasal continuous positive airways pressure immediately after extubation for preventing morbidity in preterm infants. Cochrane Database Syst Rev 2003; 2 (02) CD000143
• 6 Lin CH, Wang ST, Lin YJ, Yeh TF. Efficacy of nasal intermittent positive pressure ventilation in treating apnea of prematurity. Pediatr Pulmonol 1998; 26 (05) 349-353
• 7 Aly H. Ventilation without tracheal intubation. Pediatrics 2009; 124 (02) 786-789