Management of Severe Respiratory Failure after Acute Empyema Surgery in a Patient with Down Syndrome: A Case Report.

introductionEmpyema associated with parapneumonic pleural effusion can cause respiratory failure requiring surgical intervention. However, some cases remain difficult to manage even after surgery. Patients with Down syndrome are particularly susceptible to respiratory infections and tend to develop more severe symptoms. Few studies have addressed the management of postoperative respiratory failure in acute empyema. CASE PRESENTATION: A 12-year-old girl with Down syndrome developed acute empyema following right-sided parapneumonic pleural effusion and underwent thoracoscopic empyema cavity debridement. Surgical intervention alone was not sufficient to resolve postoperative respiratory failure. She was managed with adjunctive therapies including inhaled nitric oxide (iNO), intrapulmonary percussive ventilation (IPV), and prone positioning therapy. These therapies resulted in marked improvements in postoperative atelectasis and respiratory failure, enabling successful weaning from mechanical ventilation.

conclusionsThe combined use of iNO, IPV, and prone positioning therapy may be an effective management strategy for severe respiratory failure after acute empyema surgery in patients with Down syndrome. These adjunctive therapies could contribute to recovery of respiratory function in patients with postoperative atelectasis.