Diagnosis, Severe Mechonium aspiration Syndrome with PAH (Pulmonary Arterial Hypertension)

38 wk, Term, Male child was presented to us at 1st hour of life

With H/O thick MSL, with severe birth asphyxia, with Severe RD and impending respiratory failure. CMV was commenced and he required very high settings on CMV (MAP14, Fio2 of 0.8 giving result to spo2 of 94%). At 26 hour of life he developed massive pneumothorax on CMV. At night 03:00 am Lt. intercostal drain was inserted by using 8 Fr. IC Drainage catheter and pneumothorax was drained successfully.

To avoid further leak and in view of providing lung protective ventilation, child was shifted to HFOV. Insertion femoral arterial line was performed for repeated ABG sampling required. Air leak resolved after 24 hours (Shown in x-rays wide infra) and weaning of ventilation was possible quite faster than expected. On day 3, child was switched on SIMV and child was successfully extubated on day 5 of admission.