PUNE: “I like to play and eat chocolates,” says Prem, grinning from ear to ear. It’s hard to believe that just 10 days ago, the bubbly four-year-old had overcome severe Covid-linked pneumonia with acute respiratory distress syndrome (ARDS) that had kept him strapped to an invasive ventilator for 45 days.
Doctors said Prem’s recovery following such a long period of mechanical ventilation was in all probability the first such case in the world.
“A ventilator support of 41 days following a severe form of Covid is documented in adults. But this is perhaps the first case in the world where a child has fought off adult-like Covid-ARDS for 45 days on ventilator support and recovered,” said Dr Sagar Lad, Prem’s treating doctor and Jehangir hospital’s paediatric intensivist. Lad is also a member of the paediatric Covid task force in Pune.
Prem was admitted to the hospital on November 11, 2021, and discharged following complete lung recovery after 67 days on January 18, 2022. This included 45 days on an invasive high-frequency ventilator, an advanced version of mechanical ventilation.
“We initially admitted him to a small private hospital in Moshi for fever not responding to medication and chest congestion. His bed was next to an adolescent recovering from post-Covid symptoms. After five days, Prem started gasping,” said the boy’s father.
Prem’s blood oxygen saturation had dropped to 42%, an extremely low oxygen level in blood indicative of severe respiratory distress.
A patient with blood oxygen saturation going below 93% requires oxygen therapy and the extremely low levels in Prem’s case necessitated aggressive treatment with invasive ventilator support. The family started searching for a paediatric ventilator bed at different hospitals and eventually found one at Jehangir hospital.
“Prem landed here with extreme Covid-pneumonia. His high resolution chest tomography (HRCT) score was 21, showing adult-like acute Covid-penumonia severity rarely seen in children,” Lad said. He was immediately put on invasive ventilator support but there was not much improvement. Hence, a special type of ventilator, called high frequency invasive ventilator, was used to treat complications of Covid pneumonia termed as ARDS.
“Theboy had a very stor my course in the pediatric ICU. Every day was challenging. He required high ventilation settings to increase oxygen levels in the blood. He also had air accumulation surrounding the lungs and required a tube to suck the air out,” Lad said.
Prem was treated with medicines, including steroid and antiviral remdesivir. Due to the requirement of prolonged mechanical ventilation, a small hole was made in the windpipe. “Technically, it was challenging as his oxygen would tend to drop down during the procedure (tracheotomy),” said the hospital’s senior paediatric surgeon, Dr Dasmit Singh.
Other members of the team who treated Prem included infectious diseases expert Dr Piyush Choudhari and senior paediatrician Dr Sanjay Bafna. His condition started improving and the doctors started weaning him off mechanical ventilation after 45 days of life support on ventilator. “Prem now often recalls his stay in the hospital. We are happy to see him back with his smiles and cheerfulness,” his father said.
