Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2025 May 30;14(5):1033-1038.
doi: 10.21037/tp-2024-607. Epub 2025 May 16.

Respiratory management of pediatric patient with bronchiolitis obliterans syndrome during general anesthesia surgery: a case report

Ziyu Huang  1 , Bailin Jiang  1 , Hong Zhao  1 , Yi Feng  1   2   3
Affiliations
Case Reports

Respiratory management of pediatric patient with bronchiolitis obliterans syndrome during general anesthesia surgery: a case report

Ziyu Huang et al. Transl Pediatr. .

Abstract

Background: Bronchiolitis obliterans syndrome (BOS) is a rare but severe noninfectious pulmonary complication that typically arises in the context of chronic graft-versus-host disease (cGVHD) following allogeneic hematopoietic stem cell transplantation (HSCT). Characterized by progressive small airflow obstruction and irreversible airflow limitation, it poses significant challenges in managing general anesthesia, especially in pediatric patients. There is currently no established consensus or clinical research on the optimal anesthetic approach for such cases, making this report noteworthy.

Case description: We report the case of a 6-year-old boy with BOS and steroid-induced obesity who had undergone HSCT for acute lymphoblastic leukemia and required general anesthesia for cataract surgery. He had severely reduced lung function and hypercapnia. Anesthesia was induced with propofol, rocuronium, and remifentanil, and mechanical ventilation was managed using pressure-controlled ventilation-volume guaranteed (PCV-VG) mode to minimize airway pressures and prevent barotrauma. The surgery was completed without complications, and the patient was safely extubated and discharged the next day.

Conclusions: This case demonstrates that the PCV-VG ventilation mode can be a viable option for managing pediatric patients with severe BOS undergoing general anesthesia. This approach can help achieve sufficient ventilation while minimizing airway pressures and the risk of ventilator-induced lung injury. This approach offers a viable anesthetic management option for similar cases in the future.

Keywords: Bronchiolitis obliterans syndrome (BOS); anesthesia management; case report; mechanical ventilation; pressure-controlled ventilation-volume guaranteed (PCV-VG).

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tp.amegroups.com/article/view/10.21037/tp-2024-607/coif). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
The child was lying on the operating table and receiving preoxygenation. This image is published with the consent of the patient’s legal guardian.
Figure 2
Figure 2
Respiratory parameters displayed on the anesthesia machine during the surgery.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Shanthikumar S, Gower WA, Srinivasan S, et al. Detection of Bronchiolitis Obliterans Syndrome after Pediatric Hematopoietic Stem Cell Transplantation: An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med 2024;210:262-80. 10.1164/rccm.202406-1117ST - DOI - PubMed
    1. Yousem SA, Berry GJ, Cagle PT, et al. Revision of the 1990 working formulation for the classification of pulmonary allograft rejection: Lung Rejection Study Group. J Heart Lung Transplant 1996;15:1-15. - PubMed
    1. Sato M, Waseda Y, Sonoda T, et al. Bronchiolitis Obliterans Syndrome after Hematopoietic Stem Cell Transplant Diagnosed Using Ultrathin Bronchoscopy. Am J Respir Crit Care Med 2022;206:e1-3. 10.1164/rccm.202109-2073IM - DOI - PubMed
    1. Barker AF, Bergeron A, Rom WN, et al. Obliterative bronchiolitis. N Engl J Med 2014;370:1820-8. 10.1056/NEJMra1204664 - DOI - PubMed
    1. Williams KM. How I treat bronchiolitis obliterans syndrome after hematopoietic stem cell transplantation. Blood 2017;129:448-55. 10.1182/blood-2016-08-693507 - DOI - PMC - PubMed

Publication types

LinkOut - more resources