High-frequency oscillatory ventilation in an infant with necrotizing pneumonia and bronchopleural fistula.

Community-acquired necrotizing pneumonia caused by methicillin-resistant Staphylococcus aureus (MRSA) has been reported with increasing frequency in children.1 MRSA pneumonia can be complicated by pleural effusion, empyema, pneumatoceles, respiratory failure, and bronchopleural fistula.1,2 Maintaining adequate gas exchange with conventional mechanical ventilation is often problematic in patients with pneumonia complicated with bronchopleural fistula. In this setting, high-frequency oscillatory ventilation (HFOV) may be more effective than conventional mechanical ventilation because it avoids cyclic stretching of lung and pleural tissue, thus increasing the likelihood that the bronchopleural fistula will spontaneously seal.3,4 We present the case of a previously healthy 8-month-old infant with community-acquired-MRSA pneumonia complicated by bronchopleural fistula, who failed conventional mechanical ventilation and was subsequently successfully supported with HFOV.