Doctors at a private hospital in Bengaluru recently treated a one-year-nine-month-old child who had suffered severe brain and lung injuries following a road accident. The child had also developed a multidrug-resistant infection and required nearly a month of intensive paediatric critical care and rehabilitation.

The child, Vihaan S. Jithin, had sustained multiple life-threatening injuries and required prolonged ventilator support, repeated respiratory interventions and neurological rehabilitation before eventually regaining the ability to breathe, eat and walk again.

He was admitted to the Paediatric Intensive Care Unit (PICU) at Manipal Hospital Yelahanka after receiving initial emergency treatment elsewhere.

Doctors said the child had suffered severe traumatic brain injuries, including subarachnoid haemorrhage, diffuse axonal injury and cerebellar contusions affecting areas of the brain responsible for breathing, movement and swallowing.

Lung injury

He had also developed aspiration-related lung injury after food and fluids entered the airway around the time of the accident. Complicating treatment further, the child arrived with multidrug-resistant bloodstream infection and pneumonia acquired prior to transfer.

Doctors said even basic bodily functions such as breathing, coughing and swallowing had become medically dangerous because of the combined neurological and respiratory injuries.

Ventilator support

According to Karthik Arigela, Consultant - Paediatrics and Paediatric Intensive Care at the hospital, one of the biggest challenges involved determining when to continue ventilator support and when to attempt extubation.

“The brain injury had taken away the natural reflexes that protect the airway, including coughing and swallowing. At the same time, the lungs were severely affected by aspiration and multidrug-resistant infection. Every decision regarding ventilator support involved balancing risks,” Dr. Arigela said.

He explained that prolonged ventilation increased the risk of further infection and ventilator-associated injury, while premature removal of breathing support could have resulted in airway collapse or repeated aspiration.

Doctors undertook multiple structured extubation attempts, each preceded by neurological assessment, spontaneous breathing trials, bedside ultrasound evaluation and assessment of cough strength and airway secretions. When extubation attempts were considered unsafe, the child was re-intubated and stabilised before another attempt was made.

The treatment course involved prolonged mechanical ventilation with lung-protective settings, bronchoscopy to clear airway secretions and obtain cultures, targeted antimicrobial therapy against resistant organisms, and gradual transition to non-invasive respiratory support and high-flow oxygen before eventual recovery on room air.

Rehabilitation

Alongside respiratory management, the child underwent multidisciplinary rehabilitation involving specialists in paediatric neurology, neurosurgery, pulmonology, radiology, physiotherapy and clinical nutrition.

Doctors said the care plan included chest physiotherapy, tube feeding until swallowing reflexes recovered, neuro-rehabilitation and gradual restoration of motor functions.

After nearly 30 days in intensive care, Vihaan was discharged breathing independently, tolerating oral feeds, sitting without support and walking with assistance.