A Case of Pertussis in the PICU
PICU Doc On Call
Compassionate Withdrawal and Lessons from a Pertussis Case
This chapter explores a complex clinical case of a patient on VA ECMO for refractory cardiopulmonary failure, highlighting the severe complications encountered. It also underscores critical lessons on recognizing pertussis in children and the impact of family dynamics in healthcare decisions.
In this episode, Dr. Rahul Damania, Dr. Pradip Kamat, and Dr. Monica Gray dive into a critical case involving a five-week-old baby facing acute respiratory failure due to pertussis. They chat about how this condition shows up, how it's diagnosed, and the best ways to manage it, especially considering the serious complications it can cause in infants, like pulmonary hypertension and the potential need for ECMO. The conversation underscores the importance of catching it early and providing supportive care, while also highlighting how crucial vaccination is in preventing pertussis. Tune in to learn how severe this disease can be and why staying alert in pediatric care is so important.
Show Highlights:
- Clinical case of a five-week-old infant with acute respiratory failure and pertussis diagnosis
- Epidemiology and public health impact of pertussis, including vaccination rates and outbreak patterns
- Pathophysiology of pertussis and its effects on respiratory health, particularly in infants
- Clinical presentation of pertussis, including stages of the disease and atypical symptoms in infants
- Diagnostic approaches for pertussis, including laboratory findings and PCR testing
- Management strategies for severe pertussis, including supportive care and antibiotic therapy
- Potential complications associated with pertussis, especially in young infants
- Differential diagnosis considerations for pertussis and distinguishing features from other infections
- Importance of vaccination in preventing pertussis and reducing morbidity and mortality
- ECMO as a treatment option for severe cases and its associated challenges, and outcomes
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References:
- Fuhrman & Zimmerman - Textbook of Pediatric Critical Care Chapter and Rogers texbook of Pediatric intensive care -both do not have any Pertussis mentioned in their index.
- Rowlands HE, Goldman AP, Harrington K, Karimova A, Brierley J, Cross N, Skellett S, Peters MJ. Impact of rapid leukodepletion on the outcome of severe clinical pertussis in young infants. Pediatrics. 2010 Oct;126(4):e816-27. doi: 10.1542/peds.2009-2860. Epub 2010 Sep 6. PMID: 20819895.
- Lauria AM, Zabbo CP. Pertussis. [Updated 2022 Oct 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519008/
- Berger JT, Carcillo JA, Shanley TP, Wessel DL, Clark A, Holubkov R, Meert KL, Newth CJ, Berg RA, Heidemann S, Harrison R, Pollack M, Dalton H, Harvill E, Karanikas A, Liu T, Burr JS, Doctor A, Dean JM, Jenkins TL, Nicholson CE; Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Collaborative Pediatric Critical Care Research Network (CPCCRN). Critical pertussis illness in children: a multicenter prospective cohort study. Pediatr Crit Care Med. 2013 May;14(4):356-65. doi: 10.1097/PCC.0b013e31828a70fe. PMID: 23548960; PMCID: PMC3885763.
- Cousin, V.L., Caula, C., Vignot, J. et al. Pertussis infection in critically ill infants: meta-analysis and validation of a mortality score. Crit Care 29, 71 (2025). https://doi.org/10.1186/s13054-025-05300-2
- Domico M, Ridout D, MacLaren G, Barbaro R, Annich G, Schlapbach LJ, Brown KL. Extracorporeal Membrane Oxygenation for Pertussis: Predictors of Outcome Including Pulmonary Hypertension and Leukodepletion. Pediatr Crit Care Med. 2018 Mar;19(3):254-261. doi: 10.1097/PCC.0000000000001454. PMID: 29319632.
- Centers for Disease Control: https://www.cdc.gov/schoolvaxview/data/index.html; https://www.cdc.gov/pertussis/php/surveillance/pertussis-incidence-by-age-group-and-year.html; https://www.cdc.gov/pertussis/media/pdfs/2025/01/pertuss-surv-report-2024_PROVISIONAL-508.pdf (various links)
- Tuan, Ta Anh MD, PhD1; Xoay, Tran Dang MD1; Nakajima, Noriko MD, PhD2; Nakagawa, Satoshi MD3; Phuc, Phan Huu MD, PhD1; Hung, Dau Viet MD, PhD1; Dung, Nguyen Trong MD1; Dong, Ngo Tien MD1; Dung, Tran Ba MD1; Thuy, Phung Thi Bich PhD4; Hai, Le Thanh MD, PhD5; Dien, Tran Minh MD, PhD6. Pertussis Infants Needing Mechanical Ventilation and Extracorporeal Membrane Oxygenation: Single-Center Retrospective Series in Vietnam. Pediatric Critical Care Medicine 22(9):p e471-e479, September 2021. | DOI: 10.1097/PCC.0000000000002723
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