VQ mismatch?

1 I'm on a peds floor for preceptorship.

This week, we had an 8 month old girl with RSV getting nebulizer treatments. She would always drop to like 82% right after the treatments, even after she had been fine on room air otherwise. The RT said it was probably a VQ mismatch, and the doctor discontinued the nebs, and she was fine.

I know the general meaning of a VQ mismatch, but I've only heard of it with things like COPD and ventilator management. I was trying to find something about it but nothing that explains it really well.

How would a nebulizer treatment cause a VQ mismatch in an infant? Any input would be greatly appreciated!
Was the baby angry, crying and moving about during the treatment? If so, you really cannot rely on pulse oximetry all that much. If she was not having clear indications of an obstructive deficit (wheezing and so on), inhaled beta agonists are really not indicated anyway.

Quote from jeyre1847I'm on a peds floor for preceptorship.This week, we had an 8 month old girl with RSV getting nebulizer treatments. She would always drop to like 82% right after the treatments, even after she had been fine on room air otherwise. The RT said it was probably a VQ mismatch, and the doctor discontinued the nebs, and she was fine.I know the general meaning of a VQ mismatch, but I've only heard of it with things like COPD and ventilator management. I was trying to find something about it but nothing that explains it really well.How would a nebulizer treatment cause a VQ mismatch in an infant? Any input would be greatly appreciated!

This didn't happen as much when she was on continuous oxygen, it started after she was on room air. This explains how her lungs "liked" the higher FiO2 like you said. Also, it was an albuterol nebulizer because she had been wheezing when she was admitted, but by the time she didn't need O2 anymore, she wasn't really wheezing anymore and just had some fine crackles left.That explains a lot! Thanks for all your help!

Quote from jeyre1847This didn't happen as much when she was on continuous oxygen, it started after she was on room air. This explains how her lungs "liked" the higher FiO2 like you said. Also, it was an albuterol nebulizer because she had been wheezing when she was admitted, but by the time she didn't need O2 anymore, she wasn't really wheezing anymore and just had some fine crackles left.That explains a lot! Thanks for all your help!