Bein T, Krenz D, Maghsudi M, Jauch K W
Abteilung für Anästhesie und Intensivmedizin, Evangelisches Diakonissenkrankenhaus Karlsruhe.
Unfallchirurg. 2000 Sep;103(9):787-90. doi: 10.1007/s001130050618.
We report on the ventilation in prone position in a 5-year-old traumatized child with severe thoracic and abdominal injuries (lung contusion, rib fractures, rupture of liver and spleen). Under continuous analgesic sedation, the young patient was ventilated in prone position for 6 h, since acute lung injury and atelectasis persisted despite various therapeutic measures (artificial ventilation in the pressure controlled mode, fiberoptic bronchoscopy, reexpansion maneuver). After initiation of the prone position, we observed a rapid increase in arterial oxygenation, which persisted in the following period. The hemodynamic situation remained stable. The complete disappearance of atelectasis was demonstrated radiologically after supine repositioning. After cessation of analgesic sedation, the extubation was performed 2 days later. Furthermore, we found no side effects of the prone position on the injured abdomen, and the liver function improved rapidly. Although there is a lack of experience with ventilation in prone position in pediatric intensive care, our report might be a recommendation for the indication of this technique in children.
我们报告了一名5岁遭受严重胸腹部损伤（肺挫伤、肋骨骨折、肝脾破裂）的创伤儿童采用俯卧位通气的情况。在持续镇痛镇静下，尽管采取了各种治疗措施（压力控制模式的人工通气、纤维支气管镜检查、复张手法），急性肺损伤和肺不张仍持续存在，该患儿在俯卧位通气6小时。开始俯卧位通气后，我们观察到动脉氧合迅速增加，并在随后的时间段内持续存在。血流动力学情况保持稳定。仰卧位重新定位后，影像学显示肺不张完全消失。停止镇痛镇静2天后进行了拔管。此外，我们未发现俯卧位对受伤腹部有副作用，且肝功能迅速改善。尽管小儿重症监护中俯卧位通气缺乏经验，但我们的报告可能为该技术在儿童中的应用指征提供参考。
