Connolly K M, McGuirt W F
Department of Otolaryngology--Head and Neck Surgery, Wake Forest University Baptist Medical Center, Brenner Children's Hospital Winston-Salem, North Carolina 27157, USA.
Ann Otol Rhinol Laryngol. 2001 Mar;110(3):205-9. doi: 10.1177/000348940111000301.
The surgical management of children with tracheal stenosis and obstruction is complicated by the perioperative needs of pressure ventilation and indwelling endotracheal tubes. These factors predispose to surgical failure and anastomotic breakdown, restenosis. and pneumomediastinum. The use of extracorporeal membrane oxygenation (ECMO) to manage ventilation during tracheal repair allows better visualization at the surgical site and obviates the need for indwelling endotracheal tubes and high-pressure ventilation. Six children were treated with elective ECMO at a tertiary care hospital. All 6 underwent successful surgical repair, and 4 of the 6 were ultimately extubated. There were no significant complications at the surgical site. There was 1 death from postoperative complications, and 2 patients required tracheotomy. One tracheotomy was performed for upper airway obstruction secondary to retrognathia, and this patient was subsequently decannulated. Medical complications were confined to 2 patients and included sepsis, hyperbilirubinemia, seizure disorder, renal failure, intracranial hemorrhage, and hydrocephalus. Elective ECMO provides a reliable perioperative technique for airway management of children with tracheal stenosis or obstruction. This technique offers the advantage of improved visibility at the operative site and eliminates the need for high-pressure ventilation, thereby likely reducing the risk of perioperative morbidity.
气管狭窄和梗阻患儿的外科治疗因围手术期压力通气和留置气管内导管的需求而变得复杂。这些因素易导致手术失败、吻合口破裂、再狭窄和气纵隔。在气管修复过程中使用体外膜肺氧合（ECMO）进行通气管理，可使手术部位视野更清晰，无需留置气管内导管和进行高压通气。一家三级护理医院对6名儿童进行了择期ECMO治疗。所有6例均成功进行了手术修复，其中6例中有4例最终拔管。手术部位无明显并发症。有1例因术后并发症死亡，2例患者需要气管切开术。1例因小颌畸形导致上呼吸道梗阻而行气管切开术，该患者随后拔管。医疗并发症仅限于2例患者，包括败血症、高胆红素血症、癫痫、肾衰竭、颅内出血和脑积水。择期ECMO为气管狭窄或梗阻患儿的气道管理提供了一种可靠的围手术期技术。该技术具有手术部位视野改善的优势，消除了高压通气的需求，从而可能降低围手术期发病率的风险。
