Farr M J, Cyna A M
Anaesthetic Registrar, Department of Paediatric Anaesthesia, Women's and Children's Hospital, 72 King William Road, North Adelaide, South Australia, 5006.
Anaesthesia. 2006 Mar;61(3):285-90. doi: 10.1111/j.1365-2044.2005.04508.x.
We report the case of a 15-year-old girl with a near fatal obstructive tracheal lesion following tracheal intubation. The patient developed stridor and acute respiratory distress 29 h following tracheal extubation, after 35 h intubation in the intensive care unit. The failure of conventional management of stridor, including re-intubation, to provide a satisfactory airway prompted an urgent bronchoscopy, which revealed a tracheal mucosal flap causing 80% obstruction of the subglottic trachea. The fibreoptic bronchoscope allowed careful placement of a tracheal tube distal to the obstruction. The patient eventually made a full recovery. The low incidence of similar lesions and the lack of distinguishing clinical features from other causes of post-extubation stridor make diagnosis and appropriate management of this life-threatening condition difficult. We discuss how early consideration of the diagnosis and optimal initial management reduce the risk of an adverse outcome.
我们报告了一例15岁女孩在气管插管后出现近乎致命的气管阻塞性病变的病例。该患者在重症监护病房插管35小时后，气管拔管29小时后出现喘鸣和急性呼吸窘迫。包括再次插管在内的常规喘鸣治疗未能提供满意的气道，促使紧急进行支气管镜检查，结果发现一个气管黏膜瓣导致声门下气管80%的阻塞。纤维支气管镜使气管导管能够小心地放置在阻塞部位的远端。患者最终完全康复。此类病变的低发病率以及与拔管后喘鸣其他原因缺乏明显的临床特征，使得对这种危及生命状况的诊断和适当治疗变得困难。我们讨论了早期考虑诊断和最佳初始治疗如何降低不良后果的风险。
