Pawar Manjeet Singh, Suri Neelam
Department of Anesthesia and Critical Care, National Trauma Center, Khoula Hospital, Sultanate of Oman.
Oman Med J. 2011 Jan;26(1):48-9. doi: 10.5001/omj.2011.12.
A polytrauma patient on ventilator was admitted to ICU with open tracheostomy, GCS 8/15 and unequal pupils. After 10 days, he was weaned from the ventilator. The patient had respiratory problems i.e. expiratory stridor, shortness of breath, dysphonia and dyspnea on closing tracheostomy. It was diagnosed as a case of asthma, and the patient responded to salbutamol nebulization and intravenous steroid therapy. However, after some time, he desaturated and a plan for rapid sequence intubation was made. Endotracheal tube could not be negotiated beyond vocal cords, so an unprepared tracheostomy without proper equipment had to be immediately done by an anesthetist to save the patient's life. CT scan revealed tracheal stenosis. This case demonstrates that patients with a short 15-days history of previous tracheostomy may have tracheal stenosis.
一名使用呼吸机的多发伤患者因开放性气管切开术、格拉斯哥昏迷评分8/15且双侧瞳孔不等大而入住重症监护病房。10天后，他成功脱机。该患者存在呼吸问题，即呼气性喘鸣、呼吸急促、声音嘶哑以及气管切开术封堵时出现呼吸困难。诊断为哮喘病例，患者对沙丁胺醇雾化吸入和静脉注射类固醇治疗有反应。然而，一段时间后，他出现了血氧饱和度下降，于是制定了快速顺序插管计划。气管内导管无法通过声带，因此麻醉医生不得不立即在没有合适设备的情况下进行了紧急气管切开术以挽救患者生命。CT扫描显示气管狭窄。该病例表明，既往气管切开术病史仅15天的患者可能会出现气管狭窄。
