Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
J Pediatr Surg. 2011 Dec;46(12):e11-5. doi: 10.1016/j.jpedsurg.2011.09.048.
Bi-caval dual lumen venovenous extracorporeal membrane oxygenation (VV-ECMO) as a nonoperative approach to postintubation tracheal injury has not been described. We report the case of a 7-year-old boy who sustained a postintubation tracheal injury, developed acute respiratory distress syndrome from aspiration and viral pneumonitis, and was supported on bi-caval dual lumen VV-ECMO for 16 days until the trachea healed without surgical repair. Before ECMO decannulation, high-frequency percussive ventilation using a volumetric diffusive respiration ventilator was used for lung recruitment and airway clearance without disruption of the healed trachea. The use of ECMO to allow for lower mean airway pressure during initial healing and high-frequency percussive ventilation for lung recruitment and secretion clearance is a promising strategy to allow nonoperative tracheal injury repair in critically ill patients with multiple comorbidities.
双腔颈静脉-股静脉体外膜肺氧合（VV-ECMO）作为一种非手术方法治疗插管后气管损伤尚未被描述。我们报告了一例 7 岁男孩，他发生了插管后气管损伤，由于吸入和病毒性肺炎导致急性呼吸窘迫综合征，并接受了双腔颈静脉-股静脉 VV-ECMO 支持 16 天，直到气管愈合而无需手术修复。在 ECMO 拔管之前，使用容积扩散呼吸通气机进行高频叩击通气以进行肺复张和气道清除，而不会破坏愈合的气管。使用 ECMO 在初始愈合期间允许较低的平均气道压力，以及高频叩击通气进行肺复张和分泌物清除，这是一种有前途的策略，可以在患有多种合并症的危重症患者中允许非手术性气管损伤修复。
