Garnaud T, Samii K
Centre hospitalier de Villefranche-de-Rouergue, avenue Caylet, 12200 Villefranche-de-Rouergue, France.
Ann Fr Anesth Reanim. 2013 Dec;32(12):872-5. doi: 10.1016/j.annfar.2013.09.012. Epub 2013 Oct 31.
A 3-year-old child was anesthetized for ENT examination and surgery. After induction and tracheal intubation, the patient was ventilated (controlled mode). The respirator screen showed information compatible with a failure of intubation: no expired CO2, no expired flow, no alarm of high pressure limit, and no respiratory chest movement. A fall of SpO2 appeared rapidly which recovered after extubation and manual ventilation through a face mask and reintubation. The expiratory CO2 was present when the patient was ventilated manually and disappeared under controlled ventilation. The increase in the value of the maximal insufflation pressure allowed efficient ventilation with an expiratory CO2 curve and showed high ventilation pressure compatible with a bronchospasm. This case report shows that in case of bronchospasm, if the value of the maximal insufflation pressure is low, this may lead to an erroneous diagnosis of failure of intubation.
一名3岁儿童接受耳鼻喉科检查和手术麻醉。诱导和气管插管后，患者进行机械通气（控制模式）。呼吸机屏幕显示的信息提示插管失败：无呼出二氧化碳、无呼出气流、无高压上限警报且无呼吸时胸廓运动。SpO2迅速下降，拔管后通过面罩进行手动通气并重新插管后恢复。手动通气时出现呼出二氧化碳，控制通气时消失。最大充气压力值增加后可实现有效通气并出现呼出二氧化碳曲线，且显示出与支气管痉挛相符的高通气压力。本病例报告表明，在支气管痉挛情况下，如果最大充气压力值较低，可能会导致插管失败的错误诊断。
