Vobruba Vaclav, Grus Tomas, Mlejnsky Frantisek, Belohlavek Jan, Hridel Jan, Lambert Lukas
1 Department of Pediatrics and Adolescent Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic.
2 Department of Cardiovascular Surgery, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic.
Perfusion. 2018 Jan;33(1):77-80. doi: 10.1177/0267659117723453. Epub 2017 Aug 17.
Severe pulmonary hemorrhage in the newborn is an infrequent, but life-threatening, event. A newborn with persistent pulmonary hypertension and a large persistent ductus arteriosus and open foramen ovale presented with hypoxemia and progressive right heart failure shortly after birth, requiring veno-arterial extracorporeal membrane oxygenation (ECMO) support. Twenty minutes after the initiation of ECMO, the patient developed severe pulmonary hemorrhage refractory to conventional treatment. As a last resort, the endotracheal tube was clamped. After transport to the ECMO center, repeated attempts to open the endotracheal tube resulted in continued blood loss and the endotracheal tube was clamped for a total of 63 hours without any mechanical ventilation. On the third postnatal day, the endotracheal tube was reopened, large amounts of clot were removed by bronchoscopy and mechanical ventilation was resumed followed by improved general condition and favorable outcome.
新生儿严重肺出血是一种罕见但危及生命的事件。一名患有持续性肺动脉高压、大型动脉导管未闭和卵圆孔未闭的新生儿在出生后不久出现低氧血症和进行性右心衰竭，需要静脉-动脉体外膜肺氧合（ECMO）支持。在启动ECMO后20分钟，患者出现了对常规治疗无效的严重肺出血。作为最后的手段，气管插管被夹闭。转运至ECMO中心后，多次尝试打开气管插管导致持续失血，气管插管总共被夹闭63小时，期间未进行任何机械通气。在出生后第三天，重新打开气管插管，通过支气管镜清除了大量血凝块，恢复机械通气，随后患儿一般状况改善，预后良好。
