一例使用高流量加温湿化鼻导管期间发生皮下气肿/纵隔气肿的病例。
A case of subcutaneous emphysema/mediastinal emphysema during the use of humidified high-flow nasal cannula.
作者信息
Sonobe Shota, Inoue Satoki, Nishiwada Tadashi, Egawa Junji, Kawaguchi Masahiko
机构信息
Division of Intensive Care, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
Department of Anesthesiology, Nara Medical University, Kashihara, Nara, Japan.
出版信息
JA Clin Rep. 2019 Dec 26;5(1):85. doi: 10.1186/s40981-019-0305-3.
BACKGROUND
Heated, humidified, high-flow nasal cannula (HHFNC) oxygen therapy allows optimal humidification of inspired gas at high flows and creates a distending pressure similar to nasal continuous positive airway pressure [1]. It has been safely used in adults with moderate hypoxemia with few complications [2, 3]. Hereby, we report serious complications occurred during HHFNC oxygen therapy.
CASE PRESENTATION
A 53-year-old female with hemophagocytic lymphohistiocytosis (HLH) was admitted to the intensive care unit because of respiratory failure. After weaning from mechanical ventilation which lasted for 2 weeks, HHFNC therapy at 40 L/min with an FiO2 of 0.5 was started for hypoxemia. Four days later, dyspnea and hypoxemia occurred and chest X-ray and CT scan revealed localized pneumothorax, subcutaneous emphysema, and massive pneumomediastinum. After cessation of HHFNC, respiratory condition improved.
CONCLUSION
Subcutaneous emphysema, pneumothorax, and pneumomediastinum should be notified as a serious complication during HHFNC therapy.
背景
加热湿化高流量鼻导管（HHFNC）氧疗可在高流量时对吸入气体进行最佳湿化，并产生类似于鼻持续气道正压的扩张压力[1]。它已安全用于中度低氧血症的成人，并发症较少[2,3]。在此，我们报告HHFNC氧疗期间发生的严重并发症。
病例介绍
一名53岁患有噬血细胞性淋巴组织细胞增生症（HLH）的女性因呼吸衰竭入住重症监护病房。在持续2周的机械通气撤机后，开始以40 L/min的流量和0.5的FiO2进行HHFNC治疗以治疗低氧血症。四天后，出现呼吸困难和低氧血症，胸部X线和CT扫描显示局限性气胸、皮下气肿和大量纵隔气肿。停止HHFNC后，呼吸状况改善。
结论
皮下气肿、气胸和纵隔气肿应作为HHFNC治疗期间的严重并发症通报。
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