Cohen William, Mirzai Saeid, Combs Pamela, Rose Rebecca, Kagan Viktoriya, Correia Camil, Gottlieb Lawrence J, Song Tae
Section of Cardiac Surgery, Department of Surgery, University of Chicago, Chicago, Illinois, USA.
Section of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Chicago, Chicago, Illinois, USA.
Head Neck. 2020 Nov;42(11):E30-E34. doi: 10.1002/hed.26371. Epub 2020 Aug 6.
Patients requiring intensive upper airway reconstruction are anatomically restricted in terms of the respiratory support they can receive. While intraoperative extracorporeal membrane oxygenation (ECMO) has been effectively utilized, little has been shown regarding the utility of ECMO for long-term support in these patients.
We demonstrate how a patient with tongue and hypopharyngeal squamous cell carcinoma that necessitated upper airway reconstruction was supported with veno-venous (VV) ECMO due to postoperative respiratory failure and an inability to maintain a stable airway.
By initiating VV ECMO, we were able to decrease positive pressure ventilation and FiO , thereby minimizing ventilator-associated trauma and irritation to facilitate wound healing. Over time, ventilatory support was increased in parallel with decreasing ECMO support, allowing discharge to rehabilitation after 74 days of ECMO.
ECMO can effectively support patients with ongoing respiratory requirements following upper airway reconstruction when standard ventilatory techniques are inadequate or not feasible.
需要进行复杂上气道重建的患者在可获得的呼吸支持方面存在解剖学限制。虽然术中体外膜肺氧合（ECMO）已得到有效应用，但关于ECMO在这些患者长期支持中的效用的研究较少。
我们展示了一名患有舌和下咽鳞状细胞癌且需要进行上气道重建的患者，由于术后呼吸衰竭且无法维持稳定气道，如何通过静脉-静脉（VV）ECMO获得支持。
通过启动VV ECMO，我们能够降低正压通气和吸入氧分数（FiO ），从而将呼吸机相关创伤和刺激降至最低，以促进伤口愈合。随着时间的推移，通气支持随着ECMO支持的减少而增加，在ECMO支持74天后允许患者出院接受康复治疗。
当标准通气技术不足或不可行时，ECMO可以有效地支持上气道重建后仍有呼吸需求的患者。
