Ali Osman, Verceles Avelino C, Barrett Matthew L, Franklin Christopher M, Khan Imran, Naderi Negar, McCurdy Michael T
University of Maryland Medical Center Midtown Campus, Baltimore, MD, USA.
University of Maryland School of Medicine, Baltimore, MD, USA.
J Crit Care Med (Targu Mures). 2020 Aug 11;6(3):186-189. doi: 10.2478/jccm-2020-0023. eCollection 2020 Jul.
An airway exchange catheter is a hollow-lumen tube able to deliver oxygen and maintain access to a difficult endotracheal airway. This case report demonstrates an undocumented complication associated with an airway exchange catheter and jet ventilation, particularly in a patient with reduced airway diameter due to thick endotracheal secretions. Due to the frequent use of airway exchange catheters in the intensive care unit, this report highlights an adverse event of bilateral pneumothoraces that can be encountered by clinicians.
This case report describes a 24-year-old female with severe adult respiratory distress syndrome and thick endotra-cheal secretions whose hospital course was complicated by bilateral pneumothoraces resulting from the use of an airway exchange catheter connected to jet ventilation. During the exchange, the catheter occluded the narrowed endotracheal tube to create a one-way valve that led to excessive lung inflation.
Airway exchange catheters used with jet ventilation in a patient with a narrowed endotracheal tube and reduced lung compliance have the potential risk of causing a pneumothorax. Clinicians should avoid temporary concomitant oxygenation via jet ventilation in patients with these findings and reserve the use of airway exchange catheters for difficult airways.
气道交换导管是一种中空管腔的管子，能够输送氧气并维持对困难气管内气道的通路。本病例报告展示了一种与气道交换导管和喷射通气相关的未记录并发症，特别是在因气管内分泌物浓稠导致气道直径减小的患者中。由于重症监护病房中频繁使用气道交换导管，本报告强调了临床医生可能会遇到的双侧气胸这一不良事件。
本病例报告描述了一名24岁患有严重成人呼吸窘迫综合征且气管内分泌物浓稠的女性，其住院过程因使用连接喷射通气的气道交换导管而并发双侧气胸。在交换过程中，导管阻塞了变窄的气管内导管，形成了一个单向阀，导致肺部过度充气。
在气管内导管变窄且肺顺应性降低的患者中，将气道交换导管与喷射通气一起使用有导致气胸的潜在风险。对于有这些表现的患者，临床医生应避免通过喷射通气进行临时同步给氧，并将气道交换导管的使用保留给困难气道。
