Munakata Hisaaki, Higashi Michiko, Tamura Takahiro, Adachi Yushi Ueda
Department of Surgical Intensive Care Medicine, Nagoya University Hospital, Nagoya, Japan.
Department of Emergency and Medical Intensive Care Unit, Nagoya University Hospital, Nagoya, Japan.
Acute Crit Care. 2020 Nov;35(4):298-301. doi: 10.4266/acc.2019.00570. Epub 2020 Apr 20.
Endo-tracheal tube obstruction due to an extensive blood clot is a recognized but very rare complication. A ball-valve obstruction in the airway could function as a check valve for the lung and thorax, resulting in tension pneumothorax-like abnormalities. A 47-year-old female patient had undergone implantation of a left ventricular assist device 3 weeks prior. On post-operative day 17, planned thoracentesis was performed for drainage of a pleural effusion. Despite the drainage, the patient's oxygenation did not improve, and emergency tracheal intubation was conducted. Subsequent computed tomography revealed bilateral pneumothorax. Two days later, the patient's trachea was extubated without complication, and a mini-tracheostomy tube was placed. Three hours later, reintubation was conducted due to progressive tachypnea. Although successful intubation was confirmed, ventilation became increasingly difficult and finally impossible. Marked increase in pulmonary artery and central venous pressures suggested progression of the previous tension pneumothorax. After emergency extracorporeal membrane oxygenation was initiated, fiberoptic bronchoscopy revealed the presence of a massive clot and ball-valve obstruction of the endotracheal tube. Two weeks later, the patient died due to severe hypoxic brain damage. Diagnosis of ball valve clot is not simple, but intensivists should consider this rare complication.
广泛血凝块导致的气管内导管阻塞是一种已被认识但非常罕见的并发症。气道中的球阀阻塞可起到肺和胸腔单向阀的作用，导致类似张力性气胸的异常情况。一名47岁女性患者在3周前接受了左心室辅助装置植入手术。术后第17天，计划进行胸腔穿刺以引流胸腔积液。尽管进行了引流，但患者的氧合情况并未改善，于是进行了紧急气管插管。随后的计算机断层扫描显示双侧气胸。两天后，患者气管拔管无并发症，并置入了一根微型气管切开导管。三小时后，由于进行性呼吸急促再次进行插管。尽管确认插管成功，但通气变得越来越困难，最终无法进行。肺动脉和中心静脉压显著升高提示先前的张力性气胸病情进展。在启动紧急体外膜肺氧合后，纤维支气管镜检查发现气管内有大量血凝块和球阀阻塞。两周后，患者因严重缺氧性脑损伤死亡。球阀血凝块的诊断并不简单，但重症监护医生应考虑这种罕见的并发症。
