Shirasaki Kasumi, Hifumi Toru, Kato Takashi, Ishimatsu Shinichi
Department of emergency and critical care medicine, St Luke's International University, Chuo-ku, Tokyo, Japan
Critical Care Medicine and Trauma, St Luke's International University, Chuo-ku, Tokyo, Japan.
BMJ Case Rep. 2021 Mar 10;14(3):e237282. doi: 10.1136/bcr-2020-237282.
A 24-year-old man with Down syndrome and congenital tracheal stenosis, who had undergone cartilage patch tracheoplasty twice in infancy, was transferred from a local hospital to manage an airway emergency. On arrival, the patient was in severe respiratory distress. Increased airway pressure following endotracheal intubation complicated the administration of mechanical ventilation. CT of the chest showed widespread consolidation and tracheal stenosis 3 cm above the carina distal to the tip of the endotracheal tube. The diagnosis was tracheal stenosis with type A influenza infection. The patient was transferred to another hospital for initiating venovenous extracorporeal membrane oxygenation (VV-ECMO). Intubation with a 6.0 mm spiral tube was successful after intraluminal balloon dilatation of the tracheal stenosis. The patient was admitted to the intensive care unit and was weaned off VV-ECMO on day 3 due to improvement in respiratory status. A tracheotomy was performed on day 28 and the tracheal tube was removed on day 41.
一名24岁患有唐氏综合征和先天性气管狭窄的男性，在婴儿期曾接受过两次软骨补片气管成形术，从当地医院转来处理气道急症。到达时，患者处于严重呼吸窘迫状态。气管插管后气道压力增加使机械通气的实施变得复杂。胸部CT显示广泛实变，气管插管尖端远端隆突上方3 cm处存在气管狭窄。诊断为气管狭窄合并甲型流感感染。患者被转至另一家医院开始进行静脉-静脉体外膜肺氧合（VV-ECMO）。在气管狭窄进行腔内球囊扩张后，成功插入一根6.0 mm的螺旋管。患者被收入重症监护病房，由于呼吸状况改善，在第3天撤掉了VV-ECMO。在第28天行气管切开术，第41天拔除气管导管。
