Tani Makiko
Department of Anesthesiology and Resuscitology, Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1, Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
JA Clin Rep. 2021 Oct 16;7(1):77. doi: 10.1186/s40981-021-00480-6.
Bronchial dehiscence is a life-threatening complication after lung transplant. If it is not treated by placement of stent or reanastomosis, the chance of survival will depend on the availability of a new graft. However, retransplant is not a practical management option in Japan, where waiting time for lung transplant is extensive. We described a case of refractory bilateral bronchial dehiscence managed by veno-venous extracorporeal oxygenation membrane (VV ECMO) while allowing the dehiscence to heal.
A 25-year-old man with idiopathic pulmonary arterial hypertension underwent a bilateral lung transplant. The patient developed bilateral bronchial dehiscence. Open reanastomosis was not successful, and air leakage recurred under low positive pressure ventilation. VV ECMO was established to maintain oxygenation with spontaneous breathing until both dehiscence were closed by adhesions.
In a patient with refractory bilateral bronchial dehiscence, VV ECMO may provide bronchial rest and serve as a bridge therapy to recovery.
支气管裂开是肺移植术后一种危及生命的并发症。如果不通过放置支架或再次吻合进行治疗，存活几率将取决于是否有新的移植物。然而，在日本，再次移植并非切实可行的治疗选择，因为肺移植的等待时间很长。我们描述了一例难治性双侧支气管裂开病例，通过静脉 - 静脉体外膜肺氧合（VV ECMO）治疗，同时让裂开处愈合。
一名25岁的特发性肺动脉高压男性接受了双侧肺移植。患者出现双侧支气管裂开。开放再次吻合未成功，在低压力通气下漏气复发。建立VV ECMO以在自主呼吸时维持氧合，直到裂开处通过粘连闭合。
对于难治性双侧支气管裂开患者，VV ECMO可使支气管得到休息，并作为恢复的桥接治疗。
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