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一种用于先天性心脏病儿科患者的新型肺复张技术:病例系列

A novel lung recruitment technique in pediatric patients with congenital heart diseases: A case series.

作者信息

Pujara Jigisha Chandrakant, Singh Guriqbal, Ninama Sunil, Agrawal Satbir Kaur, Shukla Kamayani, Surti Jigar

机构信息

Department of Cardiac Anesthesia, U. N. Mehta Institute of Cardiology and Research Centre, Affiliated to B. J. Medical College, Ahmedabad, Gujarat, India.

Department of Anesthesia, U. N. Mehta Institute of Cardiology and Research Centre, Affiliated to B. J. Medical College, Ahmedabad, Gujarat, India.

出版信息

Ann Pediatr Cardiol. 2022 Jul-Aug;15(4):389-393. doi: 10.4103/apc.apc_76_22. Epub 2023 Jan 6.

Abstract

BACKGROUND

Lung recruitment techniques are employed to help in improvement of pulmonary mechanics, facilitate early weaning, and shorten the duration of mechanical ventilation. We are reporting a novel lung recruitment technique employed in four children with left lung atelectasis, who underwent corrective surgery for congenital heart disease.

MATERIALS AND METHODS

From January 2020 to March 2021, four pediatric cardiac patients having left lung atelectasis, undergoing corrective surgery were subjected to lung recruitment technique and had elective endobronchial intubation and suctioning with chest physiotherapy in the form of vibration and percussion. This was done along with intermittent ventilation with 100% oxygen.

RESULTS

Successful recruitment of lung segments and clearance of atelectasis were confirmed by auscultation and chest X-ray in all four patients. All the cases were successfully weaned off the ventilator within 24-48 h. One patient had an opposite lung collapse after extubation, which was managed conservatively with chest physiotherapy. Another patient had bradycardia and desaturation during the procedure, which was improved after withdrawing the tube and instituting two lung ventilation with 100% oxygen.

CONCLUSIONS

This novel lung recruitment technique helps in recruitment of collapsed lung segments and thus helps in early weaning and shortens the duration of mechanical ventilation.

摘要

背景

肺复张技术用于帮助改善肺力学、促进早期脱机并缩短机械通气时间。我们报告了一种应用于四名左肺肺不张且接受先天性心脏病矫正手术患儿的新型肺复张技术。

材料与方法

2020年1月至2021年3月,对四名患有左肺肺不张且接受矫正手术的小儿心脏疾病患者采用肺复张技术,并进行选择性支气管内插管及以振动和叩击形式进行的胸部物理治疗吸痰。这一操作同时配合100%氧气的间歇通气。

结果

通过听诊和胸部X光检查确认所有四名患者的肺段均成功复张且肺不张消失。所有病例均在24 - 48小时内成功脱机。一名患者拔管后对侧肺发生萎陷,通过胸部物理治疗进行保守处理。另一名患者在操作过程中出现心动过缓和血氧饱和度下降,在拔出导管并采用100%氧气进行双肺通气后情况得到改善。

结论

这种新型肺复张技术有助于使萎陷的肺段复张,从而有助于早期脱机并缩短机械通气时间。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eaa8/10015386/e1920419c93f/APC-15-389-g001.jpg

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