Tanimura Soichiro, Morimoto Kenji, Tanaka Masumi, Saito Osamu
Division of Critical Care Medicine, National Center for Child Health and Development, Setagaya, JPN.
Division of Critical Care Medicine, Tokyo Metropolitan Children's Medical Center, Fuchu, JPN.
Cureus. 2024 Jul 23;16(7):e65233. doi: 10.7759/cureus.65233. eCollection 2024 Jul.
The nasopharyngeal tube (NT) is an effective interface for noninvasive ventilation (NIV). In cases of severe heart failure, assistance with noninvasive positive-pressure ventilation (NPPV) effectively reduces afterload and alleviates respiratory effort. We present the case of a three-day-old male neonate diagnosed with severe aortic valve stenosis (AS). In respiratory management, extubation was delayed due to increased respiratory effort and afterload, so this patient was extubated and managed with NPPV using an NT. An uncuffed endotracheal tube was inserted, initiating NIV with a positive end-expiratory pressure of 8 cmHO. The patient exhibited stable vital signs post-extubation and was weaned off NPPV and transferred to the general ward. In this case of severe AS, the use of NT as an interface for NPPV demonstrated efficacy in respiratory and circulatory management. This approach could have shortened the duration of mechanical ventilation and facilitated safe postoperative care, highlighting the potential benefits of NT in managing severe heart failure.
鼻咽管（NT）是无创通气（NIV）的一种有效接口。在严重心力衰竭的病例中，无创正压通气（NPPV）辅助能有效降低后负荷并减轻呼吸负担。我们报告一例3日龄男性新生儿，诊断为严重主动脉瓣狭窄（AS）。在呼吸管理方面，由于呼吸负担和后负荷增加，气管插管延迟，因此该患者拔除气管插管后使用鼻咽管进行NPPV管理。插入无套囊气管内导管，呼气末正压8 cmHO启动无创通气。患者拔管后生命体征稳定，停用NPPV并转入普通病房。在该严重AS病例中，使用鼻咽管作为NPPV接口在呼吸和循环管理方面显示出疗效。这种方法可能缩短机械通气时间并促进安全的术后护理，突出了鼻咽管在管理严重心力衰竭方面的潜在益处。
