Zhou Hao-Su, Wan Yu-Xiang, Qin Hao, Zhou Jun-Ping, Nie Xiao-Meng, Wang Qin, Bai Chong, Zhang Wei
Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Second Military Medical University, Shanghai, China.
Department of Clinical Laboratory, The First Affiliated Hospital of Second Military Medical University, Shanghai, China.
BMC Pulm Med. 2025 Mar 31;25(1):144. doi: 10.1186/s12890-025-03612-1.
Severe tracheal stenosis is a life-threatening condition that often requires immediate intervention. Traditional surgical approaches may be challenging in critically ill patients, and bronchoscopic therapies have emerged as a less invasive alternative. However, maintaining adequate oxygenation and ventilation during these procedures can be challenging, especially in patients with near-complete airway obstruction. The manipulation of the already compromised airway during bronchoscopy can exacerbate respiratory insufficiency, leading to hypoxemia, hypercapnia, and even cardiac arrest. To address these challenges, extracorporeal membrane oxygenation (ECMO) has been increasingly utilized as a supportive measure during high-risk airway interventions. The use of ECMO in managing severe tracheal stenosis is a relatively recent development, with growing evidence supporting its role in facilitating complex airway interventions. By ensuring hemodynamic stability and adequate gas exchange, ECMO enables the safe and effective application of bronchoscopic techniques in critically ill patients who would otherwise be deemed unsuitable for such procedures. This approach can improve outcomes and expand treatment options for patients with severe tracheal stenosis.
A 49-year-old woman, who underwent metal stent placement in her upper trachea 24 years ago due to tuberculous tracheal stenosis, was hospitalized due to worsening dyspnea. A thorough evaluation showed that the entire tracheal section was narrowed, with the smallest diameter measuring approximately 4-5 mm. Traditional respiratory support was inadequate for maintaining the patient's oxygen levels during bronchoscopy. We conducted bronchoscopic treatment with ECMO support, significantly alleviating the patient's dyspnea symptoms post-treatment. This is the first documented case of ECMO being utilized alongside bronchoscopy for patients with tracheal narrowing caused by tuberculosis.
The case study described a patient experiencing severe tracheal scar stenosis due to tuberculosis, who underwent successful treatment that included bronchoscopy supported by ECMO. Our effective handling of this case has provided crucial insights and strategies for managing similar situations in the future.
严重气管狭窄是一种危及生命的疾病，通常需要立即干预。传统手术方法对于重症患者可能具有挑战性，而支气管镜治疗已成为一种侵入性较小的替代方法。然而，在这些操作过程中维持足够的氧合和通气可能具有挑战性，尤其是在气道近乎完全阻塞的患者中。支气管镜检查期间对本已受损的气道进行操作会加重呼吸功能不全，导致低氧血症、高碳酸血症，甚至心脏骤停。为应对这些挑战，体外膜肺氧合（ECMO）已越来越多地被用作高风险气道干预期间的支持措施。ECMO在治疗严重气管狭窄中的应用是一项相对较新的进展，越来越多的证据支持其在促进复杂气道干预中的作用。通过确保血流动力学稳定和充分的气体交换，ECMO能够在原本被认为不适合此类手术的重症患者中安全有效地应用支气管镜技术。这种方法可以改善严重气管狭窄患者的治疗效果并扩大治疗选择。
一名49岁女性，24年前因结核性气管狭窄在上段气管置入金属支架，因呼吸困难加重入院。全面评估显示整个气管段狭窄，最小直径约为4 - 5毫米。传统呼吸支持在支气管镜检查期间不足以维持患者的氧水平。我们在ECMO支持下进行了支气管镜治疗，治疗后患者的呼吸困难症状明显缓解。这是有记录的首例ECMO与支气管镜联合用于治疗结核性气管狭窄患者的病例。
该病例研究描述了一名因结核病导致严重气管瘢痕狭窄的患者，其接受了包括ECMO支持下的支气管镜检查在内的成功治疗。我们对该病例的有效处理为未来管理类似情况提供了关键的见解和策略。
