Kirpalani H, Higa T, Perlman M, Friedberg J, Cutz E
Crit Care Med. 1985 Oct;13(10):792-7. doi: 10.1097/00003246-198510000-00004.
From January 1983 to September 1984 our neonatal ICU (NICU) treated eight endotracheally intubated infants who had suspected airway obstruction characterized by hypercarbia dissonant with severity of lung disease and difficulty in ventilation with lack of chest movement, both on conventional intermittent mandatory ventilation and high-frequency oscillation. Bronchoscopic removal of necrotic tissue was possible in six infants, two of whom survived. Bronchoscopy showed desquamation of epithelial surfaces, leaving encrusted exudations considered to be characteristic of necrotizing tracheobronchitis (NTB). The four nonsurvivors of bronchoscopy and one of the infants not submitted to bronchoscopy had NTB confirmed at autopsy. NTB was not associated with any specific lung disease, humidifier, or ventilator. The autopsy frequency of NTB during this period was 5 per 160 NICU admissions. A separate chart review of unselected autopsied cases in 1981 and 1982 showed that 12 of 284 neonates admitted to the NICU had NTB. NTB appears to be a rediscovered condition related to endotracheal intubation and mechanical ventilation using high mean airway pressures.
1983年1月至1984年9月期间，我们新生儿重症监护病房（NICU）收治了8例经气管插管的婴儿，这些婴儿疑似气道梗阻，其特征为高碳酸血症与肺部疾病严重程度不符，且在传统间歇强制通气和高频振荡通气时均存在通气困难且胸部活动缺乏。6例婴儿可行支气管镜下坏死组织清除术，其中2例存活。支气管镜检查显示上皮表面剥脱，留下结痂性渗出物，被认为是坏死性气管支气管炎（NTB）的特征。支气管镜检查的4例非存活者以及1例未接受支气管镜检查的婴儿在尸检时确诊为NTB。NTB与任何特定的肺部疾病、加湿器或呼吸机均无关联。在此期间，NTB的尸检发生率为每160例NICU入院病例中有5例。对1981年和1982年未选择的尸检病例进行单独的病历审查显示，NICU收治的284例新生儿中有12例患有NTB。NTB似乎是一种与气管插管和使用高平均气道压力的机械通气相关但重新被发现的病症。
