Gregoretti C, Foti G, Beltrame F, Giugiaro P M, Biolino P, Burbi L, Turello M, Agostini F, Berardino M, Musto P
Intensive Care Unit of the Orthopedic and Trauma Center, Turin, Italy.
Intensive Care Med. 1995 Dec;21(12):1054-6. doi: 10.1007/BF01700674.
To evaluate pressure control ventilation (PCV) delivered through a minitracheotomy in treating severe flail chest trauma.
Case report.
Intensive care unit of a trauma center.
A 34-year-old woman affected by flail chest trauma and acute respiratory failure, who was initially treated with tracheal intubation to obtain internal pneumatic stabilization. The patient failed extubation and noninvasive mask treatment (pressure support ventilation plus PEEP) due to poor chestwall mechanics.
Minitracheotomy was performed and ventilation was achieved with high levels of inspiratory pressure (PCV or assisted PCV) to overcome the resistance of the cannula (Mini-Trach II, Portex, ID 4 mm). Esophageal and carinal pressures were monitored. Ventilatory treatment was always performed with the full cooperation of the patient; the patient's glottic function was always intact. The patient was successfully treated with pressure control ventilation delivered through the Mini-Trach. After 7 days of PCV, the patient was switched to assisted PCV. On the 20th day after admission, she was weaned from mechanical ventilation.
We conclude that a suitable gas exchange and pneumatic stabilization in a flail chest condition can be achieved using minitracheostomic ventilation. At the same time, this treatment could reduce some side effects of traditional tracheal intubation.
评估经微型气管切开术进行压力控制通气（PCV）治疗严重连枷胸创伤的效果。
病例报告。
创伤中心重症监护病房。
一名34岁女性，患有连枷胸创伤和急性呼吸衰竭，最初接受气管插管以实现内部气体稳定。由于胸壁力学不佳，患者拔管及无创面罩治疗（压力支持通气加呼气末正压）失败。
进行微型气管切开术，并采用高水平吸气压力（PCV或辅助PCV）实现通气，以克服套管（Mini-Trach II，Portex，内径4mm）的阻力。监测食管和隆突压力。通气治疗始终在患者充分配合下进行；患者声门功能始终完好。患者通过经Mini-Trach进行的压力控制通气成功治疗。PCV治疗7天后，患者转为辅助PCV。入院第20天，患者脱机。
我们得出结论，使用微型气管切开术通气可在连枷胸情况下实现合适的气体交换和气体稳定。同时，这种治疗可减少传统气管插管的一些副作用。
