Limits...
Conservative extracorporeal membrane oxygenation treatment in a tracheal injury: a case report.

Son BS, Cho WH, Kim CW, Cho HM, Kim SH, Lee SK, Kim do H - J Cardiothorac Surg (2015)

Bottom Line: In patients with tracheal injuries, conservative treatment is an alternative approach when surgical treatment is difficult.However, the success rate of conservative treatment is low when a ventilator is used constantly because of underlying lung disease, and successful conservative treatment requires the maintenance of as much self-respiration as possible without a ventilator.Here, we report a case of lower tracheal injury in which both surgical and conservative treatments were difficult, but conservative treatment with extracorporeal membrane oxygenation was successful while maintaining self-respiration without a ventilator.

View Article: PubMed Central - PubMed

Affiliation: Departments of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Hospital, Mulgeum-eup, Yangsan-si, Gyeongnam, 626-770, South Korea. wtknight98@gmail.com.

ABSTRACT
In patients with tracheal injuries, conservative treatment is an alternative approach when surgical treatment is difficult. However, the success rate of conservative treatment is low when a ventilator is used constantly because of underlying lung disease, and successful conservative treatment requires the maintenance of as much self-respiration as possible without a ventilator. Here, we report a case of lower tracheal injury in which both surgical and conservative treatments were difficult, but conservative treatment with extracorporeal membrane oxygenation was successful while maintaining self-respiration without a ventilator.

No MeSH data available.


Related in: MedlinePlus

Bronchoscopic findings. (a) The bronchoscopic view showing a 5-cm-long full-thickness tear of the membranous trachea extending proximally from the carina. (b) Follow-up bronchoscopy on day 40 showing complete healing at the site of the tear in the membranous portion of the trachea.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
getmorefigures.php?uid=PMC4487840&req=5

Fig2: Bronchoscopic findings. (a) The bronchoscopic view showing a 5-cm-long full-thickness tear of the membranous trachea extending proximally from the carina. (b) Follow-up bronchoscopy on day 40 showing complete healing at the site of the tear in the membranous portion of the trachea.

Mentions: This revealed an approximately 5-cm tear in the posterior membranous portion 1 cm above the carina. After removing the hematoma, the bleeding site was confirmed to be in the right upper lobe. There was no more bleeding from the site. Emergency surgery was judged to be too difficult to perform because of her underlying disease and acute respiratory distress, which occurred after massive hemoptysis (Figure 1). Maintaining the intubation tube and ventilator care for conservative treatment was also difficult because the injury was close to the carina. Since the patient was able to breathe with ECMO support alone and total airway obstruction, conservative treatment with ECMO seemed appropriate. The patient was kept awake without sedation to allow spontaneous breathing. To maintain the airway without irritating the torn area, a 5–0 tracheostomy tube was kept in place without inflating the balloon, while maintaining an FiO2 of 0.5 oxygen supplying 10 L of oxygen per minute through a T-piece. To prevent bleeding, the activated clotting time (ACT) was maintained at about 160 s. The patient’s blood oxygen saturation was set to >95% and the carbon dioxide level to 35–45 mm Hg. We attempted to maintain the optimal oxygen and carbon dioxide levels with the minimum blood flow. ECMO was maintained with self-respiration for 28 days until the patient’s lung condition improved and the injured area had healed. Following ECMO weaning, she was transferred to a general ward 35 days after the tracheal injury. Bronchoscopy 40 days after the injury revealed that the injury had healed (Figure 2a and b).Figure 1


Conservative extracorporeal membrane oxygenation treatment in a tracheal injury: a case report.

Son BS, Cho WH, Kim CW, Cho HM, Kim SH, Lee SK, Kim do H - J Cardiothorac Surg (2015)

Bronchoscopic findings. (a) The bronchoscopic view showing a 5-cm-long full-thickness tear of the membranous trachea extending proximally from the carina. (b) Follow-up bronchoscopy on day 40 showing complete healing at the site of the tear in the membranous portion of the trachea.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4487840&req=5

Fig2: Bronchoscopic findings. (a) The bronchoscopic view showing a 5-cm-long full-thickness tear of the membranous trachea extending proximally from the carina. (b) Follow-up bronchoscopy on day 40 showing complete healing at the site of the tear in the membranous portion of the trachea.
Mentions: This revealed an approximately 5-cm tear in the posterior membranous portion 1 cm above the carina. After removing the hematoma, the bleeding site was confirmed to be in the right upper lobe. There was no more bleeding from the site. Emergency surgery was judged to be too difficult to perform because of her underlying disease and acute respiratory distress, which occurred after massive hemoptysis (Figure 1). Maintaining the intubation tube and ventilator care for conservative treatment was also difficult because the injury was close to the carina. Since the patient was able to breathe with ECMO support alone and total airway obstruction, conservative treatment with ECMO seemed appropriate. The patient was kept awake without sedation to allow spontaneous breathing. To maintain the airway without irritating the torn area, a 5–0 tracheostomy tube was kept in place without inflating the balloon, while maintaining an FiO2 of 0.5 oxygen supplying 10 L of oxygen per minute through a T-piece. To prevent bleeding, the activated clotting time (ACT) was maintained at about 160 s. The patient’s blood oxygen saturation was set to >95% and the carbon dioxide level to 35–45 mm Hg. We attempted to maintain the optimal oxygen and carbon dioxide levels with the minimum blood flow. ECMO was maintained with self-respiration for 28 days until the patient’s lung condition improved and the injured area had healed. Following ECMO weaning, she was transferred to a general ward 35 days after the tracheal injury. Bronchoscopy 40 days after the injury revealed that the injury had healed (Figure 2a and b).Figure 1

Bottom Line: In patients with tracheal injuries, conservative treatment is an alternative approach when surgical treatment is difficult.However, the success rate of conservative treatment is low when a ventilator is used constantly because of underlying lung disease, and successful conservative treatment requires the maintenance of as much self-respiration as possible without a ventilator.Here, we report a case of lower tracheal injury in which both surgical and conservative treatments were difficult, but conservative treatment with extracorporeal membrane oxygenation was successful while maintaining self-respiration without a ventilator.

View Article: PubMed Central - PubMed

Affiliation: Departments of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Hospital, Mulgeum-eup, Yangsan-si, Gyeongnam, 626-770, South Korea. wtknight98@gmail.com.

ABSTRACT
In patients with tracheal injuries, conservative treatment is an alternative approach when surgical treatment is difficult. However, the success rate of conservative treatment is low when a ventilator is used constantly because of underlying lung disease, and successful conservative treatment requires the maintenance of as much self-respiration as possible without a ventilator. Here, we report a case of lower tracheal injury in which both surgical and conservative treatments were difficult, but conservative treatment with extracorporeal membrane oxygenation was successful while maintaining self-respiration without a ventilator.

No MeSH data available.


Related in: MedlinePlus