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

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

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.

Related collections

Most cited references 5

Record: found
Abstract: found
Article: not found

Tracheal rupture after endotracheal intubation: a literature systematic review.

M Ballesteros, J Burón, Javier Llorca … (2009)

We aim to perform a systematic review and meta-analysis of the cases of postintubation tracheal rupture (PiTR) published in the literature, with the aim of determining the risk factors that contribute to tracheal rupture during endotracheal intubation. A further objective has been to determine the ideal treatment for this condition (surgical repair or conservative management). A MEDLINE review of cases of tracheal rupture after intubation published in the English language and a review of the references in the articles found. The articles included were those that reported at least the demographic data (age and sex), the treatment performed, and the outcome. Those papers that did not detail the above variables were excluded. The search found 50 studies that satisfied the inclusion criteria. These studies included 182 cases of postintubation tracheal rupture. The overall mortality was 22% (40 patients). A statistical analysis was performed determining the relative risk (RR), 95% confidence intervals (95% CI) and/or statistical significance. The analysis was performed on the overall group and after dividing into 2 subgroups: patients in whom the lesion was detected intraoperatively, and other patients. Patient age (p=0.015) and emergency intubation (RR=3.11; 95% CI, 1.81-5.33; p=0.001) were variables associated with an increased mortality. In those patients in whom the PiTR was detected outside the operating theatre (delayed diagnosis), emergency intubation (RR=3.05; 95% CI, 1.69-5.51; p<0.0001), the absence of subcutaneous emphysema (RR=2.17; 95% CI, 1.25-4; p=0.001), and surgical treatment (RR=2.09; 95% CI, 1.08-4.07; p=0.02) were associated with an increased mortality. In addition, age (p=0.1) and male gender (RR=1.89; 95% CI, 0.98-3.63; p=0.13) showed a clear trend towards an increased mortality. PiTR is an uncommon condition but carries a high morbidity and mortality. Emergency intubation is the principal risk factor, increasing the risk of death threefold compared to elective intubation. Conservative treatment is associated with a better outcome. However, the group of patients who would benefit from surgical treatment has not been fully defined. Further studies are required to evaluate the best treatment options.

0 comments Cited 68 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Extracorporeal membrane oxygenation in nonintubated patients as bridge to lung transplantation.

K Olsson, Daniel Gottlieb, M Strueber … (2010)

We report on the use of veno-arterial extracorporeal membrane oxygenation (ECMO) as a bridging strategy to lung transplantation in awake and spontaneously breathing patients. All five patients described in this series presented with cardiopulmonary failure due to pulmonary hypertension with or without concomitant lung disease. ECMO insertion was performed under local anesthesia without sedation and resulted in immediate stabilization of hemodynamics and gas exchange as well as recovery from secondary organ dysfunction. Two patients later required endotracheal intubation because of bleeding complications and both of them eventually died. The other three patients remained awake on ECMO support for 18-35 days until the time of transplantation. These patients were able to breathe spontaneously, to eat and drink, and they received passive and active physiotherapy as well as psychological support. All of them made a full recovery after transplantation, which demonstrates the feasibility of using ECMO support in nonintubated patients with cardiopulmonary failure as a bridging strategy to lung transplantation. © 2010 The Authors Journal compilation © 2010 The American Society of Transplantation and the American Society of Transplant Surgeons.

0 comments Cited 46 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Membranous tracheal rupture after endotracheal intubation.

Charles-Henri Marty-Ané, Eric Picard, Olivier Jonquet … (1995)

Tracheobronchial rupture after tracheal intubation has been infrequently reported. We report 6 cases of membranous tracheal rupture after endotracheal intubation treated at our institution over 7 years. Overinflation of the tracheal cuff was speculated to be a frequent cause of the tracheal damage because the lesion was always a linear laceration of the posterior membranous wall. The diagnosis was suspected on the basis of common signs such as subcutaneous emphysema, respiratory distress, pneumomediastinum, and pneumothorax. Fiberoptic bronchoscopy was the best means of confirming the diagnosis and determining the location and extent of the lesion. In 5 patients, extensive laceration with severe respiratory disorders required emergent repair through a right posterolateral thoracotomy. There were two postoperative deaths unrelated to the tracheal lesion. A patient with a small tracheal defect and favorable clinical presentation showed a rapid positive outcome after conservative treatment. Tracheal intubation-related airway ruptures are rare but probably underestimated. Early recognition and emergent repair are essential, because failure to do so could result in potentially lethal events.

0 comments Cited 26 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Contributors

Bong Soo Son: wtknight98@gmail.com

Woo Hyun Cho: popeyes0212@hanmail.net

Chang Wan Kim: asparag@naver.com

Hyun Min Cho: csking1@pnuh.co.kr

Seon Hee Kim: ksh810427@naver.com

Sang Kwon Lee: lsgwon@gmail.com

Do Hyung Kim: yumccs@nate.com

Journal

Journal ID (nlm-ta): J Cardiothorac Surg

Journal ID (iso-abbrev): J Cardiothorac Surg

Title: Journal of Cardiothoracic Surgery

Publisher: BioMed Central (London )

ISSN (Electronic): 1749-8090

Publication date (Electronic): 1 April 2015

Publication date PMC-release: 1 April 2015

Publication date Collection: 2015

Volume: 10

Electronic Location Identifier: 48

Affiliations

[ ]Departments of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Hospital, Mulgeum-eup, Yangsan-si, Gyeongnam 626-770 South Korea

[ ]Departments of Pulmonary and Critical Care Medicine, Pusan National University Yangsan Hospital, Mulgeum-eup, Yangsan-si, Gyeongnam 626-770 South Korea

[ ]Department of Thoracic and Cardiovascular Surgery, Trauma Center of Pusan National University Hospital, Gudeok-ro, Seo-gu, Busan-si South Korea

Article

Publisher ID: 252

DOI: 10.1186/s13019-015-0252-7

PMC ID: 4487840

PubMed ID: 25885371

SO-VID: 60f3f6df-5565-4b6f-ad60-805367af1a49

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 21 October 2014

Date accepted : 13 March 2015

Custom metadata

ScienceOpen disciplines: Surgery

Keywords: extracorporeal membrane oxygenation,tracheal injury,conservative care

Data availability:

ScienceOpen disciplines: Surgery

Keywords: extracorporeal membrane oxygenation, tracheal injury, conservative care

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

Read this article at

Abstract

Related collections

ScienceOpen Clinical Case Reports Collection

Most cited references 5

Tracheal rupture after endotracheal intubation: a literature systematic review.

Extracorporeal membrane oxygenation in nonintubated patients as bridge to lung transplantation.

Membranous tracheal rupture after endotracheal intubation.

Author and article information

Contributors

Journal

Affiliations

Article

History

Categories

Custom metadata

Comments

Comment on this article

Similar content 205

Cited by 5

Most referenced authors 60