Extracorporeal membrane oxygenation, extubation, and lung-recruitment maneuvers as rescue therapy in a patient with tracheal dehiscence following slide tracheoplasty

Respir Care. 2011 Aug;56(8):1198-202. doi: 10.4187/respcare.00948. Epub 2011 Apr 15.

Abstract

Long-segment congenital tracheal stenosis is characterized by complete tracheal rings. Surgery is required during infancy to optimize outcomes, and the post-surgery complications include mucus plugging, airway trauma, dehiscence at the surgery site, and death. We report a 5-week-old patient who developed a tracheal-wall dehiscence after a slide tracheoplasty. To safeguard against further dehiscence and to protect her one functional lung, we used extracorporeal membrane oxygenation (ECMO). After she was stabilized on veno-arterial ECMO we extubated and continued ECMO for 5 days. On postoperative day 14 we removed the ECMO and transitioned her to high-frequency oscillatory ventilation, and performed slow lung-recruitment maneuvers every 2 hours. This strategy of ECMO with extubation, then high-frequency oscillatory ventilation is a useful rescue therapy in patients with postoperative tracheal dehiscence.

Publication types

  • Case Reports

MeSH terms

  • Bronchoscopy
  • Device Removal / methods*
  • Extracorporeal Membrane Oxygenation / methods*
  • Female
  • Humans
  • Infant, Newborn
  • Intubation, Intratracheal / instrumentation*
  • Plastic Surgery Procedures / adverse effects*
  • Surgical Wound Dehiscence / diagnosis
  • Surgical Wound Dehiscence / etiology
  • Surgical Wound Dehiscence / therapy*
  • Trachea / abnormalities
  • Trachea / surgery*
  • Tracheal Stenosis / congenital
  • Tracheal Stenosis / surgery*