title: Extracorporeal membrane oxygenation, extubation, and lung-recruitment maneuvers as rescue therapy in a patient with tracheal dehiscence following slide tracheoplasty.
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.
authors.affiliation: Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA. jenni.raake@cchmc.org
authors.forename: Jenni
authors.initials: J
authors.lastname: Raake
authors.forename: Bethann
authors.initials: B
authors.lastname: Johnson
authors.forename: Brandy
authors.initials: B
authors.lastname: Seger
authors.forename: Peter B
authors.initials: PB
authors.lastname: Manning
authors.forename: Pirooz
authors.initials: P
authors.lastname: Eghtesady
authors.forename: Paul
authors.initials: P
authors.lastname: Boesch
authors.forename: Michael
authors.initials: M
authors.lastname: Rutter
authors.forename: Amanda
authors.initials: A
authors.lastname: Woodard
authors.forename: Ranjit S
authors.initials: RS
authors.lastname: Chima
mesh_terms: D001999:Bronchoscopy; D020878:Device Removal / Q000379:methods*; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007442:Intubation, Intratracheal / Q000295:instrumentation*; D019651:Plastic Surgery Procedures / Q000009:adverse effects*; D013529:Surgical Wound Dehiscence / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D014132:Trachea / Q000002:abnormalities / Q000601:surgery*; D014135:Tracheal Stenosis / Q000151:congenital / Q000601:surgery*