High-Frequency Oscillatory Ventilation With Subcutaneous Drainage in Children With Postintubation Tracheal Injury

Area of Science:

• Pediatric critical care medicine
• Respiratory physiology
• Trauma surgery

Background:

• Tracheal injury is a rare but serious complication of intubation in children.
• Management strategies for pediatric postintubation tracheal injury lack a definitive consensus.
• Conservative treatment is often favored, with limited evidence on advanced ventilation techniques.

Observation:

• A 1-year and 7-month-old girl sustained tracheal injury post-intubation, developing massive subcutaneous emphysema, pneumothorax, and pneumomediastinum.
• Conventional mechanical ventilation (CMV) proved insufficient for the patient's deteriorating condition.
• The clinical team transitioned to high-frequency oscillatory ventilation (HFOV) and implemented bedside subcutaneous air drainage using a butterfly needle.

Findings:

• HFOV demonstrated efficacy in managing air leaks and improving oxygenation and ventilation in a pediatric patient with severe tracheal injury.
• Bedside subcutaneous drainage with a butterfly needle provided a practical and convenient method for air removal.
• The combined approach led to progressive clinical improvement in the patient.

Implications:

• HFOV may be a valuable alternative for pediatric patients with tracheal injury failing CMV.
• Simple bedside subcutaneous drainage offers a feasible and accessible technique for managing related complications.
• This conservative management strategy holds promise for improving outcomes in resource-limited settings.