"不能输管不能氧化"情况在被怀疑患有沙丘病的选择性患者中:一个病例报告
Veronica Gerli1, Eva Koetsier2,3, Nicola Ledingham1,3
1Anaestesiology, Ospedale Regionale di Lugano - Civico e Italiano, Ente Ospedaliero cantonale, Lugano, Switzerland.
European journal of case reports in internal medicine
|November 3, 2023
概括
管理"不能输管,不能氧化" (CICO) 紧急情况需要在失败的cricothyroidotomy后进行微喉管. 患者病史的术前评估对于预测呼吸道困难和优化麻醉管理至关重要.
科学领域:
- 麻醉学 麻醉学
- 肺部病理学 肺部病理学
- 关键护理医学 关键护理医学
背景情况:
- "不能输管,不能氧化" (CICO) 协议是管理难治的呼吸道问题的关键紧急程序.
- 虽然麻醉师和肺科医生接受了CICO协议的培训,但其实际应用并不常见.
研究的目的:
- 报告在可选性内支气管超声波支气管镜检查 (EBUS) 期间意外出现呼吸道困难的情况.
- 以突出成功管理CICO情况使用先进的气道装置和复苏技术.
主要方法:
- 一名因怀疑患有沙丘症而接受EBUS治疗的患者在用喉面具诱导麻醉时经历了困难的呼吸道.
- 由于口腔内管和紧急cricothyroidotomy的尝试失败,需要应用CICO协议.
- 通过6手口罩通风保持通风,然后在纤维镜上使用微喉管进行输管.
主要成果:
- 由于快速脱和无法通风,启动了CICO协议,包括紧急cricothyroidotomy.
- 患者经历了无脉冲的电活动,导致心肺复苏,成功恢复了重要功能.
- 手术后的评估显示,没有神经或心脏病的后果. 发现的患者病史包括使用持续正气道压力 (CPAP) 和显著的体重增加,有助于气道妥协.
结论:
- CICO协议在管理这种意外困难的气道场景方面被证明是有效的.
- 使用纤维镜的微喉内管在成功实现内管内输入和患者复苏方面发挥了重要作用.
- 彻底的手术前麻醉评估,包括特定的患者病史,对于识别潜在的呼吸道挑战和定制麻醉计划至关重要.
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