A Successful Prevention of Reintubation Using the Mechanical Insufflation-Exsufflation in a Critically Ill Patient With Impaired Airway Mucus Expectoration: A Case Report.

在患有气道黏液排痰受损的重症患者中 ， 使用机械吹气 - 排气成功预防了插管 ： 病例报告。

• 发表时间: 2023 Oct
• 来源期刊: Cureus
• DOI: 10.7759/cureus.47776
• PMID: 38021928
• 文章类型: Case Reports
• 作者列表: Nishida C,Utsumi S,Sera T,Ohshimo S,Shime N

关键词: acute respiratory failure; airway management; cough augmentation; intensive care unit; mechanical insufflation-exsufflation; musculoskeletal rehabilitation; reintubation; respiratory care

Abstract

We report a case of post-extubation respiratory failure due to insufficient airway mucus expectoration that was successfully treated using mechanical insufflation-exsufflation (MI-E). A 32-year-old woman with a long-term history of steroid therapy for Blau syndrome was admitted to our intensive care unit with refractory hypoxemia due to pneumonia associated with the novel coronavirus disease 2019. Mechanical ventilation with veno-venous extracorporeal membrane oxygenation (VV-ECMO) was required due to severe hypoxemia. She was weaned from VV-ECMO on the 10th day and extubated on the 13th day. A few hours after extubation, she presented respiratory distress due to massive pulmonary atelectasis caused by sputum accumulation as a result of the impaired cough reflex. MI-E was applied to facilitate coughing and sputum expectoration. MI-E dramatically improved the atelectasis and prevented reintubation. This case suggests that MI-E, which is primarily used to treat chronic neuromuscular diseases, may also be effective in treating acute respiratory failure.

摘要

我们报告了一例由于气道粘液排痰不足而导致的拔管后呼吸衰竭的病例，该病例已使用机械吹气-排气（MI-E）成功治疗。一名32岁的女性因Blau综合征长期接受类固醇治疗，因2019年与新型冠状病毒疾病相关的肺炎而患有难治性低氧血症。由于严重的低氧血症，需要使用静脉-静脉体外膜氧合（VV-ECMO）进行机械通气。她在第10天从VV-ECMO断奶，并在第13天拔管。拔管几小时后,由于咳嗽反射受损，痰液积聚导致大量肺不张，她出现呼吸窘迫。应用MI-E促进咳嗽和痰痰。MI-E可显着改善肺不张并防止再插管。这个案例表明MI-E,主要用于治疗慢性神经肌肉疾病，也可有效治疗急性呼吸衰竭。