静脉体外膜氧合管理过程中负压过大导致引流插管异常狭窄:病例报告。

IF 1.1 4区 医学 Q4 ENGINEERING, BIOMEDICAL
Journal of Artificial Organs Pub Date : 2024-09-01 Epub Date: 2023-08-05 DOI:10.1007/s10047-023-01414-y
Tomoyuki Nakamura, Naohide Kuriyama, Yoshitaka Hara, Tomoaki Yamashiro, Satoshi Komatsu, Takahiro Kawaji, Seiko Hayakawa, Hidefumi Komura, Chizuru Yamashita, Osamu Nishida
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引用次数: 0

摘要

我们报告了一个病例,其中静脉体外膜氧合(V-V ECMO)过程中可能对引流插管近侧孔施加了过多负压,导致引流插管异常狭窄。一名 71 岁的男性患者因水痘肺炎和急性呼吸窘迫综合征引起的严重呼吸衰竭而从另一家医院转入 V-V ECMO。在透视下,使用 PCKC-V™ 24Fr 插管(日本 MERA 公司)经右股静脉进行引流,插管尖端接近膈肌水平。通过右颈内静脉进行再输注。由于全身氧合不良,引流插管向尾部抽出并重新固定,以减少再循环的影响。两天后,引流压力急剧下降,由于引流不畅,ECMO 血流频繁中断。腹部 X 光片显示引流插管近侧孔部位异常狭窄。我们诊断引流插管已损坏,于是更换了另一根插管,即美敦力 Bio-Medicus™ 25 Fr 插管(GETINGE,瑞典)。然而,移除的引流套管并未损坏,这表明该套管因瞬间负压过大而暂时狭窄。在多级引流套管中,主要引流部位是近侧孔,在水箱中进行的模拟活体引流实验中,根尖孔处几乎没有负压。因此,建议对多级引流套管进行改进,例如用金属丝充分加固侧孔部位。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Abnormal stenosis of a drainage cannula due to excessive negative pressure during venovenous extracorporeal membrane oxygenation management: a case report.

Abnormal stenosis of a drainage cannula due to excessive negative pressure during venovenous extracorporeal membrane oxygenation management: a case report.

We report a case in which excessive negative pressure may have been applied to the proximal side hole of a drainage cannula during venovenous extracorporeal membrane oxygenation (V-V ECMO), resulting in abnormal stenosis of the drainage cannula. V-V ECMO was introduced in a 71-year-old male patient who was transferred from another hospital for severe respiratory failure associated with varicella pneumonia and acute respiratory distress syndrome. Drainage was performed using a PCKC-V™ 24Fr (MERA, Japan) cannula via the right femoral vein with the tip of the cannula near the level of the diaphragm under fluoroscopy. Reinfusion was performed via the right internal jugular vein. Due to poor systemic oxygenation, the drainage cannula was withdrawn caudally and refixed to reduce the effect of recirculation. Two days later, drainage pressure dropped rapidly, and frequent ECMO flow interruption occurred due to poor drainage. An abdominal X-ray revealed abnormal stenosis of the proximal side hole site of the drainage cannula. We diagnosed that the drainage cannula was damaged, and it was replaced with another, namely a Medtronic Bio-Medicus™ 25 Fr (GETINGE, Sweden) cannula. However, the removed drainage cannula was not damaged, suggesting that the cannula was temporarily stenosed by momentary excessive negative pressure. In a multi-stage drainage cannula, the main drainage site is the proximal side hole, with little negative pressure applied at the apical foramen in a mock experimental ex vivo drainage test in a water tank. Hence, improvement of a multi-stage drainage cannula is recommended, such as adequate reinforcement of the side hole site with a wire.

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来源期刊
Journal of Artificial Organs
Journal of Artificial Organs 医学-工程:生物医学
CiteScore
2.80
自引率
15.40%
发文量
68
审稿时长
6-12 weeks
期刊介绍: The aim of the Journal of Artificial Organs is to introduce to colleagues worldwide a broad spectrum of important new achievements in the field of artificial organs, ranging from fundamental research to clinical applications. The scope of the Journal of Artificial Organs encompasses but is not restricted to blood purification, cardiovascular intervention, biomaterials, and artificial metabolic organs. Additionally, the journal will cover technical and industrial innovations. Membership in the Japanese Society for Artificial Organs is not a prerequisite for submission.
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