Life-threatening Upper Airway Obstruction Caused by Massive Subcutaneous Emphysema during Mechanical Ventilation: A Case Report

於呼吸器使用時，嚴重的皮下氣腫造成之致命的上呼吸道阻塞：個案報告

高建華(Jiann-Hwa Kao) ； 余文光(Wen-Kuang Yu) ； 連德正(Te-Cheng Lien)

《胸腔醫學》 28卷1期 (2013/02) Pp. 25-30

摘要

皮下氣腫一向被認為只會影響到美觀，而且只需要保守性的治療。我們提出一個病患在正壓呼吸器使用的期間，產生了嚴重的皮下氣腫。很重要地，致命的併發症發生在我們的病患身上，包括了上呼吸道阻塞造成的插管困難，和隱藏性的氣胸。急救過後的胸部電腦斷層上顯示出，因為皮下軟組織嚴重的充氣，而被壓扁的胸廓外上呼吸道。我們緊急地在病人的鎖骨下方，進行皮膚切開以便減壓，之後，病人順利插入氣管內管，電腦斷層上亦顯示出X光上無法發現的隱藏性氣胸，氣胸也趕緊小心處理。我們相信，在使用呼吸器的病人中，皮下氣腫是一個警訊，而且需要的絕對不只是保守性治療。

關鍵字

皮下氣腫 ； 上呼吸道阻塞 ； 隱藏性氣胸

並列摘要

Subcutaneous emphysema usually causes pain and swelling, and requires conservative treatment only. We present a case with severe subcutaneous emphysema during positive pressure mechanical ventilation. Life-threatening complications developed in our patient, including intubation difficulty due to upper airway obstruction and occult pneumothorax. We performed an infraclavicular skin incision for decompression, after which endotracheal intubation could be carried out. Computed tomography (CT) after intubation clearly revealed a collapsed extrathoracic upper airway, which was compressed by extremely inflated soft tissue. CT also showed occult pneumothorax not found in the chest X-ray. Occult pneumothorax was also managed by tube thoracostomy. We believe subcutaneous emphysema in mechanically ventilated patients should be considered an alarm sign sometimes deserving of more than conservative treatment.

並列關鍵字

subcutaneous emphysema ； upper airway obstruction ； occult pneumothorax