Mortality Resulting from Inability to Ventilate after Tracheostomy Bleeding: A case Report

我們報告一個病例，本預進行氣管切開手術術後出血之止血，卻因為通氣困難最終導致死亡。這是一位81歲病患，因為空腸憩室炎與沾黏性腸阻塞，而接受小腸切除與沾黏撥離手術，兩周後，病患仍無法脫離呼吸器輔助，於是安排了氣管切開手術，又過了三天後，氣管切開的地方開始出血，當病患送至手術室時，發現在病患的頸部與床上有大量的血塊，沒多久之後變成完全無法通氣，我們將抽吸管放入氣切管內，只抽吸出少量的新鮮血液，但是通氣又恢復了，於是開始換插經口的氣管內管，然而換管完成後，又變成無法通氣，這次心臟很快的就停止跳動了，我們開始體外心臟按壓，因為通氣一直無法恢復，病患最終還是死亡。呼吸道無法通氣時診斷與處置是很重要的，軟式支氣管纖維鏡除了可以幫助診斷無法通氣的原因外，若有阻塞物亦可嘗試直接移除。

關鍵字

氣切術後流血；呼吸道完全阻塞

並列摘要

We report the case of a patient who experienced difficulty breathing after a tracheostomy and was checked for hemorrhaging. The patient eventually died. An 81-year-old male patient received a small bowel resection and adhesion lysis due to jejunal diverticulitis and adhesion ileus. Two weeks later, a tracheostomy was scheduled because mechanical ventilation could not be discontinued. Hemorrhaging from the tracheostomy site occurred 3 days later. When patient was sent to the operating room, a large number of blood clots were noted over his neck and bed. Ventilation could not be achieved. A suction catheter was inserted into the tracheostomy tube, and a small amount of fresh blood was suctioned out. Ventilation resumed, and the tracheostomy tube was changed to an oral endotracheal tube. After insertion of the endotracheal tube, we were unable to reestablish ventilation. This time, asystole soon developed, and cardiac massage was started. Due to the inability to restart ventilation, the patient eventually died. Prompt diagnosis and management are important in the condition of inability to ventilate. Bronchoscopy is helpful in the diagnosis and in the removal of the obstructed lesions.

並列關鍵字

tracheostomy bleeding ； airway total obstruction

國際替代計量

Mortality Resulting from Inability to Ventilate after Tracheostomy Bleeding: A case Report

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