ABSTRACT
INTRODUCTION: Extracorporeal membrane oxygenation (ECMO) is a rescue therapy for reversible respiratory or cardiac diseases. Neonatal pathologies requiring this technique are different from the ones found later in life. OBJECTIVES: To review the main causes requiring ECMO in the neonatal period, to compare the clinical course depending on the initial illness and to identify the sequelae attributable to this technique. MATERIAL AND METHOD: A retrospective review of clinical records of all neonatal patients that received ECMO support in our centre. RESULTS: 45 neonatal ECMO were performed in our unit between January 2001 and June 2009. Forty techniques were due to respiratory failure, 2 secondary to haemodynamic shock and 3 secondary to sepsis. Veno-venous cannulation was used initially in 24 patients (53.3%). The length of technique varied depending on the underlying disease. Patients with congenital diaphragmatic hernia were in ECMO for longer periods. The overall survival to the technique was 86.3% (38/44 patients), also with differences among diseases. Extracorporeal support was withdrawn in 4 children because of a diagnosis of an irreversible pathology and one because of massive brain haemorrhage. No serious adverse outcomes attributable to the technique were found among survivors. CONCLUSIONS: Survival among newborns supported with ECMO in our hospital is similar to that recorded by the ELSO in 2004, although we use veno-venous cannulation in more than a half of the patients. The percentage of moderate to severely impaired neurodevelopmental outcome among survivors after this technique was low.
Subject(s)
Extracorporeal Membrane Oxygenation , Infant, Newborn, Diseases/therapy , Female , Humans , Infant, Newborn , Male , Retrospective Studies , Time FactorsABSTRACT
Las estenosis traqueales adquiridas en el niño son secundarias bien a traumatismo directo cérvico-torácico o a secuelas postintubación. La resección y anastomosis término-terminal sigue siendo el tratamiento de elección. La tasa elevada de reestenosis está directamente relacionada con la tensión anastomótica en lesiones de más de 2 cm de longitud. Presentamos el caso clínico de un niño de 7 años que sufre politraumatismo severo por accidente de tráfico e intubación traumática en el lugar del accidente, con desarrollo subsecuente de estenosis traqueal cervical que precisa tratamiento endoscópico con láser y dilataciones con balón en tres ocasiones, sin éxito. Se practica resección del segmento traqueal estenótico, aplicando un tutor externo de ePTFE. El postoperatorio cursó sin complicaciones y fue posible una extubación precoz del niño. La evolución posterior ha sido satisfactoria; los estudios endoscópicos y de RNM postoperatorios muestran un diámetro anastomótico normal, sin estenosis. El niño se halla asintomático en la actualidad, 3 años después de la intervención y practica deporte de competición. Podemos concluir que el modelo descrito de tutor externo de ePTFE ha sido efectivo clínicamente en la prevención de la estenosis traqueal postanastomótica en el niño (AU)
Subject(s)
Child , Male , Humans , Polytetrafluoroethylene , Trachea , Tracheal StenosisABSTRACT
Acquired tracheal stenosis in children can be either to direct cervicothoracic trauma or to post-intubation. Resection and end-to-end anastomosis continues to be the treatment of choice. The high rate of restenosis is directly related to anastomotic tension in resections of more than 2 cm. We report a case of a 7 year old child who suffered severe injury caused by car crash and intubation at the scene of the accident, with subsequent development of a cervical tracheal stenosis which required preoperative iterative laser sessions and balloon dilatation on 3 occasions, without result. Resection and primary anastomosis with an external stent of ePTFE was performed. The patient was treated successfully and was extubated promptly. Post-operative endoscopic studies and magnetic resonance imaging showed widely patent tracheal lumina with no stenosis. Three years post-operatively, the child is asymptomatic and participates in competitive sport activities. We can conclude that the model described above was clinically effective in the prevention of post-anastomotic tracheal stenosis in the child.
