High-Frequency Oscillatory Ventilation With Subcutaneous Drainage in Children With Postintubation Tracheal Injury.

Introduction: Tracheal injury during intubation is an uncommon condition in pediatric patients with a high mortality rate. There is no definitive consensus on the management of pediatric postintubation tracheal injury; most studies report satisfactory conservative treatment. High-frequency oscillatory ventilation (HFOV) with bedside subcutaneous drainage using a butterfly needle may be useful for conservative treatment in this group. Case Summary: A 1-year and 7-month-old girl experienced tracheal injury after emergency intubation. The patient developed massive subcutaneous emphysema (MSE), pneumothorax, and pneumomediastinum, accompanied by a worsening clinical condition. The conventional mechanical ventilator (CMV) failed to support this patient; thus, the physician decided to switch to HFOV and used a bedside butterfly needle for subcutaneous air drainage. The patient's condition progressively improved following this procedure. Conclusion: HFOV is beneficial for patients who are failing with CMV since it minimizes air leak and enhances oxygenation and ventilation. Using a butterfly needle for simple subcutaneous drainage at the bedside is more practical and convenient than other techniques. This technique might be advantageous in rapidly improving a patient's condition in a resource-limited setting.