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.