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首页> 外文期刊>Cureus. >Tracheal Tube Obstruction Due to Hemoptysis Associated With Pulmonary Infarction in a Patient With Severe COVID-19 Pneumonia
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Tracheal Tube Obstruction Due to Hemoptysis Associated With Pulmonary Infarction in a Patient With Severe COVID-19 Pneumonia

机译：由于严重Covid-19肺炎的患者患者肺部梗死引起的气管管梗阻

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The incidence of thrombotic complications is extremely high among severe coronavirus disease 2019 (COVID-19) patients in the intensive care unit. Various factors such as a cytokine storm due to an excessive immune response to inflammation, hypoxemia, and disseminated intravascular coagulation are considered predisposing factors for thrombotic complications. A 55-year-old Japanese man intubated eight days previously was referred to our hospital because of a severe COVID-19 pneumonia diagnosis after his pharyngeal swab tested positive for severe acute respiratory syndrome coronavirus 2 using reverse transcription-polymerase chain reaction. The patient continued to remain hypoxic (PaO 2 /FiO 2 ratio 100 mmHg) at the referring hospital. On admission, we initiated veno-venous extracorporeal membrane oxygenation (VV-ECMO). Unfractionated heparin and nafamostat mesylate were used as anticoagulants during VV-ECMO. Despite adequate anticoagulant therapy, he developed pulmonary infarction due to pulmonary embolism followed by hemoptysis. On day 10 following admission, his oxygen saturation dropped from 95% to 88%, with a marked decrease in his ventilator tidal volume, accompanied by an inability to ventilate the patient. Thereafter, we increased the VV-ECMO flow and exchanged his endotracheal tube. The lumen of the removed tracheal tube was found to be occluded by a large-sized blood coagulum. There was no further episode of tube occlusion. The patient was discharged in a walkable state on day 39 following admission. Endotracheal tube obstruction secondary to hemoptysis should be suggested in patients with COVID-19 requiring ventilator support, as they are unable to perform frequent endotracheal tube suctions owing to the risk of infection.
机译：血栓形成并发症的发病率在重症监护单位的严重冠状病毒疾病（Covid-19）患者中非常高。由于对炎症，低氧血症和传播血管内凝血过度的免疫反应，诸如细胞因子风暴的各种因素被认为是血栓形成并发症的易感因素。一个55岁的日本男子预防八天以前推荐给我们的医院，因为逆转转录聚合酶链反应的咽部拭子患者患者咽拭子阳性后的严重Covid-19肺炎诊断。在参考医院继续患者继续保持缺氧（PAO 2 / FIO 2比率＆ 100 mmHg）。在入院时，我们引发了静脉体外膜氧合（VV-ECMO）。在VV-ECMO期间，使用未被二肝素和NaFamostat甲磺酸盐作为抗凝血剂。尽管抗凝治疗足够，但由于肺栓塞随后，他开发了肺部梗塞。在入院后的第10天，他的氧饱和度降至95％至88％，其呼吸机潮气量显着降低，伴随着不可能通风患者。此后，我们增加了VV-ECMO流程并交换了他的气管内管。发现除去的气管管的内腔被大型血凝凝血物堵塞。没有进一步的管闭塞发作。患者在入院后的第39天以可行性状态排放。在需要呼吸机支撑的Covid-19患者中应建议中血液肿阻塞，因为由于感染风险，Covid-19需要呼吸机支撑的患者患者。

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