Subcutaneous emphysema is a known complication of invasive procedures >> << some >> << surgeries and health
with airway obstruction. It can also occur during mechanical ventilation for acute respiratory distress syndrome (HRDS), and can be attributed to pneumomedia-stinum with or without pneumothorax. Any condition that creates a gradient between intra-alveolar and perivascular interstitial pressure may create a pneumo-mediastinum with subcutaneous emphysema. This condition results in injury, discomfort and anxiety, but rarely airway compromise and respiratory failure. Management is usually conservative, but in severe cases, micro-drainage described in adult patients. Case Report 30-month old boy with acute lymphoblastic leukemia who developed febrile neutropenia and severe respiratory failure requiring intubation after the first induction chemotherapy. Despite the wide coverage of antibiotics, antifungal and antiviral drugs, the child developed HRDS. Open light and permitting strategy was hyperkapnyy. Despite the light shielding strategies he developed left side pneumothorax is easily released from the catheter forward, whereupon development pnevmomediastinuma and massive subcutaneous emphysema of the head to the scrotum. Escalated ventilation requirements without any other identifiable cause suggested that his massive subcutaneous emphysema combined with pnevmomediastinuma created a restrictive model for ventilation. Search literature has shown the potential of simple solutions with a modified perforated angiocatheters. We decided to use 18 gauge catheter through the size and condition of the skin of the child. Two angiocatheters were prepared in a bed in sterile conditions as described Beck, et al. [1], with minor modifications. A smaller catheter selected, only five holes were opened using a scalpel, three above and two below plastic and the needle was in place. The area of insertion was changed. Instead of the subclavian region, we decided to stay away from the site of vascular port and decided to use the area most swelling, which corresponded to lower thoracic region midaxillary line. After training area chlorhexidine scrub and draping, changing catheters were inserted subcutaneously 40-45 degrees, about 0. 1.5 cm cranial to and forwarded in a plane parallel to the full insertion. Angiocatheters were recorded on tape with clear skin with tape and connected to underwater seal drains tend to a closed system and allows direct visualization of air evacuation. Compression massage was applied in relation to nurses drain angiocatheters every 4:00. Dehumidification has been enhanced with massage, which verified the simultaneous observation bubbles in the chamber seal water. Angiocatheters were in place for 24-48 hours to stop bubbles. Within 24 hours, a significant improvement in ESE was not observed. Pnevmomediastinuma also declined, albeit more slowly, full resolution occurring within five days. Fan support can break, and the patient was successfully Extubation within five days. There were no complications associated with insertion angiocatheters subcutaneously. The patient was transferred back to the palace a week after Extubation. He remains at home for its maintenance chemotherapy after six months of his stay intensive care. Discussion of various invasive and inconvenient methods were used for the treatment of large subcutaneous emphysema, with potential to cause subcutaneous emphysema itself. Subclavian cuts, extra tubes breast or intrapleural or subcutaneously, and the inclusion of large diameter subcutaneous drains with or without suction, and Tracheostomy was the traditional treatment options. Successful micro-drainage of subcutaneous emphysema with simply arranged angiocatheters was first described by Beck et al. [1]. This was followed by three other reported cases of adult [2-4]. Leo and others. [5] and reported their experience with microdrainage catheters in a retrospective review of 12 patients from the European Institute of Oncology in the database after major thoracic surgery. The procedure is said to have effective and free of complications [5]. Our patient required increasing ventilation pressure, despite the tolerance permits hyperkapnyy after development and ESE pnevmomediastinuma, and only after microdrainage we can wean supplemental oxygen and ventilation pressure. This observation indicates that the subcutaneous air can potentially create a restrictive lasix 40 mg ivp defect in the ventilation of the lungs are diseased. We noticed that this minimally invasive method was simple and effective in our patient, and is unable to serious complications. We believe that this procedure can be considered as first-line therapy for symptomatic patients in the ESE children. Contributors: All authors contribute to the management of patients and preparation of manuscripts. Funding: No competing interests: Not applicable.
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