PMC5449159_01
Veno-venous extracorporeal membrane oxygenation.
tcrm-13-655Fig1.jpg
PMC5449159_01_tcrm-13-655Fig1.jpg
f1-tcrm-13-655
She was put on veno-venous extracorporeal membrane oxygenation (vv-ECMO) with a partial thromboplastin time of 60 seconds in a preseptic status (Figure 1).
Additional low tidal ventilation through a percutaneous tracheostoma.
tcrm-13-655Fig2.jpg
PMC5449159_01_tcrm-13-655Fig2.jpg
f2-tcrm-13-655
In addition, she was ventilated through a tracheostoma with low ventilation forces (Figure 2).
Tracheal cannula just at the lower end of the mediastinal fistula.
tcrm-13-655Fig3.jpg
PMC5449159_01_tcrm-13-655Fig3.jpg
f3-tcrm-13-655
A thoracic computed tomography on October 27, 2016, confirmed a big fistula of the tracheal membrane of at least 3.5 cm length (Figure 3).
First DLET in the FS, a second DLET is used for distal ventilation.. Abbreviations: DLET, double-lumen endotracheal tube exchange catheter; FS, Freitag stent.
tcrm-13-655Fig4.jpg
PMC5449159_01_tcrm-13-655Fig4.jpg
f4-tcrm-13-655
A bronchoscope is introduced in the FS in order to push downward the manually compressed distal y of the FS.. Abbreviation: FS, Freitag stent.
tcrm-13-655Fig5.jpg
PMC5449159_01_tcrm-13-655Fig5.jpg
f5-tcrm-13-655
Fluoroscopy of the above-mentioned situation.
tcrm-13-655Fig6.jpg
PMC5449159_01_tcrm-13-655Fig6.jpg
f6-tcrm-13-655
The FS has already pushed down to the level of clavicles' insertion. Abbreviation: FS, Freitag stent.
tcrm-13-655Fig7.jpg
PMC5449159_01_tcrm-13-655Fig7.jpg
f7-tcrm-13-655
Before stent modification, the bronchoscope was removed and, in addition, a nasal jet-catheter was introduced into the FS by seldinger technique.. Abbreviation: FS, Freitag stent.
tcrm-13-655Fig8.jpg
PMC5449159_01_tcrm-13-655Fig8.jpg
f8-tcrm-13-655
The lower new edge of this stoma was fixed subcutaneously (Figures 8 and 9).
The anterior surface of FS has been cut already, and inside the FS a DLET and nasal jet-catheter are used for stabilization.. Abbreviations: DLET, double-lumen endotracheal tube exchange catheter; FS, Freitag stent.
tcrm-13-655Fig9.jpg
PMC5449159_01_tcrm-13-655Fig9.jpg
f9-tcrm-13-655
The lower new edge of this stoma was fixed subcutaneously (Figures 8 and 9).
The orally maneuvered jagwire running outward of the new stoma of the FS. This jagwire is bended up, introduced into the proximal orifice of the FS, and leads outward again at the new stoma of the FS. Over this jagwire is pushed downward out of the mew stoma of the FS a DLET for stabilization. A nasal jet-catheter is used for additional ventilation in the distal y-stent by insertion into the new stoma of the FS.. Abbreviations: DLET, double-lumen endotracheal tube exchange catheter; FS, Freitag stent.
tcrm-13-655Fig10.jpg
PMC5449159_01_tcrm-13-655Fig10.jpg
f10-tcrm-13-655
By bending the FS outward at the level of percutaneous stoma and pulling the jagwire at both ends - one end was below the level of percutaneous stoma, the other was beyond the mouth - the FS flipped with its upper part over the soft-tip stiff DLET into the upper third of the trachea (Figures 10-12).
By tearing both ends of the jagwire and bending the straight part of the y-stent outward, the upper half of the FS is flipped over the jagwire into the upper third of the ruptured trachea.. Abbreviation: FS, Freitag stent.
tcrm-13-655Fig11.jpg
PMC5449159_01_tcrm-13-655Fig11.jpg
f11-tcrm-13-655
By bending the FS outward at the level of percutaneous stoma and pulling the jagwire at both ends - one end was below the level of percutaneous stoma, the other was beyond the mouth - the FS flipped with its upper part over the soft-tip stiff DLET into the upper third of the trachea (Figures 10-12).
Continuous patient airway management with the help of a DLET over a jagwire introduced orally and lead out of the tracheal airways at the level of the percutaneous tracheostoma. Jet-catheter ventilation into the distal part of the FS.. Abbreviations: DLET, double-lumen endotracheal tube exchange catheter; FS, Freitag stent.
tcrm-13-655Fig12.jpg
PMC5449159_01_tcrm-13-655Fig12.jpg
f12-tcrm-13-655
By bending the FS outward at the level of percutaneous stoma and pulling the jagwire at both ends - one end was below the level of percutaneous stoma, the other was beyond the mouth - the FS flipped with its upper part over the soft-tip stiff DLET into the upper third of the trachea (Figures 10-12).
Flouroscopy of the above-mentioned moment.
tcrm-13-655Fig13.jpg
PMC5449159_01_tcrm-13-655Fig13.jpg
f13-tcrm-13-655
As the DLET came downward from the mouth, the whole fistula was bridged by the FS up to the level of the vocal cords (Figure 13).
Fixation of the new stoma of the cut FS by subcutaneous threads.. Abbreviation: FS, Freitag stent.
tcrm-13-655Fig14.jpg
PMC5449159_01_tcrm-13-655Fig14.jpg
f14-tcrm-13-655
At the end, the upper edge of the new FS stoma was fixed subcutaneously (Figure 14).
Introduction of a regular tracheal cannula through the new stoma.
tcrm-13-655Fig15.jpg
PMC5449159_01_tcrm-13-655Fig15.jpg
f15-tcrm-13-655