H.K. Lin

Conservative management of a 13-year-old boy with postintubation tracheal injury

Injuries to the trachea can occur in the event of accidental trauma or complications from various medical procedures. Postintubation tracheal injury can be a critical issue; it needs to be recognized as soon as possible because it can be life threatening. The mortality rate of postintubation tracheal injury is as high as 22%. Management has traditionally consisted of surgery, but more and more case reports describe successful recovery after a course of conservative treatment. We present the case of a 13-year-old boy who was transferred to our pediatric intensive care unit with progressive subcutaneous emphysema after emergent endotracheal intubation. This patient was found cyanotic and unconscious in his bed at home. His mother started chest compression at the behest of an emergency medical technician over the phone. The boy had pulseless ventricular tachycardia and ventricular fibrillation during transportation and received endotracheal intubation immediately. After 40 minutes of cardiopulmonary resuscitation, he regained spontaneous circulation. Progressive subcutaneous emphysema was palpable from neck to trunk, and the sound of the boy’s breathing was subdued on his right side. A computed tomography scan showed a pouch-like lesion with rupture at the right side of the middle to lower part of his trachea, as

Airway Delivery of Bone Marrow–Derived Mesenchymal Stem Cells Reverses Bronchopulmonary Dysplasia Superimposed with Acute Respiratory Distress Syndrome in an Infant

Bronchopulmonary dysplasia (BPD), a disease affecting extremely premature infants, results from the disruption of normal pulmonary vascular and alveolar growth. Currently, there is no specific effective treatment. We report a case of a 10-mo-old female infant with BPD, who was admitted because of adenovirus pneumonia and acute respiratory distress syndrome (ARDS) with prolonged venovenous and arteriovenous extracorporeal membrane oxygenation (ECMO) support (total 125 d). The respiratory condition dramatically improved, and ECMO was removed 25 d after intratracheal delivery of maternal bone marrow-derived mesenchymal stem cells (BM-MSCs). Short tandem repeat examinations revealed that there was no maternal cells in the bronchial wash fluid. To our knowledge, this is the first human report of BM-MSC therapy reversal of the course of BPD superimposed with ARDS. We also suggest that BM-MSC therapy may not only be effective in the newborn stage but also works in infants and children with BPD.