Online ISSN: 2187-2988 Print ISSN: 0911-1794
特定非営利活動法人日本小児循環器学会 Japanese Society of Pediatric Cardiology and Cardiac Surgery
Pediatric Cardiology and Cardiac Surgery 40(1): 57-63 (2024)

症例報告Case Report

頸部カニュレーションによる体外式膜型人工肺装着中の患児に対して,合併症なく早期理学療法が施行可能であった一例Uncomplicated Early Physiotherapy for a Child with Extracorporeal Membrane Oxygenation with Neck Cannulation: A Case Report

1北海道立子ども総合医療・療育センター リハビリテーション課Department of Rehabilitation, Hokkaido Medical Center for Child Health and Rehabilitation ◇ Hokkaido, Japan

2北海道立子ども総合医療・療育センター 小児集中治療科Department of Pediatric Intensive Care Medicine, Hokkaido Medical Center for Child Health and Rehabilitation ◇ Hokkaido, Japan

3札幌医科大学 麻酔科学講座Department of Anesthesiology, Sapporo Medical University ◇ Hokkaido, Japan

4北海道立子ども総合医療・療育センター 小児循環器内科Department of Pediatric Cardiology, Hokkaido Medical Center for Child Health and Rehabilitation ◇ Hokkaido, Japan

受付日:2023年9月20日Received: September 20, 2023
受理日:2024年2月12日Accepted: February 12, 2024
発行日:2024年2月29日Published: February 29, 2024

小児重症患者に対する体外式膜型人工肺(extracorporeal membrane oxygenation: ECMO)装着中の早期理学療法に関する報告は本邦ではまれである.その理由として,理学療法中の送脱血管の先端位置の移動や計画外抜去のリスクが考えられる.頸部カニュレーションによるECMO装着中の患児に,合併症なく早期理学療法を施行可能であった一例の経過と,具体的な早期理学療法内容を報告する.症例は既往のない2歳,14.3 kgの男児で,頻脈,頻呼吸を認め,精査の後に頻拍誘発性心筋症と診断された.第2病日に心不全増悪かつ低心拍出状態に対し頸部カニュレーションによるECMOを導入した.関節可動域運動,呼吸理学療法に加え,ECMOの送脱血管の挿入角度の変化を脱血圧と送血流量を見ながら注意し,楔状のウレタンフォームを用い側臥位の体位ドレナージを行った.早期理学療法の合併症はなく,第4病日にECMOを離脱した.第11病日抜管し,第14病日に小児集中治療室を退室した.頸部カニュレーションによるECMOを要した小児急性・重症心不全患者の早期理学療法は,送脱血管の位置や角度を注意する事で合併症なく施行可能であった.

There are few reports on early physiotherapy for critically ill pediatric patients and extracorporeal membrane oxygenation in Japan due to concerns about medical device removal by accident. We present a safe method of early physiotherapy during extracorporeal membrane oxygenation with neck cannulation, as well as the treatment plan. The patient was a 2-year-old boy weighing 14.3 kg with no medical history. He had symptoms of tachypnea and severe tachycardia, so tachycardia-induced cardiomyopathy was diagnosed. On the 2nd day of hospitalization, the heart failure worsened, resulting in low cardiac output syndrome and requiring extracorporeal membrane oxygenation. Physiotherapy, which included range of motion exercises, respiratory physiotherapy, and postural drainage, began on the same day as extracorporeal membrane oxygenation; it was ensured that the neck cannulation insertion angle, drainage pressure, and blood flow were not changed using a handmade wedged-shape urethane cushion. Extracorporeal membrane oxygenation was removed on the 4th day of hospitalization, and there were no complications during the initial physiotherapy. The patient was extubated on the 11th day of hospitalization and discharged on the 14th hospitalization day. Early physiotherapy during extracorporeal membrane oxygenation could be performed safely in a pediatric patient with acute or severe heart failure by ensuring the neck cannulation insertion angle and neck position.

Key words: rehabilitation; pediatric intensive care unit; physiotherapy; early mobilization; extracorporeal membrane oxygenation

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