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Resuscitation and Critical Care

A2.2 Mediastinal Mass

Dr Shu-wing Ku
Associate Consultant,
Department of Paediatrics and Adolescent Medicine,
Hong Kong Children’s Hospital

Dr Shu-wing Ku is currently working in the field of Paediatric critical care. He had received training in Paediatrics, anaesthesiology and intensive care medicine. He is a fellow of the Hong Kong College of Paediatricians, Hong Kong College of Anaesthesiologists, Australian and New Zealand College of Anaesthetists, and College of Intensive Care Medicine of Australia and New Zealand. He has overseas training experience in Australia, Japan and Sweden in the fields of paediatric intensive care medicine and extracorporeal membrane oxygenation. He has publications both in paediatrics and anaesthesiology. Besides working in the Paediatric Intensive Care Unit, he is also an assistant centre-in-charge of the Simulation Training Centre of Hong Kong Children’s Hospital.

Mediastinal masses consist of a group of benign and malignant tumours. They are uncommon but can lead to significant mortality and morbidity because of airway compression and superior vena cava compression. In high risk patients with mediastinal mass, severe cardiorespiratory compromise may occur with the use of sedation, neuromuscular blocking agents, and initiation of positive pressure ventilation. The principles of management include determination of optimal position for haemodynamic and respiratory status, preload optimization, avoidance of sedation, maintenance of spontaneous breathing, reliable IV access at lower limbs. If endotracheal intubation becomes necessary, an appropriate airway management plan and specially designed equipment should be considered. Transport to a centre with oncology expertise and cardiothoracic surgery support may be required. Transport of patients with mediastinal mass is a high risk procedure that necessitates a careful plan with the consideration of same management principles.

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