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Abstract
Respiratory care advances such as the introduction of ventilatory assistance have been associated with postintubation airway stenosis resulting from tracheal injury at the site of the inflatable cuff on endotracheal or tracheostomy tubes. Low-pressure cuffs have significantly reduced this occurrence. Loss of airway stability at the site of a tracheostomy stoma may result in tracheal stenosis. Subglottic stenosis may result from a high tracheostomy site at, or just inferior to, the cricoid arch, or to malposition of an endotracheal tube cuff. Awareness of these complications and their causes is essential to prevent their occurrence.
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Affiliation(s)
- Joel D Cooper
- Department of Surgery, Division of Thoracic Surgery, Hospital of the University of Pennsylvania, University of Pennsylvania, 3400 Spruce Street, White 6, Philadelphia, PA 19104, USA.
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2
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[A Successful Case of Tracheal Segmental Resection and Reconstruction for Cicatricial Tracheal Stenosis]. J UOEH 2017; 39:309-312. [PMID: 29249744 DOI: 10.7888/juoeh.39.309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A 45-year-old man had consciousness disorder due to fall trauma had received ventilation support and tracheostomy. Two months later, the tracheostomy tube was removed. One year later, he suffered from severe cicatricial tracheal stenosis. Under a diagnosis of post-intubation tracheal stenosis, he underwent circumferential resection and end-to-end anastomosis of the trachea. The central part of the resected trachea of 3 cartilage rings showed a stenosis like a pin hole. The post operative course was uneventful, and there was no stenosis or sutural insufficiency on examination by bronchoscopy. Tracheal resection and reconstruction is rare but effective for refractory tracheal stenosis.
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3
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Nakashima K, Naito T, Endo M, Nakajima T, Takahashi T. Tracheal granuloma 7 years after extubation. Respirol Case Rep 2017; 5:e00252. [PMID: 28736614 PMCID: PMC5518767 DOI: 10.1002/rcr2.252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 06/10/2017] [Accepted: 06/11/2017] [Indexed: 11/08/2022] Open
Abstract
Tracheal granuloma can cause severe stenosis long after extubation. When a patient with a history of endobronchial intubation has an intratracheal tumour, we should consider the possibility of this condition.
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Affiliation(s)
| | - Tateaki Naito
- Division of Thoracic Oncology Shizuoka Cancer Center Shizuoka Japan
| | - Masahiro Endo
- Division of Diagnostic Radiology Shizuoka Cancer Center Shizuoka Japan
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4
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Abstract
The causes of respiratory failure can be divided into two main groups: extrapulmonary and pulmonary. Extrapulmonary causes of respiratory failure include conditions that exclusively or primarily cause respiratory failure by their effect on structures other than the lungs (i.e., the extrapulmonary compartment). To place the topic of extrapulmonary respiratory failure into perspective, we briefly review normal and abnormal gas exchange and then examine how one can use this information to suspect or confirm the diagnosis of an extrapulmonary cause of respiratory failure. We then review the individual causes of extrapulmonary respiratory failure. These have been divided into two main functional categories: (1) those that involve a decrease in normal force generation, and (2) those that involve an increase in resistance to (bulk flow) ventilation. We then briefly consider the treatment of these disorders from a respiratory point of view.
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Affiliation(s)
- Melvin R. Pratter
- University of Massachusetts Medical School, Pulmonary Medicine Division, Worcester, MA 01605
| | - Richard S. Irwin
- University of Massachusetts Medical School, Pulmonary Medicine Division, Worcester, MA 01605
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5
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Cooper JD. Surgery of the airway: historic notes. J Thorac Dis 2016; 8:S113-20. [PMID: 26981261 PMCID: PMC4775264 DOI: 10.3978/j.issn.2072-1439.2016.01.87] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 01/06/2016] [Indexed: 11/14/2022]
Abstract
Prior to the 20(th) century, the need for surgical procedures on the airway was infrequent and consisted mainly of tracheostomy to relieve airway obstruction or repair of tracheal injuries such as lacerations. Even the ability of tracheal suture lines to heal primarily was viewed with concern due to the rigidity of the tracheal wall, its precarious blood supply and uncertainty as to whether the cartilage components could heal without complications. In the 20(th) century the evolution of tracheal procedures on major airways evolved to meet the challenges provided by the expanding fields of thoracic surgery and advent of mechanical respiratory support with its associated complications. In the first half of the century lobar and lung resections done for tuberculosis and lung cancer required methods for safe closure of the resulting bronchial stumps and end-to-end bronchial anastomosis in the case of sleeve resections of the lung. Beginning in mid-century the advent of respiratory care units for the treatment of polio and for the expanding fields of thoracic and cardiac surgery resulted in a significant number of post-intubation tracheal stenosis requiring resection and primary repair. In the last 20 years of the century the development of lung transplantation with its requirement for successful bronchial anastomoses between the donor and recipient bronchi, created unique challenges including ischemia of the donor bronchus the adverse effects of immunosuppression, donor lung preservation and diagnosis and management of post-transplant infection and rejection.
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Affiliation(s)
- Joel D Cooper
- Division of Thoracic Surgery, University of Pennsylvania Health System, Philadelphia, PA 19104, USA
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6
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Jung YR, Taek Jeong J, Kyu Lee M, Kim SH, Joong Yong S, Jeong Lee S, Lee WY. Recurred Post-intubation Tracheal Stenosis Treated with Bronchoscopic Cryotherapy. Intern Med 2016; 55:3331-3335. [PMID: 27853078 PMCID: PMC5173503 DOI: 10.2169/internalmedicine.55.6421] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Post-intubation tracheal stenosis accounts for the greatest proportion of whole-cause tracheal stenosis. Treatment of post-intubation tracheal stenosis requires a multidisciplinary approach. Surgery or an endoscopic procedure can be used, depending on the type of stenosis. However, the efficacy of cryotherapy in post-intubation tracheal stenosis has not been validated. Here, we report a case of recurring post-intubation tracheal stenosis successfully treated with bronchoscopic cryotherapy that had previously been treated with surgery. In this case, cryotherapy was effective in treating web-like fibrous stenosis, without requiring more surgery. Cryotherapy can be considered as an alternative or primary treatment for post-intubation tracheal stenosis.
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Affiliation(s)
- Ye-Ryung Jung
- Department of Internal Medicine, Yonsei University, Wonju College of Medicine, Korea
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7
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Cho EJ, Kim CJ, Lee MN, Chung MY. Tracheal granuloma after thyroidectomy with difficult intubation. Korean J Anesthesiol 2013; 65:S38-40. [PMID: 24478865 PMCID: PMC3903853 DOI: 10.4097/kjae.2013.65.6s.s38] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Eun-Jeong Cho
- Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chang Jae Kim
- Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Myung No Lee
- Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Mee Young Chung
- Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
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8
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Liju A, Sharma N, Milburn H. An unusual cause of bronchial obstruction. Lung India 2012; 29:393-4. [PMID: 23243362 PMCID: PMC3519034 DOI: 10.4103/0970-2113.102847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Ahmed Liju
- Department of Respiratory Medicine, Lambeth Wing, St Thomas’ Hospital, Guys and Thomas NHS Foundation Trust, London, UK. E-mail:
| | - Neel Sharma
- Department of Respiratory Medicine, Lambeth Wing, St Thomas’ Hospital, Guys and Thomas NHS Foundation Trust, London, UK. E-mail:
| | - Heather Milburn
- Department of Respiratory Medicine, Lambeth Wing, St Thomas’ Hospital, Guys and Thomas NHS Foundation Trust, London, UK. E-mail:
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9
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Tracheostomy in maxillofacial surgery: a simple and safe technique for residents in training. J Craniofac Surg 2011; 22:243-6. [PMID: 21233743 DOI: 10.1097/scs.0b013e3181f7b6e8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Tracheostomy is a frequently performed surgical procedure and may be required under emergency, semiurgent, or elective conditions. In maxillofacial surgery, it is indicated in congenital, inflammatory, oncologic, or traumatic respiratory obstruction and prolonged intubation. This article presents a simplified tracheostomy procedure based on anatomic markers that gives the best compromise between minimum invasiveness and safety. PATIENTS AND METHODS A retrospective study analyzed the clinical aspects, treatment methods, and clinical course of 198 patients who underwent tracheostomies performed by residents in training under the supervision of surgeons between October 2002 and December 2007 at the Maxillofacial Surgery Department of Carlo Poma Hospital, Mantova, and the Maxillofacial Unit, Head and Neck Department, University of Modena and Reggio Emilia, Italy. Tracheostomies were performed in 127 patients (64.14%) with neoplastic diseases (tumors of the tongue base, tonsils, and oral and pharyngeal regions) and in 71 patients with trauma (35.86%). The patients were followed up for 3 to 65 months. RESULTS Acceptable clinical healing and outcomes were obtained in all patients. Intraoperative complications occurred in 35 patients (17.7%): bleeding in 32 patients (16.2%) and pretracheal or paratracheal tube placement in 3 patients (1.51%). Postoperative complications after tracheostomy closure included tracheostomy dehiscence in 5 patients (2.52%) and subcutaneous emphysema in 26 patients (13.12%). Tracheostomy dehiscence occurred in 3 patients with neoplasia (1.51%) and in 2 patients with trauma (1.01%). No symptomatic tracheal stenosis developed. CONCLUSIONS The standardized surgical technique presented here reduces the associated surgical risk when the correct anatomic markers are used and important structures are recognized and handled correctly.
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10
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Sivakumar K, Prepageran N, Raman R. Evaluation of tracheal diameter after surgical tracheostomy. Am J Otolaryngol 2006; 27:310-3. [PMID: 16935173 DOI: 10.1016/j.amjoto.2006.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2005] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this study was to evaluate the narrowing of the trachea in head and neck surgical patients who had undergone elective tracheostomy. MATERIALS AND METHODS This is a prospective study. Twenty-five patients were included in this study. All these patients had a preoperative elective tracheotomy, preceding major head and neck surgery for head and neck malignancies. An x-ray of the lateral soft tissue neck was taken after a minimum of 6 weeks after the dissimulation of tracheotomy tube. Diameter of the trachea above the stoma (around 2 cm below the cricoid ring that can be clearly seen in lateral x-ray corresponding to the second tracheal ring) was taken as controls. Data were entered into a computer database and statistically analyzed using SPSS for Windows (version 12.0; SPSS, Chicago, Ill). In addition to descriptive statistics for all patients, inferential statistics were used to compare the 2 tracheal diameters across all patients and within the subgroups of men and women. Associations between outcome and other variables were evaluated statistically using an chi 2 test for the categorical data. Other parametric and nonparametric statistical tests were used when appropriate. Criterion for statistical significance was set at P < .05 (Student t test and 2-tailed test). RESULTS From this study, 92% (23/25) patients developed narrowing of trachea, all less than 50%. Very early decanulation of tracheotomy shows low or no narrowing at all. There is gradual narrowing in patients in whom dissimulations were performed after 14 days. Ethnicities of Indian decent (13/25) predominate in this study population. Male patients in this study have shorter decanulation period compared with female. CONCLUSIONS Elective surgical tracheotomy is a relatively safe procedure resulting in minimum asymptomatic tracheal stenosis.
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Affiliation(s)
- Kumarasamy Sivakumar
- Department of Otolaryngology, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
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11
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Grillo HC. Concentration versus specialization? a case study on the arteria aspera. J Am Coll Surg 2004; 198:291-301. [PMID: 14759787 DOI: 10.1016/j.jamcollsurg.2003.08.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2003] [Accepted: 08/27/2003] [Indexed: 11/30/2022]
Affiliation(s)
- Hermes C Grillo
- General Thoracic Surgical Division, Massachusetts General Hospital, and Harvard Medical School, Blake 1570, 55 Fruit Street, Boston, MA 02114, USA
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12
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Abstract
Tracheal surgery, which did not exist in a coherent, systematic fashion 45 years ago, has developed techniques that allow resection of approximately half of the adult trachea with primary reconstruction, largely by anatomic mobilization procedures. Dependable methods have also been developed for laryngotracheal and carinal resection and reconstruction. The daunting problem of long congenital tracheal stenosis appears to be largely solved by slide tracheoplasty. In the past four decades much has also been learned about the etiology, natural history, pathology, and (in some cases) prevention of tracheal diseases including primary and secondary tumors, postintubation injuries, and idiopathic stenosis.
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Affiliation(s)
- Hermes C Grillo
- Massachusetts General Hospital, 55 Fruit Street, Blake 1570, Boston, MA 02114, USA
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13
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Affiliation(s)
- Hermes C Grillo
- Division of General Thoracic Surgery, Massachusetts General Hospital and Department of Surgery, Harvard Medical School, Boston, Massachusetts 02114, USA.
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14
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Affiliation(s)
- Hermes C Grillo
- Division of General Thoracic Surgery, Massachusetts General Hospital and Department of Surgery, Harvard Medical School, Boston, Massachusetts 02114, USA.
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15
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COELHO MARLOSDESOUZA, STORI JUNIOR WILSONDESOUZA. Lesões crônicas da laringe pela intubação traqueal. ACTA ACUST UNITED AC 2001. [DOI: 10.1590/s0102-35862001000200003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Introdução: Várias complicações, muitas vezes graves, têm sido relacionadas com a intubação traqueal (IT), com incidência chegando a 18%. Objetivos: Analisar as alterações da laringe provocadas pela IT: o desenvolvimento de estenose e de granuloma na laringe e a evolução da voz. Pacientes e métodos: Foram estudados prospectivamente 73 pacientes internados na Unidade de Terapia Intensiva do Hospital Cajuru, da Pontifícia Universidade Católica do Paraná, na região Sul do Brasil, submetidos a IT por cinco dias consecutivos e com previsão de necessidade de IT por mais sete dias, que foram traqueostomizados no sexto dia de IT. Foi realizada fibrolaringotraqueobroncoscopia (FLTB) nos 6º, 14º, 21º, 28º, 60º, 90º e no 180º dias após a IT. Resultados: No 180º dia do estudo havia 30 pacientes sobreviventes: 18 apresentavam voz normal, nove não puderam ser avaliados e três apresentavam disfonia. Em oito pacientes foram observados granulomas na laringe, sendo que cinco foram curados espontaneamente, dois foram ressecados e um permaneceu no 180º dia do estudo. Apenas um paciente apresentou estenose de laringe. Conclusões: Devido ao menor tempo de exposição da laringe ao trauma da cânula orotraqueal, a realização da traqueostomia no 6º dia da IT parece causar poucas complicações.
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16
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Affiliation(s)
- W T Miller
- Department of Radiology, Suite 3390 Gibbon, Thomas Jefferson University Hospital, 111 S 11th St, Philadelphia, PA 19107, USA
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17
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Tan HK, Holinger LD, Chen JC, Gonzalez-Crussi F. Fragmented, distorted cricoid cartilage: an acquired abnormality. Ann Otol Rhinol Laryngol 1996; 105:348-55. [PMID: 8651627 DOI: 10.1177/000348949610500504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
This paper reports the identification of the fragmented, distorted cricoid cartilage. The laryngeal findings in four patients with this acquired abnormality are presented. The postmortem whole organ serial section of their larynges is described and illustrated with horizontal sections from the Laryngeal Development Laboratory in Chicago. The histopathologic sequence, pathogenesis, and clinical relevance are elucidated.
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Affiliation(s)
- H K Tan
- Division of Pediatric Otolaryngology, Children's Memorial Hospital, Chicago, IL 60614, USA
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18
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Law JH, Barnhart K, Rowlett W, de la Rocha O, Lowenberg S. Increased frequency of obstructive airway abnormalities with long-term tracheostomy. Chest 1993; 104:136-8. [PMID: 8325056 DOI: 10.1378/chest.104.1.136] [Citation(s) in RCA: 80] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Eighty-one patients with long-term tracheostomy tubes (mean duration, 4.9 months) were examined via fiberoptic bronchoscopy prior to decannulation. Obstructive airway lesions were observed in 54 patients (67 percent). All tracheal lesions were anatomically located proximal to the stoma. No cuff lesions were observed. The two most commonly observed lesions were tracheal granuloma (60 percent) and tracheomalacia (29 percent). Less frequently observed lesions were tracheostenosis (14 percent) and vocal cord and laryngeal dysfunction (8 percent). As a result of the high frequency of tracheal abnormalities, especially that for tracheal granuloma which has not been previously reported (to our knowledge), we recommend that all decannulation candidates undergo anatomic examination of the airways.
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Affiliation(s)
- J H Law
- Department of Respiratory Services and Speech Pathology, Tustin Rehabilitation Hospital, Calif
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19
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Kato I, Uesugi K, Kikuchihara M, Iwasawa H, Iida J, Tsutsumi K, Iwatake H, Takeyama I. Tracheostomy--the horizontal tracheal incision. J Laryngol Otol 1990; 104:322-5. [PMID: 2196315 DOI: 10.1017/s0022215100112599] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The complication rate after emergency tracheostomy is two to five times greater than after elective procedures. One of the main causes of the high risk of complications in emergency tracheostomy appears to be the amount of time required to open the trachea. Therefore, simple and fast procedures are mandatory. We have developed a new procedure as follows: A horizontal skin incision is performed. Strap muscles are dissected and retracted laterally. A transverse cut between tracheal rings below the thyroid isthmus is performed up to membranous portion of the trachea. The cut ends of the trachea remain open naturally because of the elasticity of the trachea. Skin and tracheal cut-ends are then joined by interrupted sutures. We have used this procedure during the past three years and have not experienced any major complications. This demonstrates the clear advantage and the more physiological nature of the procedure over various other incisions of the tracheal wall.
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Affiliation(s)
- I Kato
- Department of Otolaryngology, St. Marianna University School of Medicine, Kanagawa, Japan
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20
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Maeda M, Nakamoto K, Ohta M, Nakamura K, Nanjo S, Taniguchi K, Tsubota N. Statistical survey of tracheobronchoplasty in Japan. J Thorac Cardiovasc Surg 1989. [DOI: 10.1016/s0022-5223(19)34579-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Rowbottom SJ, Sudhaman DA. Anaesthesia in the management of congenital tracheal stenosis. Anaesth Intensive Care 1989; 17:93-6. [PMID: 2712282 DOI: 10.1177/0310057x8901700120] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- S J Rowbottom
- Department of Anaesthetics, Grantham Hospital, Aberdeen, Hong Kong
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22
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Abstract
Reported is a case of fracture of a tracheal T-tube caused by the patient, a child, pulling on it. A discussion of the use of such tubes is presented and their removal in the event of such an accident.
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Affiliation(s)
- N B Solomons
- Department of Otolaryngology, Red Cross War Memorial Children's Hospital, R.S.A
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23
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Abstract
Subglottic stenosis is the most common serious long-term complication of endotracheal intubation in neonates and its pathogenesis is poorly understood. We describe the experience of one unit with 15 cases of subglottic stenosis requiring operative intervention seen over a 3-year period and review the pathology and pathogenesis of the condition. In 1 instance operative intervention was successful in treatment and avoided the need for long-term tracheostomy. A possible aetiological factor in at least 2 of the cases of subglottic stenosis was insertion of the wide shoulder of the endotracheal tube through the vocal cords. It is suggested that subglottic stenosis is due to reparative fibrosis following particularly severe acute intubation injury. Another factor may be delayed healing of the subglottic mucosa possibly exacerbated by full thickness cricoid cartilage necrosis. Although severe subglottic injury may occur at any time that the endotracheal tube is in situ, the most critical period is the first week of intubation.
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25
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Abstract
In selected patients with obstructive sleep apnea, the uvulopalatopharyngoplasty procedure may be performed to remove excessive tissue in the oropharyngeal airway. This may improve the symptoms of sleep apnea as well as snoring. Tracheostomy may be indicated in patients with obstructive sleep apnea with associated severe medical problems.
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26
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Gould SJ, Howard S. The histopathology of the larynx in the neonate following endotracheal intubation. J Pathol 1985; 146:301-11. [PMID: 4032125 DOI: 10.1002/path.1711460403] [Citation(s) in RCA: 59] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Subglottic stenosis is the most common serious complication of endotracheal intubation in the neonate with an incidence of between 1-8 per cent. While considered a complication of traumatic injury to the larynx and possibly associated with prolonged intubation, the pathogenesis is poorly understood and the pathology has not been described in detail. The nature of intubation induced injury has been investigated by examining step-sections of 43 larynges removed from neonates post-mortem who had been intubated for periods ranging from 10 min to 12 weeks. Focal ulceration was identified in the supraglottis and the anterior glottis. Similar injury was seen in the posterior glottis and subglottis but with more prolonged intubation there was full thickness mucosal necrosis, perichondritis and partial destruction of the arytenoid and cricoid cartilages. Although the severity of the injury progressed with time and many of the most severe injuries occurred early, in the second and third weeks of intubation, the larynx usually healed despite the continued presence of the endotracheal tube. Prolonged intubation on its own does not appear to be an important factor in the production of severe laryngeal injury nor, therefore, the subsequent complications such as subglottic stenosis.
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27
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Holst M, Hedenstierna G, Kumlien JA, Schiratzki H. Five years experience of coniotomy. Intensive Care Med 1985; 11:202-6. [PMID: 4044996 DOI: 10.1007/bf00272404] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The view held over the last six decades that coniotomy often leads to subglottic stenosis has recently been called into question. In this study 203 electively performed coniotomies were analysed. The operation was found to be much simpler than tracheostomy. No severe intra- or postoperative complications occurred. Six months after decannulation 61 patients operated on were alive and accessible to follow-up examination. No evidence of subglottic stenosis was found. The main disadvantage was a relatively high frequency of voice disorder.
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28
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Abstract
The view current over the last 60 years or so that coniotomy often leads to subglottic stenosis has recently been called into question. In the present study 103 electively performed coniotomies have been analysed. The operation was found to be much easier than tracheotomy. There was no case of severe peroperative or postoperative complications. Six months after decannulation 28 patients were alive and accessible to follow-up examination. No evidence of subglottic stenosis was found. The main disadvantage of this operation would seem to be a tendency for the development of voice changes.
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29
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Abstract
A questionnaire was circulated to members of the Intensive Care Society and hospitals with more than 120 acute beds in the United Kingdom. The object was to determine the usage of the various types of cuffs on tracheal tubes and the practice of long-term tracheal intubation in contrast to tracheostomy. One hundred and fifty two replies were received (a 55% response rate). The majority of units favoured the high volume cuff for long term ventilation (61% for tracheal tubes and 69.2% for tracheostomy tubes). The cuffs were mainly inflated to 'no-leak' ventilation and pressure was not measured. The majority of units changed from tracheal tubes to tracheostomy after about one week but, for children, a longer period of tracheal intubation is employed. The results are discussed.
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30
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James OF, Moore PG. Tracheostomy in the management of chest injuries: its use and complications. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 1981; 51:598-602. [PMID: 6949560 DOI: 10.1111/j.1445-2197.1981.tb05261.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
During the period March 1968 to June 1978 a total of 238 adult patients received long term artificial ventilation for acute respiratory failure following chest and associated injuries. In 180 of these tracheostomy was used as the means of access to the tracheobronchial tree. Our indications for tracheostomy in these patients, details of treatment and the complications which resulted from this aid to management are given. The lack of serious complications suggests that tracheostomy can be used safely and with advantage in the management of acute respiratory failure after injury.
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31
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Verano Rodriguez A. Problematica clinica y radiologica. Arch Bronconeumol 1981. [DOI: 10.1016/s0300-2896(15)32388-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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32
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Natvig K, Olving JH. Tracheal changes in relation to different tracheostomy techniques. (An experimental study on rabbits). J Laryngol Otol 1981; 95:61-8. [PMID: 7462779 DOI: 10.1017/s0022215100090411] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
An experimental study on rabbits was undertaken to evaluate the effect of the tracheostomy technique on the development of tracheal stenosis. An operation model was made for the purpose of excluding all pathogenetic factors in the formation of tracheal stenosis, except the surgical procedure. Five different operative methods were used: A. vertical incision, B. anterior wall flap, C. H-type incision, D. window-type excision, and E. subperichondreal enucleation of cartilage. The "cannulation" period was 7 days, and the animals were kept alive for another 140 days before postmortem examinations were undertaken. Minor macroscopical and microscopical changes were noted. The pathological findings were somewhat more pronounced in groups B, C and E than in the other groups. The tracheostomy technique apparently plays a minor role in the formation of tracheal stenosis.
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Stauffer JL, Olson DE, Petty TL. Complications and consequences of endotracheal intubation and tracheotomy. A prospective study of 150 critically ill adult patients. Am J Med 1981; 70:65-76. [PMID: 7457492 DOI: 10.1016/0002-9343(81)90413-7] [Citation(s) in RCA: 725] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
A prospective study of the complications and consequences of translaryngeal endotracheal intubation and tracheotomy was conducted on 150 critically ill adult patients. Adverse consequences occurred in 62 percent of all endotracheal intubations and in 66 percent of all tracheotomies during placement and use of the artificial airways. The most frequent problems during endotracheal intubation were excessive cuff pressure requirements (19 percent), self-extubation (13 percent) and inability to seal the airway (11 percent). Patient discomfort and difficulty in suctioning tracheobronchial secretions were very uncommon. Problems with tracheotomy included stomal infection (36 percent), stomal hemorrhage (36 percent), excessive cuff pressure requirements (23 percent) and subcutaneous emphysema or pneumomediastinum (13 percent). Complications of tracheotomy were judged to be more severe than those of endotracheal intubation. Follow-up studies of survivors revealed a high prevalence of tracheal stenosis after tracheotomy (65 percent) and significantly less after endotracheal intubation (19 percent)(p < 0.01). Thirty-nine of 41 (95 percent) patients with endotracheal intubation and 20 of 22 (91 percent) patients with tracheotomy had laryngotracheal injury at autopsy. Ulcers on the posterior aspect of the true vocal cords were found at autopsy in 51 percent of the patients who died after endotracheal intubation. There was no significant relationship between the duration of endotracheal intubation or tracheotomy and the over-all amount of laryngotracheal injury at autopsy, although patients with prolonged endotracheal intubation followed by tracheotomy had more laryngeal injury at autopsy (P = 0.06) and more frequent tracheal stenosis (P = 0.05) than patients with short-term endotracheal intubation followed by tracheotomy. Adverse effects of both endotracheal intubation and tracheotomy are common. The value of tracheotomy when an artificial airway is required for periods as long as three weeks is not supported by data obtained in this study.
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Philips RL, Swart JG. Radiology in the detection and management of tracheal stenosis. AUSTRALASIAN RADIOLOGY 1980; 24:250-4. [PMID: 7236162 DOI: 10.1111/j.1440-1673.1980.tb02194.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Arola MK, Puhakka H, Mäkelä P. Healing of lesions caused by cuffed tracheostomy tubes and their late sequelae; a follow-up study. Acta Anaesthesiol Scand 1980; 24:169-77. [PMID: 7445932 DOI: 10.1111/j.1399-6576.1980.tb01528.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The healing of tracheostomy and cuff-induced tracheal injury was followed up in 48 tracheostomized patients (44 men and 4 women). The patients were studied by means of tracheoscopy, fluoroscopy and tracheography, with a positive contrast medium. At extubation, tracheoscopy revealed 12 mild, 23 moderate and 13 severe injuries at the cuff level. Three months after extubation, the stoma had closed in 89% of the patients studied. In 85% of the patients, the side wall of the stoma was found to have collapsed inwards and in 71% scars were observed at the cuff level. No significant changes took place after the follow-up study at 3 months. At tracheography it was found that narrowing of the tracheal diameter at the stomal level was of only mild or moderate degree (i.e. 0-33%). There was not a single instance of severe stenosis. At the cuff level, a slight inward collapse of the side wall was observed in one patient, and in all the other patients the lumen was normal. Fluoroscopy did not reveal severe tracheomalacia in any patient. Increased mobility of the stomal scar, especially in connection with coughing was seen in some patients. One tracheo-innominate artery erosion and one bleeding granulation tissue at the stoma were confirmed during follow-up. Surgical trauma to the trachea at the stoma seems to be a more potent cause of subsequent narrowing of the trachea than the cuff. Even though severe injuries may also heal with few sequelae, the use of tracheostomy tubes with large, low-pressure cuffs, which have been shown to cause less damage to the trachea, is indicated.
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Stenqvist O, Bagge U, Nilsson K. The tracheal mucosa microvasculature and microcirculation. Intravital microscopic observations in rabbits and a histologic study in man. Acta Otolaryngol 1979; 87:123-8. [PMID: 760371 DOI: 10.3109/00016487909126396] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
A method for the intravital microscopic study of the tracheal mucosal microcirculation in the rabbit is described. A low tracheostomy is performed for ventilation, while a hole cut in the ventral portion of the trachea cranial to the tracheostomy is used for observations. The trachea is immobilized by a fixation device. Microscopic observations are made with a Leitz stereo microscope. The microvasculature of the rabbit tracheal mucosa is characterized by centripetally arranged arterioles which subdivide into a fairly sparse capillary network at the mucosal surface. The capillaries drain into venular networks at different levels of the mucosa and collect finally into circumferentially arranged veins which run mainly between the cartilages. For comparative purposes the microvasculature of the human tracheal mucosa has been analysed in clarified (Spalteholz) preparations. This investigation shows that the microvascular architecture is principally the same in the human and rabbit tracheal mucosa. There is, however, a much denser capillary network in the human tracheal mucosa.
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Kleinhaus S, Winslow PR, Sheran M, Boley SJ. Evolution of individualized management of tracheal obstruction. J Pediatr Surg 1978; 13:669-76. [PMID: 215735 DOI: 10.1016/s0022-3468(78)80112-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Abstract
The trachea is a dynamic organ that responds to the demands of deglutition, respiration, and gravity. Following tracheal resection, reconstruction should allow the trachea to assume its dynamic functions. Experiments in dogs revealed that mercury-in-silastic strain gage apparatus can successfully be used to measure the biomechanical dynamics of the trachea and subglottis. The upper tracheal segments assume a larger stress load than the lower tracheal segments following tracheal resection.
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Control mediante el broncofibroscopio del arbol traqueobronquial en pacientes con intubacion. Arch Bronconeumol 1976. [DOI: 10.1016/s0300-2896(15)32725-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Friman L, Hedenstierna G, Schildt B. Stenosis following tracheostomy. A quantitative study of long term results. Anaesthesia 1976; 31:479-93. [PMID: 779512 DOI: 10.1111/j.1365-2044.1976.tb12353.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Seventy out of the 320 patients treated with tracheostomy and respiratory care in an intensive care unit, were included in a follow-up study. A variety of surgical (38) and medical (32) conditions had prompted IPPV for 1-59 days; 33 had had primary and 37 secondary tracheostomies. The final study included an interview, physical examination, radiographic examination and spirometry. Using radiographic measures, the area of stenosis was calculated as well as the pressure drop across the stenosis at various flow rates. The methods of calculation were tested in one patient and compared with the actual tracheal pressure and gas flow recordings. Lateral stenosis was found in 69 and frontal stenosis in 25 patients, the length being 0-2-5-0 cm. The stenosis was situated at the level of the stoma in 59, at the cuff in 6, and at both sites in 2; in 2 the level could not be determined accurately. The mean area of normal trachea was 2-8+/-0-8 cm2 in females and 3-7+/-0-7 cm2 in males, while the stenotic area ranged from 0-86 to 4-54 cm2. A stenosis of potential functional significance was found in 8 patients (area less than 1-5 cm2). The stenotic area correlated well with the pressure drop across the stenosis and better than with the stenosis percentage (1-74%). The predicted pressure falls over the stenosis at different flow rates were in excellent agreement with those measured in one patient. Spirometry was unsuitable for detecting the stenosis. Poor correlation were found between the degree of tracheal stenosis and chronic respiratory disease, smoking, age, interval between intubation and tracheostomy, or duration of IPPV. Dysponea during moderate exercise was present in all patients who had a pronounced stenosis.
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Abstract
We compared 11 patients with upper airway obstruction (obstruction at or proximal to the carina) to 22 patients with chronic obstructive pulmonary disease and to 15 normal subjects utilizing spirometry, lung volumes, airway resistance, maximal voluntary ventilation, single-breath diffusion capacity, and maximal inspiratory and expiratory flow-volume loops. Four values usually distinguished patients with upper airway obstruction: (1) forced inspiratory flow at 50 percent of the vital capacity (FIF50%) less than or equal to 100 L/min; (2) ratio of forced expiratory flow at 50 percent of the vital capacity of the FIR50% (FEF50%/FIF50%) larger than or equal to 1; (3) ratio of the forced expiratory volume in one second measured in milliliters to the peak expiratory flow rate in liters per minute (FEV1/PEFR) larger than or equal to 10 ml/L/min; and (4) ratio of the forced expired volume in one second to the forced expired volume in 0.5 second (FEV1/FEV0.5) larger than or equal to 1.5. The last ratio can be determined with a simple spirometer.
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Primary tracheal anastomosis after resection of the cricoid cartilage with preservation of recurrent laryngeal nerves. J Thorac Cardiovasc Surg 1975. [DOI: 10.1016/s0022-5223(19)39664-3] [Citation(s) in RCA: 207] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Dane TE, King EG. A prospective study of complications after tracheostomy for assisted ventilation. Chest 1975; 67:398-404. [PMID: 1122767 DOI: 10.1378/chest.67.4.398] [Citation(s) in RCA: 77] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
A prospective study of 40 patients having elective tracheostomy for ventilatory assistance used fiberoptic bronchoscopy and radiologic examination to assess tracheal healing after extubation. Ten percent of patients had bleeding complications of tracheostomy and 17.5 percent had tracheostomy management problems. Sixteen percent of survivors had asymptomatic stomal site tracheal narrowing and 8 percent required tracheal resection for symptomatic stomal site tracheal stenosis, 16 percent had asymptomatic tracheal defects at the cuff site. Stomal healing was seen to consist of gradual stomal shrinkage, resolution of tracheitis, and approximation of divided tracheal rings. No statistically significant correlation was demonstrated between various factors operative during ventilatory assistance and subsequent tracheal healing. All patients should have routine endoscopic or radiologic tracheal assessment after-tracheostomy.
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Eriksson I, Nilsson LG, Nordström S, Sjöstrand U. High-frequency positive-pressure ventilation (hfppv) during transthoracic resection of tracheal stenosis and during peroperative bronchoscopic examination. Acta Anaesthesiol Scand 1975; 19:113-9. [PMID: 1094781 DOI: 10.1111/j.1399-6576.1975.tb05230.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Operation of a patient with intrathoracic tracheal stenosis using a new ventilation technique (HFPPV) is described. The technique permits tracheoscopy during ventilation and operation, thus enabling exact location of the stenosis to be obtained. Further, peroperative tracheoscopic checking of the anastomosis can be carried out. Resection and anastomosis can be performed without interference of a bulky endotracheal tube.
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McKibbin B, Brotherton BJ. The early management of cervical spin injuries. Resuscitation 1973; 2:241-8. [PMID: 4793520 DOI: 10.1016/0300-9572(73)90028-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Abstract
Grillo, H. C. (1973).Thorax, 28, 667-679. Reconstruction of the trachea. Experience in 100 consecutive cases. Anatomic mobilization of the trachea permits resection of one-half or more with primary anastomosis. An anterior approach by a cervical or cervicomediastinal route utilizes cervical flexion to devolve the larynx and tracheal mobilization with preservation of the lateral blood supply. The transthoracic route is employed for lower tracheal lesions. Over 100 tracheal resections have been done using these methods of direct reconstruction. Eighty-four patients suffered from benign strictures, 79 resulting from intubation injuries. Eleven primary tracheal tumours and five secondary tumours are included. The majority of lesions following intubation occurred at the level of the cuff. It was possible to repair 78 of the 84 stenotic lesions through a cervical or cervicomediastinal approach. Seventy-three of the 84 patients with inflammatory lesions obtained an excellent or good functional and anatomic result. Nine of 11 patients with primary neoplasms who underwent reconstruction are alive and without known disease. There were five early postoperative deaths in these 100 consecutive patients who underwent tracheal reconstruction.
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