Acquired subglottic stenosis caused by methicillin resistant Staphylococcus aureus that produce epidermal cell differentiation inhibitor.
Local infection of the trachea in intubated neonates is one of the main risk factors for development of acquired subglottic stenosis, although its role in the pathogenesis is unclear. Methicillin resistant Staphylococcus aureus (MRSA) is often the cause of critical illness in neonatal patients. Two cases are reported of acquired subglottic stenosis following bacterial infection of the trachea, suggesting an association with the staphylococcal exotoxin, epidermal cell differentiation inhibitor (EDIN). EDIN-producing MRSA were isolated from purulent tracheal secretions from both infants. Acquired subglottic stenosis in both cases was probably caused by delayed wound healing as the result of EDIN inhibition of epithelial cell migration. (+info)
New approaches to the management of subglottic stenosis in Wegener's granulomatosis.
Further development of conservative endoscopic procedures at the CCF has provided patients with dependable surgical adjuncts to the systemic medications of WG. In most instances, a single surgical dilatation procedure stabilizes the patients at an airway diameter that exceeds 50% of the norm, thereby rendering the patient almost asymptomatic at rest and minimally restricted during exercise. The more chronic patients presenting with history of previous surgical procedures performed on their larynx and trachea, usually in other institutions, have been observed to require consecutive treatments after the original treatment, enjoying shorter symptom-free intervals. We have not encountered any local complications such as damage to the vocal cords, altered voice, or compromised structural integrity of the larynx and the trachea. The procedure has been found to be effective and well-tolerated as a means for treating, maintaining, and rehabilitating patients with chronic airway obstruction, particularly in those that have been initially treated by our service, and those that were managed from the very beginning of their disease. However, even the more difficult and complicated cases clearly demonstrate an improvement in their condition through the above treatment protocol, and the interval between treatments gradually increases in this group as well. The more aggressive long-term tube-free tracheostomy procedure, usually performed only on difficult and select patients with severe complications, has proven itself to be a highly gratifying procedure, achieving a permanent mode of management for these patients which safely allows for almost complete freedom from symptoms combined with good tolerance and functional rehabilitation. Video documentation will serve to further demonstrate the beneficial effects of both these modes of treatment. (+info)
Double respiratory sequelae of head injury: subglottic stenosis and bilateral pneumothoraces.
An 18-yr-old man with insulin-dependent diabetes developed severe subglottic stenosis after a very brief period of intubation. Emergency tracheostomy was complicated by the development of bilateral pneumothoraces. This case highlights the importance of making an early diagnosis to minimize the risk of complications and examines postintubation subglottic stenosis in the context of poorly controlled insulin-dependent diabetes mellitus. (+info)
Laryngeal trauma may be obscured by associated injuries of the face and chest. An early assessment of these injuries should be made. Many cases may require observation only. In patients with severe laryngeal fractures, preservation of the airway and control of hemorrhage must first be assured. Following this, splinting by external or internal means should be carried out. Three severe laryngeal injuries were splinted with open and closed plastic moulds, with satisfactory results. It is proposed that early recognition and proper management of severe cases of this nature would shorten the treatment and achieve the best results. (+info)
Acquired subglottic stenosis is a compication or neonatal endotracheal intubation. Although it is rare, it contributes significantly to the morbidity and physical well being of post extubated neonates. A 20-day old neonate, ventilated for meconium aspiration syndrome and persistent fetal circulation, presented with marked stridor and respiratory embarrassment. A stenosed subglottic area was found on rigid bronchoscopy. Anterior cricoid split was performed to relieve the obstruction. He is asymptomatic post operatively. (+info)
Use of a ProSeal laryngeal mask airway and a Ravussin cricothyroidotomy needle in the management of laryngeal and subglottic stenosis causing upper airway obstruction.
We report the successful use of a ProSeal laryngeal mask airway (PLMA) as a dedicated airway to allow fibre-optic inspection and passage through a tightly stenosed glottic and subglottic lesion, before fibre-optic-guided transtracheal placement of a Ravussin needle and jet ventilation. The described technique avoided both tracheostomy and the potential of 'seeding' the tumour by passage of the needle through the mass. The PLMA may be a useful 'dedicated airway' and has several advantages over the classic LMA(double dagger) and intubating LMA when used for this purpose. These include improved airway seal and reduced risk of aspiration. Four other cases of use of the PLMA as a dedicated airway during management of difficult airways are discussed. double daggerLMA is the property of Intavent Ltd. (+info)
Effects of helium on high frequency jet ventilation in model of airway stenosis.
BACKGROUND: The addition of helium to the inspired gas may facilitate ventilation in the presence of clinically evident upper airway obstruction. However, there are no data on the effects of using a helium-oxygen mixture during high frequency jet ventilation (HFJV) in upper airway obstruction. METHODS: HFJV at a frequency of 150 min(-1) (driving pressure 2 bar, inspiratory time 30%) was applied to a trachea-lung model to simulate ventilation through varying degrees of fixed laryngotracheal stenosis (2.5-8.5 mm). HFJV was delivered from above, through and below the level of stenosis to simulate supraglottic, transglottic and infraglottic administration. Measurements of distal tracheal pressures were repeated for each route at steady state for each stenosis diameter using both 100% oxygen and helium-oxygen (50% oxygen, 50% helium). The output of the ventilator was measured during operation on oxygen and helium-oxygen. RESULTS: Peak, mean and end-expiratory pressures were greater during simulated supraglottic HFJV than during transglottic and infraglottic HFJV, and pressures increased markedly as the diameter of the stenosis decreased for all routes of ventilation (P<0.001). Generated pressures during HFJV using helium-oxygen and 100% oxygen were very similar overall, although reductions in pressures were observed during ventilation with helium-oxygen via the transglottic and transtracheal routes at stenosis diameters <4 mm (P<0.05). However, HFJV with the helium-oxygen mixture increased the delivered gas volumes by approximately 18%. CONCLUSIONS: Using 50% helium-oxygen during HFJV in the presence of airway stenosis allows an 18% increase in minute volume at generated airway pressures which are the same as or lower than those when using 100% oxygen. (+info)
Superimposed high-frequency jet ventilation (SHFJV) for endoscopic laryngotracheal surgery in more than 1500 patients.
BACKGROUND: Superimposed high-frequency jet ventilation (SHFJV), which does not require any tracheal tubes or catheters, was developed specifically for use in laryngotracheal surgery. SHFJV uses two jet streams with different frequencies simultaneously and is applied in the supraglottic space using a jet laryngoscope and jet ventilator. METHODS: Between 1990 and 2004, SHFJV was studied in 1515 consecutive patients (including 158 children requiring laryngotracheal surgery) prospectively. Ventilation was performed with an air/oxygen mixture and anaesthesia was administered i.v. RESULTS: Adequate oxygenation and ventilation was achieved in 1512 patients. Arterial blood gas analyses (BGA) were performed between 1990 and 1994; thereafter BGA was only performed in patients with high-grade stenosis of the larynx/trachea or high-risk patients [n=623, mean Pa(O(2)) 133.8 (39.4) mm Hg and mean Pa(CO(2)) 42.3 (10.1) mm Hg]. There were no significant changes in Pa(O(2)) or Pa(CO(2)) during the entire period of SHFJV. No complications secondary to the ventilation technique were observed; in particular, no barotrauma occurred. Three patients required tracheal intubation. SHFJV was also successfully used for laser surgery (n=312). It proved to be a safe mode of ventilation without any complications such as airway fire, major haemorrhage, or aspiration of debris. CONCLUSION: SHFJV is an advanced ventilation mode playing a pivotal role in the (open) ventilatory support/ventilation of patients with laryngotracheal stenosis. It is particularly indicated in cases of severe stenosis and offers optimal conditions for laryngotracheal surgery, including laser surgery and stent implantation techniques. (+info)