Gel lubrication of the tracheal tube cuff reduces pulmonary aspiration.
(17/384)
BACKGROUND: Leakage of fluid occurs along the longitudinal folds within the wall of an inflated high-volume, low-pressure cuff. Theoretically, lubrication of the cuff with a water-soluble gel might prevent aspiration by plugging the channels in the cuff wall. Pulmonary aspiration during anesthesia has been linked with postoperative pneumonia and during critical illness causes ventilator-associated pneumonia. METHODS: Lubricated cuffs were compared with nonlubricated cuffs for leakage of dye placed in the subglottic space to the tracheobronchial tree in a benchtop model (n = 5) and in a prospective double-blinded randomized controlled trial of anesthetized patients (n = 36). The duration of the efficacy of the lubricant was determined in a prospective open observational study of critically ill patients with tracheostomies (n = 9). Dye was detected clinically by dye coloration of secretions during tracheal suctioning. RESULTS: In the benchtop model the incidence of leakage was 0% in the lubrication group and 100% in the nonlubrication group (P < 0.01). Dye leakage in anesthetized patients was 11% in the lubrication group and 83% in the nonlubrication group (P < 0.0001). In the critically ill patients with lubricated cuffed tracheostomy tubes, leakage first occurred after a median period of 48 h (range, 24-120 h). CONCLUSIONS: Cuff lubrication with a water-soluble gel reduces pulmonary aspiration in anesthetized patients. In the critically ill patient with a tracheostomy the protective effect is lost after 24-120 h. (+info)
Obstructive sleep apnea syndrome in a patient with medulloblastoma.
(18/384)
We present one adult patient with medulloblastoma who developed polysomnographically documented obstructive sleep apnea after posterior fossa surgery. The sleep apnea worsened in conjunction with clinical and imaging-confirmed neoplastic progression and clinically improved after craniospinal radiation therapy. Medulloblastoma or its surgical treatment has never before been implicated in a sleep-related breathing disorder. We discuss possible mechanisms for its occurrence and management implications. (+info)
Overexpression of TGF-alpha increases lung tissue hysteresivity in transgenic mice.
(19/384)
Increased transforming growth factor (TGF)-alpha has been observed in neonatal chronic lung disease. Lungs of transgenic mice that overexpress TGF-alpha develop enlarged air spaces and pulmonary fibrosis compared with wild-type mice. We hypothesized that these pathological changes may alter the mechanical coupling of viscous and elastic forces within lung parenchyma. Respiratory impedance was measured in open-chested, tracheostomized adult wild-type and TGF-alpha mice by using the forced oscillation technique (0.25-19.63 Hz) delivered by flexiVent (Scireq, Montreal, PQ). Estimates of airway resistance (Raw), inertance (I), and the coefficients of tissue damping (G(L)) and tissue elastance (H(L)) were obtained by fitting a model to each impedance spectrum. Hysteresivity (eta) was calculated as G(L)/H(L). There was a significant increase in eta (P < 0.01) and a trend to a decrease in H(L) (P = 0.07) of TGF-alpha mice compared with the wild-type group. There was no significant change in Raw, I, or G(L). Structural abnormality present in the lungs of adult TGF-alpha mice alters viscoelastic coupling of the tissues, as evidenced by a change in eta. (+info)
Airway fire during tracheostomy: prevention strategies for surgeons and anaesthetists.
(20/384)
Airway fires are an uncommon but real and devastating complication of tracheostomy. One such fire in a 31-year-old man is described. Surgical fires are discussed, and 15 reported cases of tracheostomy fire are reviewed. A tracheostomy protocol, adopted by our department and designed to avoid this life-threatening complication, is described. Surgeons and anaesthetists involved in tracheostomy must understand the fire hazard and how to avoid it. (+info)
Airway risk in hospitalized trauma patients with cervical injuries requiring halo fixation.
(21/384)
OBJECTIVE: To identify the incidence and outcomes of emergent and semiemergent intubations in hospitalized trauma patients with cervical fractures and/or dislocations treated with halo fixation. SUMMARY BACKGROUND DATA: Intubating a trauma patient in halo fixation can be extremely difficult, with the potential for dire consequences. METHODS: The authors retrospectively reviewed the medical records of trauma patients with cervical injuries requiring halo fixation admitted to a level 1 trauma center between January 1992 and January 1997. The in-hospital need for emergent or semiemergent intubation was assessed and correlated with a variety of patient characteristics, including outcome. RESULTS: Of the 105 patients identified, 14 (13%) required an emergent or semiemergent intubation. Injury Severity Score, cardiac history, and intubation on arrival were significant indicators of the need for an in-hospital emergent or semiemergent intubation or reintubation. A total of seven deaths were reported, six of which were associated with an emergent or semiemergent in-hospital intubation. Although age did not appear significant in predicting the need for an emergent intubation, it was significant in predicting arrest-related deaths. A total of 17 tracheostomies were performed. Eight were considered "initial" in that they were performed before an emergent intubation, and nine were performed after an emergent intubation. Patients in the initial tracheostomy group did not differ in terms of the variables investigated from those who required an emergent intubation. None of the patients who underwent initial tracheostomy, however, had an airway emergency or died. CONCLUSIONS: A significant number of trauma patients treated with halo fixation ultimately require an in-hospital emergent or semiemergent intubation. Given the difficulty and potential lethality associated with these intubations, heightened vigilance regarding the airway is warranted. The authors recommend that early tracheostomy be considered in patients with a history of cardiac disease, especially when a high Injury Severity Score is present. Older patients (older than 60 years) are more at risk for arrest-related death and may also benefit from early tracheostomy. (+info)
Percutaneous tracheostomy by guidewire dilating forceps technique: review of 98 patients.
(22/384)
BACKGROUND: Percutaneous tracheostomy to a large extent has replaced conventional surgical tracheostomy by virtue of its low incidence of complications and the rapidity with which the procedure can be performed at the bedside avoiding transport of critically ill patients to the operating rooms. Since it is a blind approach, bronchoscopic guidance has been suggested which might not always be possible due to logistic reasons. METHODS: A retrospective study of 98 patients who had guide wire dilating forceps technique of percutaneous tracheostomy without the aid of a bronchoscope was undertaken. By ensuring the free mobility of the guide wire at each step of the procedure, a safe placement of the tracheostomy tube was achieved. RESULTS: The mean operating time was 3.05 mins [S.D:2.20]. Two patients had peristomal bleeding as an early complication. 34 patients could be decannulated with good primary approximation of the stomal tissues [mean: 3.92days, S.D: 1.46]. There were no deaths or life threatening complications attributable to this technique. CONCLUSIONS: In the absence of bronchoscopic guidance, adopting the simple but effective precaution of free movement of guide wire at each step of the procedure, a safe tracheostomy tube placement is possible. (+info)
Effects of spontaneous swallows on breathing in awake goats.
(23/384)
The effects of spontaneous swallows on breathing before, during, and after solitary swallows were investigated in 13 awake goats. Inspiratory (TI) and expiratory (TE) time and respiratory output were determined from inspiratory airflow [tidal volume (VT)] and peak diaphragmatic activity (Dia(peak)). The onset time for 1,128 swallows was determined from pharyngeal muscle electrical activity. During inspiration, the later the swallowing onset, the greater increase in TI and VT, whereas there was no significant effect on TE and Dia(peak). Swallows in early expiration increased the preceding TI and reduced TE, whereas later in expiration swallows increased TE. After expiratory swallows, TI and VT were reduced whereas minimal changes in Dia(peak) were observed. Phase response analysis revealed a within-breath, phase-dependent effect of swallowing on breathing, resulting in a resetting of the respiratory oscillator. However, the shift in timing in the breaths after a swallow was not parallel, further demonstrating a respiratory phase-dependent effect on breathing. We conclude that, in the awake state, within- and multiple-breath effects on respiratory timing and output are induced and/or required in the coordination of breathing and swallowing. (+info)
Tracheostomy, lingular tonsillectomy and sleep-related breathing disorders.
(24/384)
Laser resection of lingual tonsils and formal closure of a tracheostomy improved the airway in a 14-yr-old patient with Down's syndrome. Non-invasive airway support to treat obstructive sleep apnoea was postponed with this treatment. During the anaesthetic a laryngeal mask airway was used to support the airway after lingual tonsillectomy, to assess the suitability of defunctioning the tracheostomy. Laryngeal mask airways assist management of lingual tonsils. Lingual tonsillar hypertrophy can lead to obstructive sleep disorders. (+info)