The Laryngoscope
-
Comparative Study
Airway resistance and work of breathing in tracheostomy tubes.
Recommendations for sizing of tracheostomy tubes are generally based on anatomic considerations with the largest fitting tube most commonly placed. Once in the tracheostomy site, the tube assumes the new role of the upper airway. Consideration of the airway resistance of each tracheostomy tube and change in work of breathing are important in maintaining the respiratory system homeostasis. ⋯ Adult tubes 8 and 10 most closely simulated the upper airway resistance of adults and neonatal tube 0 appeared most appropriate for the newborn. Work of breathing was determined for each tracheostomy tube. Increasing tube diameter as well as decreasing tidal volume and respiratory rate decreased the amount of work required to maintain a given flow.
-
Meningitis and cerebrospinal fluid (CSF) leak are serious complications of acoustic tumor surgery. Previous reports have varied in the incidence of and the predisposing factors to these complications. This study reviews a series of 723 acoustic tumors removed via the translabyrinthine approach at the House Ear Clinic in Los Angeles. ⋯ Meningitis occurred more frequently in larger tumors, and patients with either complication had a longer hospital stay. The presence of CSF leak did not predispose to meningitis. It is concluded that technical factors account for postoperative CSF leak and meningitis after translabyrinthine acoustic tumor removal.
-
Penetrating trauma of the oropharynx is not an uncommon problem in the pediatric population. Innocuous injuries with minor soft-tissue trauma have been associated with severe neurologic sequelae. A review of 77 oral trauma cases that occurred from 1981 to 1990 at Boston Children's Hospital was undertaken to see if constant factors could be identified so that a treatment protocol might be outlined for these patients. ⋯ Physical examination may not correlate with the development of symptoms nor the mechanism of injury. Care should be taken during the examination to identify any neurological problems that may not relate to the degree of injury. Conservative management can be entertained if no abnormal neurologic findings are noted.
-
Communication for handicapped ventilator-dependent patients is a problem, not only for the patient but also for the healthcare personnel. The inability of these patients to vocalize is a paramount problem in their care. This study evaluates the efficacy of a one-way speaking valve on ventilator-dependent patients and evaluates the resulting effectiveness of their speech. ⋯ All 15 patients showed marked improvement, not only in speech intelligibility but in speech flow, the elimination of speech hesitancy, and speech time. This ability to communicate enhanced the care given by the healthcare personnel. In conclusion, use of the Passy-Muir Tracheostomy Speaking Valve restored verbal communicative skills of ventilator-dependent patients, facilitated care, and greatly enhanced the mental outlook of these patients without observed complications.