Articles: intubation.
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A significant portion of critically ill patients with coronavirus disease 2019 (COVID-19) are at high risk of developing intensive care unit (ICU)-acquired swallowing dysfunction (neurogenic dysphagia) as a consequence of requiring prolonged mechanical ventilation. Pharyngeal electrical stimulation (PES) is a simple and safe treatment for neurogenic dysphagia. It has been shown that PES can restore safe swallowing in orally intubated or tracheotomized ICU patients with neurogenic dysphagia following severe stroke. We report the case of a patient with severe neurogenic post-extubation dysphagia (PED) due to prolonged intubation and severe general muscle weakness related to COVID-19, which was successfully treated using PES. ⋯ PES treatment contributed to the restoration of a safe swallowing function in this critically ill patient with COVID-19 and ICU-acquired swallowing dysfunction. Early clinical bedside swallowing assessment and dysphagia intervention in COVID-19 patients is crucial to optimize their full recovery. PES may contribute to a safe and earlier ICU discharge of patients with ICU-acquired swallowing dysfunction. Earlier ICU discharge and reduced rates of re-intubation following PES can help alleviate some of the pressure on ICU bed capacity, which is critical in times of a health emergency such as the ongoing COVID-19 pandemic.
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We describe a case of a complete endotracheal tube (ETT) transection due to patient bite. The patient was intubated for postoperative pneumonia; during weaning of sedation, the patient was unable to tolerate pressure support ventilation (PSV) due to agitation. ⋯ Utilizing a multidisciplinary approach, we provided respiratory support and performed nasopharyngolaryngoscopy (NPL) to identify and extract the foreign body. An algorithm for management of ETT fragment extraction is provided.
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Scand J Trauma Resus · Mar 2021
Observational StudyAnalysis of tracheal intubation in out-of-hospital helicopter emergency medicine recorded by video laryngoscopy.
Tracheal intubation remains the gold standard of airway management in emergency medicine and maximizing safety, intubation success, and especially first-pass intubation success (FPS) in these situations is imperative. ⋯ Airway management using the C-MAC video laryngoscope with Macintosh blade in a group of operators with mixed experience showed high FPS and overall rates of intubation success. Video recording emergency intubations may improve education and quality control.
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Canaliculops is a rare condition, and only 11 cases have been reported previously. We report 2 cases of canaliculops, which were successfully treated using the new recanalization technique under dacryoendoscopy followed by bicanalicular lacrimal intubation. ⋯ Eleven case series of canaliculops have been described previously, but this is the first report of this recanalization procedure offering a new, less invasive treatment option compared to complete or partial resection of the cystic lesion.
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Case Reports
Conversion of an oral to nasal intubation in difficult nasal anatomy patients: two case reports.
Nasal intubation is indispensable for some cases that require intraoral surgical access, and the fiberoptic bronchoscope is the best tool for difficult airways. However, fiberoptic bronchoscopy is not always possible in cases with altered pharyngeal anatomy. ⋯ Our simple and safe technique, which use a tube exchange catheter retrogressively, provides an alternative method for a difficult airway in which the fiberscope is not helpful.