Articles: intubation.
-
Anesthesia and analgesia · Jul 1986
Randomized Controlled Trial Clinical TrialPrevention of silent aspiration due to leaks around cuffs of endotracheal tubes.
Significant aspiration may occur around correctly inflated high volume, low pressure endotracheal tube cuffs. The prevention of silent aspiration due to leaks around cuffs of endotracheal tubes was investigated during general anesthesia for hip replacement in 47 patients. The patients were randomly assigned to one of three groups, in which one of three endotracheal tubes of different designs were used for intubation. ⋯ At termination of the operation, the trachea below the cuff was inspected with a fiberoptic bronchoscope. Aspiration was found in 12.5% with the Rüsch tube, in 31.2% with the Mallinckrodt tube, and in 0% with the NL tube. Our results show that silent aspiration is still a problem with standard endotracheal tubes, but that it may be minimized by use of appropriate tubes, cuffs, and control of cuff inflation.
-
Anesthesia and analgesia · Jun 1986
Endotracheal tube leak pressure and tracheal lumen size in swine.
Endotracheal tube "leak" is often estimated in children to judge the fit of uncuffed endotracheal tubes within the trachea. Twenty-five swine were intubated with uncuffed tracheal tubes to determine whether a more sensitive measurement of leaks could be devised and whether leak pressure estimates fit between tracheal tube and trachea. ⋯ Regression analysis revealed a linear relationship between tracheal lumen size and tracheal tube size for both low leak pressure (y = -0.4 + 0.79x, r = 0.88, P less than 0.05) and high leak pressure (y = -2.9 + 0.71x, r = 0.92, P less than 0.05) groups. We conclude that leak testing with a stethoscope and aneroid manometer is sensitive and accurate, and that tracheal tube leak pressure accurately portrays fit between tube and trachea.
-
A 48-year-old woman with non-small cell lung cancer involving the mediastinum and producing extrinsic tracheal compression is presented. The patient failed to respond to all conventional therapy and presented with stridor and respiratory distress due to progressive airway obstruction. Continuous positive airway pressure (CPAP) by mask was used to physiologically stent the airway until a mechanical Silastic stent could be placed by tracheostomy.
-
Critical care medicine · Jun 1986
Case ReportsInadvertent gastric balloon inflation within the chest in the management of esophageal varices.
Balloon tamponade of esophageal variceal hemorrhage is palliative therapy which is associated with a certain incidence of morbidity, perhaps mortality. Three cases of intrathoracic inflation of the gastric balloon of such tubes are described. The precise mechanism of thoracic placement remains uncertain. Fluoroscopy or chest x-ray should be used to confirm appropriate tube tip placement.