Articles: intubation.
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Critical care medicine · May 1983
Laryngotracheal injury due to endotracheal intubation: incidence, evolution, and predisposing factors. A prospective long-term study.
The purpose of this study was to assess the incidence, evolution and long-term effects of laryngotracheal lesions due to endotracheal intubation and to evaluate the import of factors in the genesis of laryngotracheal injury. Over a 12-month period, we performed fiberoptic bronchoscopy (FBS) in 19 critically ill patients with endotracheal intubation. ⋯ In 6 (31%) patients, early tracheal lesions appeared in the form of ring-shaped tracheitis at the cuff level and granulomas at the tube-tip level; in 2 (10%) patients, an established tracheal stenosis developed and early detected ring-shaped tracheitis preceded circumferential fibrous stenosis. Severe respiratory failure, high cuff pressure, and secretion infection showed a statistical correlation to tracheal injury.
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Case Reports
[Lung injury after use of respiratory revival materials sterilized with ethylene oxide].
One of the most used method of medical appliances sterilization uses ethylene oxide. At high concentration, this very reactive product, causes caustic burns of skin and mucous membranes. ⋯ This led us to review the toxicological data on this substance. It should be emphasized that the sterilization and the desorption according to simple and precise rules should prevent such acute accidents.
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As the newer high volume low pressure endotracheal tube cuffs have replaced the high pressure cuffs commonly used in the past, there has been a marked decline in the incidence of severe complication due to cuff injury. Studies have shown, however, that the respiratory epithelium of the trachea at the cuff site undergoes squamous metaplasia following prolonged intubation with low pressure cuffs. An experimental model utilizing the canine trachea has been developed to study cuff induced squamous metaplasia and the present study was undertaken to determine the effect of the induced squamous metaplasia on tracheal mucous velocity as well as to determine whether the induced epithelial changes are reversible following removal of the cuffed tube.
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The recognition of the importance of the enteral route for (hyper) alimentation led us to develop three methods for enteral placement of feeding tubes using endoscopic techniques. With these three treatment modalities it was possible to carry out enteral administration of nutrients in a group of patients, in whom otherwise only total parenteral feeding or enteral feeding by needle catheter jejunostomy was considered feasible. The use of endoscopic equipment permitted correct placement of tubes beyond the stomach either in the duodenum, at the ligament of Treitz or into the jejunum. Also simultaneous distal feeding combined with proximal intestinal drainage in the case of fistula, perforation, anastomotic leakage, or gastric dysfunction was achieved using this endoscopic approach.