Articles: intubation.
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Critical care medicine · Jul 1982
Predictive value of stridor in detecting laryngeal injury in extubated neonates.
We evaluated 73 consecutively extubated neonates for evidence of acute laryngeal injury from intubation. Hoarseness and stridor were graded by a clinical scoring system. ⋯ All patients with stridor had moderate or major injury, as did 38% of patients without stridor. Stridor was quite specific for detecting moderate or major injury but did not identify the type of injury.
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Randomized Controlled Trial Comparative Study Clinical Trial
Tracheal damage after endotracheal intubation: comparison of two types of endotracheal tubes.
Twenty-eight patients who required endotracheal intubation for open-heart surgery were randomly allocated to one of two types of endotracheal tube. The tracheal mucosa was examined with a fibreoptic bronchoscope at the time of extubation, usually 24 hours after operation. The degree of oedema, inflammation, and ulceration was scored by the bronchoscopist, who also photographed the whole length of the trachea. ⋯ Both observers found significantly less mucosal damage with the low-pressure, high-volume type of cuff than with the traditional high-pressure, low-volume type. This difference may be related to the differences in lateral wall pressures exerted by the two types of cuff. The low-pressure type of cuff may be preferable in patients requiring prolonged endotracheal intubation.
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Thirty adult patients were intubated with the help of a flexible fiberoptic instrument (FOI). The endotracheal tube was passed through the right nostril as in blind nasal intubation. At the same time the FOI was passed through the left nostril. ⋯ By this means, it was also possible to alter exactly the position of the tube visually. This procedure presents distinct didactic advantages and helps to prevent false positioning of the tube and subsequent injuries. Indications, in particular its potential use in paediatric anesthesia, as well as its disadvantages, are discussed in the conclusion of this paper.
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Ann Oto Rhinol Laryn · Jul 1982
Cricothyroidotomy: the impact of antecedent endotracheal intubation.
In light of the current debate regarding cricothyroidotomy, we elected to study the procedure at our institution. Cricothyroidotomy was instituted whenever tracheotomy was necessary for airway management. After a fairly short period of time, some significant complications of cricothyroidotomy were apparent and the study was aborted prior to achieving statistically significant results. ⋯ The major underlying factor in patients who developed complications was prolonged intubation prior to the institution of cricothyroidotomy. The study suggests that cricothyroidotomy should not be performed after prolonged intubation. The issue of primary cricothyroidotomy for short-term airway control remains unanswered.