Articles: intubation.
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Prolonged endotracheal intubation may be complicated by tracheal wall lesions caused by the blocking cuff of the tube. This happens when the tracheal wall load exceeds the capillary perfusion pressure. It is therefore important to control this load. ⋯ In a model trachea we showed the significance of the tracheal wall pressure as approximated by an indirect measurement principle. Our investigations demonstrate that the examined indirect method provides a sufficient approximation of the tracheal wall load only if it is used with the new low pressure high volume cuffs. It fails if it is used with the customary high pressure low volume balloons.
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A tracheoesophageal fistula secondard to prolonged nasogastric intubation and ventilatory assistance via a cuffed tracheostomy tube developed in a 27-year-old woman who had sustained a traumatic injury. The fistula grew progressively larger despite removal of the tubes, thus demonstrating the inherent poor prognosis associated with the untreated lesion. Since the cuff necessarily damages the trachea circumferentially at the same level, closure of the fistula and circumferential excision and reconstruction of the damaged tracheal wall were performed with an excellent result up to four years after the repair. This would be the preferred procedure when the patient can be weaned off the respirator and when the general condition and the size of the fistula allow such a definitive one-stage approach.
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A simple, inexpensive, readily assembled device that provides immediate temporary access to the subglottic airway for oxygenation or anesthesia induction has been presented. The device can be used in emergency clinical situations, in difficult anesthesia inductions and in children where it is difficult to introduce an endotracheal tube because of supraglottic disorders. The child can be anesthetized via this device prior to securing the airway by tracheostomy. There has been no morbidity or mortality associated with use of this device.
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Eight commercially available soft cuff endotracheal tubes were studied to determine the relationship between inflation pressure distention of the cuff. Although the balloon cuff may be easily distensible in open air, when confined within the trachea small increments in the inflation volume may produce high pressures. ⋯ Major tracheal complications in a busy ICU were examined before and after the introduction of a controlled pressure tube. Control of intratracheal cuff pressures decreased major tracheal complications tenfold and eliminated complications specifically related to the cuff.