• Journal of Chest Surgery
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• 제54권1호
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• pp.17-24
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• 2021

Background: Although extracorporeal membrane oxygenation (ECMO) is generally performed percutaneously, the technology is deployed under sedation and necessitates endotracheal intubation. However, in some patients, the use of venoarterial (VA) ECMO without intubation may be beneficial. Herein, we describe our experiences with VA ECMO performed without prior endotracheal intubation. Methods: A total of 783 patients treated with VA ECMO at a single center between January 2013 and July 2018 were reviewed retrospectively. We included patients who underwent successful VA ECMO implementation without prior endotracheal intubation, and excluded those who were younger than 18 years, had ongoing cardiopulmonary resuscitation status, and had poor quality of the vessels needed for percutaneous cannulation. The primary study outcome was in-hospital survival. Results: In total, 50 patients were included in this study, 94% of whom showed cardiogenic shock. The mean age of the study participants was 56.3±14.5 years. The median VA ECMO support time was 7 days (range, 2-13 days). Twenty-one patients (42%) did not receive ventilator care during the VA ECMO support period, while 29 patients (58%) progressed to intubation after VA ECMO implementation. The rates of survival at discharge and weaning success were 82% (n=41) and 92% (n=46), respectively, and 80% (n=40) of patients presented good Glasgow-Pittsburgh Cerebral Performance Categories scores at discharge. Conclusion: Even in patients with cardiogenic shock, percutaneous VA ECMO can be introduced safely without prior endotracheal intubation by an experienced care team. The application of nonintubated VA ECMO might be a feasible strategy in selected cases.

• 재활복지공학회논문지
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• 제9권2호
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• pp.153-160
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• 2015

최근 IT융합 기술의 발달에 따라 의료기기에 대한 IT융합 기술은 비약적으로 발전하고 있다. 응급 상황시 가장 기본적으로 우선적으로 시행 되어야 하는 것은 환자에 호흡이고 동시에 응급 환자에 기도를 유지하고 응급 처치를 해야 한다. 그러나 기도를 확보하는 술기인 기관 내 삽관을 하려면 응급 처치 사가 능숙한 경력과 경험을 요구하며 그렇지 않으면 술기에 실패 해 환자에서 후유증을 가져다 줄 수도 있는 매우 민감하고 중요한 술기이다. 이러한 이유로 현재 기관 내 삽관 술기의 성공률은 50%정도로 높은 수준이 아니다. 이러한 문제점을 보완하고자 본 논문에서는 기관 내 삽관을 하는 과정에서 인투베이션 튜브에 내시경 카메라를 삽입하여 삽관하고 실시간 모니터링과 무선 영상 전 송 방법인 스트리밍을 이용하여 스마트기기에서도 모니터링을 가능하게 하여 응급 처치 사들의 기관 내 삽관 성공률을 높이는데 목적이 있다.

• 대한기관식도과학회지
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• 제3권2호
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• pp.261-269
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• 1997

When performing an endotracheal intubation or tracheotomy to an unconscious patient in emergent situations, one should consider the possibility of later complication of laryngo-tracheal stenosis which can result in difficulties in decannulation. Laryngo-tracheal stenosis is a bothersome problem developing as a complication of treatment by tracheotomy with a cuffed tube and long-term endotracheal intubation with assisted ventilation. One hundred twenty-three cases of laryngo-tracheal stenosis patients during the four yew period from May 1992 to April 1996 were restrospectively reviewed according to several parameters such as the duration of intubation, site of stenosis, treatment modality and, site of tracheostoma. The present report is an analysis of these materials to search for the possible etiologic factors and its proper preventive methods. It was desirable that the endotracheal intubation should be limited within 20 days at most. Tracheotomy performed by non-otolaryngologists has a tendency to be on a higher level of trachea. Technical precautions should be taken into consideration when doing a tracheotomy. The success rate of decannulation of tracheal T-tube was 78.8% and it required average 11 months.

• 대한후두음성언어의학회지
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• 제11권1호
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• pp.64-68
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• 2000

Background and Objectives : To assess the role of altered vocal function in transient voice change after short-term endotracheal intubation, we evaluated acoustic parameters, aerodynamic parameters, and laryngoscopic characteristics preoperatively and postoperatively. Materials and Methods : Vocal function of 10 patients undergoing tympanoplasty and mastoidectomy using general anesthesia and endotracheal intubation were studied preoperatively, at 1day and 7 days after extubation. Acoustic analysis, aerodynamic study, and telescopic examination were used to assess vocal function. Results : In acoustic parameters, there was no significant difference between preoperative and postoperative measures. However, in subglottic pressure, ere was a significant decrease at 1 day after extubation and this change was return to preoperative value at 7 days after extubation. MPT(Maximal Phonation Time), MER(Mean flow Ratio), and VC(Vital Capacity) were decreased 1 day after extubation but did not show statistically significant change. Three of 10 patients manifested a vocal fold edema and injection 1 day after extubation. Conclusions : Subglottic pressure revealed a significant decrease at 1 day after extubation. And this change was correlated with laryngeal morphologic change and decrement in pulmonary function.

• Tuberculosis and Respiratory Diseases
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• 제53권3호
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• pp.332-336
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• 2002

흔히 응급상황에서 이루어지는 기관내삽관의 경우 무균적 조작의 중요성이 간과되어왔다. 특히 발관 후 발생하는 흡기성 천명음이 있을 때 먼저 발관 후 기관부종이나 기관협착을 고려하게 되고 세균성 기관염은 성인에서 보고된 예가 드물므로 간과되기가 쉽다. 그러나 저자들은 스테로이드 사용과 기관내삽관후 발생한 세균성 기관염을 경험하였으며 기관협착에 연관된 여러가지 후유증들을 고려할 때 기관내삽관시 무균적 조작이 필요할 것으로 사료되었다.

• 한국정보통신학회:학술대회논문집
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• 한국정보통신학회 2022년도 추계학술대회
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• pp.306-308
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• 2022

본 연구는 기관내삽관(Endotracheal intubation) 시 환자의 자세인 냄새맡는자세(Sniffing position)와 특별 제작된 기구를 사용하여 만든 수정된 경사면자세(Modified ramped position)을 비교·분석하여 전문기도술 수행을 향상시키는 데 목적이 있다. 연구대상은 전문심장소생술 및 전문기도관리학을 이수한 N대학교 응급구조학과 학생 30명을 대상으로 무작위 교차 방법(Randomized crossover study)으로 실험을 진행하였다. 연구결과 수정된 경사면자세에서 냄새맡는자세보다 더 나은 성문시야를 보였으며, 그에 따른 신속성에도 유의미한 차이를 보였다. 연구대상자의 주관적인 용이성, 자신감 그리고 선호도에서도 냄새맡는자세보다 수정된 경사면자세에서 더 향상된 결과를 나타냈다. 따라서 기관내삽관 시 환자를 수정된 경사면자세로 취할 경우 전문기도술 수행을 향상 시키는데 도움이 될 것 으로 사료된다.

• 대한치과마취과학회지
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• 제1권1호
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• pp.10-15
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• 2001

Background: This prospective study was designed to compare the cardiovascular response to endotracheal insertion of either an orotracheal tube or a nasotracheal tube Methods: 120 ASA physical status I and II surgical patients requiring general anesthesia and tracheal intubation were studied and assigned to two groups: orotracheal intubation group (n = 60) and nasotracheal intubation group (n = 60). Patients were premedicated with midazolam 0.05 mg/kg and glycopyrrolate 0.005 mg/kg intramuscularly and anesthesia was induced with thiopental sodium 5 mg/kg and succinylcholine 0.1 mg/kg intravenously. Systolic blood pressure (SBP), diastolic blood pressure (DBP). mean arterial pressure (MAP) and heart rate (HR) were assessed noninvasively before induction of anesthesia and immediately after intubation, 1 min, 2 min, 3 min, and 5 min after intubation. Results: Cardiovascular responses such as SBP, DBP, MAP and HR were similar for both techniques and no significant differences between two groups were observed until 5 min after intubation. Conclusions: In healthy ASA I and II patients with normal blood pressure, induction doses of thiopental sodium 5 mg/kg and succinylcholine 0.1 mg/kg didn't attenuated the cardiovascular response to laryngoscopy and tracheal intubation. Insertion of an endotracheal tube may be the most invasive stimulus during intubation procedures. (JKDSA 2001; 1: 10-15)

• 중환자간호학회지
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• 제3권1호
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• pp.53-65
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• 2010

Purpose: The purpose of this study was to identify the intensity and types of discomfort caused by an endotracheal tube in patients during ventilator therapy after cardiac surgery, and to analyze the differences in the intensity and types of discomfort by sociodemographic and clinical characteristics and characteristics related to endotracheal tubes. Methods: The intensity of discomfort was measured using an 11-point numeric rating scale and the types of discomfort were measured using a 4-point numeric rating scale. Sociodemographic and clinical characteristics and characteristics related to endotracheal tube were collected by observation and the electronic medical chart using a structured questionnaire. Results: The mean intensity of discomfort in patients due to endotracheal tubes was 6,91 points, 84% of patients reported discomfort over 5 points, The most severe discomfort was pain during endotracheal suctioning, and dry mouth and breathing difficulties were also found to induce discomfort. Patients who had more severe surgical site pain, longer duration of intubation and higher cuff pressure demonstrated more severe discomfort due to the endotracheal tube. Conclusion: These results can be used as basic data for developing nursing intervention to relieve the discomfort caused by endotracheal tubes in patients during ventilator therapy.

• Journal of Chest Surgery
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• 제31권10호
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• pp.1014-1016
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• 1998

이중관 튜브(double-lumen tube)로 기관 삽관한 후 발생하는 기관지 파열은 극히 드문 합병증이다. 우리 는 기관 삽관후에 발생한 좌측 기관지 파열을 치험하였다. 58세 여자 환자로 수술전 검사상 우하엽에 병 기 IIB의 분화가 잘된 악성 선암으로 진단되었다. 환자는 우하엽절제술을 위하여 로버트쇼 튜브 (Robertshaw tube)로 기관 삽관하였고 수술중 종격동 기종과 환기 장애로 인하여 좌측 주기관지의 파열을 발견하였다. 즉시 좌측 개흉술을 시행하여 기관지 파열부위를 흡수성 봉합사(PDS)로 봉합하였으며 수술 후 별다른 문제없이 회복되었다.

• 대한기관식도과학회지
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• 제9권1호
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• pp.101-104
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• 2003

One of major problem in endotracheal intubation for general anesthesia is intrathoracic tracheal obstruction induced by tumor such as, intrathoracic goiter and malignant lymphoma etc. Small amount of secretion or hemorrhage and mild tracheal edema may cause aggravation of tracheal obstruction during endotracheal intubation. Also, it is too difficult to perform the emergency tracheostomy in middle tracheal obstruction. We tried to perform femorofemoral cardiopulmonary bypass without endotracheal intubation for induction of general anesthesia in case of middle tracheal obstruction and We reported with review of literature.