• 대한기관식도과학회지
• /
• 제13권2호
• /
• pp.40-44
• /
• 2007

Background and Objectives: Most of tracheal stenosis is resulted from longstanding endotracheal tube insertion. Treatments of tracheal stenosis are divided conservative and reconstructive treatment. The propose of this study was to evaluate the effect of prosthetic tracheal T-tube insertion on tracheal stenostic patients who can not be operated invasive surgery. Subjects and Method : Nine prosthetic tracheal T-tube insertion were studied from 9 patients from January 2002 to April 2007. The effect of silastic T-tube was analyzed according to the factors that were respiratory difficulty, oxygen saturation, phonation, aspiration and significant complications. Results: Four patients were good for respiration and no complication. But five patients occur various complications. A successful group did not have cartilagenous lesions but failed group had catilagenous lesions, infection and necrosis. Conclusion: A silastic T-tube insertion was good for palliative treatment in patients without catilagenous lesions.

• 대한기관식도과학회:학술대회논문집
• /
• 대한기관식도과학회 1983년도 제17차 학술대회연제순서 및 초록
• /
• pp.10.2-10
• /
• 1983

여러가지 원인으로 인하여 유발되는 기관 협착증은 이비인후과 영역의 임상에서 아직도 심각한 문제로 남아있다. 기관 협착증의 치료법에는 많은 방법들이 이용 되고 있으며 각 경우에 따라 그 적용 방법이 달라질 수 있다. 저자들은 1978년 6세 여아에서 기관절개술후 발생한 기관 협착증에 대하여 Silicon T-tube를 사용하여 치험한 1예와, 1981년 19세 남아에서 염증성 종괴로 인한 기관 협착증에 대하여 Silicon T-tube stent with oral mucosal graft를 사용한 1예에서 좋은 결과를 얻었기에 보고하는 바이다.

• Journal of Dental Anesthesia and Pain Medicine
• /
• 제21권2호
• /
• pp.167-171
• /
• 2021

We describe the successful insertion of a nasotracheal tube following repeated cuff rupture. The patient was a 55-year-old woman with a history of nasal trauma and multiple rhinoplasties, who underwent elective Lefort I osteotomy and bilateral sagittal split osteotomy for correction of skeletal facial deformity. During fiberoptic bronchoscope-guided nasal intubation after the induction of general anesthesia, the tracheal tube repeatedly ruptured in both nares, despite extensive preparation of the nasal airways. We covered the cuff with a one-inch tape, intubated to the level of the oropharynx, pulled the tracheal tube out through the mouth, and removed the tape. The tracheal tube was then backed out to the level of the uvula, and was successfully advanced.

• Journal of Chest Surgery
• /
• 제27권2호
• /
• pp.136-139
• /
• 1994

Tracheal stenosis is relatively common complication after tracheal intubation or tracheostomy for a long time. We experienced 10 cases of tracheal stenosis with various causes, prolonged intubation or tracheostomy caused the tracheal stenosis in seven, one after advanced cancer of the lung, one after inhalation burn, and the other was palliative management for tracheal stenosis by Gianturco type tracheal stent. We tried to correct this stenosis applying three tracheal stent and one Montgomery T-tube as a palliative approach, but failed in two, one restenosis due to regrowing of granulation tissue with scarring or another metastatic spread of cancer to systemic organs after 3 months of placing the stent. Tracheal circumferential resection and end to end anastomosis were done in seven, and obtained one postoperative complication as subglottic stenosis was followed by Montgomery T-tube and reoperation later. With the brief review of references, we report the cases.

• Journal of Chest Surgery
• /
• 제23권5호
• /
• pp.1021-1026
• /
• 1990

The patients with tracheal stenosis have become more increasing in recent due to the increased use of tracheostomy and assisted ventilation Anesthetic management during tracheal reconstruction is a concern to the anesthetist and the surgeon, who must share the airway as a operation field and at the same time provide good gas exchange. Multiple technique such as the tube ventilation system or C \ulcornerP bypass method have been recommended to achieve this goals. However, these methods have disadvantages of poor surgical exposure and hemorrhagic complication from using C \ulcornerP bypass The technique for HFJV was first described for bronchoscopy, and it involves positive-pressure breathing with high flow[40 \ulcorner60L/min] of oxygen This flow is directed to a semirigid catheter inserted in the endotracheal tube and the tracheal reconstruction can be done without interruption. From Dec. 1986 to July 1990 we have experienced 6 patients of tracheal stenosis necessitating circumferential resection and end to end anastomosis; 5 patients with tracheal stenosis following cuffed tracheostomy or intubation, a patient with tracheal stenosis due to invasive thyroid cancer. The specific advantages during tracheal reconstruction are unobstructed field during surgical reconstruction and good gas exchange through the procedure.

• Journal of Chest Surgery
• /
• 제26권8호
• /
• pp.664-666
• /
• 1993

A technique for insertion of a long silicone T-tube in patient with critical stenosis and high-risk resection and primary anastomosis of long segment of the distal trachea is presented. It was not easy to insert a long T-tube by existing methods because of flexibility of a T-tube and tightness of stenosis. So we used a silastic endotracheal tube and guiding wire as stylet of a T-tube. During insertion, ventilation was normally maintained through the lumen of endotracheal tube. This provided rapid relief from airway obstruction and asphyxation and is a easy, safe and effective method to restore patency of the major airways.

• 성인간호학회지
• /
• 제21권6호
• /
• pp.570-579
• /
• 2009

Purpose: The aim of this research was to determine knowledge and management of tracheal tube cuffs among nurses of ICU. Methods: This descriptive survey recruited 150 nurses working at 8 different adult ICUs within 2 tertiary hospitals in Seoul. A survey questionnaire was developed to measure cuff management. The internal reliability of the tool was examined by Cronbach's ${\alpha}$. Descriptive statistics and multiple regressions were used to analyze data. Results: Among the 150 nurses, 94.0% replied that they would measure the pressure themselves. With regard to nurses' knowledge about tracheal tube cuffs, only 6% answered that they knew 'the appropriate cuff pressure'. The existence of a measuring device (p < .001), a guideline (p < .001), the level of knowledge on its related complications(p = .003), and clinical experience (p < .001) together accounted for 35.0% of the total variation in cuff management. They pointed out that the lack of time and the lack of education were major barriers to appropriate management; whereas education update was the most imperative factor for good management. Conclusion: ICU nurses have inappropriate knowledge and practice in cuff management. Therefore continuing education is necessary for better practice of tracheal tube cuff management.

• 대한기관식도과학회:학술대회논문집
• /
• 대한기관식도과학회 1981년도 제15차 학술대회연제순서 및 초록
• /
• pp.4.3-5
• /
• 1981

최근 병원 각과에 있어서 기관내 삽관 혹은 기관절개에 의한 장기간에 걸친 호흡관리 증례가 증가하고있다. 이는 장기간의 호흡관리상의 문제점으로서 삽관 그 자체 혹은 Cuff에 의한 조직손상으로 후두 및 기관에 협착을 일으키게 하고 있다는 것은 주지의 사실이다. Meclelland는 기관절개를 받은 389례중 14례(3.6%)가 기관삽관발거곤란증을 일으켰고, 우리나라에서도 홍등은 기관절개를 받은 1514례중 23례(1.5%)가 기관협착을 일으켰다고 보고하고 있다. 교통사고와 산업재해등에 의한 후두 및 기관손상도 증가의 경향을 보이고 있다. 이러한 후두 및 기관손상에 의한 협착에 대하여 과거 여러가지 요법이 있었다. 즉 보존적 치료법과 수술적 치료법으로 나눌 수 있는데 최근에 주목되고 있는 Silicone T-tube은 기도를 적절히 유지하고 재건한 기관을 지탱하여 주기 위해서 고안된 것이다. 최근에 저자들은 2례의 후두 및 기관외상 환자와 9개월 간의 기관 Cannula 발거곤란증 1례에 대하여 Silicone T-tube를 사용하며 좋은 결과를 얻었기에 문헌적 고찰과 함께 보고하는 바이다.

• 대한기관식도과학회지
• /
• 제16권2호
• /
• pp.131-137
• /
• 2010

Background: Montgomery T-tube is widely used to maintain airway in many cases. Market-available tubes are not always fit to the trachea of each patient and need some modification such as trimming. Complications do happen in prolonged use like tracheostomy tubes. To overcome above limitations, we designed custom-made T-tube using CT data with the aid of 3D reconstruction software. Material and Method: Boundaries were extracted from neck CT data of normal person and processed by surface rendering methods. Real laryngotracheal model and tracheal inner surface-mimicking tube model were made with plaster and rubber. The main tube was designed by accumulation of circles or simple closed curves made from boundaries. Stomal tube was made by accumulation of squares due to limitation of software. Measurement data of tracheal lumen were used to custom-made T-tubes. Tracheal lumen residing portion (vertical limb) was made like circular cylinder or simple closed curved cylinder. Stomal portion (horizontal limb) was designed like square cylinder. Results: Custom made T-tube with cylindric vertical limb and horizontal limb of square cylinder was designed. Conclusion: CT data was helpful in making custom made T-tube with 3D reconstruction technique. If suitable materials are available, commercial T-tube can be printed out from 3D printers.

• 대한기관식도과학회지
• /
• 제3권1호
• /
• pp.61-69
• /
• 1997

A total of 55 patients underwent surgical managements for postintubation tracheal stenosis from July 1975 through March 1997. All but 8 had received ventilatory assistance. The patients had S cuff lesions, 17 stoma lesions, 7 at both levels, 5 at subglottic lesions. Thirty two patients underwent the sleeve tracheal resection and end-to-end anastomosis. Five patients performed a wedge resection and end-to-end anastomosis. Twenty two patients received the Montgomery T-tube for relief of airway obstruction. Simple excision of granulation tissue was done in 7 patients. Rethi procedures(anterior division of cricoid cartilage, partial wedge resection of lower thyroid cartilage and T-tube molding) were performed in 2 subglottic stenosis patients. And the other subglottic patient was received permanent tracheal fenestration at 1975. The tracheoesophageal fistula patient was done sleeve tracheal resection and end-to-end anastomosis with interrupted double layer closure of esophageal fistula site. Cervical approach was used in 49 cases, cervicomediastinal in 13 cases and median stemotomy In 6 cases. Techniques for obtaining tension-free anastomosis included a cervical neck flexion(15-30$^{\circ}$) in all sleeve resection patients and laryngeal release in one. The length of resection was 1.5 to 5.0 on A total of 41 patients(74.5%) had good(24 patients) or satisfactory(17 patients) results. But in ten cases, the restenosis of anastomosis site which is the most common complication was developed Two of them underwent a second reconstruction and 8 patients required T-tube insertion for airway maintenance. Three patients(5.4%) died. The causes of death were tracheo-innominate artery fistula(2) and sudden obstruction of airway(1).