• Advances in pediatric surgery
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• 제16권1호
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• pp.37-42
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• 2010

Tracheal injury is a rare complication of endo-tracheal intubation. However in neonates, the rates of morbidity and mortality are high. Recommendations for treatment are based on the several reports of this injury and are individualized. Conservative management can be effective in some cases. We describe the case of a neonate who presented with subcutaneous emphysema after intubation in a neonatal intensive care unit. This patient suffered full VACTERL syndrome and had 1.7 mm diameter subglottic stenosis. Conservative management resulted in no further increase in subcutaneous emphysema and after 10 days the patient was stable.

• Journal of Dental Anesthesia and Pain Medicine
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• 제18권6호
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• pp.375-378
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• 2018

Endotracheal intubation is commonly associated with laryngeal injury that often resolves spontaneously without any complication. However, stenosis or granulomatous lesions are generally found on the tracheal wall or vocal process at the tube cuff level, caused by excessive cuff pressure. We present a case of fatal vocal cord granuloma leading to dyspnea following orthognathic surgery and sustained intubation for 14 hours.

• 대한기관식도과학회:학술대회논문집
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• 대한기관식도과학회 1993년도 제27차 학술대회 초록집
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• pp.76-76
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• 1993

기관내 삽관은 전신마취 및 기도 확보를 위해 시행되어 왔으나, 이비인후과 영역의 합병증으로는 육아종 등이 유발될 수 있는 문제점을 안고 있다. 이에 저자들은 1982년부터 1992년까지 만 10년 동안 본원 이비인후과에서 경험한 16례에서 아래와 같은 결과를 얻었다. 1. 연령 분포는 20세에서 49세까지가 84% 로써 가장 많았으며 남녀 비는 1 : 7 로써 여성에서 호발 하였다. 2. 임상증상으로 애성 12례(75 %), 후두 이물감 3례(18 %), 호흡곤란 1례(6 %)이었다. 3. 발생 부위로는 양측성 6례(37 %), 일측성 10례(63 %)중 우측 7례(70 %), 좌측 3례(30 %)이었고 발생 장소는 피열연골 성대돌기 8례(50 %), 성대 후방1/3 부위 6례(37 %), 성대 중앙 부위 2례(12 %)이었다. 4. 과거력상 삽관후 임상 증상 발현 기간은 1 개월이내 7례(44 %)로 가장 많았으며 4 개월 이상은 없었다. 5. 과거력상 수술 종류 및 빈도수는 제왕절개술이 6례(37 %)로써 가장 많았다. 6. 평균삽관 시간은 2시간 5분 이었다. 7. 튜브재질은 모두 rubber tube 이었다. 8. 수술후 재발은 1례(6 %)이었다.

• 대한방사선기술학회지:방사선기술과학
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• 제41권5호
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• pp.505-509
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• 2018

VCP (Vocal Cord Paralysis) is rare but one of most serious complications related to endotracheal intubation. This report is a clinical experience of radiography and laryngeal EMG (Electromyography) assessment for the VCP. A 50-year-old woman with hoarseness, which was occurred after urethral diverticulum excision was examined by laryngoscopy. As a result of laryngoscopy, VCP was observed in left side of her vocal cord, and then recurrent laryngeal nerve damage was detected with additional CT (Computed tomography) scan and laryngeal EMG. After that, the vocal cord movement was recovered as normal state with regular conservative treatment for the 6 months.

• 대한기관식도과학회지
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• 제7권1호
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• pp.40-45
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• 2001

Management of laryngotracheal stenosis remains one of the most challenging problems facing the otolaryngologist. The key to success is to obtain adequate rigid circular support with normal mucosal lining. Four Patients with laryngotracheal stenosis were surgically treated in our institution in 2000. All the patients were male adults. The cause of stenosis were longterm or repeated endotracheal intubation and tracheostomy in our patients. All patients were successfully decannulated following segmental resection of the stenotic portion including the anterior arch of the cricoid cartilage and end-to-end anastomosis after suprahyoid laryngeal release. The time between treatment and decannulation was just one day in three patients. These results suggest the Possibility of early decannulation even if the cricoid cartilage was partially resected. It is better to prevent laryngotracheal stenosis rather than to treat it once it has occurred.

• 한국응급구조학회지
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• 제21권1호
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• pp.99-109
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• 2017

Purpose: There is no recommended bag-squeezing technique for emergency medical providers to maintain correct tidal volume during mechanical ventilation. This study compared the tidal volume of two different bag-squeezing techniques during mechanical ventilation. Methods: The subjects were 38 paramedic students who were trained in airway management techniques. Two different bag-squeezing techniques were used with a bag valve mask on an intubated manikin: a conventional technique and a finger-marked, in which the bag is squeezed until the thumb and the middle finger come into contact. Hand size and grip strength were measured and analyzed statistically. Results: The mean tidal volumes for the finger-marked were significantly higher than those for the conventional technique ($542.6{\pm}35.92mL$ versus $338.0{\pm}111.15 mL$, p<.001). There was a correlation between the two techniques (Pearson $x^2=1.160$, p<.001). The subject's characteristics, including sex, hand size, and grip strength, showed no correlation with tidal volume. Conclusion: A finger-marked bag-squeezing technique provides adequate and correct tidal volumes during mechanical ventilation.

• 대한기관식도과학회지
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• 제3권1호
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• pp.185-187
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• 1997

Acquired tracheal dilatation is a state of abnormal tracheal dilatation developing from various causes. Tracheomalacia and tracheal dilatation can develop in respiratory distress patients with prolonged endotracheal intubation with assisted positive-pressure ventilation due to positive airway pressure and high cuff pressure. The authors have recently experienced one case of respiratory failure, cardiac arrest, and whole body emphysema after tracheostomy and portex tube insertion were performed to patient with the endotracheal intubation with assisted positive-pressure ventilation for two weeks in the septic shock resulted from colon perforation, who developed tracheal dilatation. We summarize diagnostic and therapeutic strategies of acquired tracheal dilatation for the prevention of emergency status and the management for that patients.

• Tuberculosis and Respiratory Diseases
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• 제67권1호
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• pp.21-26
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• 2009

연구배경: 급성 호흡부전 환자에서 기관지경 검사 시비침습적 양압환기를 적용하면 저산소혈증의 악화 없이 안전하게 검사를 시행할 수 있으나 일부 환자에서는 저산소혈증의 악화로 기계 환기가 필요하게 된다. 본 연구는 저산소혈증으로 비침습적 양압환기 적용 하에 기관지경 검사를 시행한 환자들에서 검사 후 기관 삽관의 빈도 및 예측 인자를 알아보고자 하였다. 방 법: 2005년 1월부터 2007년 10월까지 삼성서울병원 내과계 중환자실에서 기관지경 검사를 받은 환자 210명 중 저산소혈증으로 비침습적 양압환기 적용 하에 기관지경 검사를 시행한 36명의 환자를 대상으로 후향적 조사를 시행하였다. 결 과: 36명의 환자(남:여, 18:18)들의 중앙연령은 55세(사분위 범위, 43~65세)였다. 기관지경 검사 전 SOFA 점수는 4점(3~7점), SAPSII 점수는 37점(30~42점)이었고 P/F ratio는 중앙값 155 (90~190)이었다. 기관지경 검사 후 17명(47%)에서 기관 삽관이 시행되었고, 시술 후 삽관까지 걸린 시간의 중앙값은 22시간(2~50시간) 이었다. 36명의 환자 중 15명(42%)이 사망하였고, 기관 삽관이 필요했던 경우 그렇지 않은 경우보다 병원 내 사망률이 높았다(11 [65%] vs. 4 [21%], p=0.017). 다중 로지스틱 회기분석 결과 기관지경 검사 전의 P/F ratio만이 기관지경 검사 후 기관 삽관과 독립적으로 관련이 있었다(OR, 0.961; 95% CI, 0.924~0.999; p=0.047). 결 론: 급성 호흡부전 환자에서 기관지경 검사 시 저산소혈증의 악화를 방지하기 위해 비침습적 양압환기를 적용할 때 적절한 환자 선택이 중요하며, 중증 저산소혈증환자에서는 기관 삽관을 대비하여 검사 후 집중적인 감시가 필요할 것으로 사료된다.

• 대한수의학회지
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• 제45권2호
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• pp.279-285
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• 2005

One-lung ventilation (OLV) is the isolation and selective ventilation of one lung field. OLV allows the collapse of lung lobes on the side of the thoracic surgical approach to facilitate observation of intrathoracic structures and to achieve lung immobility. OLV be achieved by endotracheal intubation with double lumen tubes or bronchial blockers. In this study, cardiopulmonary consequences of two-lung ventilation (TLV), OLV and Re-TLV (TLV after OLV) were evaluated in 5 dogs. The dogs were anesthetized with mask induction and maintained with isoflurane in oxygen. Tidal volume and respiratory rates were set to maintain end-tidal $CO_2$ at $40{\pm}2mmHg$ during instrumentation. Following instrumentation, the dogs were placed in right lateral recumbency and induced spontaneously respiration state. Effect of TLV on hemodynamic and pulmonary variables were recorded. Then, the left bronchus was obstructed by endotracheal intubation with double lumen endotracheal tube to achieve OLV state and recording was continued. After OLV, double lumen endotracheal tube was extubated, and standard endotracheal tubes was intubated again. In this study, spontaneous OLV caused significant decrease in $PaO_2$, arterial oxygen saturation, mixed-venous oxygen saturation, and increase in $PaCO_2$. Especially, a significant elevation in $PaCO_2$ and respiratory acidosis were remarkable findings. So spontaneous ventilation in OLV affected gas exchange and hemodynamic function.

• Acute and Critical Care
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• 제33권4호
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• pp.260-268
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• 2018

Background: The purpose of this study was to evaluate the clinical application of modified Burns Wean Assessment Program (m-BWAP) scoring at first spontaneous breathing trial (SBT) as a predictor of successful liberation from mechanical ventilation (MV) in patients with endotracheal intubation. Methods: Patients requiring MV for more than 72 hours and undergoing more than one SBT in a medical intensive care unit (ICU) were prospectively enrolled over a 3-year period. The m-BWAP score at first SBT was obtained by a critical care nursing practitioner. Results: A total of 103 subjects were included in this study. Their median age was 69 years (range, 22 to 87 years) and 72 subjects (69.9%) were male. The median duration from admission to first SBT was 5 days (range, 3 to 26 days), and the rate of final successful liberation from MV was 84.5% (n=87). In the total group of patients, the successful liberation from MV group at first SBT (n=65) had significantly higher m-BWAP scores than did the unsuccessful group (median, 60; range, 43 to 80 vs. median, 53; range, 33 to 70; P<0.001). Also, the area under the m-BWAP curve for predicting successful liberation of MV was 0.748 (95% confidence interval, 0.650 to 0.847), while the cutoff value based on Youden's index was 53 (sensitivity, 76%; specificity, 64%). Conclusions: The present data show that the m-BWAP score represents a good predictor of weaning success in patients with an endotracheal tube in place at first SBT.