1/8. Translaryngeal open ventilation to treat acute respiratory failure in acute exacerbation of chronic obstructive pulmonary disease. A preliminary report.PURPOSE: To describe a minimally invasive alternative to conventional mechanical ventilation, using a small size uncuffed nasotracheal tube (translaryngeal open ventilation) paired with pressure control ventilation, in acute respiratory failure complicating chronic obstructive pulmonary disease (COPD). Clinical features: Two cooperative COPD patients, who failed noninvasive mechanical ventilation, were intubated nasotracheally. Mechanical ventilation was initiated in pressure control mode via an uncuffed 6 mm tube. RESULTS: respiratory rate improved after 1 hour (from 44 to 28 breaths*min(-1) in case 1 and from 32 to 25 breaths*min(-1) in case 2); PaC0(2) decreased (from 120 to 62 mmHg in case 1 and from 69 to 51 mmHg in case 2); with pressure control mode levels of 45 cm H(2)O and 55 cm H(2)O respectively. PaO(2) increased from 40 mmHg (with FIO(2) 0.3) to 55 mmHg (with FIO(2) 0.3) in the first patient and from 55 mmHg (with FIO(2) 0.4) to 60 mmHg (with FIO(2) 0.4 ) in the second patient; pH improved from 7.18 to 7.31 in case 1 and from 7.22 to 7.39 in case 2. Patients were able to trigger the ventilator, speak, swallow and to clear secretions spontaneously. Both patients were ventilated for three days in this manner without any adverse effects. Both survived and were discharged home after 20 and 18 days in hospital respectively. CONCLUSION: This very preliminary report suggests that, in carefully selected patients who fail mask ventilation, mechanical support with translaryngeal open ventilation can improve gas exchange, breathing pattern and tachypnea, without hindering glottic function.- - - - - - - - - - ranking = 1keywords = trachea (Clic here for more details about this article) |
2/8. Congenital high airway obstruction syndrome and airway reconstruction: an evolving paradigm.OBJECTIVES: To refine the classic definition of, and provide a working definition for, congenital high airway obstruction syndrome (CHAOS) and to discuss the various aspects of long-term airway reconstruction, including the range of laryngeal anomalies and the various techniques for reconstruction. DESIGN: Retrospective chart review. PATIENTS: Four children (age range, 2-8 years) with CHAOS who presented to a single tertiary care children's hospital for pediatric airway reconstruction between 1995 and 2000. CONCLUSIONS: To date, CHAOS remains poorly described in the otolaryngologic literature. We propose the following working definition for pediatric cases of CHAOS: any neonate who needs a surgical airway within 1 hour of birth owing to high upper airway (ie, glottic, subglottic, or upper tracheal) obstruction and who cannot be tracheally intubated other than through a persistent tracheoesophageal fistula. Therefore, CHAOS has 3 possible presentations: (1) complete laryngeal atresia without an esophageal fistula, (2) complete laryngeal atresia with a tracheoesophageal fistula, and (3) near-complete high upper airway obstruction. Management of the airway, particularly in regard to long-term reconstruction, in children with CHAOS is complex and challenging.- - - - - - - - - - ranking = 1keywords = trachea (Clic here for more details about this article) |
3/8. Severe respiratory failure after infraclavicular block with 0.75% ropivacaine: a case report.upper extremity surgery is usually performed with an axillary block. There is a risk of pneumothorax and phrenic nerve block when interscalene or supraclavicular block are used in day case surgery, or in patients with chronic obstructive pulmonary disease. The infraclavicular block is a simple, reliable, and easy to learn method to block the brachial plexus. No clinically relevant respiratory effects have been reported with infraclavicular block. Nonetheless, we report a case of a chronic obstructive pulmonary disease patient who developed severe respiratory failure requiring tracheal intubation after an infraclavicular block.- - - - - - - - - - ranking = 0.5keywords = trachea (Clic here for more details about this article) |
4/8. Saber-sheath malacic trachea remodeled and fixed into a normal shape by long-term placement and then removal of gianturco wire stent.We report the case of a 59-year-old man who presented with major dyspnea due to saber-sheath malacic trachea associated with chronic pulmonary obstructive disease. The placement of a temporary tracheal stent alleviated his dyspnea very well; hence the stent was replaced with a Gianturco wire stent (Cook cardiology, Bloomington, IN). However, this required removal due to wire-stent-related complications 2 years after the replacement. Surprisingly the trachea had been remodeled to a normal shape resulting in comfortable, functional respiratory status. A review of the literature reveals our case to be the first report of curing saber-sheath malacic trachea without leaving any prostheses or other foreign materials.- - - - - - - - - - ranking = 4keywords = trachea (Clic here for more details about this article) |
5/8. tracheomalacia associated with Mounier-Kuhn syndrome in the intensive care Unit: treatment with Freitag stent. A case report.tracheomalacia is a process characterized by softness of the supporting tracheal cartilages, by the extension of the posterior membranous wall and by reduction of the tracheal antero-posterior diameter. Exceptionally, tracheomalacia can be associated with tracheobronchomegaly or Mounier-Kuhn syndrome. Fibro-bronchoscopy represents the ''gold standard'' for diagnosis. The case of a 79-year-old male observed after hospitalization in a medical ward for chronic pulmonary obstructive disease (COPD) decompensation, and with basal left bronchopulmonary focus, is described. During this period, a progressive worsening of clinical conditions occurred, despite cortisone and antibiotic therapy, and the patient was transferred to the ICU for dyspnea, hypoxia, hypocapnia and with a diagnosis of pulmonary fibrosis. bronchoscopy, performed during spontaneous breathing, revealed tracheomalacia which was responsible for tracheal dynamic complete stenosis during expiration and dynamic subtotal stenosis of the left primary bronchus in the first tract, together with sputum retention. Moreover, this investigation confirmed the diagnosis of tracheobronchomegaly already seen on CT. It was suggested to place a Freitag stent, since the insertion of another model would not have had enough chance of stability, due to the enormous extension of the tracheal lumen and could not have guaranteed good clearance of the secretions. Seven days after this intervention, performed in an outpatients' setting, the patient was dismissed from the ICU, without the help of O2, with good ventilation, saturation in line with his age and good expectoration.- - - - - - - - - - ranking = 2keywords = trachea (Clic here for more details about this article) |
6/8. Double lung transplantation in a patient with tracheobronchomegaly (Mounier-Kuhn syndrome).Mounier-Kuhn syndrome is a rare condition characterized by marked dilation of the trachea and main bronchi resulting in bronchiectasis and emphysema. We report a case in which a patient underwent successful double lung transplantation for COPD that was found on pathologic examination of the explanted lungs to be Mounier Kuhn syndrome. To our knowledge this is the first case reporting lung transplantation in this syndrome.- - - - - - - - - - ranking = 0.5keywords = trachea (Clic here for more details about this article) |
7/8. Tracheal tube obstruction in a case of concealed tracheomalacia--a case report.We report on the successful mangement of airway obstruction, immediately after tracheal intubation for elective operation, in a patient with concealed tracheomalacia. We discuss the issues posed in patients with mild or undiagnosed chronic obstructive pulmonary disease (COPD) that are relevant to tracheomalacia. We underline the link between tracheomalacia and COPD and emphasize the high level of awareness needed, in order to avoid or manage promptly adverse events during airway management for anesthesia in these patients.- - - - - - - - - - ranking = 0.5keywords = trachea (Clic here for more details about this article) |
8/8. Failure of NIV in acute asthma: case report and a word of caution.noninvasive ventilation (NIV) is the provision of ventilatory support without the need for an invasive airway, and has revolutionized the management of patients with diverse forms of respiratory failure. The advantages of NIV include improved patient comfort and reduced need for sedation, while avoiding the complications of endotracheal intubation, including upper airway trauma, sinusitis, otitis, and nosocomial pneumonia. In selected patients, NIV has also been shown to improve survival. The role of NIV in acute severe asthma is at best controversial. In this case report, we describe a patient with acute severe asthma who was initially managed and failed with NIV, and was successfully managed with invasive ventilation. We also review the pathophysiological mechanisms of benefit of NIV in acute severe asthma, and the current literature on the use of NIV in acute asthma. In conclusion, a trial of NIV in acute asthma may be justified in carefully selected and monitored patients who do not respond to initial medical therapy. However, as its role is not clear and as the condition of an asthmatic patient may deteriorate abruptly, extreme caution is advisable to recognize failure of NIV as in the case presented here. Facilities for immediate endotracheal intubation and next level of treatment should be readily available.- - - - - - - - - - ranking = 1keywords = trachea (Clic here for more details about this article) |