1/32. Ballooned trachea caused by cuffed tracheostomy tube.Despite the dramatic decrease in cuff-related complications with the introduction of high-volume low-pressure devices for intubation and tracheostomy, notable problems can still occur. A case is reported of a patient who developed persistent dilatation of the trachea after prolonged mechanical ventilation. This is an under-recognized, life threatening clinical entity occurring after cuffed intubation for prolonged time. At present there is no definitive treatment regarding the management of a dilated trachea on a ventilator-dependent patient and therefore emphasis is directed at prevention. The patient presented was managed with periodical alterations of the cuff level which although not achieving any reversal of the dilatation, have prevented further progression of tracheal damage. During the follow-up period, regular assessment with flexible endoscopy has provided more reliable information on the condition of the trachea than computed tomography (CT) scanning.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/32. Negative pressure pulmonary oedema after cryotherapy for tracheal obstruction.We report a patient who suffered negative pressure pulmonary oedema because of tracheal obstruction after cryotherapy to granulation tissue in the trachea. The pathophysiology and clinical course of negative pressure pulmonary oedema is described. Though there are reports of negative pressure pulmonary oedema after airway obstruction, to our knowledge this is the first case reported after cryotherapy.- - - - - - - - - - ranking = 7keywords = pressure (Clic here for more details about this article) |
3/32. Thoracoscopic aortopericardiosternopexy for severe tracheomalacia in toddlers.BACKGROUND/PURPOSE: Aortosternopexy from a left anterolateral thoracotomy is the procedure of choice in severe tracheomalacia. The authors report an alternative technique of modified thoracoscopic aortopericardiosternopexy. methods: thoracoscopy under mild CO2 insufflation (insufflation pressures 4 to 6 mm Hg) provides excellent access without selective intubation. The importance of visualizing the phrenic nerve, mobilization of the thymus without disrupting its vascular supply, and intraoperative bronchoscopy is stressed. The technique of passing the needle through the sternum and back is shown. In long segment tracheomalacia, not only the ascending aorta, but also the innominate artery and base of the pericardium are fixed to the sternum, and the effect is monitored by intraoperative bronchoscopy. RESULTS: This technique was dramatically successful in a 4-year-old boy with long segment tracheomalacia and as a redo procedure in a 2-year-old girl after failed open aortopexy. CONCLUSION: Thoracoscopic aortopexy seems to be as effective as open aortopexy.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
4/32. Postintubation tracheal damage. A four-year prospective study.A 4-year prospective study was undertaken to estimate the incidence and identify the pathogenesis of cuff-induced major tracheal damage. All tracheal tubes were implantation tested and the cuffs were of the high-volume low-pressure type. The cuff pressure was continuously monitored and maintained below 3kPa. During the period of the study, 684 patients were intubated. Their average age was 33.6 years (range 14-296). The average intubation period was 9.3 days (range 1-256). At first, the damage was diagnosed clinically, radiologically and then confirmed by computed tomography. Three patients (0.4%) developed lesions that were not related to excessive (CP). In this study CP control seems to have eliminated a known major cause of intubation-associated tracheal injury. To date, there is no alternative to tracheal intubation. However the laryngeal mask seems ideal if invasion of the trachea is to be avoided altogether.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
5/32. Non-invasive diagnosis of tracheobronchomalacia using a modified ventilation radioisotope lung scan.The use of radionuclide ventilation lung scan to characterise the physiological effects of tracheobronchomalacia is a novel application of this non-invasive technique. In the reported case the right upper lobe was found to be not ventilated below a pressure of 20 cm H2O despite evidence from a dynamic tracheobronchogram of the right upper lobe bronchus opening at the lower pressure of 15 cm H2O.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
6/32. Tracheocoele in a Duchenne muscular dystrophy patient. Case report.Tracheocoele, a congenital or acquired lesion, is rarely detected radiologically and even more rarely diagnosed clinically. This tracheal lesion is characterised by the presence of a single cystic lesion filled with air or a mixture of liquid and air, of extremely variable size, occurring in almost all cases, in a locus minoris resistentiae situated in the right posterolateral portion of the trachea. The rare case is described of a voluminous tracheocoele located in the left paratracheal region, extending from the cricoid to sternal notch, manifesting clinically, 3 months prior to evaluation in our hospital in a 27-year-old male suffering from Duchenne muscular dystrophy since the age of 5 years. For 10 years, the patient had been treated with intermittent positive pressure ventilation via nasal mask, due to progressive deterioration of respiratory function. diagnosis of tracheocoele, initially made at computed axial tomography scan, was confirmed by flexible laryngotracheoscopy under local anaesthesia. Due to severe comorbidity associated with the clinical picture described, the absence of a significant set of symptoms, and the problems concerning anaesthesiological management of the patient, palliative treatment was the only choice. This consisted in cervical compression bandaging during assisted nasal ventilation. Close follow-up was performed in order to monitor any progression of the lesion or onset of related complications. This is the second case of tracheocoele originating in the left paratracheal region reported in the literature, and the first associated with Duchenne muscular dystrophy and prolonged use of a positive pressure respirator. The aetiopathogenic mechanisms that may have determined the formation of this rare lesion are then taken into consideration.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
7/32. Cervical aerocele in a tracheotomy dependent pediatric patient.A 2-year-old female with tracheotomy dependent congenital bilateral vocal cord paralysis presented with a cervical aerocele inferior to the tracheotomy site. Management included bronchoscopy and surgical decompression with drain insertion and pressure dressings. review of the literature shows no similar episodes reported of an acquired aerocele associated with a maintained tracheotomy.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
8/32. Tracheo-innominate artery fistula after percutaneous tracheostomy: three case reports and a clinical review.Tracheo-innominate artery fistula (TIF) is an uncommon yet life threatening complication after a tracheostomy. Rates of 0.1-1% after surgical tracheostomy have been reported, with a peak incidence at 7-14 days post procedure. It is usually fatal unless treatment is instituted immediately. Initial case reports of TIF resulted from surgically performed tracheostomies. We present three fatalities attributable to TIF, confirmed by histopathology, after percutaneous dilatational tracheostomy (PDT). The use of PDT has resulted in tracheostomies being performed by specialists from different backgrounds and the incidence of this complication may be increasing. Pressure necrosis from high cuff pressure, mucosal trauma from malpositioned cannula tip, low tracheal incision, radiotherapy and prolonged intubation are all implicated in TIF formation. Massive haemorrhage occurring 3 days to 6 weeks after tracheostomy is a result of TIF until proven otherwise. We present a simple algorithm for management of this situation. The manoeuvres outlined will control bleeding in more than 80% of patients by a direct tamponade effect. Surgical stasis is obtained by debriding the innominate artery proximally, then transecting and closing the lumen. Neurological sequelae are few. Post-mortem diagnosis of TIF may be difficult, but specific pathology request should be made to assess innominate artery abnormalities.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
9/32. The assessment of major airway function in a ventilator-dependent patient with tracheomalacia.A 60-pack-year smoker presented with cough, dyspnea and orthopnea of three months' duration. spirometry revealed severe reduction in maximal expiratory flow; CT of the chest and bronchoscopy demonstrated expiratory collapse of a mid-tracheal segment, and a presumptive diagnosis of tracheomalacia was made. A right lateral thoracotomy was performed to resect the unstable segment and improve maximal expiratory flow. Diffuse major airway disease with absence of cartilaginous rings from the thoracic inlet to the mainstem bronchi was encountered. The trachea and mainstem bronchi were stented externally. A high resistance to airflow and absence of expiratory flow limitation were present, suggesting a fixed rather than variable intrathoracic obstruction of major airways. This case illustrates some potential pitfalls in preoperative assessment of patients with tracheomalacia. Recordings of airway pressure and flow during mechanical ventilation are useful in distinguishing between fixed and variable intrathoracic obstruction and may complement tests of airway anatomy.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
10/32. Variable intrathoracic upper airway obstruction due to non-small cell lung cancer. Palliation using physiologic and mechanical stenting.A 48-year-old woman with non-small cell lung cancer involving the mediastinum and producing extrinsic tracheal compression is presented. The patient failed to respond to all conventional therapy and presented with stridor and respiratory distress due to progressive airway obstruction. continuous positive airway pressure (CPAP) by mask was used to physiologically stent the airway until a mechanical Silastic stent could be placed by tracheostomy.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
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