Articles: intubation.
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Febrile intensive care unit (ICU) patients were evaluated prospectively for sinusitis. Of 598 admissions, 26 patients with transnasal cannulas, ICU stays over 48 hours, and occult fevers were identified. These 26 underwent physical examinations and sinus computed tomographic (CT) scans. ⋯ Most patients respond to nonoperative management. Remote infections are often present. Although radiographic nosocomial ICU sinusitis is common, it is seldom the sole source of fever or the proximate cause of significant morbidity.
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Ann Acad Med Singap · Nov 1992
Case ReportsTracheal rupture from incorrect positioning of endotracheal tube.
Significant ischaemic tracheal damage from endotracheal intubation is uncommon when the lateral wall pressure exerted by the cuff does not exceed the mean capillary perfusion pressure of the mucosa. This is facilitated by the modern endotracheal tubes with high-volume-low-pressure cuffs. We report a case of tracheal rupture due to an incorrectly positioned softcuffed tube. The need to review tube position radiologically and to make immediate adjustment cannot be overemphasised.
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The Journal of pediatrics · Oct 1992
Randomized Controlled Trial Clinical TrialEffectiveness of dexamethasone in preventing extubation failure in preterm infants at increased risk for airway edema.
We studied 50 preterm infants who had multiple or traumatic endotracheal intubations, or whose duration of endotracheal intubation was > or = to 14 days, and who were considered at high risk for airway edema. These infants were enrolled in a prospective, randomized, controlled clinical trial to assess whether prophylactic dexamethasone therapy would be effective in the prevention of postextubation stridor and respiratory distress. At study entry, both groups had similar weights, postnatal ages, methylxanthine use, ventilator settings, blood gas values, and pulmonary function test results (dynamic compliance, total respiratory resistance, tidal volume, peak-to-peak transpulmonary pressure, minute ventilation, and peak inspiratory and expiratory flow rates). ⋯ Of 23 control infants, 10 had postextubation stridor compared with 2 of 27 dexamethasone-treated patients (p < 0.006). Of the 23 control patients, 4 required reintubation compared with none of the treated group (p < 0.05). We conclude that the prophylactic use of corticosteroids for the prevention of postextubation stridor and respiratory distress is efficacious in low birth weight, high-risk preterm infants.