Articles: intubation.
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Nihon Kyobu Geka Gakkai Zasshi · Aug 1990
Case Reports[A case of thyroid carcinoma required the incision of the thyroid cartilage for inserting the silicone T tube after extensive tracheal resection and reconstruction].
A 57-year-old female with thyroid carcinoma, who had developed tracheal stenosis, underwent extensive tracheal resection and reconstruction. After the tracheal sleeve resection 5.2 cm in length, primary tracheal reconstruction was performed. Although complication did not occur at the anastomotic site, the patient had dyspnea due to cord dysfunction by bilateral recurrent nerve paralysis. ⋯ The patient inserting the T tube through the laryngeal stoma had no dyspnea and no aspiration about two years after the operation in spite of palliative operation. It seemed likely that the trouble that tracheostomy could not be done would occur in some patients who had undergone extensive tracheal resection and reconstruction. But the insertion of silicone T tube through the laryngeal stoma provided a satisfactory result for airway problem.
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Decisions regarding the application and care of airways in respiratory failure are important determinants of outcome in critically ill patients. Specialized procedures for institution of translaryngeal intubation in difficult circumstances, such as fiberoptic intubation, and provision of immediate surgical airway access, such as cricothyroidotomy, are requisite skills for the intensivist. The evolving application of standard techniques and advent of newer procedures for airway cannulation require extensive experience and cognitive skills in the management of tracheal intubation to enhance patient benefit and limit adverse effects from tracheal intubation.
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Unplanned removal of an endotracheal airway tube by a patient (SXT) represents a potentially life-threatening incident. Prospective monitoring of all intubated adult ICU patients for one year revealed that 12 of 112 extubated themselves (overall incidence, 11 percent). Comparison of SXT patients with the NXT group disclosed no risk factors for this occurrence. ⋯ The complication (and reintubation) rate in the SXT group was 31 percent. The reintubation rate in deliberate extubations was 11 percent. Self-extubation is a common occurrence which, despite obvious hazards, often is tolerated well by adults.