Articles: intubation.
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A study was undertaken to assess the applicability of transtracheal ventilation in the instance of total upper airway obstruction. The effect of transtracheal jet ventilation through a variety of inflow catheters in the dog was studied. Arterial blood gas values, intratracheal pressure and minute ventilation were compared. ⋯ A dual-lumen needle, to provide exclusive respiratory access and support was then designed based on the preliminary data. Prolonged transtracheal jet ventilation with a totally obstructed upper airway was successfully conducted in a live canine subject. A review of the literature is presented.
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The esophageal obturator airway (EOA) was introduced for clinical use in 1973. There have been few controlled studies on its effectiveness or safety; those published had differing results--one showed no clinically significant difference in PaO2 and PaCO2 between EOA and tracheal tube, while two others reported slightly increased PaCO2. Subsequent modifications include the esophageal pharyngeal airway, esophageal gastric tube airway, and Vermont, or Pilcher, model. ⋯ It is contra-indicated in the conscious or semiconscious patient, in children, for more than 1-2 hours, and in known cases of esophageal trauma or pathology. The most commonly reported hazard is esophageal perforation; others include tracheal intubation (which is actually the most common hazard), failure to seal mask, failure to pass tube, incorrect assembly of mask and tube, the tube's becoming an intragastric foreign body, and obstruction to intubation. While the tube is not the hazard-free device it was once thought to be, it has a place in emergency airway management in preventing insufflation of air into the stomach as well as aspiration of gastric contents.
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Comparative Study
Lubrication of tracheal tubes to prevent sore throat from intubation.
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We developed a canine animal model of subglottic stenosis following prolonged intubation with modified non-cuffed endotracheal tubes. None of the puppies intubated for seven days had an irreversible stenosing subglottic lesion, whereas all animals intubated for 14 days or more had at least a 40% to 50% reduction of the subglottic lumen secondary to maturing fibrotic stenosis. The model described is more congruent with the known and suspected pathogenesis in those infants and children who require prolonged endotracheal intubation and subsequently acquire subglottic stenosis, and can be used in evaluating the efficacy of medical therapy or surgical therapy, or both, in the prevention or management of this disease.