Articles: 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.
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Four hundred and twenty-seven patients with severe blunt chest trauma were treated resulting in (1) flail chest, (2) pulmonary contusions, (3) pneumothorax, (4) hemothorax, or (5) multiple rib fracture. The need for endotracheal intubation and mechanical ventilation was determined selectively by standard clinical criteria. Avoidance of fluid overload and vigorous pulmonary toilet was attempted in all patients. ⋯ Half of the flail chest patients were intubated, but 69.5% were intubated less than three days. Twenty per cent of the patients with pulmonary contusion required mechanical ventilation, usually for less than three days. This study demonstrates that patients with severe blunt chest trauma can be managed safely by selective intubation and mechanical, ventilation and that the incidence of complications associated with controlled mechanical ventilation can be greatly reduced.
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Otolaryngol Head Neck Surg · Sep 1982
Experimental induction of squamous metaplasia in the dog trachea with cuffed endotracheal tubes.
Clinical reports cite the development of squamous metaplasia in tracheas following tracheostomy, laryngectomy, and cuffed intubation. The purpose of this study was (1) to develop an experimental model using the dog trachea and study the effects of prolonged cuffed intubation and (2) to determine whether squamous metaplasia is produced by prolonged contact of the endotracheal cuff with the tracheal mucosa. ⋯ The dogs remained intubated for 14 days, at which time they were killed; seven animals were available for histologic study. Varying degrees of squamous metaplasia were produced in all animals.
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Bull Eur Physiopathol Respir · Sep 1982
A method for measuring tidal volume and lung compliance in intubated neonates in the presence of endotracheal tube leakage.
Leakage around the uncuffed endotracheal tube is a major cause of error in the measurement of tidal volume and compliance in intubated neonates. A correction for the leakage can be made if the intratracheal pressure is measured during inflation provided the compliance is linear and the inflation flow is held constant. ⋯ The validity of the function has been tested using a model of the system tube-trachea-lung. In practice, the calculation is done from data obtained by graphical analysis of the pressure-time curve.