Articles: intubation.
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Critical care medicine · Mar 1982
Comparative StudyTracheal tube forces on the posterior larynx: index of laryngeal loading.
Most tracheal tubes sold today are arcuate in shape while the human airway is S-shaped. In situ, the tubes exert different forces on the posterior larynx, depending on their stiffness. Laryngeal damage after prolonged intubation is recognized as the result of these forces. ⋯ The airway model and test procedure can be utilized by manufactures, designers, and others to provide valuable information on tracheal tube performance and to develop improved tracheal tubes in the future. The results indicate that the polyvinylchloride tubes (PVC) and the silicone rubber tubes had the lowest index of laryngeal loading after long-term conditioning and would be preferable for prolonged intubation. The red rubber tube had the highest index of laryngeal loading after long-term conditioning, yet its stiffness would facilitate intubation.
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In a patient with cirrhosis and bleeding esophageal varices who had previously undergone a partial gastric resection, the gastric balloon of a Sengstaken-Blakemore tube was inadvertently placed into the efferent jejunal limb of the gastrojejunostomy. Inflation of the balloon to the standard volume of 150 ml resulted in rupture of the jejunum. Precautions in the use of the Sengstaken-Blakemore tube that might prevent this complication are described.
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During a 24-month period, 34 cases of nosocomial sinusitis associated with nasopharyngeal instrumentation were identified in 32 severely traumatized patients, accounting for 5% of all nosocomial infections. Diagnosis was based on roentgenographic findings consistent with acute sinusitis and either purulent material aspirated from the involved sinus or purulent nasal discharge. All patients had fever and most had leukocytosis. ⋯ Seven, although asymptomatic, had persistent radiological abnormalities consistent with chronic sinusitis. Five patients died of intercurrent disease before resolution of their sinusitis. Sinusitis should be ruled out as a cause of infection in febrile intensive care patients with an indwelling nasal tube.