Articles: intubation.
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Critical care medicine · Jun 1980
Complications of airway intrusion in 100 consecutive cases in a pediatric ICU.
One-hundred consecutive patients who underwent orotracheal intubation (OT), nasotracheal intubation (NT), or tracheostomy in the pediatric ICU were evaluated for complications of these airway invasions. Twelve patients had major complications as a result of airway intervention. The mortality for patients requiring mechanical ventilation was 17% as compared with a total overall mortality of 8.3% for patients in the pediatric ICU. ⋯ Laryngotracheobronchitis (croup) was the primary diagnosis associated with the highest rate of complications. An association was found between the occurrence of seizures or hypoperfusion state (shock) while intubated and the occurrence of major complications of airway intrusion. Acquired infections of the respiratory tract with Hemophilus influenzae, Pseudomonas, Klebsiella, and Candida albicans were also associated with a high rate of complications.
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The Laerdal mask can be easily modified to permit nasotracheal intubation to be undertaken under general anaesthesia with the aid of a fiberoptic laryngoscope.
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A retrospective review of 100 surviving infants, all requiring nasotracheal intubation in the neonatal period for greater than 24 hr. was performed to assess the morbidity of this form of airway management. Seventy infants needed only one intubation, 22 were intubated twice and 8 infants required 3 intubations. No infant had evidence of laryngeal or tracheal sequelae, either in the immediate newborn period or on follow-up. Nasotracheal intubation by an experienced practitioner with appropriate tube fixation and toilet coupled with the use of low pressure ventilation and a consistent extubation routine will result in very low long-term tracheal morbidity in the neonate.
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A tracheal-esophageal airway for field or hospital use is described. The airway consists of a clear plastic mask and endotracheal low pressure cuffed tube with a Murphy tip. ⋯ The endotracheal tube is attached to the mask by a tubular coupler and easily disconnected by removing a metal clip in the event of tracheal insertion of the tube. Our four-year experience with the tracheal-esophageal airway in 400 cardiac arrests has shown it to be safe, simple, and useful.
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It is widely accepted and taught that the accidental placement of a tracheal tube in the oesophagus can be readily detected if it is looked for, though it is recognised that death from this cause occurs from time to time. Evidence is now presented of instances where anaesthetists have been misled by a range of tests which are commonly used to check the correct placement of a tracheal tube. An explanation is offered for this unexpected finding, and some recommendations are formulated to improve patient safety.