Equipment Failure ; Foreign Bodies ; etiology ; Humans ; Trachea ; Tracheostomy ; instrumentation

Aged ; Equipment Failure ; Foreign Bodies ; Humans ; Kyphosis ; Male ; Scoliosis ; Spine ; abnormalities ; Trachea ; Tracheostomy ; instrumentation

Aged ; Female ; Humans ; Iatrogenic Disease ; Lacerations ; etiology ; Pneumoperitoneum ; etiology ; therapy ; Trachea ; injuries ; Tracheostomy ; adverse effects ; instrumentation ; Treatment Outcome

Awake intubation with a flexible fibrescope is usually done electively in patients with a known difficult airway. Herein, we describe the case of an elective awake tracheal intubation that was performed on a patient with a large, obstructive supraglottic mass. The intubation was successfully performed using the Bonfils fibrescope after several failed attempts with a flexible fibrescope. This case highlights the usefulness of the Bonfils fibrescope and the limitations of the flexible fibrescope in certain clinical situations.
Fiber Optic Technology ; Humans ; Intubation, Intratracheal ; instrumentation ; methods ; Laryngeal Neoplasms ; diagnosis ; Laryngoscopes ; Laryngoscopy ; instrumentation ; Male ; Middle Aged ; Trachea ; Tracheostomy ; methods ; Wakefulness

Adult ; Aged ; Female ; Humans ; Infection ; Infection Control ; instrumentation ; methods ; Intubation, Intratracheal ; instrumentation ; methods ; Male ; Middle Aged ; Suction ; Tracheostomy ; adverse effects ; Young Adult

A 1D point-prevalence study was performed to describe the characteristics of conventional mechanical ventilation in intensive care units (ICUs). In addition, a survey was conducted to determine the characteristics of ICUs. A prospective, multicenter study was performed in ICUs at 24 university hospitals. The study population consisted of 223 patients who were receiving mechanical ventilation or had been weaned off mechanical ventilation within the past 24 hr. Common indications for the initiation of mechanical ventilation included acute respiratory failure (66%), acute exacerbation of chronic respiratory failure (15%) (including tuberculosis-destroyed lung [5%]), coma (13%), and neuromuscular disorders (6%). Mechanical ventilation was delivered via an endotracheal tube in 68% of the patients, tracheostomy in 28% and facial mask with noninvasive ventilation (NIV) in 4%. NIV was used in 2 centers. In patients who had undergone tracheostomy, the procedure had been performed 16.9+/-8.1 days after intubation. Intensivists treated 29% of the patients. A need for additional educational programs regarding clinical practice in the ICU was expressed by 62% of the staff and 42% of the nurses. Tuberculosis-destroyed lung is a common indication for mechanical ventilation in acute exacerbation of chronic respiratory failure, and noninvasive ventilation was used in a limited number of ICUs.
APACHE ; Acute Disease ; Aged ; Data Collection ; Education, Professional, Retraining ; Female ; Hospitals, University ; Humans ; *Intensive Care Units ; Intubation, Intratracheal ; Male ; Middle Aged ; Prospective Studies ; *Respiration, Artificial/instrumentation ; Respiratory Insufficiency/therapy ; Tracheostomy

OBJECTIVE: The purpose of this study is to evaluate the airway dynamics of the upper airway as depicted on cine MRI in children with tracheotomy tubes during two states of airflow through the upper airway. MATERIALS AND METHODS: Sagittal fast gradient echo cine MR images of the supra-glottic airway were obtained with a 1.5T MRI scanner on seven children with tracheotomy tubes. Two sets of images were obtained with either the tubes capped or uncapped. The findings of the cine MRI were retrospectively reviewed. Volume segmentation of the cine images to compare the airway volume change over time (mean volume, standard deviation, normalized range, and coefficient of variance) was performed for the capped and uncapped tubes in both the nasopharynx and hypopharynx (Signed Rank Test). RESULTS: Graphical representation of the airway volume over time demonstrates a qualitative increased fluctuation in patients with the tracheotomy tube capped as compared to uncapped in both the nasopharyngeal and hypopharyngeal regions of interest. In the nasopharynx, the mean airway volume (capped 2.72 mL, uncapped 2.09 mL, p = 0.0313), the airway volume standard deviation (capped 0.42 mL, uncapped 0.20 mL, p = 0.0156), and the airway volume range (capped 2.10 mL, uncapped 1.09 mL, p = 0.0156) were significantly larger in the capped group of patients. In the hypopharynx, the airway volume standard deviation (capped 1.54 mL, uncapped 0.67 mL, p = 0.0156), and the airway volume range (capped 6.44 mL, uncapped 2.93 mL, p = 0.0156) were significantly larger in the capped tubes. The coefficient of variance (capped 0.37, uncapped 0.26, p = 0.0469) and the normalized range (capped 1.52, uncapped 1.09, p = 0.0313) were significantly larger in the capped tubes. CONCLUSION: There is a statistically significant change in airway dynamics in children with tracheotomy tubes when breathing via the airway as compared to breathing via the tracheotomy tube.
Adolescent ; Child ; Child, Preschool ; Female ; Humans ; Hypopharynx/anatomy & histology/*physiology ; Image Processing, Computer-Assisted ; Magnetic Resonance Imaging, Cine/*methods ; Male ; Nasopharynx/anatomy & histology/*physiology ; Retrospective Studies ; Time Factors ; Tracheostomy/*instrumentation ; Work of Breathing/*physiology