BACKGROUND Primary intratracheal schwannoma is an extremely rare type of benign airway tumor,especially in adolescents.The presenting symptoms are typically prolonged cough and wheezing that can be misdiagnosed as ast...BACKGROUND Primary intratracheal schwannoma is an extremely rare type of benign airway tumor,especially in adolescents.The presenting symptoms are typically prolonged cough and wheezing that can be misdiagnosed as asthma in adolescent patients.CASE A 16-year-old adolescent girl admitted to a local hospital with symptoms of an irritating cough and wheezing was diagnosed with bronchial asthma and treated with budesonide and formoterol.Over the next year,the patient's wheezing and coughing symptoms gradually worsened and the antiasthma treatment was ineffective.One week prior to this admission,the patient developed dyspnea after catching a cold and was transferred to our hospital with a diagnosis of severe asthma.However,chest computed tomography and bronchoscopy showed a mass in the trachea.Primary intratracheal schwannoma was diagnosed by biopsy.Her symptoms were relieved by endoscopic resection by electrosurgical snaring combined with argon plasma coagulation.No relapse occurred during an 18 mo follow-up.CONCLUSION Primary intratracheal schwannoma should be considered in the differential diagnosis in adolescents with recurrent asthma-like attacks.展开更多
BACKGROUND:Adequate airway management plays an important role in high-quality cardiopulmonary resuscitation(CPR).Airway management is usually performed using an endotracheal tube(ETT)during CPR.However,no study has as...BACKGROUND:Adequate airway management plays an important role in high-quality cardiopulmonary resuscitation(CPR).Airway management is usually performed using an endotracheal tube(ETT)during CPR.However,no study has assessed the effect of ETT size on the fl ow rate and airway pressure during CPR.METHODS:We measured changes in peak inspiratory fl ow rate(PIFR),peak airway pressure(Ppeak),and mean airway pressure(Pmean)according to changes in ETT size(internal diameter 6.0,7.0,and 8.0 mm)and with or without CPR.A tidal volume of 500 mL was supplied at a rate of 10 times per minute using a mechanical ventilator.Chest compressions were maintained at a constant compression depth and speed using a mechanical chest compression device(LUCAS2,mode:active continuous,chest compression rate:102±2/minute,chest compression depth 2–2.5 inches).RESULTS:The median of several respiratory physiological parameters during CPR was significantly different according to the diameter of each ETT(6.0 vs.8.0 mm):PIFR(32.1 L/min[30.5–35.3]vs.28.9 L/min[27.5–30.8],P<0.001),Ppeak(48.84 cmH2O[27.46–52.11]vs.27.45 cmH2O[22.53–52.57],P<0.001),and Pmean(18.34 cmH2O[14.61–21.66]vs.13.66 cmH2O[8.41–19.24],P<0.001).CONCLUSION:The changes in PIFR,Ppeak,and Pmean were related to the internal diameter of ETT,and these values tended to decrease with an increase in ETT size.Higher airway pressures were measured in the CPR group than in the no CPR group.展开更多
Intratracheal aspiration in a patient on ventilation is generally performed using a catheter. Of late, closed suction systems have been used more frequently than open systems. To remove tracheal secretions through the...Intratracheal aspiration in a patient on ventilation is generally performed using a catheter. Of late, closed suction systems have been used more frequently than open systems. To remove tracheal secretions through the intratracheal tube, catheter suction is used, and the suction catheter may be of the closed- or open-type. The catheters are cleaned by flushing with sterile 0.9% saline, resulting in dropping of dew. This phenomenon is caused by some factors: influence of flow, clogging of the suction tube, problem of manipulation of flushing and angle between the intubation tube and the connection port. But this dropping has not yet been investigated. In this study, we focused at this angle and we used the test lung which is simulated machine on behalf of patient. We consider two situations adult and child, also two types of catheters Eco-Cath and Ty-care. In child case we consider elbow-type suction catheters and Y-connector type. The angle was set at 0°, 20°, 40°, 60°, and 90°, and we observed the difference between Eco-Cath and Ty-care. In adults difference is significant (p 0.001), In 90°between Tracheal intubation and Tracheotomy (p ≈ 0.26). In child difference is significant (p 0.001), In 90°between Tracheal intubation and Tracheotomy (p ≈ 0.15). In child case we observed dependency of angle on various conditions too. The relation of the angle and dew was clarified.展开更多
Digital intubation was discovered as one of the first methods to face a difficult airway without direct laryngoscopy. From the very beginning, this technique has been surrounded by much controversy, mainly because it ...Digital intubation was discovered as one of the first methods to face a difficult airway without direct laryngoscopy. From the very beginning, this technique has been surrounded by much controversy, mainly because it required to be performed by an expert. Nowadays, it remains a useful technique when treating patients with difficult airways, so it is of utmost importance all personnel involved with airway management must know and perfect this technique when scenarios where conventional laryngoscopy or rescue devices for difficult airway are not available or contraindicated. The present work’s main objective is to suggest digital intubation as a safe and effective technique for the management of patients with difficult airways when there are no other devices available. The authors present a successful case of digital intubation on a patient with a difficult airway, demonstrating this technique is useful when performed by expert practitioners and when there is no other equipment available.展开更多
基金Natural Science Foundation of Gansu Province,China,No.20JR5RA335.
文摘BACKGROUND Primary intratracheal schwannoma is an extremely rare type of benign airway tumor,especially in adolescents.The presenting symptoms are typically prolonged cough and wheezing that can be misdiagnosed as asthma in adolescent patients.CASE A 16-year-old adolescent girl admitted to a local hospital with symptoms of an irritating cough and wheezing was diagnosed with bronchial asthma and treated with budesonide and formoterol.Over the next year,the patient's wheezing and coughing symptoms gradually worsened and the antiasthma treatment was ineffective.One week prior to this admission,the patient developed dyspnea after catching a cold and was transferred to our hospital with a diagnosis of severe asthma.However,chest computed tomography and bronchoscopy showed a mass in the trachea.Primary intratracheal schwannoma was diagnosed by biopsy.Her symptoms were relieved by endoscopic resection by electrosurgical snaring combined with argon plasma coagulation.No relapse occurred during an 18 mo follow-up.CONCLUSION Primary intratracheal schwannoma should be considered in the differential diagnosis in adolescents with recurrent asthma-like attacks.
基金supported by the Chungnam National University Hospital Research Fund,2016
文摘BACKGROUND:Adequate airway management plays an important role in high-quality cardiopulmonary resuscitation(CPR).Airway management is usually performed using an endotracheal tube(ETT)during CPR.However,no study has assessed the effect of ETT size on the fl ow rate and airway pressure during CPR.METHODS:We measured changes in peak inspiratory fl ow rate(PIFR),peak airway pressure(Ppeak),and mean airway pressure(Pmean)according to changes in ETT size(internal diameter 6.0,7.0,and 8.0 mm)and with or without CPR.A tidal volume of 500 mL was supplied at a rate of 10 times per minute using a mechanical ventilator.Chest compressions were maintained at a constant compression depth and speed using a mechanical chest compression device(LUCAS2,mode:active continuous,chest compression rate:102±2/minute,chest compression depth 2–2.5 inches).RESULTS:The median of several respiratory physiological parameters during CPR was significantly different according to the diameter of each ETT(6.0 vs.8.0 mm):PIFR(32.1 L/min[30.5–35.3]vs.28.9 L/min[27.5–30.8],P<0.001),Ppeak(48.84 cmH2O[27.46–52.11]vs.27.45 cmH2O[22.53–52.57],P<0.001),and Pmean(18.34 cmH2O[14.61–21.66]vs.13.66 cmH2O[8.41–19.24],P<0.001).CONCLUSION:The changes in PIFR,Ppeak,and Pmean were related to the internal diameter of ETT,and these values tended to decrease with an increase in ETT size.Higher airway pressures were measured in the CPR group than in the no CPR group.
文摘Intratracheal aspiration in a patient on ventilation is generally performed using a catheter. Of late, closed suction systems have been used more frequently than open systems. To remove tracheal secretions through the intratracheal tube, catheter suction is used, and the suction catheter may be of the closed- or open-type. The catheters are cleaned by flushing with sterile 0.9% saline, resulting in dropping of dew. This phenomenon is caused by some factors: influence of flow, clogging of the suction tube, problem of manipulation of flushing and angle between the intubation tube and the connection port. But this dropping has not yet been investigated. In this study, we focused at this angle and we used the test lung which is simulated machine on behalf of patient. We consider two situations adult and child, also two types of catheters Eco-Cath and Ty-care. In child case we consider elbow-type suction catheters and Y-connector type. The angle was set at 0°, 20°, 40°, 60°, and 90°, and we observed the difference between Eco-Cath and Ty-care. In adults difference is significant (p 0.001), In 90°between Tracheal intubation and Tracheotomy (p ≈ 0.26). In child difference is significant (p 0.001), In 90°between Tracheal intubation and Tracheotomy (p ≈ 0.15). In child case we observed dependency of angle on various conditions too. The relation of the angle and dew was clarified.
文摘Digital intubation was discovered as one of the first methods to face a difficult airway without direct laryngoscopy. From the very beginning, this technique has been surrounded by much controversy, mainly because it required to be performed by an expert. Nowadays, it remains a useful technique when treating patients with difficult airways, so it is of utmost importance all personnel involved with airway management must know and perfect this technique when scenarios where conventional laryngoscopy or rescue devices for difficult airway are not available or contraindicated. The present work’s main objective is to suggest digital intubation as a safe and effective technique for the management of patients with difficult airways when there are no other devices available. The authors present a successful case of digital intubation on a patient with a difficult airway, demonstrating this technique is useful when performed by expert practitioners and when there is no other equipment available.
