“Post intubation Laryngeal injuries in a pediatric intensive care unit of tertiary hospital in India: A Fibreoptic endoscopic study”

Study objectivesTo identify acute laryngeal injuries among pediatric patients intubated for more than 48 hours, and to correlate these injuries with clinical variables.SettingPediatric Intensive Care Unit (PICU) of a tertiary level hospital in India.Patients and MethodsProspective, observational study. Thirty-four children meeting the inclusion and exclusion criteria were recruited into the study after obtaining informed consent from the parents. A bedside, flexible, fiberoptic laryngoscopy was done within the first 24 hours of extubation. Laryngeal injuries were documented and graded. Individual types of laryngeal injuries were correlated to the duration of intubation, size of the tube, the experience of the intubator and the patient's demographics. A repeat endoscopy was done in the outpatient department, 3-4 weeks after extubation, and findings noted.Results97% had acute laryngeal injury, of which 88% were significant. Erythema was the most common form of injury. Duration of intubation, with a mean of 4.5 days, showed a trend towards significance (p = 0.06) for association with subglottic narrowing. Laryngeal injuries were similar with both cuffed and uncuffed tubes. Age of the subject, size of the tube and skill level of the intubator did not correlate with the laryngeal injuries. 18% required intervention for post-extubation laryngeal lesions. Three (10%) children had post-extubation stridor, and of these, two needed surgical intervention (6%).ConclusionPost-extubation laryngeal injuries are not uncommon. Fiberoptic endoscopy is an inexpensive and cost-effective tool for bedside evaluation of post-intubation status in pediatric larynx. Early diagnosis of post-intubation laryngeal injuries in children can prevent long term sequelae. Hence, post-extubation fiberoptic laryngoscopy should be done routinely in pediatric population.     

可视喉镜联合纤维支气管镜在声门显露困难患者双腔支气管插管中的应用

目的探讨GlideScope可视喉镜联合纤维支气管镜引导在声门显露困难患者双腔支气管插管中的应用。方法选择择期行胸科手术患者40例,男24例,女16例,年龄24~78岁,ASAⅠ或Ⅱ级,MallampatiⅢ或Ⅳ级,随机分为GlideScope可视喉镜组(GF组)和Macintosh喉镜组(M组),每组20例。GF组运用可视喉镜联合纤维支气管镜引导进行支气管插管及对位;M组运用传统方法(先用Macintosh喉镜插管,再使用纤维支气管镜对位)。记录患者喉镜下声门显露程度Cormack-Lehane分级、插管时间、插管一次成功率、需喉部按压的患者例数以及术后48h内的声音嘶哑及咽痛情况。结果GF组Cormack-Lehane分级明显低于M组(P0.01)。GF组插管时间明显短于M组[(104.3±11.1)s vs.(138.6±33.0)s](P0.01),一次插管成功率明显高于M组(90%vs.55%)(P0.05),需要喉部按压患者比例明显低于M组(20%vs.90%)(P0.01),术后声音嘶哑和咽痛的发生率明显低于M组(5%vs.35%,25%vs.75%)(P0.05)。结论与传统方法比较,可视喉镜联合纤维支气管镜引导用于声门显露困难患者可以提高插管的成功率,减少插管时的应激反应,降低声嘶和咽痛的发生率。     

一种新型面罩联合 Storz 硬质支气管镜在小儿气管支气管异物取出术中的应用

目的：评价使用一种新型面罩联合 Storz 硬质支气管镜在小儿支气管异物取出术中的有效性和安全性。方法选择行气管及支气管异物取出术的患者60例随机分成两组：实验组30例和对照组30例,（实验组,新型面罩联合 Storz 硬质支气管镜;对照组,Storz 硬质支气管镜）。两组均实施小剂量短效肌松剂的全身麻醉,观察患者术中 SPO2变化情况及控制呼吸给氧次数,并记录麻醉前（T0）、支气管镜进入气管前（T1）、支气管镜进入气管后1 min（T2）、支气管镜进入气管后3 min（T3）、支气管镜进入气管后5 min（T4）及术毕退出支气管镜后（T5）患者的血压、心率和手术所用时间及并发症。结果组间各时点患者的血压及心率变化不大（P ＞0．05）,组内各时点患者的血压及心率比较有统计学差异（P ＜0．05）;术中暂停手术行控制呼吸给氧次数及手术时间,实验组与对照组比较有统计学差异（P ＜0．05）。结论该新型面罩联合 Storz 硬质支气管镜控制呼吸用于小儿支气管异物取出术,不仅能维持良好的血氧饱和度,保证麻醉的安全性,而且还为手术提供良好的操作条件,值得临床推广。     

纤维支气管灌洗治疗重型颅脑损伤合并肺部感染的临床分析及护理效果评估

重型颅脑损伤患者常出现的严重并发症之一即是肺部感染,其发病率较高,达57%,严重影响到患者的预后及转归,此外,患者晚期死亡的主要原因多为由肺部感染而引起的多脏器功能衰竭,因此,在对重型颅脑损伤患者进行治疗时,必须加强对肺部感染防治,从而有效提高重型颅脑损伤的治愈率。     

经纤维支气管镜局部冲洗治疗支气管扩张症53例报告

目的探讨经纤维支气管镜（以下简称纤支镜）局部灌洗注药治疗支气管扩张症的疗效。方法53例支气管扩张病人除常规治疗外，还采用纤维支气管镜反复气道灌洗和注药，在纤维支气管镜治疗前后常规监测患者临床情况、通气换气功能及血气指标。结果灌洗注药后患者体温迅速下降，外周血白细胞、痰液量明显减少，X线胸片明显改善。灌洗后血气指标（PaO2，SaO2及PaO2／FiO2）改善；肺通气功能检测（VC、FEVI、FEVI％、VS0、V25及MVV）明显改善（P〈0．05）。结论经纤维支气管镜肺泡灌洗和注药能有效清除痰痂和气道分泌物，解除支气管的阻塞，改善患者通气换气功能，是一种安全、简便实用的治疗支气管扩张的有效手段。     

纤维支气管镜引导双腔气管导管插管和可视双腔气管导管插管的对比研究

目的比较纤维支气管镜引导普通双腔气管导管插管和可视双腔气管导管插管用于开胸手术单肺通气麻醉的临床效果。方法选择需行开胸手术的患者60例,随机均分为两组。分别使用纤维支气管镜引导普通双腔气管导管插管和可视双腔气管导管插管。比较两组双腔气管导管定位时间及观察插管应激的血流动力学反应。结果可视双腔气管导管插管组气管导管定位时间比纤维支气管镜引导普通双腔气管导管插管组短,定位及术中管理便捷;可视双腔气管导管插管组插管引起的血流动力学反应与纤维支气管镜引导普通双腔气管导管插管组也没有差异。结论可视双腔气管导管定位时间短,定位准确,易于术中管理。但是仅有左侧双腔一种类型,应用范围存在一定局限性。     

Diagnostic utilities of tracheal ultrasound and USB-endoscope for the confirmation of endotracheal tube placement: A cadaver study

Objectives

Confirmation of the endotracheal tube placement (CoETP) has the utmost importance in the management of an airway. Visualization of tracheal rings or carina with a fiber-optical bronchoscope (FOB) has considered to be a reliable method for the CoETP. However, FOB is expensive, time-consuming, and not always practical. Inexpensive endoscopic USB-cameras were shown to aid intubation successfully and reliably. On the other hand, there have been no studies investigating their use for the CoETP. Tracheal ultrasonography (TUS) is also a new, inexpensive and widely available alternative. A cadaver study has planned to evaluate the diagnostic utility of TUS and a USB-camera.