Tracheobronchial stents in patients with malignant airway disease: Finnish tertiary care experience

Open in a separate window OBJECTIVESTracheobronchial stenting has an established role in the palliation of malignant central airway obstruction (CAO). The purpose of this study is to describe the experience with self-expanding metal airway stents in 2 tertiary referral centres, covering a third of the population of Finland.METHODSPatients referred to and treated with airway stenting for malignant CAO using self-expanding metal-stents were identified from electronic patient records, and data were collected using a structured Endoscopic Lower Airway Management instrument. Statistical analysis to reveal factors affecting patient benefit and survival was carried out.RESULTSA total of 101 patients (mean age 65.8) and 116 procedures were identified. Procedure-related mortality was rare (3/101 patients) and complications infrequent. The median survival was 2.3 months [95% confidence interval (CI): 1.4–3.1). Stent benefit was not significantly affected by clinical characteristics. Survival was impacted by the use of adjunct procedures [hazard ratio (HR) 0.36, 95% CI: 0.23–0.58, P < 0.001), procedural urgency (HR 0.40; 95% CI: 0.23–0.71, P = 0.002) and post-treatment chemoradiotherapy (HR 0.29, 95% CI: 0.15–0.56, P < 0.001).CONCLUSIONSThe beneficial impact observed supports the further use of tracheobronchial stenting in malignant CAO. The use of self-expanding metal stents is encouraged.     

老年气管插管患者舒适护理的管理

目的：探讨舒适护理在老年气管插管患者的应用及管理。方法：对46例老年气管插管患者，在整体护理中运用舒适护理，并评价其效果。结果：老年气管插管患者实施舒适护理，患者能适应非语言沟通方式，90％患者感觉身体舒适，能配合治疗；部分患者恐惧焦虑情绪逐渐好转，病人及家属满意度为96％。结论：舒适护理在老年气管插管患者中的应用，体现了以人为本的护理理念，提高了患者及家属的满意度，提高了护理服务质量。     

Wegener’s Granulomatosis Presenting as Mediastinal Soft Tissue Mass Invading the Tracheal Wall

Wegener’s granulomatosis (WG) is a clinicopathologic entity of unknown cause characterised by a necrotising granulomatous vasculitis affecting multiple organs, especially the upper and lower respiratory tracts, lung and kidney. The lung is the most frequently, and sometimes the only involved organ. Single or multiple nodules, with or without cavitation, are the most common pulmonary manifestations in WG, but mediastinal involvement is atypical. The sole tracheal involvement is rare and hilar and mediastinal involvement has been thought not to be part of the clinical feature. We experienced a rare case of WG presenting as paratracheal mediastinal lesions with tracheal wall invasion, which responded dramatically to corticosteroid treatment. We present this case with a review of the literature. Received: 22 October 1999 / Accepted: 20 April 2000     

Aberrant left pulmonary artery with tracheal stenosis without vascular sling

Summary We report a case of abnormal origin of the left pulmoanry artery from the right pulmonary artery, associated with tracheal stenosis but with no vascular sling. This is the first such case, to our knowledge, without vascular sling.     

The efficiency of β2-agonist delivery through tracheal tubes with the metered-dose inhaler: an in vitro study

Purpose. To study the delivery efficiency of procaterol aerosols administered through the tracheal tube (ETT) with a metered-dose inhaler (MDI) during apnea. Methods. First, in a normal room air environment (at ambient temperatures of 24° to 26°C), we measured the amount of aerosol delivered through the ETT by comparing the weight of a 2-l bottle before and after firing the MDI directly into the 15-mm adapter of the ETT. The distal half of the ETT was inserted in the bottle. This procedure was repeated using five different ETTs with an internal diameter of 4–8.5 mm. The delivery efficiency was obtained by dividing the amount of aerosol delivered through the ETT by the total aerosol output per MDI puff. Next, we investigated whether the connector attached to the 15-mm ETT adapter could reduce the delivery, by repeating the same procedure with 4-mm and 5-mm ETTs. Finally, we compared the efficiencies of aerosol delivery through the 5-mm ETT and the 7.5-mm ETT in a normal room air environment with results obtained under a humidified condition (100% humid air at 37°C). Results. The percentages of aerosol delivered through the ETTs in a normal room air environment were 40%–60%, except for the 4-mm ETT, for which the percentage was 32.7% ± 6.6% (P < 0.05 vs that with the 5-mm ETT or the 6-mm ETT). A connector attached to the 15-mm ETT adapter significantly decreased the delivery efficiencies (19.0% ± 5.8% vs 32.7% ± 6.6% with the 4-mm ETT, 24.6% ± 11.8% vs 51.7% ± 10.8% in the 5-mm ETT) when compared with those without a connector. The delivery efficiencies under the humidified condition in the 5-mm ETT and the 7.5-mm ETT were 65.5% (P < 0.05) and 89.8% of those in the normal room air environment, respectively. Conclusion. The efficiency of delivery of procaterol aerosol through the ETTs was unexpectedly high (approximately half of the total aerosol output per MDI puff in the 5-mm to 8.5-mm ETTs, and one third of the total aerosol output per MDI puff in the 4-mm ETT). A connector attached to the 15-mm ETT adapter noticeably decreased the delivery efficiency. In the smaller-sized ETT, delivery efficiency was significantly lower under the humidified condition than in the normal room air environment. Received: September 28, 2001 / Accepted: June 24, 2002 Address correspondence to: T. Takaya     

盐酸地尔硫卓抑制高血压患者拔管反应的观察

【目的】观察高血压患者在全麻术后拔管期间应用盐酸地尔硫卓(合贝爽)对拔管时的心血管反应作用。【方法】选择60例患者,随机分为2组,治疗组在具拔管指征时静脉注射盐酸地尔硫卓(合贝爽)0.15~0.25 mg/kg。对照组注入等量生理盐水,观察其心率(HR)、收缩压(SBP)、平均动脉压(MBP)和血氧饱和度(SpO2)变化。【结果】治疗组用药后1 min HR比对照组明显降低(P<0.05);SBP、MBP与对照组比较均明显下降(P<0.01);拔管时的SBP、MBP与对照组比较均有显著差异(P<0.01);SpO2用药后两组间无显著差异。【结论】盐酸地尔硫卓(合贝爽)能减轻高血压患者拔管期间的心血管反应,具有一定的临床应用价值。     

带囊气管导管在神经外科ICU大便失禁患者中的应用

目的 探讨神经外科大便失禁患者留置带囊气管导管引流的效果.方法 对18例神经外科大便失禁患者进行带囊气管导管引流(实验组),观察其肛周皮肤受损情况并与15例前期采用传统护理方法的神经外科大便失禁患者(对照组)比较.结果 实验组的肛周皮肤受损率为5.6%,明显低于对照组(53.3%)(χ2=3.87,P＜0.05).结论 带囊气管导管引流能明显降低神经外科大便失禁患者的肛周皮肤受损并发症,能极大地减轻病人痛苦.     

Fulminant pulmonary edema after near-drowning: remarkably high colloid osmotic pressure in tracheal fluid

A 44-year-old man developed severe permeability pulmonary edema associated with septic shock after near-drowning. Colloid osmotic pressure (COP) of deep tracheal fluid was persistently higher than plasma COP. Tracheal/plasma COP ratio reached a peak value of 1.75. A massive colloid infusion of 5% protein solution was incriminated in the development of this markedly elevated COP in the tracheal fluid.