SEARCH · PubMed Health
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Thermal degradation products (tdp) from a model, rigid polyurethane foam were collected in such a manner as to eliminate carbon monoxide and other gases with low boiling points. The effects in rats resulting from intratracheal intubation (I.T.) of the tdp are discussed. Cyanide was found to be a major factor associated with severe toxic responses of the experimental rats.
Nosocomial bronchopneumonia is a frequent complication in patients with chronic intratracheal intubation. Despite targeted antibiotic treatment, production of abundant bronchial secretion containing pathogen bacteria often tends to be chronic, and so mortality drastically increases. This problem led to an investigation of the penetration of five cephalosporin antibiotics into the sputum. Serum and sputum were collected from 24 chronically intubated patients having purulent nosocomial bronchopneumonia treated in an intensive care unit (ICU). Patients received the following doses intravenously every 24 h: five received 70 mg/kg of body weight cefuroxime, four received 110 mg/kg cefamandole, six received 80 mg/kg ceftriaxone, four received 80 mg/kg ceftazidime, and five received 80 mg/kg cefepime. Antibiotic concentrations in the serum and sputum were evaluated by capillary electrophoresis. MICs were determined for bacteria isolated from the purulent bronchial secretions. The mean levels of the cephalosporins in the sputum did not reach the MICs for the bacteria isolated from the same samples. Ceftriaxone was the only one of the investigated five cephalosporins that had a measurable concentration in the sputum (1.4 +/- 1.2 mg/liter). The low concentration of antibiotics in the purulent tracheobronchial secretion can be one of the many reasons for ineffective therapy of nosocomial bronchopneumonia in intubated patients in the ICUs. In the case of intubated or mechanically ventilated patients having chronic bronchopneumonia, determination of drug concentration in the bronchial secretion might be considered when selecting an antibiotic for treatment.
Weanling and 9 months or older rats were exposed to particles of an aged (PUF I) or freshly prepared (PUF II) rigid polyurethane foam by intratracheal intubation. The dose was 5 mg of particles. The response of the lung tissue was examined morphologically by serial sacrifices. Inflammation and macrophage activity were the initial responses. Fibrosis developed after 6 months. Nodular scars and perifocal emphysema were seen after 12 months. Four rats had a papillary adenoma in a major bronchus after 18 months exposure to PUF II.
Three mixtures of benzo(alpha)(a)pyrene (BP) and ferric oxide with different physical properties were given intratracheally to Syrian golden hamsters for an examination of their neoplastic potential. Hamsters treated with a preparation containing large aggregates of BP and ferric oxide resulting from nucleation of BP on the particles showed an earlier onset and higher incidence of respiratory tract tumors than animals given a mixture containing smaller aggregates prepared by hand-grinding. The greatest number of tumors were present in the trachea and the predominant type was the squamous carcinoma. A third preparation in which the carcinogen was not attached to the ferric oxide showed a low tumor incidence similar to that present after intratracheal intubation of BP in gelatin without a carrier particle. For this model system of respiratory carcinogenesis, the physical attachment of BP and the carrier dust is necessary for a high tumor yield.
Surgical treatment was applied to 18 patients for intrathoracic struma. Dyspnoea, dysphagia, recurrent palsy, and dilatated cervical veins with facial flushing were indications for surgery. Surgical access routes depended on localisation of the intrathoracic struma and its connection to the thyroid gland. Goitre located in the anterior mediastinum (substernal) can be extirpated, using the cervical approach (Kocher). Sternotomy was found to be necessary only in cases with tracheal resection. Goitres located in the posterior mediastinum were removed by means of right or left thoracotomy. Postoperative "collapse" of the posterior tracheal wall in patients with extreme dislocation of the trachea was successfully avoided by means of intratracheal intubation for 24 hours.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
To investigate the extent to which intratracheal intubation may alter the respiratory epithelium of the Syrian golden hamsters, single and repeated intubations were undertaken and the resulting injury and subsequent epithelial regeneration were examined by scanning electron microscopy. Generally, epithelial injury as a result of a single intubation had healed ad integrum within 20 to 40 days. On the other hand, repeated treatment often caused tracheitis and led to prolonged regeneration which sometimes persisted as papillary hyperplasia 40 days after the final intubation. The appropriateness of intratracheal instillation as a method of administering chemical carcinogens and the similarity of the epithelial regeneration processes to early neoplastic alterations of the epithelium are discussed.
The Candida colonization and the dynamics of antibodies to Candida were studied in intensive care patients. 20 patients received no antifungal prophylaxis, 20 patients were treated by local application of Pimaricin into the mouth, nose, and into the respiratory tract during the time of intratracheal intubation. The frequencies and quantities of yeasts in the respiratory secretions were considerably reduced in the group receiving Pimaricin, whereas the amount of faecal colonization showed no difference between both groups of patients. During the 2nd-3rd week of hospitalization 17 patients of the untreated group and 4 patients of the treated group developed a significant rise of Candida antibodies. The association between the respiratory colonization and the antibody response indicates that the mucosa of the mouth and the respiratory tract is a main source of Candida invasion. In order to prevent that precondition of Candida endomycosis, routine ororespiratory antifungal prophylaxis is recommended, particularly in patients with prolonged intratracheal intubation.
Explore the source record for details and available documents.
OBJECTIVE: To explore the causes and management of acute respiratory tract obstruction in patients undergoing thyroid operation. METHODS: A retrospective review was conducted in 10 such cases that we encountered in our 11 years' experience with thyroid operation. RESULTS: Respiratory tract obstructions occurred in 10(0.31%) of 3,186 cases during thyroid operation. The causes for the obstructions included tracheomalacia in 2 cases, hematoma compression in 5 cases, trachea convulsion in 2 cases and phlegm obstruction in 1 case. Tracheotomy or intratracheal intubation was performed in 6 cases and hematoma removal in 4 cases, with the occurrence of death in 1 case. CONCLUSION: Hematoma compression and tracheomalacia etc. are among the most common causes of acute respiratory tract obstruction during thyroid operation, the occasion of which demands immediate implementation of tracheotomy or intratracheal intubation.
BACKGROUND: Intratracheal pressure (Ptrach) should be the basis for analysis of lung mechanics. If measured at all, Ptrach is usually assessed by introducing a catheter into the trachea via the lumen of the endotracheal tube (ETT). The authors propose a computer-assisted method for calculating Ptrach on a point-by-point basis by subtracting the flow-dependent pressure drop delta PETT(V) across the ETT from the airway pressure (P(aw)), continuously measured at the proximal end of the ETT. METHODS: The authors measured the pressure-flow relationship of adult endotracheal tubes with different diameters (ID, 7-9 mm) at different lengths and of tracheostomy tubes (ID, 8-10 mm) in the laboratory. The coefficients of an approximation equation were fitted to the measured pressure-flow curves separately for inspiration and expiration. In 15 tracheally intubated patients under volume-controlled ventilation and spontaneous breathing, the calculated Ptrach was compared with the measured Ptrach. RESULTS: The authors present the coefficients of the "nonlinear approximation": delta PETT = K1.VK2, with delta PETT being the pressure drop across the ETT and K1 and K2 being the coefficients relating V to delta PETT. An important result was an inspiration/expiration asymmetry: the pressure drop caused by the inspiratory flow exceeds that of the expiratory flow. A complete description of the pressure-flow relationship of an ETT, therefore, requires a set of four coefficients: K1I, K2I, K1E, and K2E. The reason for this asymmetry is the abrupt sectional change between ETT and trachea and the asymmetric shape of the swivel connector. Comparison of calculated and measured Ptrach in patients gives a correspondence within +/- 1 cmH2O (mean limits of agreement). The mean root-mean-square (rms) deviation is 0.55 cmH2O. CONCLUSIONS: Ptrach can be monitored by combining our ETT coefficients and the flow and airway pressure continuously measured at the proximal end of the ETT.
STUDY OBJECTIVES: A miniaturized, infrared, solid-state, end-tidal CO2 detector was used to confirm emergency endotracheal tube (ETT) placement. DESIGN: This prospective, clinical study used a miniature, infrared, solid-state end-tidal CO2 detector to confirm ETT placement in an acute setting. SETTING: The ICU, emergency department, and hospital floor. TYPE OF PARTICIPANTS: There were 88 consecutive adult patients requiring 100 emergency intubations. MEASUREMENTS AND MAIN RESULTS: The indication for airway intervention was considered urgent in 79% and under arrest conditions in 21%. The mean number of intubation attempts was 1.83 (range, one to five) with difficulty of intubation of 6.48 and confirmation of 7.75, on a linear scale from 0 (lowest) to 10 (highest). Determination of ETT position revealed intratracheal intubation in 96% and esophageal intubation in 4%. Placement was confirmed by direct visualization or radiography in all cases. Sensitivity and specificity for ETT localization was 100% (P less than .0001). CONCLUSION: This hand-held infrared capnometer reliably confirms ETT placement under emergency conditions.
A 49-year-old housewife with membranous laryngotracheobronchitis (the membranous croup) was referred to our clinic because of difficulty in breathing. Instant intubation in the emergency room did not relieve her breathing trouble, thus, following emergency tracheostomy accompanied by irrigation with mucolytic agents and antibiotics proved effective. Preceding intratracheal intubation made the patient suffocate because it induced membranous debris to detach and become lodged in the tracheal wall. In addition, dryness seemed to worsen her respiratory distress, thus high humidification was felt to be instrumental in relieving her symptoms. No pathological bacteria were found in specimens detached from the tracheal wall.
Within the scope of emergency medicine nearly every arrest of respiration and circulation must be treated in its critical phase by clearing the airways, artificial respiration and external cardiac compression. Chances for a successful cardiopulmonary resuscitation can be essentially improved, if the lifesaving emergency-treatment is improved by suitable technical measures. Start of an intravenous infusion, suctioning the airways with techniques, insertion of oropharyngeal airways, intratracheal intubation or in special cases coniotomy and transtracheal insufflation improve the chances of oxygenation. Simultaneously must be treated complicating accident effects as pneumothorax and shock. Additional administration and intravenous or intratracheal application of sympathicomimetic drugs, counteraction of acidosis with sodium bicarbonat often are the only possibility to continue successfully the cardiopulmonary resuscitation. In scope of emergency care the electrical external defibrillation is for treatment of fibrillation the best method to be applied.
We administered a calcium channel blocker, nicardipine 0.01 mg.kg-1 i. v. bolus or 5 micrograms.kg-1.min-1 i. v. infusion before induction with thiamylal or modified NLA (thiamylal, droperidol and butorphanol) to prevent hypertension at intratracheal intubation, and measured blood pressure and heart rate before and after intubation. Blood pressure of all experimental groups was significantly reduced in comparison with the control group right after intubated. Nicardipine is effective to prevent hypertension at intubation.
We have described a patient with Creutzfeldt-Jakob disease who showed disappearance of sleep apnea by tracheal intubation. All night polygraphic study revealed a clear correlation between the cyclic EEG change and sleep apnea. The periodic synchronous discharge (PSD) phase in EEG corresponded to the breathing phase in respiration and non-PSD phase corresponded to the apneic phase. Intratracheal intubation has completely stopped both the apnea and the cyclic EEG change. Therefore, we assumed that the PSD-non-PSD cycle in EEG might causally relate with the peripheral obstruction of the airway during sleep.