Migration of foreign body from mouth to nose (Views : 1098 times)
Written by:
Koji Yamakawa, Hiroshi Dohgomori, Takehiko Furusawa, Yoshihisa Sode, Kiminori Netsu
Case reports
Abstract
A man appeared in the Emergency Department complaining of discomfort in his neck because he had swallowed a toothpick while taking a nap. The examining physician could find no foreign body in the patient's mouth or pharynx. An additional examination using a fiberscope disclosed the existence of a foreign body in the nose. The toothpick was thought to have migrated to the nose from the pharynx after it was swallowed. Foreign bodies of various sizes may migrate to the nose from other parts of the body. Therefore, protocols must be designed for additional examination of the nose.
Key words: airway, foreign bodies, migration, toothpick
Serious complications of an obstructive upper airway infection in a young child (Views : 1952 times)
Written by:
Sandra Kralik, Ivačica Škarić, Diana Butković, Lili Mikecin, Karmen Kondža, Jasminka Jakobović
Case reports
Abstract
A 15-month old boy was admitted to our intensive care unit (ICU) cyanotic, unresponsive, apneic, pulseless, with fixed, dilated pupils and a Glasgow Coma Score (GCS) of 3/15. Prompt cardiopulmonary resuscitation (CPR) was initiated and cardiac function was resumed after 10 minutes. The boy was intubated but could not be ventilated because of a thick, viscous secretion obstructing the trachea and causing total airway obstruction. Bronchoscopy revealed laryngotracheitis as the reason for airway obstruction. A computed tomography (CT) scan of the brain showed diffuse edema and ischemic brain injury, which were considered responsible for the boy's comatose situation. Clinical status remained unchanged for 11 days, after which the boy was transported to another hospital. In children presenting with upper airway obstructing syndromes, not responding to therapy, the diagnosis of bacterial tracheitis should be considered and the child should be monitored in a pediatric intensive care unit.
Key words: children, respiratory infection, airway obstruction, bacterial tracheitis
Mediastinal tube placement in a premature infant with cardiorespiratory derangement due to ventilator associated pneumomediastinum (Views : 1571 times)
Written by:
Sandro Dessardo, Kristina Lah Tomulić, Neven Frleta, Nada Sindičić Dessardo
Case reports
Abstract
While mediastinal free air in the ventilated newborn is usually benign, tension pneumomediastinum can lead to further cardiorespiratory compromise due to the compression of mediastinal structures, including the heart and large blood vessels. The authors present a case of life-threatening pneumomediastinum in a ventilated preterm leading to abrupt onset of cardiorespiratory failure. An 8 French (Fr) drainage catheter was placed in the anterior mediastinum using the 2nd right intercostal space as an insertion site, with prompt hemodynamic improvement. A brief description of the drainage technique and a literature review is presented.
Key words: hemodynamics, mechanical ventilation, pneumomediastinum, pneumothorax, thoracocentesis
Relationship between mean arterial pressure and end-tidal partial pressure of carbon dioxide during (Views : 13213 times)
Abstract
Objectives. We examined the relationship between partial end-tidal CO2 (pet) and mean arterial pressure in patients with traumatic hemorrhagic shock, who were receiving constant minute ventilation.
Methods. In 61 patients we continuously measured pet CO2 with a capnograph, direct arterial pressure via a cannula, oxygen levels via pulse oximetry and body temperature.
Results. We observed significant changes in pet CO2 (increase) after volume resuscitation and a quantitative linear relationship between pet CO2 and mean arterial pressure.
Conclusions. Partial end-tidal CO2 can be used as a reliable non-invasive monitoring device in patients with hemorrhagic shock when minute ventilation is relatively constant. The monitoring of pet CO2 might also be a useful guide for volume resuscitation in hemorrhagic shock, especially in the pre-hospital setting.
Keywords: end- tidal CO2, mean arterial pressure, hemorrhagic shock, relationship
Tracheotomy versus prolonged intubation in medical intensive care unit patients (Views : 5232 times)
Written by:
Boubaker Charra, Abdelhamid Hachimi, Abdellatif Benslama, Said Motaouakkil
Original articles
Abstract
Introduction. The contribution of tracheotomy in comparison to intubation in patients on the resuscitation ward is debated. The main purpose of our study is to assess if tracheotomy compared to prolonged intubation, reduces the whole duration of ventilation, the frequency of nosocomial pneumopathy, the mean duration of hospitalisation in the resuscitation ward and mortality.
Patients and method. It is a retrospective and comparative study between two groups of patients who presented neurological or respiratory pathology and required mechanical ventilation for more than three weeks. The study lasted 7 years and involved 60 patients divided into 2 groups : the Tracheotomy Group (TG, n=30), in which a tracheotomy was performed between the eighth day and the fifteenth day, after the first period of tracheal intubation; and the Intubation Group (IG, n=30), where the patients were intubated throughout the period of hospitalization until extubation or death. We monitored the whole duration of ventilation, the frequency of nosocomial pneumopathy, the incidence of each technique as well as the mean duration of hospitalization in the resuscitation ward and the mortality rate. The two groups were similar in age, sex and gravity score : SAPS II and APACHE II.
Results. The results showed a significant statistical decrease of the whole duration of mechanical ventilation for the TG: 27.03 ± 3.31 days versus 31.63 ± 6.05 days for the IG (P = 0.001). However, there is no significant difference between the two groups, whereas the frequency of nosocomial pneumopathy is about 53.3% in the group with tracheotomy versus 70% for the intubated group (P = 0.18). This shows, on the other hand, the late prevalence of nosocomial pneumopathy in the tracheotomy group patients.
We noticed one case of bleeding after tracheotomy. Sinusitis was also diagnosed but without a significant difference between the two groups, 6.7% (2 cases) in the TG and 10% (3 cases) for the IG (P = 0.31). The mean duration of hospitalization didn't differ between the two groups; it was 30.96 ± 9.47 days for the TG versus 34.26 ± 9.74 days for the IG (P = 0.10). The study shows that there is no statistically significant difference in mortality between the two groups, 26.7% in the TG versus 46.7% for the IG (P = 0.10).
Conclusion. It seems that tracheotomy, in medical ICU patients, leads to a shorter duration of ventilation, delayed nosocomial pneumopathy without the modification of its frequency and the mean duration of hospitalization or death.
Keywords: tracheotomy, prolonged intubation, pneumopathy, mechanical ventilation, mortality
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