Acute and Critical Care

Case Reports

Delayed Obstruction of Endotracheal Tube by Previously Aspirated Foreign Body: A Case Report: Sungsik Chon, Jinho Kim, Shin Ok Koh, Jung Goo Cho, In Soon Hwang, In Seon Jin; Korean J Crit Care Med. 2005;20(2):174-177.

Abstract PDF: Acute airway obstruction during endotracheal intubation status is embarrassing and critical situation which requires early diagnosis and immediate management. Endotracheal tube obstruction with foreign body is rare but a variety of objects have been reported. We present a case of endotracheal tube obstruction as a result of previous aspirated foreign body that moved from the bronchial tree into the endobroncheal tube.

Subcutaneous Emphysema and Pneumothorax Occurred during Patient Transfer to Intensive Care Unit: A Case Report: Yoonki Lee, Won Young Kim; Korean J Crit Care Med. 2004;19(1):52-56.

Abstract PDF: A 48 years old female patient was scheduled for emergency surgery due to bleeding after intracerebral aneurysmal clipping under general anesthesia. Previously checked chest X-ray taken just a few hours before surgery showed no abnormal finding and she didn't show any sign of pneumothorax or hemothorax including dyspnea, tachypnea or cyanosis. Surgery was uneventful. After the completion of surgery, patient was transferred to the neurosurgical intensive care unit with intubation. During transfer, patient showed bucking and signs of subcutaneous emphysema around chest, shoulder and face. Oxygen saturation was low when she admitted to the neurosurgical intensive care unit, so the ventilator care was started. The patient's oxygenation were getting worse progressively, so we checked chest AP several times and one of the chest X-ray taken at that time revealed no vascular and lung marking on the left lung field suggesting pneumothorax. Emergency chest tube drainage was performed. She recovered dramatically and three days later, ches X-ray showed the complete resorption of the pneumothorax.

Original Articles

Clinical Survey of Appropriate Cuff Volume and Pressure during General Anesthesia in Pediatric Patients: Dong Suk Chung; Korean J Crit Care Med. 2000;15(2):93-97.

Abstract PDF: BACKGROUND
Uncuffed endotracheal tubes are commonly used in pediatrics even when the risk of gastric aspiration is significant. But cuffed endotracheal tubes effectively protect the risk of pulmonary aspiration and completely seal the airway. This study was designed to determine the appropriate cuff volume and pressure with low risk of ischemic injury to children's airway.
METHODS
We intubated cuffed endotracheal tube (internal diameter 4.5, 5.0, 5.5 mm) in 90 surgical pediatric patient from 16 to 118 months of age. After intubation, initial cuff volume and pressure were measured at the level of complete sealing in each group. Each group was administrated 50% nitrous oxide and 67% nitrous oxide and measured cuff pressure at 20 minutes, 40 minutes.
RESULTS
1) The mean initial cuff volume and pressure of 4.5 ID tube were 0.59 +/- 0.16 ml and 14.5 +/- 0.31 cmH2O (n=30). 2) The mean initial cuff volume and pressure of 5.0 ID tube were 1.00 +/- 0.38 ml and 14.3 +/- 3.55 cmH2O (n=30). 3) The mean initial cuff volume and pressure of 5.5 ID tube were 1.06 +/- 0.26 ml and 14.28 +/- 2.01 cmH2O (n=30). 4) The cuff pressure increased significantly in the course of time, but no pressure in three groups was above 30 cmH2O.
CONCLUSIONS
We could determine the appropriate cuff volume of cuffed endotracheal tube in pediatric patients. Also we concluded that nitrous oxide concentration affect little intracuff pressure in brief operation.

Differences of Incidence and Severity of Sore Throat and Hoarseness between the Methods of Airway Security: Yeoung Hwan Choi, Hee Chung Kim; Korean J Crit Care Med. 1997;12(1):43-48.

Abstract PDF: Introduction: The sore throat and hoarseness are common complications during the postoperative period. We investigated differences of incidence and severity of sore throat and hoarseness according to methods of airway security.
METHODS
One hundred twelve patients, in ASA physical status class 1~2, were included in this study (58 males and 54 females). They were divided into three groups: group 1 (n=42), intubated with endotracheal tube lubricated with normal saline; group 2 (n=40), intubated with endotracheal tube lubricated with 5% lidocaine ointment; group 3 (n=30), inserted with laryngeal mask airway (LMA) for airway security.
RESULTS
The incidence of sore throat and hoarseness were 78.6% and 54.8% in group 1, 35% and 30% in group 2, and 33.3% and 20.0% in group 3.
CONCLUSIONS
Both 5% lidocaine-lubricated endotracheal tube and laryngeal mask airway showed tendency of decreased incidence of postoperative sore throat and hoarseness but there are no statistical significance.

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