ETD Collection

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Subject: search.filters.subject.Intubation, Intratracheal

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Now showing 1 - 4 of 4
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    Retrospective Review of the Short-Term Outcomes of Tracheal resection for Laryngotracheal stenosis at Chris Hani Baragwanath hospital
    (2019) Makaulule, Ratshili Prince
    INTRODUCTION: Laryngotracheal stenosis is rare but has become a well-recognized pathological otorhinolaryngological condition. It develops when scar tissue forms in the trachea and larynx. Laryngotracheal stenosis can cause significant morbidity and the management of it is often complex. Tracheal resection with end-to-end anastomosis is a well-recognized surgical procedure performed for treatment of larygotracheal stenosis and has been shown to have great success. AIM: To review the short-term outcomes of tracheal resection for larygotracheal stenosis at the Chris Hani Baragwanath Academic Hospital Otorhinolaryngology Department. METHOD: This was a retrospective study, reviewing 24 patients with larygotracheal stenosis who underwent segmental tracheal resection with end-to-end anastomosis at the Chris Hani Baragwanath Academic Hospital, performed between 2005 and 2015. RESULTS: The study included 24 patients with ages ranging from 18 to 64 years. There were 15 (62.5%) males and 9 (37.5%) females. The causes of larygotracheal stenosis were prolonged intubation in 22 (91.7%) and inhalation burns in 2 (8.3%) patients. Eleven patients (45.8%) had postoperative complications, of which 4 (36.4%) were minor complications and 7 (63.6%) were major complications. The outcomes of surgery were excellent in 13 (54.2%), satisfactory in 8 (33.3%) and unsatisfactory in 3 (12.5%). CONCLUSIONS: Prolonged intubation was found to be the most common cause of larygotracheal stenosis. Tracheal resection for larygotracheal stenosis has been shown to have satisfactory to excellent short-term outcomes in terms of successful decannulation, voice quality, and low morbidity. In our study, the surgery was successful in 21 (87%) patients, which is comparable to success rates shown in the literature. Preoperative tracheostomy and higher degree of stenosis Meyer Cotton (III and IV) were associated with high postoperative complications. Irrespective of the cause, tracheal resection is a good surgical option, for the treatment of patients with severe stenosis and those who have failed treatment from other alternative surgeries.
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    The accuracy of anaesthetists in the depth of oral endotracheal tube placement in an academic hospital
    (2017) Campbell A, Ryan Jonathan
    Background: Endotracheal intubation is currently the proverbial “gold standard” for securing and protecting a patient’s airway. However, endotracheal tube (ETT) misplacement is a recognised complication of intubation and can result in significant patient morbidity and mortality. The aims of this study were to describe anaesthetists accuracy at placing oral ETTs to the correct depth, factors which influenced this accuracy and the methods used by anaesthetists to confirm correct ETT placement. Methods: A prospective, contextual, descriptive research design was used. The sample included 138 adult patients presenting for elective surgery requiring oral ETT insertion, and the anaesthetists intubating these patients. Recorded variables included patient age, gender, height, ETT position at the front upper incisors, ETT tip to carina distance and the methods used by anaesthetists to confirm correct ETT placement. Results: Only 45.7% of ETTs were accurately placed with 34.8% being too deep. There were significantly more deep ETT misplacements in females (p=0.0231), and patients with deep ETT placement were significantly shorter than those with accurate ETT placement (p<0.05). The number of methods used by anaesthetists to confirm correct ETT placement did not influence accuracy (p=0.4014). Neither the 21/23 cm nor the 20/22 cm methods were shown to improve the accuracy of ETT placements. Endotracheal tube distance measured at the front upper incisors was weakly correlated to the ETT distance measured above the carina in female patients but not in males. Conclusion: Endotracheal tube misplacement is a frequent event in the intraoperative period, and potential risk factors identified included female gender and extremes of height. Endotracheal tube placement should be individualized. Airway ultrasound is a point of care test that could potentially help confirm correct ETT placement.
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    Recognizing oesophageal intubation: successful use of the oesophageal detector device combined with a disposable end-tidal carbon dioxide detector
    (2016-08-17) Bothma, Pieter Adriaan
    Unrecognized oesophageal intubation leads to death or severe disability. Even careful, well trained anaesthetists may be unable to differentiate tracheal from oesophageal intubation by the commonly employed methods. End-tidal carbon dioxide measurement has been found to be a reliable test of tracheal intubation. The availability of a small disposable end-tidal carbon dioxide detector, the Easy cap makes this facility universally available. The oesophageal detector device is a small mechanical device used to recognize oesophageal intubation. By combining two reliable devices working on completely different principles the risk of false negative or false positive results are virtually eliminated. The potential defects of each device are covered by the other. The purpose of this study was to evaluate the combined use of the oesophageal detector device and the Easy cap by a blinded observer to differentiate the endotracheal tube from an oesophageal tube in sixty patients. These two tests were found to be very reliable, easy, rapid and cheap - ideal for use in theatre, casualty departments and in the field. The advantages and disadvantages of these devices are discussed and the relevant literature is reviewed.
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    A review of indications for endotracheal intubation in a private emergency centre in Pretoria
    (2012-07-12) Groenewald, Anita
    There is no clear list of indications for endotracheal intubation in the emergency centre. Current indications are derived from studies done in other disciplines, such as anaesthesiology (1, 2). The emergency centre is unique due to the presence of clinically undifferentiated patients as well as the urgency accompanying the management of critically ill or injured patients. A consensus statement for South African emergency centres was developed using a modified Delphi approach. The statement makes recommendations for a list of indications for endotracheal intubation in the emergency centre. This retrospective record review looks at indications used for endotracheal intubation in a private emergency centre during 2006. These indications were then measured against the consensus document derived from indications suggested by experts. The study evaluated 183 critically ill or injured patients during the study period of which 56 were intubated. Of all the critically ill or injured patients, only three were not intubated that should have been, according to the consensus document. The study found that the emergency doctors in the specific emergency centre used similar indications to intubate as suggested by the consensus document.