• Tuberculosis and Respiratory Diseases
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• v.47 no.3
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• pp.365-373
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• 1999

Background: Despite widespread use of tracheostomy in intensive care unit, it is still controversial to define the best timing from endotracheal intubation to tracheostomy under prolonged mechanical ventilation. Early tracheostomy has an advantage of easy airway maintenance and enhanced patient mobility whereas a disadvantage in view of nosocomial infection and tracheal stenosis. However, there is a controversy about the proper timing of tracheostomy. Methods: We conducted a retrospective study of the 35 medical and 15 surgical ICU patients who had admitted to Ewha Womans University Mokdong Hospital from January 1996 to August 1998 with the observation of APACHE III score, occurrence of nosocomial infections, and clinical outcomes during 28 days from tracheostomy in terms of early (n=25) vs. late (n=25) tracheostomy. We defined the reference day of early and late tracheostomy as 7th day from intubation. Results: The number of patients were 25 each in early and late tracheostomy group. The mean age were $48{\pm}18$ years in early tracheostomy group and $63{\pm}17$ years in late tracheostomy group, showing younger in early tracheostomy group. The median duration of intubation prior to tracheostomy was 3 days and 13 days in early and late tracheostomy groups. Organs that caused primary problem were nervous system in 27 cases(54%), pulmonary 14(28%), cardiovascular 4(8%), gastrointestinal 4(8%) and genitourinary 1(2%) in the decreasing order. Prolonged ventilation was the most common reason for the purpose of tracheostomy in both groups. APACHE m scores at each time of intubation and tracheostomy were slightly higher in late tracheostomy group but not significant statistically. Day to day APACHE III scores were not different between two groups with observation upto 7th day after tracheostomy, Occurrence of nosocomial infections, weaning from mechanical ventilation, and mortality showed no significant difference between two groups with observation of 28 days from tracheostomy. The mortality was increased as the APACHE m score upto 7 days after tracheostomy increased, but there were no increment for the mortality in terms of the time of tracheostomy and the days of ventilator use before tracheostomy, Conclusion: The early tracheostomy seems to have no benefit with respect to severity of illness, nosocomial infection, duration of ventilatory support, and mortality. It suggests that the time of tracheostomy is better to be decided on clinical judgement in each case. And in near future, prospective, randomized case-control study is required to confirm these results.

• Proceedings of the KOR-BRONCHOESO Conference
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• 1991.06a
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• pp.26-26
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• 1991

기관 절개술은 절대적으로 필요한 수술 방법임에도 불구하고 경우에 따라서는 매우 심각한 합병증이나 후유증을 유발하고 있어 가능한 피하는 것이 좋으며 부득이하여 시술을 하더라도 그 적절한 시기를 정하기 어려운 경우가 많다. 특히 유소아에서는 최근에 개량된 삽관튜브의 출현으로 비교적 장기간의 기관삽관이 가능해지자 기관절개술의 적용예가 많이 감소하기는 하였으나 합병증이나 후유증을 너무 우려한 나머지 기관절개술을 기피하거나 적절한 수술시기를 놓쳐 더욱 어려운 입장에 처하게 되기도 한다. 저자들은 1977년도부터 1990년까지 세브란스 병원에서 기관절개술을 시행받은 15세이하의 유소아 환자 94례에서 기관절개술의 원인 질환과 적용시기 및 합병증을 알아보고 기관삽관과의 관계를 후향적으로 조사하여 다음의 결과를 얻었다. 1. 유소아 기관 절개술의 원인 질환은 두부외상이 28례(29.8%)로 가장 많았고, 신경계 질환 17례(18%), 기도 감염 10례(10.6%)의 순이었고 그 외 선천적 기형 종양, 외상, 감염 등으로 다양한 분포를 보였다. 2.기관 절개술전에 기관삽관을 시행하지 않았던 예는 18례(19.1%)이고 기관삽관을 시행했던 예는 76례(80.9%)이며, 38례(40.4%)는 일주이내에 기관절개술을 시행하였고 12례(12.8%)는 2주이내에, 8례(8.5%)는 3주이내, 6례(6.4%)는 4주이내에 시행하였으며 12례(12.8%)는 기관 삽관후 4주이후에 기관절개술을 시행하였다. 3.기관 절개술후, 합병증은 26례(27.7%)에서 있었고 육아조직 형성이 14례(14.9%) 였고 기관 협착이 12례(12.8%)의 순이었다. 4.인공 호흡기률 사용하였던 46례(48.9%)중 14례(14.9%)에서 합병증이 있었고, 인공 호흡기를 사용치 않았던 48례(51.5%)에서는 12례(12.8%)에서 합병증이 발생하였다. 5.삽관 발거를 시행할 수 있었던 예는 47례(50%)였으며, 기관 절개술후 1개월이내에 시행한 예가 21례(16%), 6개월이내 시행한 예가 16례(17%), 2년이내에 시행한 예가 6？(6.4%)였으며 2년 이후 시행할 수 있었던 예도 4례(4.3%) 있었다. 6.기관 절개술 환자중 26례(27.7%)는 원인 질환으로 결국은 사망하였으며, 21례(22.3%)는 삽관 발거를 하지 않은 상태에서 퇴원하여 추적이 불가능하였다.

• Proceedings of the KOR-BRONCHOESO Conference
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• 1983.05a
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• pp.5.4-6
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• 1983

A tracheostomy is performed to relieve an upper airway obstruction, to facilitate bronchial toilet, to decrease dead space, to assist ventilation and as an elective procedure in head and neck surgery. Many complications are associated with tracheostomy, both in the actual performance of the operation and in the postoperative management. Recently the authors report one case ; a two years old children got a severe burn on face and neck and received tracheostomy and have carried tracheostomy cannula for 10 years, at last the cannula was worn out and the 12 years old boy came to the hospital.

• Proceedings of the KOR-BRONCHOESO Conference
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• 2007.05a
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• pp.45-45
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• 2007

• Proceedings of the KOR-BRONCHOESO Conference
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• 1981.05a
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• pp.4.3-5
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• 1981

The Silicone tracheal T-tube was designed to maintain an adequate tracheal airway as well as to provide support in the stenotic reconstituted or reconstructed trachea. This report is our experiences with using silicone T-tube which were successfully used to two cases with extensive laryngotracheal trauma, and one case with decannulation difficulty for 9 months. Authors strongly believe that silicone T-tube is an excellent device out of consideration for our experienced cases, though many techniques have been applied for the treatments of tracheal problems.

• Proceedings of the KOR-BRONCHOESO Conference
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• 1982.05a
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• pp.12-12
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• 1982

We have recently experienced a case of decannulation difficulty resulted from head and thoracic injury. The patient was 21-year-old male who undergone craniectomy and tracheotomy at other hospital about 7 months ago prior to admission On admission, there was swelling in glottic and subglottic region in indirect laryngoscopy and bronchoscopy with fixation of vocal cords in paramedian position. We tried to reestablish an adequate air way with bougination using Jackson esophageal bougie but there was no effect with it. So we performed vertical incision through cricoid cartilage and tracheal rings and insertion of Teflon tube in stenotic lesion for 9 months and removed it. At present time, the patient has been satisfactory corking training course.

• Journal of Chest Surgery
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• v.29 no.11
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• pp.1288-1291
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• 1996

Tracheoinnominate artery fistula is a rare but a catastrophic complication after tacheostomy or tracheal reconstruction. We experienced one case of tracheoinnominate artery fistula after tracheal reconstruction. The patient was a 11 year old girl with cerebral arteriovenous malformation who maintained tracheostomy for 6 months before undergoing tracheal reconstruction. She complained of dyspnea and paroxysmal cough 5 months after tracheostomy and was diagnosed as tracheal stenosis. We performed 4cm of tracheal resection and end to end anastomosis. Three days after tracheal reconstruction, massive bleeding occurred through the intubation tube. She underwent emergency reoperation of repair the innominate artery with 5-0 Prolene and re-reconstruction of trachea. The patient died of bleeding 3 days after the reoperation.

• Proceedings of the KSLP Conference
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• 1993.12a
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• pp.9-9
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• 1993

후두 형태에 이상이 없는 잡종개 2마리를 정맥 마취한 상태에서 생체 발성 모형을 만들었다. 경부 피부를 수직절개하고 후두 및 기관을 노출시킨 후, 기관에 상, 하 두 개의 기관절개를 가하고 두개의 삽관튜브를 삽입하였다. 아래 튜브로는 호흡을 유지하게 하였고, 위의 튜브로는 공기를 후두 방향으로 보내면서, 상후두신경의 외지와 반회신경 및 반회신경의 최종 분지인 갑상피열 분지에 전극을 각각 부착하여 일정한 정도의 전기자극을 가함으로써 소리가 유발되도록 하였다.(중략)

• Proceedings of the KOR-BRONCHOESO Conference
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• 2005.04a
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• pp.42-46
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• 2005

• Journal of the Korea Academia-Industrial cooperation Society
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• v.13 no.7
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• pp.3030-3036
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• 2012

The purpose of this study was to investigate the efficacy of mechanical in-exsufflator (MI-E) with on pulmonary rehabilitation in stroke patients with trachostomy tube. Methods： We studied ten stroke patients who had neither history nor radiologic finding of pulmonary disease. The pulmonary function was evaluated by measuring forced vital capacity (FVC), forced expiratory volume at one second (FEV1) and forced expiratory ratio (FEV1/FVC) The capacity of cough was evaluated by measuring manual assisted peak cough flow (MPCF). Data were analyzed statistically using repeated ANOVA test. Results：The results were as follows : 1) There are significant improvement of FVC and FEV1 according to training period (p<.05). 2) There are significant improvement of MPCF according to training period (p<.05). Conclusion：These results suggest that MI-E training can be used as an effective therapeutic modality for improvement of pulmonary function and capacity of cough in stroke patients with tracheostomy.