• Proceedings of the KOR-BRONCHOESO Conference
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• 1993.05a
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• pp.80-80
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• 1993

Airway stenosis in children may be classified into congenital and acquired forms. The incidence of acquired forms is increasing mainly due to increase in prolonged intubation and trauma. In congenital stenosis with significantly compromised airway, the patient may be tracheotomized and allowed some waiting period while expecting spontaneous resolution as the child grows. However, with this treatment policy, there is a considerably higher mortality and morbidity for the acquired disease as to often warrant surgical reconstruction. The authors reviewed the medical records of 22 pediatric patients under the age of 15 who have had airway reconstruction at the authors' department from the beginning of January, 1988 through the end of December, 1992. The prognosis was analyzed in light of the etiology, site and severity of the stenosis, and the type of reconstructive measures.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.14 no.5
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• pp.2360-2367
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• 2013

The purpose of this study was to improve the paramedics skills to manage advanced airway by comparing speed and success rate between endotracheal intubation and laryngeal mask airway(LMA) insertion in a moving ambulance. Sixty subjects were randomly recruited and samely divided into control group and experimental group. And they were asked to join a practical experiment using dummy model. Data analysis was done by SPSS WIN 14.0 Version. As a result of this research, in terms of difference in speed according to patient's intubation posture, the speed of control group was indicated to be good in sniffing position(t=-4.038, p<.001). There was no difference in speed between two groups in neutral position. In the neutral posture given the endotracheal intubation, tooth fracture occurred in 16 people(53.3%). There was no difference in success rate between two groups. As for a change in self-confidence before and after experiment, the post self-confidence was indicated to have been enhanced in both groups. In conclusion, it is effective to use LMA in the traumatic patient who is unable to receive endotracheal intubation in sniffing position. It is very important for the paramedics to receive the continuous training of the airway management skills.

• Proceedings of the KOR-BRONCHOESO Conference
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• 1993.05a
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• pp.76-76
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• 1993

Endotracheal intubation is common technique for general anesthesia or patency of airway. However, laryngeal intubation granuloma is the most common sequale of endotracheal intubation in otolaryngologic field. From 1982 to 1992, the authors had experienced 16 cases intubation granuloma. The following results were as follows; 1. Age distribution was mostly in the 20 to 49 years old group (84 %).The sex ratio of male to female was 1:7, predominantly in female. 2. Main sx. were hoarse in 12(75%), F.B. sensation in 3(18%), dyspnea in 1 (6%). 3. The side of lesion was bilateral in 6 cases (37%) and unilateral in 10 cases (63%). Unilateral had the 3 cases (30%) in left and the 7 cases (70%) in right. The location of mass was vocal process of arytenoid cartilage in 8 cases(50%), post 1/3 of vocal cord in 6 cases (37 %) and middle 1/3 of vocal cord in 2 cases (12 %). 4. The duration between extubation and onset of symptom in less than a month was most frequent in 7 cases (44 %) out of 16 cases. 5. The most common operation was cesarean section in 6 cases (37 %). 6. Mean duration of intubation time was 2 hour 5 minutes. 7. Composition of used intubation tube was red rubber tube. 8. One case (6 %) was recurred.

• Journal of Chest Surgery
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• v.25 no.6
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• pp.581-587
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• 1992

Tracheoesophageal fistula[TEF] is a rare but life-threatening lesion that may occur from ventilation with a cuffed tube. It occurs most frequently when an inlying esophageal tube is also being used-usually for feeding purposes. The mechanism of injury appears to be pressure experted on the tracheal wall by the cuff, which then compresses the "party wall" of the trachea and esophagus against the foreign body that lies in the esophagus. The patient was 32 years old female who had been receiving a treatment of respiratory failure induced by postoperative sepsis with assist ventilator and nasogastric tubal feeding. Sudden attack of abdominal gas distention and massive drainage of gas through N-G tube were developed during assist ventilation in that patient, so we diagnosed as tracheal stenosis with a tracheoesophageal fistula induced by prolonged endotracheal intubation We performed tracheal reconstruction and primary closure of perforated esophagus after weaning ventilator. The postoperative course was uneventiful.eventiful.

• Proceedings of the KOR-BRONCHOESO Conference
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• 2003.09a
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• pp.112-112
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• 2003

호흡곤란에 대한 적절한 대처는 의사로서 숙지하여야 할 가장 중요하고도 기본적인 개념 중의 하나이다. 상부 기도에 발생하는 여러 가지 임상적 상황은 흔히 흡기성 천명을 동반하는 호흡 곤란으로 나타나고, 이에 대해 흔히 기도 삽관이나, 기관절개술 등이 행해 지지만, 그 발생 원인에 대해서 감별점들을 숙지하지 않으면, 원발 질환에 대한 합리적인 치료 뿐만 아니라 응급상황에서 적절하게 기도를 확보하는 데에도 문제가 생길 수 있다. 후두 상부에 일어나는 기도폐쇄의 상황은 비강에서부터 인두와 성문 상부, 식도 입구부에 이르는 해부학적 위치에 발생하는 다양한 질환들에 의한다. 비강과 비인두에는 pyriform aperture stenosis, choanal atresia, lacrymal duct cyst, 또는 teratoma나 encephalocele과 같은 질환이 발생할 수 있다. 구강, 인두부에서는 다양한 종류의 안면골격의 이상이나 설거대증, 또는 설갑상선, 갑상설관낭종, 또는 유피종등이 설기저부에 발생하기도 하고, 흔한 이유로 심한 편도-아데노이드 비대가 심각한 호흡곤란을 일으키기도 한다. 특히 소아에서는 이물의 가능성도 항상 염두에 두어야한다 이와 같이 기도 협착의 위치에 따라서 임상적 표현 양상이 구별될 수 있고, 또 부위에 따라 다양한 질환이 감별되어야 하므로 발생 위치에 따른 각 질환의 이해가 적절한 기도의 관리를 위해서 필수적이다.

• Korean Journal of Bronchoesophagology
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• v.17 no.1
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• pp.65-67
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• 2011

Pyriform sinus perforation is a rare complication of endotracheal intubation. It most commonly occurs at the hands of the less experienced physician in emergency situations. It can occur after traumatic intubation and is potentially lethal. The site most commonly perforated is the pharynx, posterior to the cricopharyngeal muscle; the second most common site is the pyriform sinus. We report a case of pyriform sinus perforation after endotracheal intubation, which was successfully treated with primary closure.

• Clinical and Experimental Pediatrics
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• v.48 no.5
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• pp.512-517
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• 2005

Purpose : In adults, endoscopic tracheobronchial balloon dilatation and stenting have become valuable methods to establish and maintain an adequate airway lumen when tracheomalacia or neoplastic growth compromise the airways. But in children, only a few cases were reported due to technical problems. We report six children who were treated with stent implantation and describe the use and safety of airway stents. Methods : Six patients with severe airway obstruction were treated. We investigated the underlying medical problems, stenotic site, symptomatic improvement and complications, and the size and location of stent. Results : The median age of the six patients was 21 months. Three of them were mechanically ventilated and one had an endotracheal tube to maintain the patency of airway. Diagnoses were : congenital tracheal stenosis with or without bronchomalacia, granulation tissue formation after right upper lobectomy by bronchial carcinoid or after prolonged intubation, endobronchial tuberculosis, and airway compression by mediastinal undifferentiated sarcoma. Nitinol stents were implanted in the airway guided by bronchoscopy and fluoroscopy simultaneously. Three cases were placed in trachea, the others were in the bronchus. After stent implantation, all patients showed marked improvements of their airway obstructive symptoms. Four patients are doing well, although two expired due to underlying diseases. Four patients had granulation tissue formation around stents, but that was tolerable after removing the stent. Conclusion : We suggest that the use of expandible metallic stent implantation can offer safe therapeutic option even in extremely severe, life threatening and inoperable airway stenosis in children.

• Journal of Trauma and Injury
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• v.28 no.2
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• pp.75-78
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• 2015

Mandible dislocation during endotracheal intubation is an unusual occurrence but easy to be overlooked for its unfamiliarity. We recently had a case of iatrogenic bilateral dislocation of a temporomandibular joint during orotracheal intubation and emphasize the importance of an early awareness of this possible complication.

• The Korean Journal of Emergency Medical Services
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• v.14 no.1
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• pp.5-18
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• 2010

Objective : This study compares Video laryngoscope and Direct laryngoscope in tracheal Intubation on rapidity and accuracy by paramedic and aims to improve efficiency of airway management and survival rate in pre-hospital treatment for the patients with severe trauma, cardiac arrest or dyspnea caused by acute diseases. Methods : 60 paramedics were recruited from 13 fire stations located in C province. With the consent of the paramedics, likelihood ratio test was carried out and they were divided into two different groups; DL group (30) and GVL group (30). Regarding intubation conditions, difficult airway grade I, grade II and grade III as well as sniffing position and neutral position were examined. This study also compared between ambulance in motion and in stand still. Frequency, average and standard deviation were analyzed with statistics program, SPSS WIN 17.0 and repeated measure design was introduced to examine inter-relations between position, grade and groups. Results : Intubation was performed more rapidly in neutral position and GVL than in sniffing position and DL(F = 15.260, p = .000). Rapidity value was better with grade I and grade II than grade III and better with GVL than DL(F = 32.629, p = .000). Accuracy value was higher with neutral position and GVL than sniffing position and DL(F = 5.008, p = .011). grade III was less accurate than grade I, grade II and GVL was more accurate than DL(F = 10.966, p = .000). Ambulance motion status did not show any statistically significant differences in accuracy and rapidity. Conclusion : Given this study results, neutral position is better for the patient with severe trauma. For a better survival, GVL intubation can be considered since GVL can enhance accuracy as well as rapidity regarding difficult airway. Since there is no significant differences in ambulance motion factors, intubation can be recommended even in moving ambulance for shortening traveling time to a hospital.

• Journal of Korean Biological Nursing Science
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• v.17 no.2
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• pp.97-103
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• 2015

Purpose: The aim of the study was to identify effects of oral care protocol on bacterial floras of the oral cavity and oral health status of intubated patients in an intensive care unit. Methods: The participants were 60 intubated patients who were recruited from an intensive care unit of a university hospital from Dec. 28, 2010 to Mar. 25, 2011. The participants were randomly assigned into 3 groups of 20 patients according to the application time of oral care (1-minute oral care, 2-minute oral care, and 3-minute oral care groups). The numbers of bacterial flora colonies in the oral cavity was assessed before and after the oral care. Oral health status was assessed using a Korean version of the Oral Assessment Guide developed by Elier et al. originally. Results: The numbers of bacterial flora colonies were less after oral care than those before the care, but there was no significant differences among the 3 groups after the care. Oral health status was better after the oral care than it was before the care, but there was also no significant differences among the 3 groups. Conclusion: If well-trained nurses perform oral care for 1 minute using a chlorhexidine swab on intubated patients, the numbers of bacterial flora colonies will be reduced and healthy oral status will be maintained.