Laryngotracheal lesions following routine orotracheal intubation in the horse

Heath, R. B.; Steffey, Eugene; Jc, Thurmon; Wertz, E M; Meagher, Dennis; Hyyppa, T; Slyke, G. L. Van

doi:10.1111/j.2042-3306.1989.tb02190.x

Cited by 35 publications

(48 citation statements)

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“…Though the number of attempts did not differ between SGAD and ETT, our results show that even one to two attempts with ETT resulted in measurable trauma to the tracheal tissues. Similar findings have been reported in horses and our findings are consistent with those of Phaneuf et al, where histologic changes were reported after a single intubation event (the number of attempts was not reported) using both cuffed and uncuffed endotracheal tubes (7, 23). Since animals were euthanized at the end of our study, the consequences of the histologic changes are unknown; however, morbidity and mortality have been reported following apparently uneventful blind orotracheal intubations (7, 24).…”

Section: Discussionsupporting

confidence: 93%

Comparison of a Supraglottic Airway Device (v-gel®) with Blind Orotracheal Intubation in Rabbits

Engbers

Larkin

Rousset³

et al. 2017

Front. Vet. Sci.

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IntroductionAchieving a secure airway in rabbits is generally considered more difficult than in cats or dogs. Their relatively large tongue, small oropharyngeal cavity and glottis limit direct visualization. A rabbit-specific supraglottic airway device (SGAD) may offer benefits over blind orotracheal intubation.Animals and methodsFifteen adult New Zealand white rabbits were randomized to SGAD or orotracheal intubation (ETT). All animals were sedated with dexmedetomidine (0.1 mg kg−1 IM) and midazolam (0.5 mg kg−1 IM), followed by induction with alfaxalone (0.3 mg kg−1 IV). Two CT scans of the head and neck were performed, following sedation and SGAD/ETT placement. The following were recorded: time to successful device insertion, smallest cross-sectional airway area, airway sealing pressure, and histological score of tracheal tissue. Data were analyzed with a Mann–Whitney test.ResultsTwo rabbits were excluded following failed ETT. Body masses were similar [ETT; n = 6, 2.6 (2.3–4.5) kg, SGAD; n = 7, 2.7 (2.4–5.0) kg]. SGAD placement was significantly faster [33 (14–38) s] than ETT [59 (29–171) s]. Cross-sectional area (CSA) was significantly reduced from baseline [12.2 (6.9–3.4) mm2] but similar between groups [SGAD; 2.7 (2.0–12.3) mm2, ETT; 3.8 (2.3–6.6) mm2]. In the SGAD group, the device tip migrated into the laryngeal vestibule in 6/7 rabbits, reducing the CSA. ETT airway seals were higher [15 (10–20) cmH2O], but not significant [SGAD; 5 (5–20) cmH2O, p = 0.06]. ETT resulted in significantly more mucosal damage [histological score 3.3 (1.0–5.0)], SGAD; 0.67 (0.33–3.67).ConclusionThe SGAD studied was faster to place and caused less damage than orotracheal intubation, but resulted in a similar CSA.

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Section: Discussionsupporting

confidence: 93%

Comparison of a Supraglottic Airway Device (v-gel®) with Blind Orotracheal Intubation in Rabbits

Engbers

Larkin

Rousset³

et al. 2017

Front. Vet. Sci.

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“…Exposure to cigarette smoke results in hypersecretion in the airways [13]. Orotracheal intubation-induced injury and other types of mechanical damage to the airway epithelium also result in mucus hypersecretion [14,15,16]. Neutrophils and their products are implicated in cystic fibrosis [10], COPD [11], and acute severe asthma [17].…”

Section: Stimuli For Mucin Synthesis: Role Of the Epidermal Growth Famentioning

confidence: 99%

“…The authors of those studies did not comment on goblet-cell metaplasia. However, in horses, orotracheal intubation results in mucus hypersecretion [14], and mechanical denudation of hamster airways results in secretory-cell metaplasia [15]. Lee et al [16] instilled irregular agarose plugs into rat airways to produce irritation, which also resulted in a profound increase in goblet cells.…”

Section: Stimuli For Mucin Synthesis: Role Of the Epidermal Growth Famentioning

confidence: 99%

“…First, epithelial damage is believed by some investigators to occur in asthma, and this damage could induce mucus hypersecretion. Second, because chronic intubation leads to mucus hypersecretion in horses [14], a similar effect is likely to occur in humans. It would be difficult to differentiate secretions generated in the lower airways and transported to the trachea from those secretions generated at the site of intubation.…”

Section: Stimuli For Mucin Synthesis: Role Of the Epidermal Growth Famentioning

confidence: 99%

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Role of epidermal growth factor receptor activation in regulating mucin synthesis

Nadel¹

2001

Respir Res

111

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commentary review reports primary research COPD = chronic obstructive pulmonary disease; EGF(R) = epidermal growth factor (receptor); MAPK = mitogen-activated protein kinase; TGF = transforming growth factor; TNF = tumor necrosis factor. Available online http://respiratory-research.com/content/2/2/085 IntroductionEpidermal growth factor (EGF) was discovered by Cohen, and he and his colleagues subsequently extended our knowledge of the mechanisms of action of EGF and its receptor EGFR [1]. EGFR is a 170 kDa membrane glycoprotein, which is activated by ligands such as EGF, transforming growth factor (TGF)-α, heparin-binding EGF, amphiregulin, betacellulin, and epiregulin. These proteins are synthesized as transmembrane precursors and are cleaved proteolytically by metalloproteases to release the mature growth factor, which can interact with EGFR and cause its activation. Epidermal growth factor expression and activation causes goblet-cell metaplasia in airwaysThe discovery that a human epidermoid (A-431) cancer cell line contains high concentrations of EGFR led to extensive investigation into the role of the EGFR cascade in epithelial cell multiplication (cancer). Although growth factors can act as transforming proteins, it was recently hypothesized that EGFR activation may also be involved in epithelial differentiation into mucin-containing goblet cells by specific inflammatory mediators. The hypothesis was supported by the following observations. First, mucosubstances can be detected in dysplastic lesions and in foci of carcinoma in situ in human airways, and in tracheal lesions induced by carcinogens in animals [2]. The coexistence of mucin-containing cells and cancer cells suggests the possibility of a common progenitor. Second, Clara cells (also called 'nongranulated secretory cells') are believed to be the progenitor cells for bronchiolar carcinoma AbstractHealthy individuals have few goblet cells in their airways, but in patients with hypersecretory diseases goblet-cell upregulation results in mucus hypersecretion, airway plugging, and death. Multiple stimuli produce hypersecretion via epidermal growth factor receptor (EGFR) expression and activation, causing goblet-cell metaplasia from Clara cells by a process of cell differentiation. These cells are also believed to be the cells of origin of non-small-cell lung cancer, but this occurs via cell multiplication. The mechanisms that determine which pathway is chosen are critical but largely unknown. Although no effective therapy exists for hypersecretion at present, the EGFR cascade suggests methods for effective therapeutic intervention.

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“…Nearly a third of these patients are at risk for the development of ventilator-associated pneumonia (VAP). Intubation causes mucous hypersecretion in animals (26) and that mechanical irritation causes upregulation of mucin production via EGFR activation (12). The presence of mucins in secretions creates an atmosphere conducive for the growth of certain bacteria, and subsequent aspiration of mucus-containing bacteria results in VAP, the leading cause of death from hospital-acquired infection.…”

mentioning

confidence: 99%

Role of the Airway Epithelium in Defense Against Inhaled Invaders

Nadel

2005

COPD: Journal of Chronic Obstructive Pulmonary Disease

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Laryngotracheal lesions following routine orotracheal intubation in the horse

Cited by 35 publications

References 17 publications

Comparison of a Supraglottic Airway Device (v-gel®) with Blind Orotracheal Intubation in Rabbits

Comparison of a Supraglottic Airway Device (v-gel®) with Blind Orotracheal Intubation in Rabbits

Role of epidermal growth factor receptor activation in regulating mucin synthesis

Role of the Airway Epithelium in Defense Against Inhaled Invaders

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