Trachealrupturen unter endotrachealer Intubation

Seidl, Rainer; Todt, Ingo; Nielitz, T; Ernst, Arne

doi:10.1007/s001060100532

Cited by 9 publications

(5 citation statements)

References 24 publications

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“…In literature, there are few case studies, the largest involving 30 patients [ 2 3 ]. The most common hypothesis for PTR is overinsufflation of the cuff, usually in connection with the use of oversized tracheal tubes as PTR are most often found in women [ 5 8 9 11 16 21 22 23 ]. There is, however, no data on tracheal pressure rupture resistance in literature.…”

Section: Discussionmentioning

confidence: 99%

“…The exact mechanism of PTR and the values of pressure rupture resistances continue to remain uncertain. The most common hypothesis for PTR is overinsufflation of the cuff, usually in connection with the use of oversized tracheal tubes [ 5 8 9 11 16 21 22 23 ], both of which can be prevented. Our research group has previously produced evidence for appropriate tube size selection according to a body size based nomogram [ 24 ].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Association of Oversized Tracheal Tubes and Cuff Overinsufflation With Postintubation Tracheal Ruptures

Sudhoff

Seidl

Estel

et al. 2015

Clin Exp Otorhinolaryngol

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ObjectivesPostintubation tracheal ruptures (PTR) are rare but cause severe complications. Our objective was to investigate the tracheal pattern of injury resulting from cuff inflation of the tracheal tube, to study the two main factors responsible for PTR (cuff overinsufflation and inapplicable tube sizes), and to explain the context, why small women are particularly susceptible to PTR.MethodsExperimental study performed on 28 fresh human laryngotracheal specimens (16 males, 12 females) within 24 hours post autopsy. Artificial ventilation was simulated by using an underwater construction and a standard tracheal tube. Tube sizes were selected according to our previously published nomogram. Tracheal lesions were detected visually and tracheal diameters measured. The influence of body size, sex difference and appropriate tube size were investigated according to patient height.ResultsIn all 28 cases, the typical tracheal lesion pattern was a longitudinal median rupture of the posterior trachea. Appropriate tube sizes according to body size caused PTR with significantly higher cuff pressure when compared with oversized tubes. An increased risk of PTR was found in shorter patients, when oversized tubes were used. Sex difference did not have any significant influence.ConclusionThis experimental model provides information about tracheal patterns in PTR for the first time. The model confirms by experiment the observations of case series in PTR patients, and therefore emphasizes the importance of correct tube size selection according to patient height. This minimizes the risk of PTR, especially in shorter patients, who have an increased risk of PTR when oversized tubes are used.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Association of Oversized Tracheal Tubes and Cuff Overinsufflation With Postintubation Tracheal Ruptures

Sudhoff

Seidl

Estel

et al. 2015

Clin Exp Otorhinolaryngol

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“…Derartige Infektionen können durch Ösophagus-oder Trachealrupturen hervorgerufen werden [, 2,3]. Aufgrund der speziellen Anatomie des Halses können sich Halsinfektionen in das Mediastinum zwischen mittlerer und tiefer Halsfaszie ausbreiten.…”

Section: Tiefe Halsinfektionen Und Absteigendeunclassified

Tiefe Halsinfektionen und Mediastinitis

Herzog

Davies

Kenn

et al. 2005

HNO

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Deep neck infections and subsequent mediastinitis can occur as lethal complications after endotracheal intubation. A 53 year old female patient developed a neck abscess and mediastinitis due to esophageal perforation after endotracheal intubation. Neck and mediastinal exploration were performed as primary surgical treatment in cooperation with thoracic surgeons. Drainage tubes for neck and mediastinum were inserted and irrigated frequently. The abscess cavity was re-examined twice after primary surgery. Microbiological tests were performed at regular intervals to guarantee appropriate antibiotic therapy. This case demonstrates the importance of early and extensive surgical intervention and the necessity of interdisciplinary cooperation in treating such infections.

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“…2,3 The causes and treatment of these complications in adults have been previously described, but to date there have been few studies on the aetiology and management of tracheal injuries in children. 4 For this reason, we performed a retrospective study to examine the frequency, aetiology, and treatment of tracheal injuries in children.…”

Section: Introductionmentioning

confidence: 99%