Acute epiglottitis: a report of the two different methods of airway management in adults.

The authors present two cases of acute epiglottitis with upper airway obstruction that urgently needed artificial airways. In case 1, a 55-year-old woman with DM presented with severe upper airway obstruction and sepsis. The tracheostomy was chosen for airway management, antibiotic was given, and fluid and inotropic drug (dopamine) were used for cardiovascular support. She received continuing care in the intensive care unit for several days. In case 2, a 40-year-old man presented with acute airway obstruction when he breathed forcefully. The prophylaxis tracheal intubation was done by using sevoflurane inhalation. The life-threatening situations of both patients were managed successfully by the team approach of ENT surgeons, anesthesiologists, and intensivists.

Perioperative desaturation: incidence, causes, management and outcome.

OBJECTIVE: To determine the incidence, causes, management and outcome of desaturation occurring in the perioperative peroids (induction, maintence, emergence and recovery room) at Siriraj Hospital from June 2001-December 2001. METHOD: Perioperative incident reports were collected and analyzed. Patients were catergorized as having desaturation if the SPO2 was below 90 per cent for more than 3 minutes. The incidence, causes, management, and outcomes of these patients were examined in detail. RESULTS: 62 out of 16,716 cases (0.37%) experienced desaturation. Elective patients (0.41%) experienced desaturation more frequently than emergency patients (0.14%). The causes were airway obstruction, hypoventilation, endotracheal tube problems, aspiration, atelectasis, and pulmonary edema. These patients were treated with higher FiO2, airway management, and ventilatory support which led to unplanned ICU admission. 4 patients developed cardiac arrest with successful resuscitation although 2 patients had cerebral infarction. CONCLUSION: Perioperative desaturation is an important sign of respiratory complications that should be recognized and treated immediately to prevent mortality and serious morbidity.

Clinical outcomes of failed extubation in a postoperative intensive care unit.

The causes and consequences of failed extubation in postoperative intensive care unit (ICU) patients were prospectively collected by clinical observation study in the surgical ICU Siriraj Hospital from 1st October 2000 to 31st March 2001. The failure rate was 1.7 per cent (9/477). Patients underwent the following types of surgery: abdominal surgery 66.67 per cent, orthopedic 22.22 per cent, and head-neck surgery 11.11 per cent. Reasons for reintubation were respiratory failure 55.56 per cent (5/9), inadequate cough reflex 22.22 per cent (2/9), congestive heart failure 11.11 per cent (1/9), and acute myocardial infarction 11.11 per cent (1/9). The consequences of failed extubation were worse outcomes:- the average length of stay in these patients increased from 3.67 days to 9.3 days. The mortality rate was 33.33 per cent. Tracheostomy was required in 55.56 per cent. From these observations we conclude that extubation should be performed at the appropriate time for each patient. This will differ according to the patient and his/her circumstances.

The causes and effects of airway incidents on Post-surgical ICU patients.

Objective : To identify the causes and effects of in airway incident reduction in the post-surgical ICU, Siriraj Hospital. CQI program was gradually implemented to reduce the incidence. Methods : Self-reported of airway incidents ( unplanned extubation, tube dislocation, tube obstruction, unrecognised disconnection etc.) from August 2000-January 2001 were used for data collection and analysis. CQI program was implemented gradually over six months. Results : Among 284 intubated patients in 524 patients admitted to post-surgical ICU, there were 24 episodes of airway incidents during 6 months, 15 episodes in the first trimester and 9 episodes in the second trimester. The incidents happened during afternoon shifts more than other shifts. Five patients experienced moderate cardiopulmonary events (hypoxemia or severe hypo or hypertension) and two resulted in death. Most (23 out of 24) episodes were considered preventable. The causes were; lack of manpower, insecure airways, lack of knowledge, inadequate communication and inadequate sedation. Conclusion : Airways incidents occurred for several different reasons and occasionally resulted in death. Most of the causes were preventable. The CQI program aimed to define preventable causes and improved the quality of care.