Submental Intubation with a Reinforced Tube for an Intubating Laryngeal Mask Airway (ILMA) / 대한마취과학회지

Nasotracheal intubation, when performed after craniomaxillofacial trauma, may result in the passage of the tube into the cranium, causing significant brain damage. Orotracheal intubation may be preferred, but interferes with the placement of intermaxillary fixation. To avoid these problems, a tracheostomy may be an alternative but it carries significant morbidity. The submental route for endotracheal intubation has been proposed as an alternative to a tracheostomy in the surgical management of craniomaxillofacial trauma. Ideally, this maneuver is performed by using a reinforced tube. Unfortunately, however, some reinforced tracheal tubes are manufactured with nondetachable connectors. Removing them forcefully may be possible, but they will then stay dangerously loose after reconnection. We report a case in which a standard oral Ring-Adair-Elwyn (RAE) tube and reinforced tube for ILMA was used so not to be loose after the reconnection.

Acute Respiratory Distress Syndrome after Severe Hypothermia and Hypotension Due to Near Drowning / 대한구급학회지

The increase in short-term survival of near-drowning victims after an acute submersion episode has resulted in an increase of major complications. Two major complications are the development of acute respiratory distress syndrome and persistent hypoxic-ischemic central nervous system injury. A 43-year-old male patient was presented with acute respiratory distress syndrome after near drowning. He was severely hypothermic and hypotensive when he arrived to emergency department. His body temperature was 24oC. There was no pulse and no spontaneous respiration. He was treated with advanced life support measure. He was intubated and vasoactive drugs such as epinephrine and norepinephrine were used. On ICU admission, his blood pressure and pulse rate were 80/40 mmHg, 170 beats/min respectively. His oxygen saturation was 40~60% with 100% oxygen. We applied 16~30 cmH2O of PEEP with low tidal volume for recruitment. Patient was flipped over to prone position. Solu-medrol 1.0 g was infused. The blood pressure restored to 140/50 mmHg, and the pulse rate was normalized to 100 beats/min. The dose of vasopressors and inotropes were reduced and stopped 5 hour after the arrival. When the oxygenation has improved, the position was changed to supine and PEEP was lowered. Eventually weaning was successful. Brain MRI and EEG showed global atrophy of cerebral cortex and moderate diffuse brain dysfunction respectively. He received tracheostomy since he was semi-comatose. He was transferred to general ward on 39th ICU day.