Sujets)
Asthme/diagnostic , Diagnostic différentiel , Humains , Intubation trachéale , Maladies du larynx/diagnostic , Laryngoscopie , Mâle , Adulte d'âge moyen , Pronostic , Récidive , Ventilation artificielle , Appréciation des risques , Indice de gravité de la maladie , Trachéostomie , Plis vocaux/physiopathologieRésumé
The use of endotracheal intubation for respiratory support of critically ill patients has become a standard life saving form of therapy. Most complications of intubation become apparent only after extubation which may manifest in the early or late post extubation period. This study was undertaken to demonstrate the occurrence and extent of laryngotracheal injuries in intubated patients by performing flexible fibreoptic bronchoscopy at varying intervals following extubation. It was found that initial laryngoscopy findings were more pronounced in patients intubated for upto twelve days. Furthermore, it was also observed that the initial laryngeal pathology seen on fibreoptic laryngoscopy was not an accurate predictor for the development of adverse post extubation sequelae. Maxillary sinusitis developed significantly in patients intubated nasally. Routine flexible fibreoptic examination of the larynx following extubation is recommended for early detection of granulomas, synechia of vocal cords and vocal cord immobility to prevent troublesome sequelae.
Sujets)
Adulte , Bronchoscopes , Femelle , Technologie des fibres optiques , Humains , Intubation trachéale/effets indésirables , Oedème laryngé/diagnostic , Laryngoscopie , Larynx/traumatismes , Mâle , Facteurs temps , Trachée/traumatismesSujets)
Oreille externe , Oesophage , Corps étrangers/thérapie , Humains , Nez , Appareil respiratoireRésumé
Two hundred and three laryngectomized patients have been evaluated for the possible causes of post operative complications. 58 out of 203 patients (28.5%) developed pharyngocutaneous fistula. Wound infection was present in 57 cases (28%). Two patients had flap necrosis and 12 patients developed dysphagia after surgery due to pharyngeal stenosis. The possible causes attributed to high occurrence of pharyngocutaneous fistula are, advanced nature of disease, preoperative radio therapy and wound sepsis. Prior to 1980, the incidence of pharyngocutaneous fistula in our series (Arora et al. 1983) was 41.6 percent. But it decreased to 13.7 percent between January 1981 to June 1987. The important factors which led to the decreased incidence of pharyngocutaneous fistula were thought to be the change of suture material for pharyngeal repair from chromic catgut to Vicryl, use of vacuum suction as a replacement of corrugated rubber drain and aseptic syringe drainage and postoperative coverage with broad spectrum antibiotics.