The Pathology of Laryngotracheal Complications: Lesions of the Larynx and Trachea After Intubation Anesthesia

Lu, Abraham T.; Tamura, Yukio; Koobs, Dick H.

doi:10.1001/archotol.1961.00740030330015

Cited by 34 publications

(6 citation statements)

References 24 publications

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“…The postoperative care of intubated patients included: (1) ventilation with 30% to 90% oxygen in nitrogen, (2) tracheobronchial toilet every morning, repeated as needed, and (3) ventilation with gases saturated with water vapor at 37 C by a Cascade humidifier (Puritan-Bennett, Inc, Santa Monica, CA). Although a high Fro, is known to produce alveolar cellular damage, there is no published evidence to suggest that it causes cytomorphologic changes in the tracheobronchial tree.…”

Section: Discussionmentioning

confidence: 99%

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Tracheobronchial Cytologic Changes during Prolonged Cannulation

Casthely¹,

Chalon²,

Ramanathan³

et al. 1980

Anesthesia & Analgesia

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The tracheobronchial cytology of eighteen patients undergoing prolonged mechanical ventilation were examined for the type of cell population present, together with the rnorphologic integrity of the ciliated epithelial cells 1 , 3, 5, 10, and 20 days after tracheal cannulation. Smears obtained from patients recovering from cardiac surgery were different from all others in that: (1 ) they contained fewer epithelial cells (ciliated and squamous) which disappeared earlier; (2) they initially had more pus cells which appeared earlier; (3) they originally contained more histiocytes but these were not found after the 5th day after cannulation; and (4) their ciliated epithelial cells displayed more cytomorphologic changes. Differences in cytology were attributed to impaired cardiac output in these patients. The reduced perfusion pressure of the vasculature of their tracheobronchial tree was presumably unable to sustain the lateral wall pressure of tube cuffs pressure, which further impaired tracheal perfusion. Less reparative processes (squamous metaplasia and early appearance of histiocytts) were also found in patients following cardiac surgery, together with early invasion of smears by pus cells indicating premature lowered resistance to bacterial infection.

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Section: Discussionmentioning

confidence: 99%

“…Reasons for mechanical ventilation included: (1) respiratory insufficiency after open heart surgery, (2) respiratory distress syndrome, (3) head injuries, and (4) transections of the cervical spinal cord. They ranged in age from 10 to 78 years.…”

Section: Methodsmentioning

confidence: 99%

Tracheobronchial Cytologic Changes during Prolonged Cannulation

Casthely¹,

Chalon²,

Ramanathan³

et al. 1980

Anesthesia & Analgesia

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show abstract

“…This is manifest usually by stridor, tracheal tug and intercostal recession, and will respond to humidification and in some instances steroids. Subglottic membranes have been described following prolonged endotracheal intubation (Lu, Tamura and Koob, 1961). Stridor with tracheal tug, intercostal recession, and restlessness with a rising pulse rate, developing 12-24 hours after extubation may indicate the presence of such a membrane.…”

Section: Complicationsmentioning

confidence: 99%

A Technique of Pulmonary Ventilation With a Nasotracheal Tube

Rees

Owen-Thomas

1966

British Journal of Anaesthesia

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A modified naso-endotracheal tube is described which facilitates prolonged intermittent positive pressure ventilation of the lungs in infants and children. A crosspiece allows connection widi the inspiratory and expiratory tubes of a drcle-type mechanical ventilator. The technique of intubation and of securing ths nasal tube to the patient is described in detaiL The tube has been used in 126 patients for periods of up to three months. Subglottic stenosis developed in two patients. It is provisionally recommended that the duration of intubation should not exceed three weeks.

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“…There is now some doubt whether laryngeal cedema following intubation is a real entity, since Snyder & Gants (1953) have suggested that because there is little areolar tissue in the larynx only minimal oedema can be formed. Similarly, Lu et al (1961) stated that the possibility of cedema causing sufficient narrowing to produce obstruction was not borne out by their study of the pathology of laryngeal complications following intubation.…”

mentioning

confidence: 99%

“…Another cause of post-operative stridor is membranous laryngotracheitis (Lu et al 1961). Trauma at the time of intubation or due to the presence of too tight a tube leads progressively to the loss of tracheal cilia, epithelial loss and the accumulation of fibrinous exudate and inspissated mucus forming a pseudomembrane.…”

mentioning

confidence: 99%

Stridor in Children

Apley

1965

Proceedings of the Royal Society of Medicine

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The Pathology of Laryngotracheal Complications: Lesions of the Larynx and Trachea After Intubation Anesthesia

Cited by 34 publications

References 24 publications

Tracheobronchial Cytologic Changes during Prolonged Cannulation

Tracheobronchial Cytologic Changes during Prolonged Cannulation

A Technique of Pulmonary Ventilation With a Nasotracheal Tube

Stridor in Children

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