Recurrent Acute Upper Airway Obstruction after Anterior Cervical Fusion

A 67-year-old man presented with cervical myelopathy for which a C3/4 discectomy and anterior fusion was performed. Recurrent episodes of acute upper airway obstruction necessitated laryngoscopy and endotracheal intubation. Drainage of a prevertebral collection of CSF and surgical repair of a dural tear corrected the obstructive symptoms. Management of the difficult airway is discussed.

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A predictive formula for difficult endotracheal intubation in the emergency department

10.21203/rs.3.rs-49018/v1 ◽

2020 ◽

Author(s):

En-Chih Liao ◽

Wen-Han Chang ◽

Ching-Hsiang Yu ◽

Cheng-Ying Shen ◽

Fang-Ju Sun ◽

...

Keyword(s):

Emergency Department ◽

Airway Obstruction ◽

Difficult Airway ◽

Endotracheal Intubation ◽

Difficult Intubation ◽

Upper Airway ◽

High Body Mass Index ◽

Upper Airway Obstruction ◽

Binary Logistic Regression Model ◽

Difficult Endotracheal Intubation

Abstract Background Current predictors for evaluating difficult endotracheal intubation had poor accessibility or sensitivity at the emergency department, so we evaluated the incidence and predictive factors, then built an easy-to-use predictive formula. Methods This was a 17-month prospective observational study. For the 110 patients, difficult airway was defined as Cormack & Lehane classification grade III and IV at first attempt of intubation. The univariate associations between patient characteristics and difficult endotracheal intubation were then analyzed, and the significantly associated factors were included in a multivariate binary logistic regression model then a predictive formula was generated. Generalized association plot (GAP) was used to show the relationship between each variable. Results The incidence of difficult intubation in our study was 35.5%. In the difficult airway group, significantly higher rates (p < 0.05) of high body mass index (BMI); double chin; thick, short neck; Mallampati difficulty; smaller inter-incisors distance; smaller thyromental distance; and upper airway obstruction were noted. Finally, a predictive formula for difficult intubation was successfully established by the combination of four predictors: BMI (odds ratio [OR] = 1.270), thyromental distance (OR = 0.614), upper airway obstruction (OR = 4.038), and Mallampati difficulty (OR = 5.163). A cut-off score of 4 provided the best sensitivity (79.5%) and specificity (81.7%)(95% CI: 0.794 to 0.938). Conclusions Our predictive formula could be used by emergency physicians to quickly identify and carefully manage patients with potentially difficult intubation. Early expert consultation could be sought when necessary.

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Predictors of diﬃcult endotracheal intubation in the emergency department: a single-center pilot study

10.22514/sv.2020.16.0118 ◽

2020 ◽

Keyword(s):

Emergency Department ◽

Tracheal Intubation ◽

Airway Obstruction ◽

Difficult Airway ◽

Endotracheal Intubation ◽

Upper Airway ◽

Difficult Tracheal Intubation ◽

Upper Airway Obstruction ◽

Cutoff Score ◽

Difficult Endotracheal Intubation

Background: Identifying patients who are at risk of difficult endotracheal intubation is crucial in the emergency department. Therefore, this study evaluated the incidence and predictive factors of difficult tracheal intubation in the emergency department. Methods: This was a 17-month prospective observational study. A difficult airway was defined as Cormack & Lehane classification grades III and IV at the first attempt of intubation. Patients who visited the emergency department, underwent traditional endotracheal intubation from participating physicians, and provided informed consent by themselves or via their delegates were enrolled in this study. Univariate associations between patient characteristics and difficult endotracheal intubation were identified, and statistically significant factors were included in a multivariate binary logistic regression model. A generalized association plot was used to show the relationships between variables. Results: A total of 110 patients were enrolled in the study. The incidence of difficult intubation was 35.5% (39/110). In the difficult airway group, significantly higher body mass index (BMI), and incidence of double chin, thick short neck, Mallampati difficulty, small interincisor distance, small thyromental distance, and upper airway obstruction were noted on univariate analysis. A predictive formula for difficult tracheal intubation was successfully established by the combination of four independent predictors: BMI (odds ratio [OR] = 1.270), thyromental distance (OR = 0.614), upper airway obstruction (OR = 4.038), and Mallampati difficulty (OR = 5.163). A cutoff score of four maximized Youden’s index, providing sensitivity (79.5%) and specificity (81.7%) (95% CI: 0.794 to 0.938). Conclusions: We used four predictors of difficult tracheal intubation, namely, BMI, thyromental distance, upper airway obstruction, and Mallampati difficulty, to create a predictive formula. This formula could help emergency physicians to quickly identify and carefully manage patients with difficult endotracheal intubation and consult experts early if necessary.

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A Predictive Formula for Difficult Endotracheal Intubation in the Emergency Department

10.21203/rs.3.rs-47509/v1 ◽

2020 ◽

Author(s):

En-Chih Liao ◽

Wen-Han Chang ◽

Ching-Hsiang Yu ◽

Cheng-Ying Shen ◽

Fang-Ju Sun ◽

...

Keyword(s):

Emergency Department ◽

Airway Obstruction ◽

Difficult Airway ◽

Endotracheal Intubation ◽

Difficult Intubation ◽

Upper Airway ◽

High Body Mass Index ◽

Upper Airway Obstruction ◽

Binary Logistic Regression Model ◽

Difficult Endotracheal Intubation

Abstract Background Current predictors for evaluating difficult endotracheal intubation had poor accessibility or sensitivity at the emergency department, so we evaluated the incidence and predictive factors, then built an easy-to-use predictive formula.Methods For the 110 patients, difficult airway was defined as Cormack & Lehane classification grade III and IV at first attempt of intubation. The univariate associations between patient characteristics and difficult endotracheal intubation were then analyzed, and the significantly associated factors were included in a multivariate binary logistic regression model then a predictive formula was generated. Generalized association plot (GAP) was used to show the relationship between each variables.Results The incidence of difficult intubation in our study was 35.5%. In the difficult airway group, significantly higher rates (p<0.05) of high body mass index (BMI); double chin; thick, short neck; Mallampati difficulty; smaller inter-incisors distance; smaller thyromental distance; and upper airway obstruction were noted. Finally, a predictive formula for difficult intubation was successfully established by the combination of four predictors: BMI (odds ratio [OR]=1.270), thyromental distance (OR=0.614), upper airway obstruction (OR=4.038), and Mallampati difficulty (OR=5.163). A cut-off score of 4 provided the best sensitivity (79.5%) and specificity (81.7%)(95% CI: 0.794 to 0.938).Conclusions Our predictive formula could be used by emergency physicians to quickly identify and carefully manage patients with potentially difficult intubation. Early expert consultation could be sought when necessary.Trial registration This 17-month (2011/11/1-2013/3/31) prospective observational study was approved by the Institutional Review Board of MacKay Memorial Hospital (11MMHISO64).

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Pneumothorax and Pneumomediastinum during Colonoscopy

Anaesthesia and Intensive Care ◽

10.1177/0310057x9802600313 ◽

1998 ◽

Vol 26 (3) ◽

pp. 302-304 ◽

Cited By ~ 21

Author(s):

T. Webb

Keyword(s):

Airway Obstruction ◽

Endotracheal Intubation ◽

Subcutaneous Emphysema ◽

Bowel Perforation ◽

Upper Airway ◽

Upper Airway Obstruction ◽

Diagnostic Colonoscopy ◽

Sudden Appearance

A case of bowel perforation during diagnostic colonoscopy is reported. This resulted in the sudden appearance of massive subcutaneous emphysema of the neck, causing acute upper airway obstruction which necessitated urgent endotracheal intubation. Large bilateral pneumothoraces and pneumomediastinum were also present.

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Subglottic Cysts: A Complication of Neonatal Endotracheal Intubation?

PEDIATRICS ◽

10.1542/peds.68.1.103 ◽

1981 ◽

Vol 68 (1) ◽

pp. 103-105

Author(s):

Jonathan M. Couriel ◽

Peter D. Phelan

Keyword(s):

Airway Obstruction ◽

Endotracheal Intubation ◽

Neonatal Period ◽

Upper Airway ◽

Upper Airway Obstruction ◽

Relationship Of ◽

The Relationship

Three patients with severe upper airway obstruction due to subglottic cysts and their subsequent progress and management are described. The relationship of the lesions to intubation in the neonatal period is discussed.

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The Percutaneous Transtracheal Jet Ventilation in a Patient with Partial Upper Airway Obstruction

Hong Kong Journal of Emergency Medicine ◽

10.1177/102490790100800406 ◽

2001 ◽

Vol 8 (4) ◽

pp. 223-226 ◽

Cited By ~ 1

Author(s):

KY Fung ◽

MC Yuen ◽

WK Tung

Keyword(s):

Airway Obstruction ◽

Difficult Airway ◽

Upper Airway ◽

Upper Airway Obstruction ◽

Emergency Physicians ◽

Jet Ventilation ◽

Partial Upper Airway Obstruction ◽

Set Up

Difficult airway is a challenging emergency problem for emergency physicians. We reported a patient with partial upper airway obstruction managed by percutaneous transtracheal jet ventilation (PTJV) before definite airway was secured. The development, the set up, the advantages, and the precautions of using PTJV are briefly described.

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