A Reinforced Endotracheal Tube Completely Severed by a Patient Bite and Lodged in the Right Main Bronchus

Permanent sequelae of nasotracheal intubation are uncommon, but acute ulceration and squamous metaplasia occur. Histological sections from the trachea and main bronchi were examined in 12 infants. A nasotracheal tube had been inserted during the first two weeks of life of these infants and had been in place for more than one week. In four cases the patient died some time (7 to 108 days) after extubation. Similar sections from patients who were not intubated, intubated only for attempted resuscitation, or intubated for several hours were studied for comparison. The sections were classified according to the degree of mucosal loss and metaplasia, and the extent of the lesions was estimated. Squamous change was seen in most sections from all 12 patients with the exception of one who died 57 days after extubation. Some respiratory epithelium was seen in all patients. In the eight patients who died while intubated, the changes were more marked in the right main bronchus than the left in seven, and more marked in the lower trachea than the upper in five. In the two patients intubated for several hours, in addition to mucosal loss, early metaplasia was seen. It is suggested that mucosal loss is replaced by the squamous metaplasia, and that trauma caused by suction catheters in the lower trachea and right main bronchus is more extensive than that due to the endotracheal tube itself.

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Successful one-lung ventilation by blocking the right intermediate bronchus in a 7-year-old child: a case report

Journal of International Medical Research ◽

10.1177/0300060519845782 ◽

2019 ◽

Vol 47 (6) ◽

pp. 2740-2745

Author(s):

Seung Youp Baek ◽

Jin Hwan Kim ◽

Goo Kim ◽

Jin Ho Choi ◽

Chang Young Jeong ◽

...

Keyword(s):

Endotracheal Tube ◽

Main Bronchus ◽

Left Lung ◽

Lung Ventilation ◽

Surgical Excision ◽

One Lung Ventilation ◽

Lower Lung ◽

Endobronchial Blocker ◽

Surgical Field ◽

The Right

A 7-year-old child underwent surgical excision of a benign mesothelioma of the pleura near the right lower lung. Although insertion of a wire-reinforced endotracheal tube through the left main bronchus was attempted for one-lung ventilation to secure the surgical field of view, the attempt failed. Therefore, an endotracheal tube was inserted into the trachea, and an Arndt endobronchial blocker (Cook Medical, Bloomington, IN, USA) was placed in the right intermediate bronchus under bronchoscopic guidance to selectively block the right lower and middle lobes. The surgery was performed while ventilating the right upper lobe and left lung, and no specific intraoperative adverse events occurred.

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A controlled trial to investigate whether the orientation of the bevel and angle of approach determine the side of endobronchial intubation in an adult manikin

Journal of Perioperative Practice ◽

10.1177/1750458919850723 ◽

2019 ◽

Vol 30 (3) ◽

pp. 63-68

Author(s):

SR Dawson ◽

PM McConaghy ◽

RC Barr

Keyword(s):

Endotracheal Tube ◽

Endotracheal Intubation ◽

Main Bronchus ◽

Controlled Trial ◽

Acute Angle ◽

Common Reason ◽

Endobronchial Intubation ◽

High Incidence ◽

Laryngoscope Blades ◽

The Right

One of the commonest complications of endotracheal intubation occurs when the tip of the endotracheal tube passes distal to the carina and enters one of the main bronchi. The perioperative practitioner may observe high airway pressures, hypoxia or even pneumothorax. The most common reason given for the high incidence of right endobronchial intubation is that the right main bronchus comes off the trachea at a more acute angle from the midline. We sought, however, to explore two other factors which may explain this phenomenon – the angle of the tube’s bevel and its trajectory of approach. We conducted a prospective controlled trial in which doctors from our department intubated the trachea of an adult manikin in three distinct sets using standard tube, reversed tubes and reversed laryngoscope blades. We found that the angle of the bevel and trajectory of approach determines the side of endobronchial intubation in an adult manikin.

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A New System for Location of Endotracheal Tube in Preterm and Term Neonates

PEDIATRICS ◽

10.1542/peds.87.1.44 ◽

1991 ◽

Vol 87 (1) ◽

pp. 44-47

Author(s):

Marc Blayney ◽

Simon Costello ◽

Max Perlman ◽

Kel Lui ◽

John Frank

Keyword(s):

Endotracheal Tube ◽

Main Bronchus ◽

Controlled Trial ◽

Standard Technique ◽

Term Neonates ◽

Clinical Method ◽

Unplanned Extubations ◽

Initial Placement ◽

The Right ◽

New System

A randomized, controlled trial was conducted to evaluate a new noninvasive system for placement of the endotracheal tube, based on a magnetic field interference-sensing technique. Seventy-two neonates treated by the standard technique were compared with 70 treated by the new system (TRACH MATE), with radiographic localization as the standard. As judged by the author(s) on the morning after the intubation, correct initial placement was achieved in 69 (78%) of 88 intubations using the new system, compared with 71 (66%) of 107 using the standard technique (Fisher's Test, one-tailed, P = .044). Repositioning was actually done in 23 (26%) of 88 TRACH MATE intubations, compared with 42 (39%) of 107 standard intubations (Fisher's test, one-tailed; P = .037). Intubation of the right main bronchus occurred in 7 standard intubations, but in none of the TRACH MATE intubations (Fisher's test, one-tailed; P = .014). Endotracheal tube position (high, low, or appropriate) was correctly determined by TRACH MATE in 77 (90%) of 85 intubations; the position was not recorded on three occasions. No differences in the number of complications (eg, unplanned extubations, distal displacement, subglottic stenosis) were found between the two groups. It is concluded that the TRACH MATE technique is superior to the standard clinical method in initial placement of the endotracheal tube.

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Providing one-lung ventilation in posttracheostomic tracheal stenosis for thoracoscopic plastic of the right diaphragm dome

Messenger of Anesthesiology and Resuscitation ◽

10.21292/2078-5658-2021-18-5-76-81 ◽

2021 ◽

Vol 18 (5) ◽

pp. 76-81

Author(s):

D. G. Kabakov ◽

A. Yu. Zaytsev ◽

M. A. Vyzhigina ◽

K. V. Dubrovin ◽

G. A. Kazaryan ◽

...

Keyword(s):

Endotracheal Tube ◽

Tracheal Stenosis ◽

Main Bronchus ◽

Prolonged Mechanical Ventilation ◽

Nasotracheal Intubation ◽

Lung Ventilation ◽

High Frequency Ventilation ◽

One Lung Ventilation ◽

Grade 3 ◽

The Right

The article is devoted to the consideration of a clinical case of providing artifcial one-lung ventilation for performing thoracoscopic plastic of the right dome of the diaphragm in a patient with grade 3 posttracheostomy cicatricial tracheal stenosis. The patient is presented after a new coronavirus infection COVID-19 from 2020, prolonged mechanical ventilation through a tracheostomy tube (74 days), the development of medium thoracic cicatricial tracheal stenosis of grade 3 (the lumen of the narrowest part of the trachea is 4 mm) after decannulation and the development of relaxation of the right dome of the diaphragm (according to CT data, the dome is located at the level of the IV intercostal space). The frst stage under conditions of combined general anesthesia and high-frequency ventilation of the lungs was performed to restore the lumen of the trachea by bougienage of the stenosis area with tubes of a rigid endoscope under the control of a fberoptic bronchoscope with further nasotracheal intubation with a thermoplastic single-lumen endotracheal tube with a diameter of 8.0 with a cuﬀ. At the second stage, during thoracoscopic plastic of the right dome of the diaphragm, to provide artifcial one-lung ventilation, a bronchial blocker was used, introduced through the same endotracheal tube into the right main bronchus under the control of a fberoptic bronchoscope.

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Velocity profiles in central airways with endotracheal intubation: a model study

Journal of Applied Physiology ◽

10.1152/jappl.1986.60.3.876 ◽

1986 ◽

Vol 60 (3) ◽

pp. 876-884 ◽

Cited By ~ 2

Author(s):

A. S. Menon ◽

M. E. Weber ◽

H. K. Chang

Keyword(s):

Endotracheal Tube ◽

Endotracheal Intubation ◽

Particle Deposition ◽

Main Bronchus ◽

Velocity Profiles ◽

Left Main Bronchus ◽

Scale Model ◽

Left Main ◽

Lobar Bronchus ◽

The Right

Steady inspiratory velocity profiles were measured at two flow rates in a 3:1 scale model of the human central airways in the presence of five modes of endotracheal intubation. The presence of an orifice or a short endotracheal tube had no significant effect on the velocity profiles distal to the carina. Long endotracheal tubes change the profiles in both main bronchi. A significant peak occurred in the frontal plane near the walls, and the maximum velocity in the airway was almost identical to the endotracheal tube center-line velocity. The flow impinging on the medial wall of the main bronchus was redirected up around the anterior and posterior walls yielding bipeak velocity profiles in the sagittal plane. A tube placed eccentrically in the trachea over the right main bronchus did not alter the velocity profiles in the left main bronchus, suggesting a redirection of flow over the carina into the left lung. An endobronchial tube at the mouth of the right main bronchus did change the shape of the velocity profiles in the left main bronchus. In the left upper lobar bronchus the presence of trachea intubation had no effect on the velocity profiles. However, in the right upper lobar bronchus, the long endotracheal tube flattened the velocity profiles from the strongly skewed ones seen in the absence of the endotracheal inserts. These results not only are relevant to distribution of ventilation and aerosol particle deposition, but also have strong implications in intrapulmonary gas mixing, especially when high-frequency low tidal-volume ventilation is involved.

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