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Video rhino-laryngoscope modified into a fibreoptic bronchoscope.

Kothari N, Biyani G, Goyal S, Sharma V - Indian J Anaesth (2015)

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.

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During the next 30–60 min, patient's oxygen (O2) demand increased necessitating increase in fraction of inspired O2 from 30% to 80%, but he remained haemodynamically stable... Auscultation of the chest revealed decreased air entry on the right side... Due to its shorter length, it could not have been possible to reach up to the right bronchus if passed through the full length of ETT, and hence it was cut at 22 cm mark... A suction catheter of 8G was attached along the length of VRL and taped with micropore at four sites as the instrument does not have an in-built suction port [Figure 2]... With gentle to and fro movements of the newly designed assembly and saline wash through the suction catheter, all the debris were cleared and patent opening of the bronchus could be visualised... Patient's O2 requirement gradually decreased over next 4–6 h... In our case, as the FOB was not available and BPL was not feasible, we decided to proceed with VRL... Availability of different airway devices such as FOB, microdebriders and adequate training of BPL are necessary to manage central airway obstruction... In circumstances where FOB and BPL facilities are not available, VRL can be used as alternative device on emergency basis to remove secretions and mucus plugs from the central airway... However, care must be taken to prevent accidental dislodgement of the micropore tapes within the tracheo-bronchial tree.

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Related in: MedlinePlus

Pre- and post-procedure chest X-rays showing right lung collapse with mediastinal shift and re-expansion, respectively
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Figure 1: Pre- and post-procedure chest X-rays showing right lung collapse with mediastinal shift and re-expansion, respectively

Mentions: A 68-year-old male patient, diagnosed case of Guillain–Barre syndrome, was referred to our Intensive Care Unit (ICU) for supportive management. Within 24 h of admission, the disease progressed acutely to involve thoracic muscles of respiration requiring intubation and mechanical ventilation (MV). For intubation, intravenous injections of fentanyl (100 µg), propofol (60 mg) and midazolam (2 mg) were administered, and patient was intubated with 8.5 mm cuffed endotracheal tube (ETT) and was put on MV. During the next 30–60 min, patient's oxygen (O2) demand increased necessitating increase in fraction of inspired O2 from 30% to 80%, but he remained haemodynamically stable. Auscultation of the chest revealed decreased air entry on the right side. Arterial blood gas (ABG) analysis showed hypoxia with hypercapnia. Chest X-ray showed complete collapse of the right lung tissue with mediastinal shift to right [Figure 1]. A provisional diagnosis of right main-stem bronchus obstruction either due to blood clot or mucus plug was made.


Video rhino-laryngoscope modified into a fibreoptic bronchoscope.

Kothari N, Biyani G, Goyal S, Sharma V - Indian J Anaesth (2015)

Pre- and post-procedure chest X-rays showing right lung collapse with mediastinal shift and re-expansion, respectively
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4645359&req=5

Figure 1: Pre- and post-procedure chest X-rays showing right lung collapse with mediastinal shift and re-expansion, respectively
Mentions: A 68-year-old male patient, diagnosed case of Guillain–Barre syndrome, was referred to our Intensive Care Unit (ICU) for supportive management. Within 24 h of admission, the disease progressed acutely to involve thoracic muscles of respiration requiring intubation and mechanical ventilation (MV). For intubation, intravenous injections of fentanyl (100 µg), propofol (60 mg) and midazolam (2 mg) were administered, and patient was intubated with 8.5 mm cuffed endotracheal tube (ETT) and was put on MV. During the next 30–60 min, patient's oxygen (O2) demand increased necessitating increase in fraction of inspired O2 from 30% to 80%, but he remained haemodynamically stable. Auscultation of the chest revealed decreased air entry on the right side. Arterial blood gas (ABG) analysis showed hypoxia with hypercapnia. Chest X-ray showed complete collapse of the right lung tissue with mediastinal shift to right [Figure 1]. A provisional diagnosis of right main-stem bronchus obstruction either due to blood clot or mucus plug was made.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

During the next 30–60 min, patient's oxygen (O2) demand increased necessitating increase in fraction of inspired O2 from 30% to 80%, but he remained haemodynamically stable... Auscultation of the chest revealed decreased air entry on the right side... Due to its shorter length, it could not have been possible to reach up to the right bronchus if passed through the full length of ETT, and hence it was cut at 22 cm mark... A suction catheter of 8G was attached along the length of VRL and taped with micropore at four sites as the instrument does not have an in-built suction port [Figure 2]... With gentle to and fro movements of the newly designed assembly and saline wash through the suction catheter, all the debris were cleared and patent opening of the bronchus could be visualised... Patient's O2 requirement gradually decreased over next 4–6 h... In our case, as the FOB was not available and BPL was not feasible, we decided to proceed with VRL... Availability of different airway devices such as FOB, microdebriders and adequate training of BPL are necessary to manage central airway obstruction... In circumstances where FOB and BPL facilities are not available, VRL can be used as alternative device on emergency basis to remove secretions and mucus plugs from the central airway... However, care must be taken to prevent accidental dislodgement of the micropore tapes within the tracheo-bronchial tree.

No MeSH data available.


Related in: MedlinePlus