기관내 삽관 커프의 과도한 공기주입으로 인한 기관식도루 발생 증례 -증례 보고-
Occurrence of Acquired Tracheoesophageal Fistula Due to Excess Endotracheal Tube Cuff Volumes -A Case Report-
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Endotracheal tube cuff volume and pressure require constant monitoring to prevent tracheal injury. Acquired tracheoesophageal fistula is common from complications of mechanical ventilation as a result of pressured necrosis of the tracheoesophageal wall by endotracheal tube cuff. It still represents a life-threatening condition, especially when the diagnosis is being delayed. We present our modest experience through an acquired TEF patient who had an excessively enlarged cuff diameter on chest radiogram in order to consider the potential of using radiological-measured cuff diameter as a simple technique for predicting tracheal damages. Although the cuff pressure was monitored with a manometer by the medical team, it was possible that the tube cuff was excessively enlarged. Proper procedures for preventing the tracheal damage by cuffs include the following: monitoring of endotracheal cuff pressure and volume, observation of cuff size on the chest radiogram, and being mindful and attentive for possibilities of misjudgements by manometer or medical teams.
Abstract
Endotracheal tube cuff volume and pressure require constant monitoring to prevent tracheal injury. Acquired tracheoesophageal fistula is common from complications of mechanical ventilation as a result of pressured necrosis of the tracheoesophageal wall by endotracheal tube cuff. It still represents a life-threatening condition, especially when the diagnosis is being delayed. We present our modest experience through an acquired TEF patient who had an excessively enlarged cuff diameter on chest radiogram in order to consider the potential of using radiological-measured cuff diameter as a simple technique for predicting tracheal damages. Although the cuff pressure was monitored with a manometer by the medical team, it was possible that the tube cuff was excessively enlarged. Proper procedures for preventing the tracheal damage by cuffs include the following: monitoring of endotracheal cuff pressure and volume, observation of cuff size on the chest radiogram, and being mindful and attentive for possibilities of misjudgements by manometer or medical teams.
참고문헌 (20)
- Kim WJ, "A case of tracheoesophageal fistula through esophageal diverticulum combined with aspiration pneumonia", Korean J Gastroenterol, 30, pp.677~683 (1997)
- Hilgenberg AD, "Acquired nonmalignant tracheoesophageal fistula", J Thorac Cardiovasc Surg, 85, pp.492~498 (1983)
- 정용훈, "인공호흡기 치료 중 발생한 후천성 기관식도루", Korean Journal of Anesthesiology, 46(1), pp.122~126 (2004), 대한마취통증의학회
- Shin WS, "Tracheoesophageal fistula due to endotracheal intubation; a case report of requiring tracheal reconstruction", Korean J Thorac Cardiovasc Surg, 30, pp.636~639 (1997)
- Grillo HC, "Development of tracheal surgery: a historical review. Part 2: Treatment of tracheal diseases", Ann Thorac Surg, 75, pp.1039~1047 (2003)
- Powaser MM, "The effectiveness of hourly cuff deflation in minimizing tracheal damage", Heart Lung, 5, pp.734~741 (1976)
- Make BJ, "Mechanical ventilation beyond the intensive care unit. Report of a consensus conference of the American College of Chest Physicians", Chest, 113(5 Suppl), pp.289S~344S (1998)
- Couraud L, "Acquired tracheoesophageal fistula and its management", Semin Thorac Cardiovasc Surg, 8, pp.392~399 (1996)
- Stauffer JL, "Complications and consequences of endotracheal intubation and tracheotomy. A prospective study of 150 critically ill adult patients", Am J Med, 70, pp.65~76 (1981)
- Marzelle J, "Surgical management of acquired post-intubation tracheo-oesophageal fistulas: 27 patients", Eur J Cardiothorac Surg, 3, pp.499~502 (1989)
- Kang JY, "Direct closure of post-intubation trachesophageal fistulas -Report of 3 cases-.", Korean J Thorac Cardiovasc Surg, 29, pp.1045~1049 (1996)
- 김승찬, "기관절개술 과거력을 가진 환자에서 기관 삽관 후 발생한 기관식도루 2예", 대한중환자의학회지, 24(2), pp.87~91 (2009), 대한중환자의학회
- Tu HN, "Nitrous oxide increases endotracheal cuff pressure and the incidence of tracheal lesions in anesthetized patients", Anesth Analg, 89, pp.187~190 (1999)
- Mooty RC, "Mangram A : Review of tracheo-esophageal fistula associated with endotracheal intubation", J Surg Educ, 64, pp.237~240 (2007)
- Irwin RS, "Irwin and Rippe's intensive care medicine. 6th ed", pp.2008, Wolters Kluwer Health
- Neumar RW, "Part 8: adult advanced cardiovascular life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care", Circulation, 122(18 Suppl 3), pp.S729~S767 (2010)
- 이삼우, "기관 삽관 후의 cuff 내에 주입되는 공기의 양과 압력에 대한 조사 보고", 대한응급의학회지, 15(1), pp.19~23 (2004), 대한응급의학회
- 강민수, "기관모형을 이용한 기관 삽관튜브의 크기에 따른 cuff내 공기 주입량 조사", 대한응급의학회지, 17(1), pp.14~18 (2006), 대한응급의학회
- Leeds WM, "Computed tomography for diagnosis of tracheoesophageal fistula", Crit Care Med, 14, pp.591~592 (1986)
- Shanmuganathan K, "Imaging diagnosis of nonaortic thoracic injury", Radiol Clin North Am, 37, pp.533~551 (1999)