Objective To investigate the current situation of salivation in patients with orotracheal cannula, and to systematically analyze its influencing factors. Methods Patients who underwent tracheal intubation treatment in 47 tertiary comprehensive medical institutions were selected between October 10th and 20th, 2023. A cross-sectional survey method was used to conduct an online survey of the patient’s salivation status. The patients were divided into the salivation group and no-salivation group. Results A total of 565 questionnaires were collected and 561 were valid, with an effective recovery rate of 99%. Among 561 patients, 284 were males (50.62%) and 277 were females (49.38%), with an age of (59.80±10.96) years; 159 cases of salivation occurred, with a total static saliva flow rate of (7.21±3.15) mL and the incidence of salivation was 28.34% (159/561). There were statistically significant differences in age, education level, body mass index, primary disease, number of concurrent functional impairments, concurrent oral diseases, smoking, intubation days, intubation depth, intubation process, sedation and/or analgesia days, and enteral nutrition treatment between the two groups (P<0.05). There was no statistically significant difference in other indicators between the two groups (P>0.05). The results of multivariate logistic regression analysis showed that body mass index, neurological diseases, number of concurrent functional impairments, concurrent oral diseases, smoking, intubation days and intubation process were independent risk factors for salivation in patients with oral catheterization. Conclusion The incidence of salivation in patients with orotracheal cannula is 28.34%, which is directly related to body mass index, neurological diseases, number of concurrent functional impairments, concurrent oral diseases, smoking, intubation days and intubation process.
Objective
To construct a new composite artificial trachea and to investigate the feasibility of trachea repair and reconstruction with the new composite artificial trachea transplantation in dogs.
Methods
The basic skeleton of the new composite artificial trachea was polytetrafluoroethylene vascular prosthesis linked with titanium rings at both ends. Dualmesh was sutured on titanium rings. Sixteen dogs, weighing (14.9 ± 2.0) kg, female or male, were selected. The 5 cm cervical trachea was resected to prepare the cervical trachea defect model. The trachea repair and reconstruction was performed with the new composite artificial trachea. Then fiberoptic bronchoscope examination, CT scan and three-dimensinal reconstruction were conducted at immediate, 1 month, and 6 months after operation. Gross observation and histological examination were conducted at 14 months to evaluate the repair and reconstruction efficacy.
Results
No dog died during operation of trachea reconstruction. One dog died of dyspnea at 37, 41, 55, 66, 140, and 274 days respectively because of anastomotic dehiscence and artificial trachea displacement; the other 10 dogs survived until 14 months. The fiberoptic bronchoscope examination, CT scan and three-dimensinal reconstruction showed that artificial tracheas were all in good location without twisting at immediate after operation; mild stenosis occurred and anastomoses had slight granulation in 6 dogs at 1 month; severe stenosis developed and anastomosis had more granulation in 1 dog and the other dogs were well alive without anastomotic stenosis at 6 months. At 14 months, gross observation revealed that outer surface of the artificial trachea were encapsulated by fibrous connective tissue in all of 10 dogs. Histological examination showed inflammatory infiltration and hyperplasia of fibrous tissue and no epithelium growth on the inner wall of the artificial trachea.
Conclusion
The new composite artificial trachea can be used to repair and reconstruct defect of the trachea for a short-term. Anastomotic infection and dehiscence are major complications and problems affecting long survival.
ObjectiveTo improve the knowledge of primary tracheobronchial lymphoma.MethodsTwo patients with primary tracheobronchial lymphoma admitted to First Affiliated Hospital Guangxi Medical University in 2013 and in 2016 were analyzed retrospectively, and related literatures were reviewed. Chinese National Knowledge Infrastructure, Wanfang database and VIP database were searched by using " trachea lymphoma” or " bronchus lymphoma” as keywords. Meanwhile, databases including PubMed, Ovid Medline and Embase database were retrieved with " Trachea” or " Bronchus” AND " Lymphoma” as keywords. Seventy-two cases of primary tracheobronchial lymphoma were reported, the clinical feature, imaging feature, pathological feature, treatment and prognosis of 72 cases were analyzed.ResultsThe two patients were both females. The chief complaints included cough and dyspnea. The tissue biopsy under bronchoscope was the main diagnostic method. On histopathology, one case was diagnosed grade B cell lymphoma, another was diagnosed mantle cell lymphomas. After chemotherapy, the symptoms were relieved and never relapsed in the follow-up period until October 2016. Literature review found 72 patients with primary tracheobronchial lymphoma with women being the majority (47 cases, 65.28%). The patients aged from16 to 82 years with a median age of 51 years, and nine cases (12.5%) of the patients aged from 16 to 30 years. The specific clinical symptoms were cough and dyspnea. Pulmonary function prompted obstructive dysfunction of pulmonary ventilation. The chest CT scan showed consolidation shadow in trachea and bronchus with or without pulmonary atelectasis. Neoplasms could be found by bronchoscopy. Mucosa-associated lymphoid tissue (MALT) lymphoma was the most common pathological characteristic (36.11%). Mantle cell lymphomas has not been reported currently.ConclusionsPrimary tracheobronchial lymphoma is one of the rare airway tumors. Its clinical features, imaging examinations and bronchoscopic characteristics are not specific, which can be easily confused with lung cancer. It also can cause life-threatening airway obstruction. The bronchoscopy play an important role in diagnosis of primary tracheobronchial lymphoma, while the diagnosis is confirmed by histopathological examination. The main pathology type is MALT lymphoma. The prognosis is good.
Objective To review the recent research progress of base and clinical application of tracheal replacement. Methods Literature concerning tracheal prosthesis and the current achievements were extensively and comprehensively reviewed. Results Most tracheal lesions can be resected and achieve primary reconstruction, but the resectable length was limited.Tracheal replacement was an efficient and feasible way to substitutethe defects resulting from extended resection. Conclusion Newtechniques such as tissue engineering, tracheal transplantation, new tracheal prosthesis of biomaterials break fresh ground for the more rapid development of tracheal surgery.
ObjectiveTo evaluate the difference between the tracheal intubation connected to conventional ventilation (TI-CV) and rigid bronchoscopy connected to high frequency ventilation (RB-HFV) under general anesthesia on patients with transbronchial cryobiopsy (TBCB).MethodA prospective, randomized, controlled trial was conducted in interstitial lung disease patients with TBCB from August 2018 to February 2019 in the First Affiliated Hospital of Guangzhou Medical University. According to the different methods of intubation, the patients were divided to a TI-CV group and a RB-HFV group randomly. The operating duration, extubation duration, total anesthesia time, heart rate, blood pressure and arterial blood gas analysis were collected and analyzed.ResultsSixty-five patients were enrolled. There were 33 patients with an average age of (48.0±15.0) years in TI-CV group and 32 patients with an average age of (48.8±10.8) years in RB-HFV group. The basic line of body mass index, pulmonary function (FEV1, FVC and DLCO), arterial blood gas (pH, PaO2 and PaCO2) and heart rate (HR), mean arterial pressure (MAP) had no significant differences between two groups. At the first 5 minutes of operation, the pH was (7.34±0.06) and (7.26±0.06), and the PaCO2 was (48.82±9.53) and (62.76±9.80) mm Hg in TI-CV group and RB-HFV group respectively, with significant differences (P=0.000). At the end of operation, the pH was (7.33±0.06) and (7.21±0.08), the PaCO2 was (48.91±10.49) and (70.93±14.83) mm Hg, the HR were (79.6±21.1) and (93.8±18.7) bpm, the MAP were (72.15±13.03) and (82.63±15.65) mm Hg in TI-CV group and RB-HFV group respectively, with significant differences (P<0.05). There were no differences in the operating duration and extubation duration between two groups. The total anesthesia time was (47.4±8.8) and (53.3±11.6) min with significant difference (P=0.017). Five minutes after the extubation, there were no significant difference in the pH, PaO2, PaCO2, HR and MAP between two groups. No serious complications occurred in either group.ConclusionsCompared with rigid bronchoscopy, TI-CV under general anesthesia is more conducive to maintain effective ventilation, and maintain the HR and MAP stable during the TBCB procedure. TBCB procedure should be performed by TI-CV under general anesthesia in patients with poor cardiopulmonary function.
ObjectivesTo systematically review the efficacy of lidocaine injected prior to tracheal extubation in preventing hemodynamic responses to tracheal extubation in general anesthesia.MethodsPubMed, Ovid, Web of Science, EMbase, The Cochrane Library, CBM, CNKI, VIP and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) on the efficacy of lidocaine administrated prior to extubation in preventing hemodynamic responses to tracheal extubation in patients undergoing general anesthesia from inception to October, 2018. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 and Stata 13.0 software.ResultsA total of 10 RCTs involving 525 patients were included. The results of meta-analysis showed that: compared with control group, lidocaine could reduce mean arterial pressure in 5 min after extubation (MD=–5.10, 95%CI –9.41 to –0.79, P=0.02), weaken the increase in systolic blood pressure caused by extubation from the moment before extubation to 5 minutes after extubation (before extubation: MD=–7.22, 95%CI –10.34 to –4.11, P<0.000 01; at extubation: MD=–14.02, 95%CI –19.42 to –8.62, P<0.000 01; 1 minutes after extubation: MD=–15.82, 95%CI –22.20 to –9.45, P<0.000 01; 3 minutes after extubation: MD=–12.55, 95%CI –20.36 to –4.74, P=0.002; and 5 minutes after extubation: MD=–12.05, 95%CI –20.35 to –3.74, P=0.004), and weakened extubation-induced increase in diastolic blood pressure at extubation (MD=–9.71, 95%CI –16.57 to –2.86, P=0.005). In addition, lidocaine inhibited heart rate in all time points except the moment of before and at 10 minutes after extubation.ConclusionsCurrent evidence shows that lidocaine can inhibit the increase in blood pressure and heart rate caused by extubation at certain times. Due to limited quality and quantity of the included studies, more high-quality studies are needed to verify above conclusions.
ObjectiveTo observe the morphological and pathological changes after transplantation of polytetrafluoroethylene (PTFE) in vivo.
MethodsPTFE microporous polypropylene tube which was encircled by spiral steel wire was used to prepare the artificial trachea.Forty New Zealand white rabbits (weighing,4-5 kg) were selected,and were divided into 2 groups.After the cervical trachea (2 cm in length) was removed,the end-to-end anastomosis between the trachea and PTFE artificial trachea was performed in the experimental group (n=20),and end-to-end anastomosis of the trachea in the control group (n=20).The survival of the rabbits was observed after operation;the X-ray,gross,and histological observations were carried out at 2,4,and 6 months after operation.The longitudinal tensile and radial support biomechanical tests were performed before and after transplantation.
ResultsThe survival time was more than 2 months and the artificial airway was patency in 15 rabbits of the experimental group;the tissue outside the artificial trachea was like tracheal tissue,which filled in the defect,but it was more than 4 months.X-ray observation showed that the PTFE artificial trachea had no obvious displacement in the experimental group,and no tracheostenosis was observed in the control group.After 2 months,there was no epithelial tissue on the artificial airway wall;after 4 months,there was some epithelial cells on the artificial airway wall,incomplete endothelialization and trachea layer structure were seen with no tracheal ciliated columnar epithelium;after 6 months,the artificial trachea wall was covered with epithelium basically,and some ciliated columnar epithelium cells were found,which had the physiological function of the trachea.The transplanted PTFE artificial trachea could keep the stability of the biological mechanics performance,and could be used for the rabbit tracheal reconstruction.
ConclusionPTFE artificial trachea can induce to form a tracheal tissue in the trachea tissues of recipients,each layer of the trachea is relatively complete and the experiment animals can be short-term survival.
Tracheal stents are often used to maintain the patency of the trachea and bronchia in patients suffering from central airway lesions. Metallic tracheal stents are now widely used in the clinical setting, but these types of stents can cause many intractable material-related complications. Biodegradable tracheal stents are made of biodegradable polymer materials with good mechanical strength for maintaining the patency of the lesion segment during a certain period of time, and then they can be gradually degraded into harmless products in human body. Compared with conventional metallic tracheal stent, biodegradable tracheal stents have a good prospect in clinic. In this article, we review the choice of biodegradable tracheal stent materials, experimental progress in biodegradable tracheal stent as well as the challenges we are facing.
Objective To review the research advances of the tracheal prosthesis. Methods The articles concerned in recent years were extensively reviewed. Results There were still many arguments about the use of tracheal substitutes. Avariety of artificial trachea had been designed and assessed, but so far none of them had been satisfactory for clinical use. The failures were mainly due to their high mortality and incidence of complication such as prosthetic defluvium, granuloma formation, local infection, air leakage, anastomotic stenosis or obstruction. Conclusion The major causes of the poor effectiveness by the use of tracheal prosthesis are closely related to its biological compatibilities. The selected biomaterials and the design of prosthesis hold the key to a breakthrough in research and clinical use of tracheal prosthesis.
ObjectiveTo explore the clinical features, diagnosis, differential diagnosis, pathological characteristics, management and prognosis of airway hemangioma, and improve the level of the diagnosis and therapy.MethodsThe clinical data of a patient with airway hemangioma admitted to West China Hospital of Sichuan University were retrospectively analyzed. The related literatures were reviewed. Databases including PubMed, Ovid Medline, Embase, VIP, Wanfang and Chinese National Knowledge infrastructure were searched using the keywords as " Trachea” OR " Bronchus” AND " Hemangioma” from January 1976 to October 2016.ResultsThe patient was a 32-year-old male presented with hemoptysis and backache more than 10 days. His enhanced chest CT scan revealed thickening of the esophagus wall and narrowing of the lumen of esophagus. A wide range of vascular tumor like changes in the trachea and the two sides of bronchus were found by the fiberoptic bronchoscopy and gastroscope examination suggested esophageal varices. Although the patient had a wide range of airway lesions, the symptom of hemoptysis was relieved after the conservative treatment. The patient’s condition was stable until now. From January 1976 to October 2016, a total of 34 related articles were retrieved and 36 cases of airway hemangioma were reported. The etiology of the disease remains unknown. Recurrent hemoptysis was the common symptoms of airway hemangioma, and imaging changes lacking characteristics. Histopathological examination revealed dilated, thin-walled and different size of vascular or hyperplastic capillary and immunohistochemical staining was positive for vascular endothelial cell specific CD34 and Ⅷ factor.ConclusionsHemangioma is a common benign tumor of head and neck in infants and children. Hemangioma is very rarely occurred in trachea in adults. Clinical and imaging manifestations are not specific, and diagnosis relies on histopathological examination. Fiberoptic bronchoscopy and three dimensional reconstruction of thoracic vessels with CT play important roles in the whole process of diagnosis and treatment of airway hemangioma. It should be differentiated from lymphangioma. The prognosis of airway hemangioma is good.
