European Journal of Molecular & Clinical Medicine

Aim: The aim of the present study to evaluate thelaryngotracheal injuries following endotracheal intubation.
Methods: A prospective study was conducted in the Department of Otorhinolaryngology, RVM Institute of Medical Sciences & Research Centre, Laxmakkapally, Telangana, India for the period of 1 year. 50 Patients intubated for more than 48 hours and admitted in medical ICU and aged more than 15 years were included in this study. To find the incidence, types of injury and to study the factors influencing LTI following intubation.
Results: Of 50, 32 were males and 18 were females with age ranging from 15 to 70 years. Majority of patients (70%) were between 15-29 years. Endotracheal tube of size 7.5 and 8 were used in 84% of patients. Majority of the patients (52%) were cases of organophosphorus (OP) poisoning followed by metabolic disorders like diabetic ketoacidosis and chronic kidney disease with encephalopathy. 36% of the patients were intubated for more than 10 days. The x-ray was normal in 36 patients (72%) while the abnormality was picked up in 14 (28%) patients. On 70-degree endoscopy, 4 patients (8%) had granulation tissue in the posterior commissure and one patient had bilateral vocal cord fixation. All the patients who had LTI were aged less than 45 years and 16 of 20 cases affected were males. Among the cases of LTI, 16 (80%) out of 20 cases were intubated with endotracheal tubes of size more than 7. 12 (60%) of the total cases of LTI had intubation for more than 10 days. OP poisoning was the etiology for LTI in 16 cases (80%).
Conclusion: A high incidence of LTI especially in cases of OP poisoning warrants one to be cautious in managing these intubated patients. Those patients requiring prolonged intubation should be considered for other alternative airway managements like tracheostomy in addition to using low pressure, high volume cuffed tubes

Background:Mechanical Ventilation (MV) is frequently used as one of the most
frequent life-supportive technology in Pediatric Intensive Care Units (PICUs). The
present study was undertaken to assess the clinical and etiological profile and outcome
of mechanically ventilated patients admitted in PICU at Tertiary Care Centre.
Methods: A total 120 children of age >30 days and <12 years, who were ventilated in
PICU mechanically from September 2019 to October 2021 were included in the
study.The demographic, clinical and etiological profile, complications and outcomes
(Extubated and died) were recorded.
Results: The mean age of patients was 3.32±1.19 years with male predominance (55%).
The commonest cause for intubation was circulatory failure (42.5%) and commonest
clinical diagnosis was septic shock (27.5%). In 71.67% patients rapid sequence
intubation (RSI) was used. Size of ET was appropriate in 92.5% and type of ET was
uncuffed in 90%. 13(10.83%) patients required reintubation and 9(7.5%) patients done
tracheostomy. Out of 120 patients, 21(17.5%) required T piece, SIMV in 9.17%, CPAP
in 5.83% and no weaning methods in 67.5%. Majority of patients required inotropes
(80.83%) and raised intracranial pressure (ICP) was seen in 27(22.5%) patients.
Nosocomial pneumonia (15%) and obstructive emphysema (15%) were the commonest
complications. 25(20.83%) patients had culture positivity and K. Pneumoniae (6.67%)
was the commonest organism isolated, among 25 cases, 7 had multiple drug resistance
(MDR) (28%). Majority of patients died (62.50%) while 37.5% patients extubated.
Conclusion:Mortality was high, hence the patients requiring MV require better
primary care availability at periphery so that they can be managed well at tertiary level
centres.Also better infection control and respiratory disease control are required.

A new respiratory illness the severe acute respiratory virus (Sars Cov2), was identified at the beginning of the new decade 2020.
Severe cases present with respiratory distress and tracheostomy has been considered to play a role in their management.
We present a report of a Tracheostomy performed on a Covid-19 patient and also a review of the relevant literature.
A 62 year old man, was brought in on a transport ventilator with a endotracheal tube insitu. From a private clinic after testing positive for COVID-19.
While on admission he desaturated further and subsequently had a tracheostomy done with marked improvement of the oxygen saturation immediate post operative period.
However on the day following the tracheostomy, he desaturated suddenly, resuscitation was commenced immediately but proved abortive, Patient was later certified dead.
Despite the unfavourable outcome, we believe the decision to perform the tracheostomy offered the patient a chance at survival