[Postintubation XXXX ; problems associated with choice of management].

@entity1 @entity825 @entity1353 @entity39 @entity6184 @entity850 @entity3503
We experienced a case with @entity6184 due to postintubation damage, or so-called cuff @entity850 . A 50-year-old @entity1 who attempted suicide by pounding nails into his head and chest using carpenter's tools was treated by endotracheal intubation and immediately underwent emergency surgery in July 2000. The @entity1 was placed on artificial ventilation with oral endotracheal intubation, and a tracheostomy was performed 4 days after the operation. After that, his respiration recovered and he was weaned from the respirator. He was discharged 22 days after surgery with no respiratory symptoms. Two days after discharge, he complained of wheezing and @entity1353 . Medical examination revealed that the cervical @entity825 had a severe circumferential @entity850 2.5 cm from the second tracheal cartilage. On retrospective inspection, the region of @entity850 was compatible with the cuff site of the endotracheal tube used for the emergency operation. At first we tried nonoperative treatment, considering his mental state. However, we found that surgical treatment was ultimately necessary. A 2.5 cm sleeve resection of the @entity825 (5 tracheal cartilage rings) was performed, followed by end-to-end suture using 21 stitches with 4-0 MEDIFIT C thread. Pathologically, the surgical specimen showed degeneration and @entity39 of tracheal cartilage with excessive growth of granulation tissue. These findings revealed that the etiologic basis of the @entity6184 was attributed to pressure @entity39 by the cuff. The postoperative course was uneventful. Sixteen months after the surgery, the granulation tissue had not recurred, and problematic @entity850 was not visible in the @entity825 . In this report, we discussed a reasonable management of postintubation @entity6184 . Tracheoplasty has been proposed as the most reliable method for treating @entity6184 . However, the best treatment in each case is still somewhat controversial because various nonoperative treatment methods are recently available, including laser phototherapy, @entity3503 plasma coagulation, mechanical dilatation, stent replacement, and drug treatment. Therefore, it is very important to judge properly the absolute indication for surgical treatment. If granulations are removed successfully by the above-described nonoperative methods, attempts at repair lead only to regrowth of granulation tissue as long as there is necrotic tracheal cartilage. Thus, the determinant of treatment methods is whether postintubation damage extends to tracheal cartilage or not. For now, there is no accurate diagnostic study for viability of cartilage preoperatively. In the literature, symptoms due to airway @entity850 occurred rapidly within one month in the case of @entity1 with @entity39 of tracheal cartilage. We concluded that the period between extubation and development of symptoms is very informative in the management of postintubation @entity6184 . Surgical approaches should be selected for a @entity1 with a rapid and progressive course after extubation when the @entity1 can tolerate it.
