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Endotracheal tube exchange and pneumothorax: A case report

Case Reports in Clinical Medicine 2013年第2期2卷 183-185页

作者： Nissar Shaikh Kasif Mahmood amr.aboul wafa Ousama Kokash Department of Anesthesia/ICU Hamad Medical Corporation Doha Qatar Department of Anesthesia/ICU Weill Cornell Medical College in Qatar Doha Qatar Department of Surgery Hamad Medical Corporation Doha Qatar

Endotracheal intubation and extubation in intensive care unit (ICU) patients are difficult. Extubation will be more worrisome if patient has difficult intubation, sleep apnea, surgical procedure involving airway or surrounding structures. In such extubation airway exchange catheters (AEC) are used, as they are simple to use and able to provide oxygen to the patient. Rarely AEC use can cause potential life threatening complications. We report a case of pneumothorax following use of AEC in post-thyroidectomy patient. Case: A 32 years old male patient was admitted to our ICU, with difficult intubation after thyroidectomy. He was a known case of obtructive sleep apnea, hypertension and large goiter. In ICU for proper visualization of vocal cords and resecuring the airway, AEC was used, but patient had hypoxia with bradycardia. He was recovered with Ambu bag ventilation and required brief cardiopulmonary resuscitation. Post resuscitation he had left impending tension pneumothorax and lung laceration requiring chest drain, which was removed after tracheostomy and weaned from the ventilator. After 9 days supra glottic edema subsided and vocal cords were moving;His trachea was decanulated and he was discharged home. Conclusion: Rarely AEC use can cause life threatening injuries. Pneumothorax following the use of AEC is not always due to tracheobronchial injury;it can also occur as a result of alveolar injury.

关键词： AEC Difficult Intubation Pneumothorax Thyroidectomy

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Transthoracic echocardiographic and clinical predictors in first versus recurrent ischemic strokes

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World Journal of Cardiovascular Diseases 2014年第2期4卷 70-76页

作者： Yasser Bahnacy amr Abo Koora Hamed Dawoud wafa Rashed Ali Sadek Cardiology Division Chest Diseases Hospital Ferwania Kuwait Cardiology Division Department of Medicine Mubarak Al-Kabeer Hospital Hawally Kuwait Neurology Division Department of Medicine Mubarak Al-Kabeer Hospita Hawally Kuwait Public Health Department Ministry of Health Ferwania Kuwait

Recurrent strokes are more likely to be disabling or fatal than first ever strokes. The aim of the study is to evaluate transthoracic echocardiographic (TTE) and clinical predictors in patients with first versus those with recurrent ischemic strokes. A prospective observational comparative study of 217 patients admitted with ischemic strokes who were in sinus rhythm. Two groups of patients were simultaneously enrolled. The first group was 110 patients with first ischemic stroke and the second was 107 patients with recurrent ischemic stroke. TTE was done for all patients. Both echocardiographic and clinical risk factors were compared between both groups. Logistic regression analysis identified predictors for recurrent strokes. Among clinical risk factors hypertension, hyperlipidemia, family history of atherosclerotic vascular disease, prior coronary artery disease, peripheral vascular disease, and chronic kidney disease were significantly higher in recurrent stroke group. Multivariate logistic analysis identified age (OR, 1.03;95% CI, 1.01 - 1.07), hypertension (OR, 2.25;95% CI, 1.03 - 4.92), and hyperlipidemia (OR, 2.73;95% CI, 1.40 - 5.35), as predictors for recurrent ischemic strokes. Left ventricular diastolic dysfunction, left ventricular hypertrophy (LVH) and aortic sclerosis were significantly more common in the recurrent stroke group compared to the first stroke group. However, in multivariate logistic analysis only LVH (OR, 3.50;95% CI, 1.69 - 7.23), was identified as a predictor for recurrent strokes. Older age, hypertension, hyperlipidemia and left ventricular hypertrophy are significant predictors of recurrent ischemic strokes in patients with sinus rhythm. Those patients need more aggressive lipid lowering therapy and optimal blood pressure control.

关键词： Echocardiography Risk Factors Predictors Ischemic Stroke

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