Successful application of non-invasive positive pressure ventilation for critically ill patients in respiratory failure with postextubation stridor: A report of consecutive three cases

김정수,전상훈,이홍렬,곽승민,류정선,남해성,조재화 대한결핵 및 호흡기학회 2017 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.124 No.-

Postextubation stridor (PES) caused by laryngeal mucosa, presented as stridor or respiratory failure is a complication of endotracheal intubation. Inhaled epinephrine and corticosteroids are known as a treatment for PES. However, the efficacy of noninvasive positive pressure ventilation (NIPPV) is not reported. The first patient was a 62 years old man with heart failure. As he got a respiratory failure by pulmonary congestion, mechanical ventilation (MV) with an endotracheal tube (ET) was applied for 3 days. Stridor was heard and dyspnea complained after extubation. Inhaled epinephrine and dexamethasone was administrated but stridor lasted. NIPPV was applied and could be weaned 18 hours later without stridor. The second patient was 40 years old pregnant woman. Massive bleeding after delivery resulted in disseminated intravascular coagulation. MV with ET was applied for transfusion related lung injury. ET could be removed after 7 days later. As soon as extubation, stridor was heard and dyspnea complained. NIPPV, inhaled epinephrine, and dexamethasone was applied. NIPPV could be weaned 2 days later without stridor. Finally, a third patient, 67 years old woman was admitted by liver abscess septic shock and acute respiratory distress syndrome. MV with ET was applied for 14 days. Stridor was heard after extubation. As she did not complain dyspnea, inhaled epinephrine and dexamethasone was preferentially administrated however it was not effective. Stridor was disappeared after applying of NIPPV for 16 hours. NIPPV could be considered as a treatment of postextubation stridor.

후두 천명을 보인 다계통위축증 환자 1례

석흥열,박건우,정기영 대한수면연구학회 2007 Journal of sleep medicine Vol.4 No.2

Sleep-related breathing disorders have been extensively reported as a frequent and major problem in patients with multiple system atrophy (MSA). Laryngeal stridor and obstructive sleep apnea are the most common sleep disordered breathing in MSA. We report laryngeal stridor in a patient with multiple system atrophy. A 56-year-old man presented with abnormal breathing sound different from snoring during sleep noticed by his bed partner. He is unaware of his nocturnal stridor. Polysomnography showed obstructive sleep apnea and laryngeal stridor. Laryngoscopy during wakefulness detects normal movement of vocal cord. CPAP (continuous positive airway pressure) eliminated laryngeal stridor and obstructive sleep apnea with pressures of 9 cmH₂O.

생후 35일부터 호흡곤란을 보였던 선천성 성대하 혈관종 1례

오지은,노은석,박재선,이강대,김영옥,정미희 고신대학교(의대) 고신대학교 의과대학 학술지 2005 고신대학교 의과대학 학술지 Vol.20 No.1

We report a case of subglottic hemangioma in an 40 days old male infant. Since 35th days of birth, he developed sudden onset of dyspnea, hoarseness, and biphasic stridors. Stridors were more prominent in inspiratory phase than expiratory phase, and were not relieved by prone positioning. Fiberscope of vocal cord was tried, but unsuccessful to make any diagnosis because of the extreme severity of the respiratory distress during the examination. Steroids were maintained for 7 days, but there was no symptomatic improvement. Emergent tracheotomy was done as signs of air hunger were aggravated in spite of oxygen supply. Neck axial CT study was possible only after tracheostomy, and it showed a small caliber trachea which was displaced to the left side. Sagittal reconstruction neck CT scan showed no connection in the upper airway. Diagnostic approach with direct laryngoscope was made in the operating room which revealed round mass located posteroinferiorly of left vocal cord. The mass, covered by normal mucosa and 1x1x1 cm in size, was ablated with CO2 laser. Sections of resected subglottic mass showed lobular proliferation of small vessels which is compatible with hemangioma. After 3 weeks of tracheostomy, decannulation was done successfully without any complication. Follow-up examination of the baby at one year of age showed excellent condition except small hemangioma of 1x1.5cm size on the skin of posterior chest wall, which was newly developed at age of 3 months.

생후 35일부터 호흡곤란을 보였던 선천성 성대하 혈관종 1례

오지은,노은석,박재선,이강대,김영옥,정미희 고신대학교 의학부 2005 高神大學校 醫學部 論文集 Vol.20 No.1

We report a case of subglottic hemangioma in an 40 days old male infant. Since 35th days of birth, he developed sudden onset of dyspnea, hoarseness, and biphasic stridors. Stridors were more prominent in inspiratory phase than expiratory phase, and were not relieved by prone positioning. Fiberscope of vocal cord was tried, but unsuccessful to make any diagnosis because of the extreme severity of the respiratory distress during the examination. Steroids were maintained for 7 days, but there was no symptomatic improvement. Emergent tracheotmoy was done as signs of air hunger were aggravated in spite of oxygen supply. Neck axial CT study was possible only after tracheostomy, and it showed a small caliber trachea which was displaced to the left side. Sagittal reconstruction neck CT scan showed no connection in the upper airway. Diagnostic approch with direct laryngoscope was made in the operating room which revealed round mass located posteroinferiorly of left vocal cord. The mass, covered by normal mucosa and 1×1×1 ㎝ in size, was ablated with CO₂ laser. Sections of resected subglottic mass showed lobular proliferation of small vessles which is compatible with hemangioma. After 3 weeks of tracheostomy, decannulation was done successfully without any complication. Follow-up examination of the baby at one year of age showed excellent condition except small hemangioma of 1×1.5cm size on the skin of posterior chest wall, which was newly developed at age of 3 months.

Munchausen Stridor–A Strong False Alarm of Anaphylaxis

Sami L. Bahna,Jennifer L. Oldham 대한천식알레르기학회 2014 Allergy, Asthma & Immunology Research Vol.6 No.6

The diagnosis of anaphylaxis is often based on reported symptoms which may not be accurate and lead to major psychosocial and financial impacts. We describe two adult patients who were diagnosed as having recurrent anaphylaxis witnessed by multiple physicians based on recurrent laryngeal symptoms. The claimed cause was foods in one and drugs in the other. We questioned the diagnosis because of absent documentation of objective findings to support anaphylaxis, and the symptoms occurred during skin testing though the test sites were not reactive. Our initial skin testing with placebos reproduced the symptoms without objective findings. Subsequent skin tests with the suspected allergens were negative yet reproduced the symptoms without objective findings. Disclosing the test results markedly displeased one patient but reassured the other who subsequently tolerated the suspected allergen. In conclusion, these 2 patients’ symptoms and evaluation were not supportive of their initial diagnosis of recurrent anaphylaxis. The compatible diagnosis was Munchausen stridor which requires psychiatric evaluation and behavior modification, but often rejected by patients.

반복적인 천음과 호흡곤란을 보인 영아에서 진단된 선천성 심, 폐기형 3례

남효경,변정혜,장기영,정지태,손창성,함수연,라경숙,최익선,유영 대한 소아알레르기 호흡기학회 2009 Allergy Asthma & Respiratory Disease Vol.19 No.2

천음은 상기도 폐쇄를 시사하는 것으로, 영아기 비감염성 천음의 가장 흔한 원인은 후두연화증이며 이는 증상이 경미하고 대부분 특별한 치료 없이 호전된다. 그러나 천음이 출생 직후부터 나타나거나 지속적이며 호흡곤란이 동반되는 경우에는 심, 폐기형 등 상기도 협착을 일으킬 수 있는 다른 질환의 동반 가능성을 고려하여야 한다. 이러한 심혈관계, 호흡기계의 기형이 있는 경우 천음, 호흡곤란 등의 증상이 호전되지 않고 심한 호흡곤란과 인공호흡기 이탈장애, 사망에까지 이를 수 있어 조기 진단과 치료에 대한 적극적인 노력이 필요하다. Although laryngomalacia is the most common cause of congenital stridor in infancy, it is a benign, self-limited disease which usually resolves by the age of 18 months with no long- term sequelae. Nevertheless, infants who suffered from recurrent stridor and respiratory distress should be evaluated for other causes of stridor such as cardiopulmonary anomalies. We report 3 cases of infants who had recurrent stridor and respiratory distress from their early infancy. Case 1 had a double aortic arch and a tracheomalacia, case 2 had a hypoplasia of the right lung, and case 3 had a horseshoe lung as well as scimitar syndrome. Physicians should be alert for the possibility of the congenital cardiopulmonary abnormalities in infants with recurrent stridor and/or respiratory distress.

반복적인 천음과 호흡곤란을 보인 영아에서 진단된 선천성 심, 폐기형 3례

남효경 ( Hyo Kyoung Nam ),라경숙 ( Kyong Suk La ),변정혜 ( Jung Hye Byeon ),최익선 ( Ic Sun Choi ),장기영 ( Gi Young Jang ),유영 ( Young Yoo ),정지태 ( Ji Tae Choung ),손창성 ( Chang Sung Son ),함수연 ( Soo Youn Ham ) 대한소아알레르기호흡기학회 2009 소아알레르기 및 호흡기학회지 Vol.19 No.2

Although laryngomalacia is the most common cause of congenital stridor in infancy, it is a benign, self-limited disease which usually resolves by the age of 18 months with no long-term sequelae. Nevertheless, infants who suffered from recurrent stridor and respiratory distress should be evaluated for other causes of stridor such as cardiopulmonary anomalies. We report 3 cases of infants who had recurrent stridor and respiratory distress from their early infancy. Case 1 had a double aortic arch and a tracheomalacia, case 2 had a hypoplasia of the right lung, and case 3 had a horseshoe lung as well as scimitar syndrome. Physicians should be alert for the possibility of the congenital cardiopulmonary abnormalities in infants with recurrent stridor and/or respiratory distress. [Pediatr Allergy Respir Dis(Korea) 2009; 19:183-190]

A case of congenital vallecular cyst associated with gastroesophageal reflux presenting with stridor, feeding cyanosis, and failure to thrive

양미애,강민재,홍지나,신승한,김상덕,김이경,김한석,권택균,김인원,최중환 대한소아청소년과학회 2008 Clinical and Experimental Pediatrics (CEP) Vol.51 No.7

Vallecular cyst is an uncommon but potentially dangerous condition causing stridor and has been associated with sudden airway obstruction resulting in death due to its anatomical location in neonates. It may also present with various degrees of feeding problems resulting in failure to thrive. When a vallecular cyst is suspected clinically, endoscopic laryngoscopy is necessary to visualize it. Other conditions leading to neonatal stridor such as laryngomalacia and other laryngotracheal abnormalities should be ruled out. Marsupialization with a CO2 laser is the most effective and safest treatment to prevent recurrence. We report a case of a 1-month-old male infant with a vallecular cyst synchronous with gastroesophageal reflux, and failure to thrive. He was referred to our hospital because of hoarseness, inspiratory stridor, feeding-cyanosis, chest retraction and failure to thrive. Diagnostic workup revealed a cyst at the tongue base, suggesting a vallecular cyst. The cyst was removed by laryngomicrosurgery with CO2 laser. After the surgery, the symptoms improved and the body weight increased steadily. We report a successfully treated case of neonatal vallecular cyst with symptoms of upper respiratory obstruction, gastroesophageal reflux, and failure to thrive.

천음을 주소로 발현된 경부 신경모세포종 1례

김미정(Mee Jeong Kim),장미숙(Mi Sook Jang),안영민(Young Min Ahn),이시경(Si Kyoung Lee),성명훈(Myoung Hoon Sung) 대한소아알레르기호흡기학회 1999 소아알레르기 및 호흡기학회지 Vol.9 No.3

Primary cervical neuroblastoma is very rare disease in neonates and should be distinguished with other diseases, which cause stridor in neonate, including laryngomalacia, vocal cord paralysis, laryngeal web, laryngotracheal esophageal cleft, laryngotracheal stenosis, etc. It is characterized by cough, stridor, dysphagia, neck mass, Horner syndrome and heterochromia iridis. Survival rate is high even in the advanced cases, in which the residual mass is remained after partial resection, without further therapy. A 1-day-old girl showed severe dyspnea with inspiratory stridor after birth. At first, she was misdiagnosed as a case of laryngomalacia, but later proved to have stage I primary neuroblastoma by plain X-ray film of lateral view of the neck, flexible nasolaryngoscopy, and computerized tomography. She has been well without relapse after total resection for 11/2 year. We report this case as the first case in Korea.

기관 삽관 발거 실패 또는 심한 천명을 호소하는 호흡 곤란 소아 환자에 대한 상기도 평가 프로토콜

박준오,박우리,조정규,조중범,김진경,정한신 대한이비인후과학회 2016 대한이비인후과학회지 두경부외과학 Vol.59 No.1

Background and Objectives Adequate evaluation of the upper airway is critical in the management of pediatric patients with stridor or extubation failure. For this purpose, we designed an evaluation protocol of the upper airway for these patients, in collaboration with Dept. of Pediatrics, Intensive care team and Anesthesiology. Here we present the clinical results of our evaluation protocol and provide information about the etiology and management of the upper airway problems. Subjects and Method Clinical data of 380 pediatric patients (M:F=231:149) having airway evaluation for their problems (stridor or extubation failure) were retrospectively analyzed. Among them, patients of age less than 3 months ranked first (30.0%). Comorbidities of pulmonary diseases (30.8%) and cardiovascular diseases (29.5%) were found. The pre and post-evaluation diagnosis, management and prognosis were evaluated and the usefulness of an airway evaluation protocol was discussed. Results Frequent pre-evaluation diagnoses were subglottic stenosis (55.2%), laryngomalacia (12.6%) and tracheal stenosis (9.2%) and these were changed to subglottic stenosis (44.5%), laryngomalacia (9.7%), tracheal stenosis (6.6%) and no abnormality (14.5%). Particularly, 50% of pre-diagnosis laryngomalacia, 25% of subglottic stenosis and 37% of tracheal stenosis were corrected to other causes by airway evaluation. The procedures were exam only (41.6%), endoscopic dilatation (20.8%) and tracheostomy (17.9%). In 190 out of 380 (50.0%), extubation was successful, but 151 patients (39.7%) had tracheostomy tube. Conclusion Adequate evaluation of the upper airway in pediatric patients with stridor or extubation failure can facilitate the diagnosis and management of their problems. Korean J Otorhinolaryngol-Head Neck Surg 2016;59(1):35-40