| 제목 |
Laryngotracheal Separation for Intractable Aspiration in Hypoxic Brain Damage : A Case Report |
| 소속 |
Gachon university Gil Medical Center, Department of Rehabilitation Medicine1 |
| 저자 |
Gyu Seok Oh1*, Je Hyun Yoo1, Oh Kyung Lim1, Ki Deok Park1, Ju Kang Lee1† |
Laryngotracheal separation(LTS) is one of the treatment options for intractable aspiration. Here we report a case of LTS which prevents intractable aspiration successfully.
A 60-year-old man with severe brain damage caused by hydrogen sulfide(H2S) intoxication admitted to our department for comprehensive rehabilitation. The level of consciousness was vegetative(JFK Coma Recovery Scale ≦ 6). He had tracheostomy and percutaneous endoscopic gastrostomy(PEG) tubes for tracheal suction and feeding. He needed frequent tracheal suction because of large amount of secretion from saliva aspiration. To make matters worse, he suffered from frequent regurgitation and vomiting followed by tracheal aspiration. His body weight had reduced from 63 kg to 56 kg for two months. We considered this condition life-threatening, because of intractable aspiration of regurgitate followed by recurrent pneumonia and malnutrition. Verbal communication was not expected to recover in such a severe neurologic condition. He underwent LTS to prevent intractable aspiration.
After the LTS operation, Videofluoroscopic swallowing study showed that the aspiration was completely prevented. Tracheal secretion was reduced, and suction was no longer needed. Aspiration pneumonia did not develop for two months after the surgery. Gastro-esophageal reflux also reduced, and PEG feeding amount was increased. The patient's nutritional status also improved significantly and the body weight had increased from 56kg to 61.5kg for two months.
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