[Endoscopic concept and fiberoptic technic in monitoring long-term intubation]

An endoscopic procedure has been developed to enable constant monitoring of the mucous membrane of the larynx and trachea. The examination can be divided into four stages. 1. Transnasal inspection. 2. Transtubal inspection. 3. Partial, endoscopically controlled extubation. 4. Endoscopically controlled re-intubation. The advantage of this newly developed technique using a flexible fiberoptic endoscope is that complete extubation is not necessary in patients who are under artificial respiration and subject to long-term intubation. In long-term intubation without artificial respiration care must be taken to provide the best possible means of sedation. Endoscopic monitoring of this kind guarantees the following: 1. Early determination of intubation damage to larynx and trachea. 2. Exact control of the position of the tube, rendering X-ray identification unnecessary. 3. Examination of the bronchial system. 4. A final check on the above-mentioned critical points during complete extubation after long-term intubation. Regular examination by this atraumatic method provides an early diagnosis of any mucosal damage caused by tubes. The recommendation that a secondary tracheotomy should be carried out after 48 h, and at the latest after a week, can no longer be supported, provided the necessary modern anaesthetic equipment and management is available.