ABSTRACT
Context and objective In intensive care units (ICU), clinicians have little information to identify COVID-19 patients at high risk of poor prognosis requiring intubation. Considering the clinical and biological parameters of the patients during their admission to ICU, we determined the incidence of a pejorative evolution requiring intubation, and secondarily we searched among the starting parameters, which were predictors of the intubation during follow-up Methods We conducted a monocentric retrospective cohort study of adult patients admitted for moderate, severe or critical COVID-19/WHO clinical classification, during the first two waves of the pandemic in Kinshasa/DR Congo. Our primary end point was the incidence of intubation. Potential predictors of intubation were determined by the Cox regression analysis. The relative risk of death was assessed according to treatment with mechanical ventilation. (intubation) Results We included 219 patients (average age of 56.8 ±15.2 years; 75 % men), respectively 37 % in the 1st and 63 % in the 2nd wave of the pandemic.Cumulative incidence of intubation was 24% (1stwave: 26% vs 2nd wave: 24%). One-third of intubations were performed on the first 3 days versus two-thirds beyond the third day. The Cox's regression model showed that among data from the 1st day of ICU admission, those predicting intubation were: age (Hazard ratio: 1.025, CI 95%: 1.005-1.044), obesity (HR: 4.808; CI 95%: 2.660-8.696), corticosteroid therapy (HR: 0.313, CI 95%: 0.102-0.965), ROX index < 4.88 (HR: 2.024, CI 95 %: 1.003-4.080) and black race (HR: 0.502, CI 95%: 0.272-0.928). In total, 54 deaths (25 % of patients) were recorded with a higher relative risk (18.8) in intubated patients. Conclusion A quarter of COVID-19 patients admitted to ICU could worsen and be intubated. The majority of intubations were performed after the third day of admission and mortality was high. The predictors of intubation that have been identified can help anticipate management by being proactive
Subject(s)
Humans , COVID-19 , Incidence , Intensive Care Units , IntubationSubject(s)
Hypoxia , Intubation , Postoperative Complications , Tracheostomy , Vocal Cord Paralysis , Vocal CordsABSTRACT
Background:A prospective study was carried out to determine the incidence of sore throat after endotracheal intubation and the associated causative factors.Methods: Two hundred patients aged 18-77 years who had surgery over sixteen months were studied. Sizes 7mm - 8.0mm internal diameter (I.D) portex endotracheal tubes with cuff were used for females while sizes 8.5mm - 9.0mm I.D were used for males. A standardized form was used to collect patients' details; types of surgery; technique of airway maintenance and number of attempts at intubation. The use of nasogastric tubes; throat pack; duration of intubation and status of the anaesthetists were also noted. The presence of sore throat and other throat complications were determined within 24 - 36 hours after surgery.Results: One hundred twenty six (63) patients experienced throat complications. The incidence of sore throat was similar in both males and females. There was no statistically significant difference P=1.0000; odd ratio = 1.035; 95CI: 0.5064 - 2.115. There was no statistical difference between the group whose tubes were lubricated and the one without tube lubrication. P = 0.5296; odds ratio - 1.255; 95CI: 0.6702 - 2.351. There was statistically significant difference between the incidence of throat complications in throat related surgery and non- throat related surgery. P=0.0001.; odds ratio-9.771; 95CI: 3.065-31.148. Multiple attempts at intubation did not contribute to the development of sore throat. Duration of intubation greater than 60 minutes contributed to a higher incidence of throat complications and it was considered statistically significant.Conclusion:Routine endotracheal intubation can result in trauma and pathological changes; which could lead to postoperative throat symptoms. There is need to further evaluate if the use of smaller sized endotracheal tubes could reduce the incidence of throat complications
Subject(s)
Intubation , Pharyngitis , PharynxABSTRACT
Background. There is an apparent high incidence of tracheal stenosis in the Bloemfontein area. The aim of this study was to determine intensive care unit (ICU) staff knowledge of the use and care of endotracheal and tracheostomy tube cuffs. Methods. One hundred and twelve qualified nurses; working in 11 different ICUs; were asked to complete an anonymous questionnaire regarding endotracheal / tracheostomy tube cuffs. Results. The results highlight the following three areas of concern: (i) there was an overall misconception in 38of the respondents that the function of the cuff was to secure the tube in position in the trachea to prevent selfextubation; (ii) accurate regulation of cuff pressure was not routine practice in any of the ICUs; and (iii) only half of the respondents felt their training regarding cuff care management was sufficient. Conclusions. ICU staff had misconceptions regarding the function and care of endotracheal / tracheostomy tube cuffs. The concept of a higher cuff pressure for better stabilisation of the tube is probably an important factor that could have caused the increase in tracheal stenosis in the Bloemfontein area. Critical care nursing needs to emphasise the use of current techniques; discourage routine cuff deflation; and encourage collaboration with ICU physicians on standards of care. A protocol that could be used in the ICUs regarding the use and care of an endotracheal / tracheostomy tube cuff is proposed