Tracheal tube cuff pressure monitoring: Assessing current practice in critically ill patients at chris hani baragwanath academic hospital

Background. Intubated patients with a high tracheal tube cuff pressure (CP) are at risk of developing tracheal or subglottic stenosis. Recently an increasing number of patients have presented to our hospital with these complications.  Objectives. To determine the frequency of tracheal tube CP measurements and the range of CP and to explore nursing knowledge regarding CP monitoring. Methods. Frequency of CP measurement was assessed using a prospective chart review, followed by an interventionalcomponent. In the final stage nurses completed a self-administered questionnaire. Results. A total of 304 charts from 61 patients were reviewed. Patientsâ€â„¢ ages ranged from 1 to 71 years, with a male preponderance (1.5:1). The majority of charts (87%) did not reflect a documented CP measurement and only 12 charts showed at least one measurement per shift. Only 17% of recorded CPs were within the recommended range; 59% were too low. The questionnaire was completed by only 51% of the 75 respondents. Nursing experience ranged from 3 to 35 years and 92% of respondents were trained in critical care. Knowledge of current critical care CP monitoring guidelines was reported by 62% of the respondents (n=23/37). Only 53% (20/38) reported routinely measuring CP. Almost all respondents (94%) knew of at least one complication of abnormal CP. Conclusion. Having a basic knowledge of CP measurement, having awareness of the complications of abnormal CP and the availability of national best practice guidelines did not translate into appropriate ICU practice. Research into effective implementation strategies to achieve best practice is needed

Pharmacological effects of gemfibrozil on some isolated smooth muscle preparations of experimental animals

Background: Gemfibrozil is a member of fibrates (gemfibrozil, fenofibrate, ceprofibrate, and benzafibrate) which is employed for treatment of dyslipidemia particularly hypertriglyceridemiae through its action on peroxisome proliflator activated receptors (PPAR-). Objective: The aim of this work was to study the site of action and pharmacololgical effects of different doses of gemfibrozil on some isolated smooth muscles preparations of experimental animals. Materials and Methods: The experiments were conducted on isolated jejunum of rabbits, isolated spiral tracheal and urinary bladder strips of guinea pigs. Results: I- On isolated rabbit jejunum, gemfibrozil produced a dose-dependent reduction on the amplitude of jejunal contractions. The inhibitory effect of gemfibrozil was not abolished after complete blockade of alpha and beta adrenergic receptors, while it was completely abolished after inhibition of nitric oxide synthase by N-methyl L-arginine. On the other hand the stimulatory effects of nicotine small dose, acetylcholine, calcium gluconate, histamine and serotonin were not abolished after administration of gemfibrozil. II- On isolated tracheal spiral strips of ginea pigs, gemfibrozil produced a dose- dependent relaxation on the basal tone and a dose-dependent reduction on the amplitude of acetylcholine-induced tracheal contractions of the tracheal strips. The inhibitory effect of gemfibrozil was completely abolished after inhibition of nitric oxide synthase by N-methyl L-arginine. Gemfibrozil completely abolished also serotonin-induced contraction, while it has no effect on histamine or calcium-induced tracheal contractions. III- On isolated urinary bladder strips of guinea pigs, gemfibrozil produced a dose-dependent reduction on the amplitude of urinary bladder contractions. The inhibitory effect of gemfibrozil was not abolished after complete blockade of beta adrenergic receptors, while it was completely abolished after inhibition of nitric oxide synthase by N-methyl L-arginine. On the other hand the stimulatory effects of acetylcholine and serotonin were not abolished after administration of gemfibrozil. Conclusion: Gemfibrozil (antidyslipidemic, PPAR- agonist) reduced jejunal and urinary bladder contractions and has a relaxant effect on tracheal basal tone. So it has a beneficial effect in obstructive airway diseases and cases of urgency and frequency of micturation and urinary incontinence. However, it may be used cauciously in cases of ,GIT disturbances as constipation and prostatic hypertrophy

Les corps etrangers tracheobronchiques a propos de 107 cas

Introduction : L'inhalation du corps etranger (Ce) est un accident domestique grave survenant surtout chez le petit enfant et peut occasionner une detresse respiratoire aigue necessitant une prise en charge therapeutique urgente. Le but de notre travail est d'analyser les aspects cliniques et therapeutique des Ce tracheo-bronchiques vus en urgence. Patients et methode ; etude retrospective regroupant 107 enfants ages de moins de 15 ans; presentant une symptomatologie respiratoire aigue (= 3 jours); admis au service d'OrL; CHU Farhat Hached Sousse; pour bronchoscopie rigide devant la suspicion d'inhalation d'un Ce; entre janvier 2000 et Decembre 2011. Resultats : nous avons retrouve en moyenne 9 cas de Ce par an. L'age moyen de nos patients etait de 30 mois avec des extremes allant de 6 mois a 15 ans. Parmi ces enfants; 70 avaient un age compris entre 1 et 3 ans. Le syndrome de penetration a ete retrouve dans 77;6 des cas. Le symptome le plus frequent etait une toux dans 74;8 des cas. Deux patients ont presente un etat d'asphyxie aigue. La diminution du murmure vesiculaire a ete retrouvee dans 39;2 des cas. L'examen clinique et la radiographie pulmonaire etaient normaux dans 24;3 des cas. Un Ce radio-opaque a ete retrouve dans 5 cas. L'emphyseme obstructif unilateral a ete retrouve dans 39;2 des cas. Les grains de tournesol etaient les plus frequents; notes dans 26;2 des cas; suivis par les cacahuetes dans 15 des cas. Le Ce etait bronchique dans la majorite des cas avec une predominance du cote droit; 62;6 contre 33;7 du cote gauche. La bronchoscopie rigide a ete pratiquee pour l'extraction des Ce chez tous nos patients. Il n'y avait pas de deces dans notre serie. Conclusion : L'inhalation d'un Ce chez l'enfant est une pathologie grave qui engage le pronostic vital. Il faut l'evoquer devant meme des anomalies non specifiques et une endoscopie bronchique doit etre faite au moindre doute

The Pattern of Foreign Body Impactions in the Tracheobronchial Tree in University of Port Harcourt Teaching Hospital

Background: Foreign body aspiration in the tracheobronchial tree usually presents as emergency. The diagnosis is often delayed. Aim: To determine the pattern of foreign body aspiration in the tracheobronchial tree in the University of Port Harcourt Teaching Hospital (UPTH) and to highlight the factors responsible for the morbidity and the unusually high mortality associated with this accident especially in the paediatric age group. Methods: This was a retrospective study of patients from the ENT Surgery department of UPTH over a ten-year period from January 1995 to December 2004. The Clinics record of attendance; augmented by ward and theatre records formed the material resource for this study. Extracted data was analysed using descriptive statistics. Results: Twenty-eight patients presented with foreign body aspirated in the tracheobronchial tree. Only 11 case notes were retrieved. There were 5 males (45.5) and 6 females (54.5) with a M: F ratio of 1:1.3. The age range was 1 to 45 years with a median age of 6 years. Children below 10 years made up the bulk (63.3). Groundnut was the commonest foreign body inhaled (45.5) while the right main bronchus was the site of lodgment in 9 patients (81.8). The outcome of treatment by the specialists showed a success rate of 63.3and mortality of 36.4. Conclusion: Foreign body in the tracheobronchial tree could be managed with better prognosis in the pediatric age group if the clinicians of first contact had a high index of suspicion and referred cases promptly