ULTRASOUND ASSESSMENT OF SUBGLOTTIC LARYNGEAL DIAMETER FOR ESTIMATION OF APPROPRIATE ENDOTRACHEAL TUBE SIZE IN PAEDIATIRIC PATIENTS – A PROSPECTIVE RANDOMIZED STUDY

Background and Aim: The appropriate size of endotracheal tube for children are traditionally selected based on their age, height and or weight by using formulas. The ultrasound guided measurement of subglottic laryngeal diameter can be used to appropriate selection of endotracheal tube. The endotracheal tube is selected based on the nearest external diameter corresponding to the measured subglottic region. The aim of the study is to compare the appropriateness of uncuffed endotracheal tube selection based on age based formula with that of ultrasound assessment of subglottic diameter in children. A prospective randomised parallel group study involving 60 children Materials and Methods: of age 2-6years undergoing elective surgeries under general anaesthesia were selected for study. They are divided into two groups as Group A – Endotracheal tube selection based on ultrasound assessment of diameter of subglottic region and Group B – Endotracheal tube selection based on age based formula which is (Age /3)+ 3.5mm ID. The noted parameters were internal diameter (ID) and external diameter (OD) of the predicted ETT by the two methods, ID and OD of the appropriate size ETT used and the ultrasound assessed subglottic diameter. The incidence of ETT size predicted by ultrasound assessment of Results: subglottic diameter was 83.33% while with age based formula it is 53.34%. The linear regression equation model in Group A showed R²= 0.694, P = 0.001 which was statistically signicant. While in Group B it was R²=0.258., p=0.001. There Conclusion: was a strong correlation between the outer diameter of clinically used uncuffed ETT and the subglottic diameter assessed with ultrasound examination in paediatric patients. Hence USG assessment of the subglottic diameter is a better tool in predicting the appropriate uncuffed ETT in paediatric patients undergoing elective surgeries under general anaesthesia than the age- based formula

Right visual double lumen endotracheal tube versus common right double lumen endotracheal tube lung isolation technique: A randomized controlled study / 中国胸心血管外科临床杂志

@#Objective    To compare the clinical efficacy between right visual double lumen tube (VDLT) intubation and right common double lumen tube (DLT) intubation in lung isolation technique. Methods    A total of 57 patients undergoing thoracoscopic surgery with right DLT lung isolation technique in the First People's Hospital of Chenzhou City and West China Hospital from June 2020 to June 2021 were randomly divided into two groups: a DLT group (n=29, 16 males and 13 females, with a mean age of 54.3±13.2 years) and a VDLT group (n=28, 18 males and 10 females, with a mean age of 55.1±13.7 years) at 1 : 1 with random number table generated by the computer. The clinical data of the two groups were compared. Results    Compared with the DLT group, the catheter positioning time in the VDLT group was statistically shorter (74.9±47.5 s vs. 151.6±88.9 s, P<0.001), the right upper lung occlusion rate (21.4% vs. 51.7%) and the intraoperative re-adjustment catheterization rate (14.3% vs. 48.3%) were lower (P<0.05). The quality of lung collapses immediately after thoracotomy (67.9% vs. 24.1%) and 20 minutes after thoracotomy (100.0% vs. 75.9%) were improved (P<0.05). There was no significant difference in the rate of fiberoptic bronchoscope assistance for positioning, or the incidence of pharynx pain and hoarseness between the two groups (P>0.05). Conclusion    Compared  with common DLT, VDLT is more efficient, accurate and intuitive in the location of right bronchial intubation.

A COMPARATIVE STUDY TO EVALUATE HEMODYNAMIC CHANGES BETWEEN ENDOTRACHEAL INTUBATION AND PROSEAL LARYNGEAL MASK AIRWAY INSERTION IN PATIENTS UNDERGOING GENERAL ANAESTHESIA

Background: Hemodynamic stability is an important aspect to the anesthesiologist for patients. Laryngoscopy and endotracheal intubation can cause striking changes in Hemodynamics as result of intense stimulation of sympathetic nervous system. ProSeal LMA (PLMA)minimizes this response without compromising the airway. The aim of this study was to compare PLMA and Endotracheal tube with respect to intra-operative hemodynamic responses in patients undergoing general anaesthesia. Material and Methods: This prospective observational study was conducted on 30 patients of either sex, age group of 18-60 years, ASA (I or II), Mallam Pati (I or II) posted for elective surgery under general anaesthesia. They were randomly divided into two group 15 each. For group A, airway was secured with laryngoscopy and intubation with appropriate size endotracheal tube and for group B, appropriate size PLMA was inserted to secure airway. The hemodynamic responses like Heart rate and Blood pressure were recorded at base line, at insertion, after 1st min, 3rd min, 5th min and after extubation. Mean increase was statistically more after endotra Results: cheal intubation than PLMA insertion. The elevation in these hemodynamic parameters significantly persisted for a longer period of time in the ETT group, where it returned to the baseline value by 5 minutes as compared to the PLMA group where it returned by 3 minutes. The hemodynamic res Conclusion: ponse produced when PLMA was used for securing airway was less than the laryngoscopy and endotracheal intubation. Thus, PLMA proved to be a suitable alternative to endotracheal tube for airway management with stable hemodynamic.

Bronchial Blocker and Double?Lumen Endotracheal Tube Combination to Facilitate Lung Isolation during Esophagectomy

Lung isolation is an essential anesthetic technique utilized in thoracic surgeries. We present a patient undergoing esophagectomy that developed an iatrogenic injury to the left mainstem bronchus that damaged the bronchial cuff of a left?sided double?lumen endotracheal tube (DLETT). A bronchial blocker (BB) was placed in the tracheal lumen of the DLETT as a rescue method to facilitate continued lung isolation. This unusual combination of a DLETT and a BB proved useful once the bronchial cuff was compromised and may serve as a viable solution to maintain lung isolation in similar circumstances

The changes of endotracheal tube intracuff pressures after ear and head and neck surgery-related positions: a prospective observational study / Alterações na pressão intracuff do tubo endotraqueal após posições cirúrgicas nas cirurgias de orelha e cabeça e pescoço: estudo observacional prospectivo

Abstract Introduction The cuff of an endotracheal tube seals the airway to facilitate positive-pressure ventilation and reduce subglottic secretion aspiration. However, an increase or decrease in endotracheal tube intracuff pressure can lead to many morbidities. Objective The main purpose of this study is to investigate the effect of different head and neck positions on endotracheal tube intracuff pressure during ear and head and neck surgeries. Methods A total of 90 patients undergoing elective right ear (Group 1: n = 30), left ear (Group 2: n = 30) or head and neck (Group 3: n = 30) surgery were involved in the study. A standardized general anesthetic was given and cuffed endotracheal tubes by the assistance of video laryngoscope were placed in all patients. The pilot balloon of each endotracheal tube was connected to the pressure transducer and standard invasive pressure monitoring was set to measure intracuff pressure values continuously. The first intracuff pressure value was adjusted to 18.4 mmHg (25 cm H2O) at supine and neutral neck position. The patients then were given appropriate head and neck positions before related-surgery started. These positions were left rotation, right rotation and extension by under-shoulder pillow with left/right rotation for Groups 1, 2 and 3, respectively. The intracuff pressures were measured and noted after each position, at 15th, 30th, 60th, 90th minutes and before the extubation. If intracuff pressure deviated from the targeted value of 20-30 cm H2O at anytime, it was set to 25 cm H2O again. Results The intracuff pressure values were increased from 25 to 26.73 (25-28.61) cm H2O after left neck rotation (p = 0.009) and from 25 to 27.20 (25.52-28.67) cm H2O after right neck rotation (p = 0.012) in Groups 1 and 2, respectively. In Group 3, intracuff pressure values at the neutral position, after extension by under-shoulder pillow and left or right rotation were 25, 29.41 (27.02-36.94) and 34.55 (28.43-37.31) cm H2O, respectively. There were significant differences between the neutral position and extension by under-shoulder pillow (p < 0.001), and also between neutral position and rotation after extension (p < 0.001). However, there was no statistically significant increase of intracuff pressure between extension by under-shoulder pillow and neck rotation after extension positions (p = 0.033). Conclusion Accessing the continuous intracuff pressure value measurements before and during ear and head and neck surgeries is beneficial to avoid possible adverse effects/complications of surgical position-related pressure changes.

Resumo Introdução O manguito ou cuff de um tubo endotraqueal sela as vias aéreas para facilitar a ventilação com pressão positiva e reduzir a aspiração de secreção subglótica. Entretanto, o aumento ou diminuição da pressão intracuff do tubo endotraqueal pode levar a muitas morbidades. Objetivo Investigar o efeito de diferentes posições da cabeça e pescoço da pressão intracuff do tubo endotraqueal durante cirurgias de orelha e cabeça e pescoço. Método Participaram do estudo 90 pacientes submetidos à cirurgia eletiva na orelha direita (Grupo 1: n = 30), orelha esquerda (Grupo 2: n = 30) ou cabeça e pescoço (Grupo 3: n = 30). Um anestésico geral padronizado foi administrado e o tubo endotraqueal com cuff foi colocado em todos os pacientes através de videolaringoscopia. O balão-piloto de cada tubo endotraqueal foi conectado ao transdutor de pressão e o monitoramento-padrão da pressão invasiva foi estabelecido para medir continuamente os valores da pressão intracuff. O primeiro valor de pressão intracuff foi ajustado para 18,4 mmHg (25 cm H2O) na posição supina e neutra do pescoço. Em seguida, os pacientes foram colocados nas posições cirúrgicas apropriadas de cabeça e pescoço antes do início da cirurgia. Essas posições foram rotação esquerda, rotação direita e extensão por rotação esquerda/direita com almofada sob o ombro, para os grupos 1, 2 e 3, respectivamente. As pressões intracuff s foram medidas e anotadas após cada posição, aos 15, 30, 60, 90 minutos e antes da extubação. Se a pressão intracuff saísse do valor desejado de 20 ~ 30 cm H2O a qualquer momento, ela era definida em 25 cm H2O novamente. Resultados Os valores de pressão intracuff aumentaram de 25 para 26,73 (25-28,61) cm H2O após a rotação do pescoço para a esquerda (p = 0,009) e de 25 a 27,20 (25,52-28,67) cm H2O após rotação do pescoço para a direita (p = 0,012) nos grupos 1 e 2, respectivamente. No Grupo 3, os valores da pressão intracuff na posição neutra, após extensão com almofada sob o ombro e rotação para a esquerda ou direita, foram 25, 29,41 (27,02-36,94) e 34,55 (28,43-37,31) cm H2O, respectivamente. Houve diferenças significativas entre a posição neutra e a extensão com almofada sob o ombro (p < 0,001) e também entre a posição neutra e a rotação após a extensão (p < 0,001). Entretanto, não houve aumento estatisticamente significante da pressão intracuff entre extensão com almofada sob o ombro e rotação do pescoço após as posições de extensão (p = 0,033). Conclusão As medições contínuas do valor da pressão intracuff antes e durante cirurgias de orelha e cabeça e pescoço são benéficas para evitar possíveis efeitos adversos/complicações de alterações de pressão relacionadas à posição cirúrgica.

Bacterial flora of biofilm in the endotracheal tube of mechanically ventilated neonates and its relationship with ventilator-associated pneumonia / 中华传染病杂志

Objective:To explore the relationship between endotracheal tube-bacterial biofilm (ETT-BF) in mechanically ventilated neonates and ventilator-associated pneumonia (VAP).Methods:A total of 30 mechanically ventilated neonates whose mechanical ventilation time were ≥48 h in the Department of Neonatology in The Second Affiliated Hospital of Wenzhou Medical University from January 2019 to January 2020 were included.According to the indwelling time of endotracheal tube, all cases were divided into three groups including group A(two to six days), group B(seven to 14 days) and group C (over 14 days). The morphological results of ETT-BF were scanned by scanning electron microscope (SEM). The incidence of VAP, the positive rates of strains isolated from endotracheal tube surface and lower respiratory tract secretion, the detection of strains and drug resistance were analyzed. Chi-squared test were used for statistical analysis.Results:The results of SEM showed that sheet matrix could be observed on the surface of the inner cavity of endotracheal tube in three days of tracheal catheter retention, and cocci adhered to it in four days. With prolonged indwelling time of endotracheal tube, the structure of bacterial biofilm (BF) had improved.The positive rate of strains isolated from the secretion of lower respiratory tract in 30 neonates was 23.3%(7/30) and all of them were Gram-negative bacteria. There was no patient developed VAP in group A, while there were two patients with VAP in group B, and five patients with VAP in group C. The incidences of VAP in the three groups were statistically significant ( χ2=10.82, P=0.004). There was no significant difference in the positive rate of strains isolated from the surface of endotracheal tube under different indwelling time in 30 cases ( χ2=1.03, P=0.598). Among of 13 neonates in group A, there were seven strains isolated from ETT-BF, mainly Gram-positive bacteria which turned out to be mainly Gram-negative bacteria with the prolongation of endotracheal tube indwelling time. Of the seven VAP cases, strains isolated from the lower respiratory tract secretion were consistent with the strains isolated from the surface of the corresponding endotracheal tube in five cases, which were Serratia liquefaciens, Klebsiella acidogenes, Serratia marcescens, Flavobacterium meningosepticum and Stenotrophomonas maltophilia, and the drug resistance was consistent. Conclusions:The colonization bacteria of early ETT-BF may come from the upper respiratory tract, with less migration which rarely causes VAP. With the prolongation of endotracheal tube indwelling time, the incidence of VAP in neonates increases. The same pathogen can be found in the ETT-BF and lower respiratory tract secretion. The source of pathogen needs further study.

An Observational Study to Evaluate the Haemodynamic Changes between Endotracheal Intubation and Laryngeal Mask Airway Insertion

Introduction: Neuromuscular blockers like Rocuroniumbromide can impair respiratory functions during generalanaesthesia. Therefore aim of present study was to find outthe biochemical changes of Rocuronium bromide and othermuscle relaxant in cardiac surgery.Material and Methods: Present study was carried out onsixty (60) patients of different age groups from both sexesscheduled for various cardiac surgical procedures at L.P.S.Institute of Cardiology, GSVM medical college Kanpurduring the period of August 1998 to August 1999. Patientswere classified in 3 equal groups. Muscle relaxants were givenaccording to the group and biochemical parameters like PCo2,PO2, pH etc. were recorded carefully at the interval of two,five and ten minutes.Results: No statistically significant changes were observed inPCo2, pH, Na+, K+ at 2 minutes, 5 minutes and 10 minutes afterthe administration of all three drugs (P >0.05) compared withcontrol values. Statistically Significant changes in PO2 andO2 saturation was observed at 2 minutes, 5 minutes and 10minutes after the administration of Pancuronium (P <0.05).Conclusion: Rocuronium bromide is safer in cardiac surgeryas compared to other muscle relaxants.

Comparison of three different techniques of endotracheal tube cuff inflation: just seal, stethoscope guided and pressure volume loop: a prospective randomized study

Background: Cuffed endotracheal tubes not only ensure a proper seal during positive pressure ventilation, but at the same time also prevent aspiration of gastric secretions. The aim of this prospective, randomized study was to compare three methods of ETT cuff inflation-- palpation of the leak in suprasternal notch (Just seal), a stethoscope guided method of tracheal tube cuff inflation and PVL guided cuff inflation.Methods: After approval by institutional ethical committee, 192 patients of either sex in age group of 18-50 years belonging to ASA physical status I or II were enrolled. Each patient was randomly allocated into one of three groups: one group received standard 'just seal' method of tracheal cuff inflation (JS), the second group, the stethoscope-guided method (SG) and in third group cuff was inflated using Pressure Volume Loop (PVL). Volume of air introduced into the cuff and pressure within the cuff was recorded.Results: A total of 192 patients were recruited to the study. The median (IQR [range]) tracheal cuff pressure was 12 (10-22 [6-28]) cm H2O, 16 (12-24[6-38]) and 14 (10-22[8-32]) cmH2O in JS, SG and PVL group respectively. Cuff pressures within the recommended range of 20-30 cm H2O fell in 25% of the patients in both JS and SG group and 31% patients in PVL group. The mean volumes of air introduced in the cuff and the resultant mean cuff pressure in all groups was found to be statistically insignificant (p= 0.4, 0.18 respectively). Tidal volume discrepancy was more and 75% of cuff pressures were less than the recommended range in JS than the other two groups.Conclusions: Real time PVL displayed on most modern anaesthesia machine is a good alternative to check for proper ETT cuff inflation, avoid high cuff pressure and monitor air leak.

Endotracheal tube damage during surgically assisted rapid palatal expansion surgery; a case report

Endotracheal tube damage is a well-known complication of maxillary surgery. We report a case of failure to ventilate due to superficial damage to the tubing between the cuff and pilot balloon in the nasal portion of a north facing Ring, Adair and Elwyn pre-formed endotracheal tube during Surgically Assisted Rapid Palatal Expansion surgery. The endotracheal tube was replaced uneventfully and surgery completed successfully. On reflection, we feel that that the vulnerable position of the cuff-pilot tubing significantly contributed to this critical incident and suggest that increased recognition of this is vital for the prevention of such cases in the future.

Effect of laryngeal mask and endotracheal tube ventilation on gastric insufflation during general anesthesia with ultrasound evaluation / 上海交通大学学报（医学版）

Objective • To observe the correlation between streamlined liner of pharynx airway (SLIPA) and gastric insufflation. Methods • Seventy patients who underwent elective general anesthesia in Jiading District Central Hospital Affiliated to Shanghai University of Medicine & Health Sciences from September 2017 to May 2018 were included. They were randomly divided into SLIPA group (S group, n=35) and endotracheal tube group (T group, n=35). The gastric antrum ultrasonography was performed at four time points before induction, immediately after intubation (insertion of laryngeal mask), before extubation (laryngeal mask), and immediately after extubation (laryngeal mask), to measure the cross sectional area (CSA) of gastric insufflation. Gastric intake was assessed by ultrasonic measurement of CSA and "comet tail sign" in ultrasound imaging. Pulse oxygen saturation (SpO2), end-tidal pressure of carbon dioxide (PETCO2), peak inspiratory pressure (PIP) and CSA were recorded and compared at the corresponding time points. Results • There was no significant difference in gastric insufflation rate between the two groups during anesthesia (P=0.894). There was no significant difference in SpO2 at each time point between the two groups (all P>0.05). At the end of surgery, PETCO2 in group S was significantly higher than that in group T (P=0.000). Conclusion • Compared with endotracheal tube, the SLIPA does not increase gastric insufflation during general anesthesia.

An Evaluation of the Efficacy of Ketamine Gargle and Benzydamine Hydrochloride Gargle for Attenuating Post Operative Sore Throat: A Prospective Randomized, Placebo Controlled Single- Blind Study

Post-operative sorethroat (POST) is a well-recognized complication in patients with endotracheal intubation for general anaesthesia. Many pharmacological measures for attenuating POST are being used during anaesthesia. In our study we compared the effectiveness of ketamine and benzydamine hydrochloride versus a placebo as preoperative gargle in decresing the incidence and severity of POST in patients undergoing endotracheal intubation for general anaesthesia. Methods: A total of 90 patients aged between 18-60 years of ASA I-II of either sex were randomly assigned into three groups of 30 patients each . Group 1(C) received distilled water,group2(BH) received 15 ml of benzydamine hcl(0.15%) and group 3(K) received preservative free ketamine 40 mg as preoperative gargle 10 min before induction. The incid- ence of POST was recorded at 2,4 and 24 hr post operatively. Results: The three groups were comparable in term of demographic characteristics. The incidence and severity of POST is much more in group 1(C) i.e control group (30%) after 24 hr compared to group 2 (BH) 0% and group 3(K)3.5%. There was no significant difference of POST in group 2(BH) and group 3(K). Conclusion: From our study it can be concluded that both benzydamine and ketamine gargle significantly reduces the incidence and severity of POST compared to ditilled water gargle up to 24 hr in the patients undergoing general anaesthesia with endotracheal intubation. Both the Benzydamine and ketamine gargles are safe, simple and equally effective in reducing POST.

A Comparative Study Between I-Gel And Endotracheal Tube For Volume Controlled Ventilation In Patients Undergoing Laparoscopic Cholecystectomy

INTRODUCTION The endotrachealtube is the gold standard for controlling the airway. Laparoscopic procedures mark the new era. However, with various advantages they have their complications. Endotracheal intubation evokes significant hemodynamic changes. We have used I-gel, to find a suitable alternative. The study was conducted to compare haemodynamic changes, efficacy of ventilation, and complications laparoscopic cholecystectomy. MATERIALS AND METHODS: After ethical approval the study was completed with 100 ASA PS I or II patients undergoing elective laparoscopic cholecystectomy. They were randomly allocated into either: Group-I (I-gel) or Group-E (ETT). Ease of insertion of device, haemodynamic and ventilatory parameters and perioperative complications were recorded. RESULTS: Ease of insertion was difficult in Group E compared to Group I. HR variation and MAP variation was highly significant between the groups. Leak Pressures were high throughout in GroupE. Mean Peak Airway Pressure was though higher in I-gel but was less than leak pressure and was clinically acceptable. CONCLUSION: I-gel may be an alternative to endotracheal intubation for laparoscopic cholecystectomy under general anaesthesia for its design, less haemodynamic perturbations and similar efficacy in maintaining oxygenation and ventilation.

Monitoreo de presión de manguito de tubo endotraqueal / Monitoring endotracheal tube cuff pressure

OBJECTIVE: Perform an objective monitoring of the endotracheal tube cuff pressure in patients under general anesthesia in the Anesthesiology Service of Hospital Privado de Córdoba. METHODS: It is a controlled, comparative, prospective study where the range of cuff pressures was analyzed at the beginning and end of surgery. A Rush brand manometer (Endotest) was used to perform the measurement. This pressure was related to the patient's data (sex, age, BMI, duration of surgery, endotracheal tube diameter). RESULTS: The total sample was 74 patients, and an initial inflation pressure outside the normal range was found in 75.7 percent of the patients of which 48.6 percent was out of the normal range and 27 percent was below of the normal range. At the end of the surgery it was found that 81.8 percent was within normal values. CONCLUSION: It is mandatory to monitor endotracheal tube cuff pressure in patients under general anesthesia.

OBJETIVOS: Realizar un monitoreo de forma objetiva de la presión del manguito de tubo endotraqueal en los pacientes bajo anestesia general en el servicio de Anestesiología del Hospital Privado de Córdoba. MATERIAL Y MÉTODOS: Es un estudio controlado, comparativo, prospectivo donde se analizo el rango de presiones del manguito al inicio y al final de la cirugía. Se utilizo un manometro de marca Rush (Endotest) para realizar la medición. Esta presión se la relaciono con los datos del paciente (sexo, edad, IMC, duración de cirugía, diámetro de tubo endotraqueal). RESULTADOS: El total de la muestra fueron 74 pacientes, y se encontró una presión de inflado inicial fuera de rango normal en un 75,7 por ciento, de los cuales un 48,6 por ciento fue elevado y un 27 por ciento por debajo del rango normal. Al final de la cirugía se comprobó que el 81,8 por ciento estaba dentro de valores normales. CONCLUSIÓN: Es mandatorio el monitoreo de presión del manguito del tubo endotraqueal en todos los pacientes bajo anestesia general.

Effect of different types of endotracheal tubes on ventilator-associated pneumonia / 中华急诊医学杂志

Objective@#To compare the clinical effect of conventional polyvinyl chloride (PVC) endotracheal tube with silicone wire reinforced endotracheal tube to prevent ventilator-associated pneumonia (VAP) in mechanical ventilation patients.@*Methods@#A total of 240 mechanical ventilation patients in the ICU were enrolled in this study, which were divided into two groups, PVC endotracheal intubation group (PVC group, n=113) and wire reinforced endotracheal intubation group (WR group, n=127). Gender, age, APACHEⅡ score, one-time success rate of intubation, intubation time, the rate of changing endotracheal, ventilation time, rate of tracheotomy and the incidence of VAP were compare between the two groups. Predictive factors for VAP were identified by the univariate and multivariate analyses in step-wise logistic regression model.@*Results@#The rate of changing endotracheal tube in the PVC group was lower than that in the WR group (χ2=5.785, P=0.016); the mechanical ventilation time in the PVC group was shorter than that in the WR group (t=2.180, P=0.018); and compared with the WR group, the PVC group had significantly lower incidence of VAP (χ2=6.215, P=0.012). The univariate analysis showed that the selection of PVC endotracheal tube, APACHE Ⅱ score and mechanical ventilation time were the significant risk factors for VAP (P < 0.05). Multivariate analysis showed that the different selection of endotracheal tube and mechanical ventilation time were independent influencing factors of VAP (P < 0.05).@*Conclusions@#PVC tracheal tube can effectively reduce the incidence of VAP in patients with mechanical ventilation.

Effect of different types of endotracheal tubes on ventilator-associated pneumonia / 中华急诊医学杂志

Objective To compare the clinical effect of conventional polyvinyl chloride (PVC) endotracheal tube with silicone wire reinforced endotracheal tube to prevent ventilator-associated pneumonia (VAP) in mechanical ventilation patients.Methods A total of 240 mechanical ventilation patients in the ICU were enrolled in this study,which were divided into two groups,PVC endotracheal intubation group (PVC group,n=1 13) and wire reinforced endotracheal intubation group (WR group,n=127).Gender,age,APACHE Ⅱ score,one-time success rate of intubation,intubation time,the rate of changing endotracheal,ventilation time,rate of tracheotomy and the incidence of VAP were compare between the two groups.Predictive factors for VAP were identified by the univariate and multivariate analyses in step-wise logistic regression model.Results The rate of changing endotracheal tube in the PVC group was lower than that in the WR group (x2=5.785,P=0.016);the mechanical ventilation time in the PVC group was shorter than that in the WR group (t=2.180,P=0.018);and compared with the WR group,the PVC group had significantly lower incidence of VAP (x2=6.215,P=0.012).The univariate analysis showed that the selection ofPVC endotracheal tube,APACHE Ⅱ score and mechanical ventilation time were the significant risk factors for VAP (P ＜ 0.05).Multivariate analysis showed that the different selection of endotracheal tube and mechanical ventilation time were independent influencing factors ofVAP (P ＜ 0.05).Conclusions PVC tracheal tube can effectively reduce the incidence of VAP in patients with mechanical ventilation.

Application study on improving the methods of endotracheal cuff pressure measurement to prevent ventilator-associated pneumonia / 中华危重病急救医学

To compare the intra cuff pressure changes during improved and the traditional method of cuff pressure measurement, then evaluate the effects of ventilator-associated pneumonia (VAP) prevention. The results highlighted practical recommendations in the process of ETT cuff pressure measurement. Methods① Experimental studies were carried out on the tracheal model with two groups: traditional pressure measurement group and improved pressure measurement group. The traditional pressure measurement group was connected to a handheld pressure gauge with the indicate cuff to get the intra-cuff pressure. The improved method was to insert a 3-way stopcock between the handheld pressure gauge and the indicate cuff. The 3-way stopcock to stabilize handheld pressure gauge reading at 32 cmH2O (1 cmH2O = 0.098 kPa) before measure the intra-cuff pressure. The pressure loss caused by two pressure measurement methods and the leakage of liquid on the balloon after 10 minutes was compared.② Clinical researches: a historic cohort study, patients with mechanical ventilation (MV) admitted to intensive care unit (ICU) of Guangxi Medical University Cancer Hospital from June 2014 to May 2018 were enrolled. The control group (249 cases) was treated with traditional method during June 2014 to May 2016, and the observation group (314 cases) was treated with improved method during June 2016 to May 2018. Clusters of strategies and actions of VAP prevention were applied in both groups. Incidence of VAP, duration of MV, and the length of ICU stay were compared between the two groups. Results ① Experimental study: the pressure leakage of the traditional pressure measurement group was (10.18±0.47) cmH2O, and that of the improved pressure measurement group was (1.33±0.42) cmH2O, with statistically significant difference between the two groups (t = 32.535, P = 0.000). All fluid on the cuffs leak after 10 minutes of traditional ways of measurement, however, no visible fluid on the cuffs leaked with improved procedures. ② Clinical research: the incidence of VAP in the observation group was slightly lower than that in the control group, however there was no significant difference [5.10% (16/314) vs. 8.43% (21/249), P > 0.05]. The duration of MV and the length of ICU stay in the observation group were significantly shorter than those in the control group (days: 9.93±3.14 vs. 16.77±5.45, 11.63 ±2.28 vs. 19.12±5.10, both P < 0.01). Conclusion The improved procedures of intra-cuff pressure measurement is a practical method to avoid the pressure leakage and fluid leakage, and the clinical course of MV patients can be significantly improved by combining the clusters of nursing strategies and actions.

Effect of a combination of 2% lidocaine jelly and thermally softened endotracheal tube on postoperative sore throat

BACKGROUND: Postoperative sore throat (POST) is a common adverse event after general anesthesia. The aim of this study was to evaluate the effectiveness of 2% lidocaine jelly applied on the single-lumen endotracheal tube (ETT) and thermal softening of the ETT, and a combination of both interventions on the development of POST. METHODS: Patients (n = 144) undergoing general anesthesia were randomly assigned to one of four groups: Control group (un-softened ETT lubricated with saline); Lidocaine group (un-softened ETT lubricated with 2% lidocaine jelly); Softened group (thermally softened ETT lubricated with saline); and Combined group (thermally softened ETT lubricated with 2% lidocaine jelly). Sore throat was evaluated at 0, 1, 6, 24, and 48 h after extubation. The occurrence of any postoperative complication was also assessed including hoarseness and coughing. RESULTS: No significant difference was observed in the severity of POST at all time points. However, the incidences of POST for overall (0–48 h) and the immediately following period (0 h) were significantly lower in the Combined group (52.9% and 47.1%) than in the Control group (79.4% and 76.5%), Lidocaine group (81.8% and 78.8%), and Softened group (82.9% and 74.3%). The overall incidence of hoarseness did not differ among the groups. No other postoperative complication was observed in any of the patients. CONCLUSIONS: No differences were observed in the severity of POST. However, 2% lidocaine jelly applied on thermally softened ETT reduced the overall incidence of POST. Therefore, this combined intervention could be considered as an alleviating strategy for POST.

Usefulness of ultrasound-guided measurement of minimal transverse diameter of subglottic airway in determining the endotracheal tube size in children with congenital heart disease: A prospective observational study

Introduction: The search for an accurate and predictable method to estimate the endotracheal tube (ETT) size in pediatric population had led to derivation of many formulae. Of this, age-based formulae are the most commonly used. Studies have shown that minimal transverse diameter of subglottic airway (MTDSA) measurements using a high-frequency probe improves the success rate of predicting the airway diameter to about 90%. We did a prospective observational study using MTDSA as the criteria to select the size of ETT in children with congenital heart disease. Methods: In this prospective observational study, 51 children aged from 1 day to 5 years, scheduled for cardiac surgery, were enrolled for this study. The ETT size was guided solely based on the MTDSA. Leak test was used to determine the best-fit ETT size. Results: Data from 49 patients were analyzed. Agreement between the ETT determined by MTDSA and that predicted by Cole's age-based formulas with the best-fit ETT size was analyzed using a Bland–Altman plot. Conclusion: Age-based formula showed poor correlation (27.5%) compared to MTDSA (87.8%) in predicting the best-fit ETT. We observed that pediatric patients with congenital heart disease need a larger sized ETT as compared to what was predicted by age-based formula. Using ultrasound MTDSA measurements to guide selection of ETT size is a safe and accurate method in pediatric cardiac population.

¿Cómo fijamos el tubo endotraqueal en la unidad de cuidados intensivos pediátricos? / How to secure the endotracheal tube in the pediatric intensive care unit?

Introducción: Las extubaciones no planeadas son eventos adversos frecuentes en áreas críticas de pediatría. La técnica y el material para llevar a cabo la fijación condicionan la aparición de estos eventos adversos. La evidencia científica que evalúe factores es escasa. Objetivos: El objetivo principal de este trabajo fue obtener datos concretos al respecto de las prácticas de los enfermeros en la fijación del tubo endotraqueal (TET) e identificar técnicas. Métodos: Estudio de carácter descriptivo y prospectivo. Se encuestaron 125 enfermeros de las diferentes Unidades de Cuidados Intensivos durante el mes de noviembre de 2016. Resultados: El 88% de los enfermeros basan su método en la utilización de cinta adhesiva. La técnica de fijación de 3 tiras prevalece por encima de las demás (64%). No existen grandes preferencias al respecto del tipo de cinta adhesiva, no obstante, el 22% menciona a la cinta de óxido de zinc. La alternativa de fijación en niños quemados muestra a la venda de tela como una opción (42%). El 27% de los enfermeros consultados coincidió en que no existe una técnica ideal ya que esta va a depender de la circunstancia clínica del niño. Las complicaciones asociadas a la fijación inadecuada son en primer lugar el desplazamiento por introducción (54%) y la extubación (31%). Conclusión: Se evidencia una amplia variedad de criterios al momento de llevar a cabo la técnica de fijación de TET. Finalmente podemos concluir en que los métodos de fijación dependerán exclusivamente de las características clínicas del niño, el criterio del operador y los recursos disponibles en cada institución (AU)

Introduction: Unplanned extubations are frequent adverse events in critical care in pediatrics. The technique of endotracheal tube (ETT) fixation and the materials affect the appearance of these adverse events. Studies that evaluate these factors are scarce. Objectives: The main aim of this study was to collect data on the practices of nurses in the fixation of the ETT and to identify techniques. Methods: A prospective, descriptive study was conducted. A survey was administered to 125 nurses from different Intensive Care Units in November 2016. Results: 88% of the nurses use tape to secure the ETT. The method of fixation with three strips was the most widely used (64%). There was no preference on the type of tape used; however, 22% preferred to use zinc oxide tape. In burned patients an alternative method with a cloth bandage was used (42%). Overall, 27% of the nurses surveyed coincided that an ideal method to secure the ETT is lacking, as this depends on the clinical circumstances of the child. Complications associated with inadequate tube fixation are displacement during fixation (54%) and la extubation (31%). Conclusion: A wide variety of criteria is used in the techniques to secure the ETT. Finally, we may conclude that fixation methods depend exclusively on the clinical characteristics of the child, criteria of the operator, and resources available at the institution (AU)

Tubo endotraqueal con aspiración subglótica y riesgo de neumonía asociada a ventilador / Subglottic secretion drainage tracheal tube and risk of ventilator-associated pneumonia / Tubo endotraqueal com aspiração subglótica e risco de pneumonia associada AO ventilador

Resumen: Introducción: El principal factor de riesgo para neumonía asociada a ventilador (NAV) es el tubo endotraqueal. Objetivo: Documentar la efectividad del tubo endotraqueal con aspiración subglótica (TEAS) en la reducción de NAV. Metodología: Estudio de casos y controles de mayo de 2012 a diciembre de 2015 en una unidad de cuidados intensivos. En muestra por conveniencia, con relación control:caso 3:1, con nivel de significancia α de 95% y poder β de 80%, fueron necesarios 18 casos y 54 controles. Se utilizó BMI® SPSS® Statistics v21. 72. Resultados: 277 (18.5%) de 1,492 pacientes recibieron asistencia mecánica ventilatoria, AMV (2,040 días ventilador); se obtuvo una tasa de 12.3 NAV por 1,000 días de ventilación. Se incluyeron 23 casos en el grupo de NAV y 67 controles. Once (18.3%) con TEAS y doce (40%) sin TEAS desarrollaron NAV (OR 0.33, IC 95% de 0.12-0.89). NNT = 4.6. Se encontró correlación significativa entre NAV y apego al protocolo de reducción de riesgos (r = 0.223, p = 0.036), días de ventilación mecánica (r = -0.51, p < 0.0001) y estancia en la unidad de cuidados intensivos, UCI (r = 0.42, p < 0.0001). Conclusión: El TEAS y el apego al protocolo de reducción de riesgos disminuyen el riesgo de NAV en pacientes con AMVI en la UCI, además de reducir los días de ventilación mecánica y la estancia hospitalaria.

Abstract: Background: Traqueal tube is the main risk factor for ventilator-associated pneumonia (VAP). Objective: Efficacy documentation of VAP reduction with endotracheal tube with subglottic secretion suction (ETSS). Methods: A case-control study from May 2012 to December 2015 in an intensive care unit. Patients who met the definition for VAP were considered as cases, and the exposition factor was the use of ETSS. Using a convenience sample with case:control rate of 1:3, α = 95% and β = 80%, a total of 18 cases and 54 controls were required. BMI® SPSS® Statistics v21 was used for the statistical analysis. Results: A total of 1,492 patients received attention in the ICU during the study period, with 277 (18.5%) requiring mechanical ventilation (2,040 ventilator-days). We included 23 cases in the VAP group and 67 controls. The rate of VAP was 12.3/1000 ventilator-days. Eleven patients (18.3%) with ETSS and twelve (40%) without it developed VAP (OR 0.33, IC 95% 0.12-0.89; NNT = 4.6). A significant correlation was found between VAP and bundle care adherence (r = 0.223, p = 0.036), days on mechanical ventilation (r = -0.51, p < 0.0001), and length of stay in the ICU (r = 0.42, p < 0.0001). Conclusions: ETSS use and care bundles adherence significantly reduced VAP risk in the intensive care unit, and shortened the days on mechanical ventilation and the length of stay.

Resumo: Introdução: O principal fator de risco para a pneumonia associada ao ventilador (PAV) é o tubo endotraqueal. Objetivo: Documentar a eficácia do tubo endotraqueal com aspiração subglótica (TEAS) na redução do PAV. Metodologia: Estudo de casos e controles durante maio de 2012 a dezembro de 2015 do Hospital. Na amostra por conveniência, com relação de controle:caso de 3:1, com nível de significância α de 95% e potência β de 80%, foram necessários 18 casos e 54 controles. Utilizou-se BMI® SPSS® Statistics v21. 72 Resultados: 277 (18.5%) de 1492 pacientes receberam AMV (2040 dias de ventilador), obtendo taxa de 12.3 PAV por 1000 dias de ventilação. Foram incluídos 23 casos no grupo de PAV e 67 controles. Onze (18.3%) com TEAS e doze (40%) sem TEAS desenvolveram PAV (OR 0.33, IC 95% de 0.12-0.89). NNT = 4.6. Uma correlação significativa foi encontrada entre PAV e a adesão ao protocolo de redução de risco (r = 0.223, p = 0.036), dias de ventilação mecânica (r = -0.51, p < 0.0001) e permanência na UTI (r = 0.42, p < 0.0001). Conclusão: El TEAS e a adesão ao protocolo de redução de riscos diminue o risco de PAV em pacientes com AMVI na UTI, além de reduzir os dias de ventilação mecânica e a estadia hospitalária.