A importância do conhecimento técnico e científico do enfermeiro no procedimento de intubação traqueal / La importancia del conocimiento técnico y científico de la enfermera en el procedimiento de intubación traqueal / The importance of the technical and scientific knowledge of the nurse in the tracheal intubation procedure

Objetivo: identificar o grau do conhecimento técnico e científico dos enfermeiros no procedimento intubação traqueal. Método: pesquisa de campo com caráter descritivo-exploratória e quantitativa tendo identificado, através do resultado de um questionário aplicado a 23 profissionais enfermeiros, em um Hospital Geral do Vale do Paraíba, o grau de conhecimento técnico e científico sobre o procedimento de intubação traqueal. A coleta dos dados foi realizada nos meses de setembro e outubro de 2021. Resultados: a enfermagem participa e desempenha papel importante no procedimento de intubação, desde os diagnósticos até a avaliação contínua dos principais sinais e sintomas, estabelecendo um plano de cuidados, intervenções e atividades que permitirão fornecer o melhor atendimento ao paciente. Conclusão: O conhecimento do enfermeiro durante o procedimento de intubação traquel é de extrema importância, visando a qualidade da assistência, e a segurança do paciente.(AU)

Objective: To identify the degree of technical and scientific knowledge of nurses in the tracheal intubation procedure. Method: descriptive-exploratory and quantitative field research, having identified, through the result of a questionnaire applied to 23 nursing professionals, in a General Hospital of the Paraíba Valley, the degree of technical and scientific knowledge about the tracheal intubation procedure. Data were collected in September and October 2021. Results: nursing participates and plays an important role in the intubation procedure, from diagnoses to continuous evaluation of the main signs and symptoms, establishing a care plan, interventions and activities that will allow providing the best patient care. Conclusion: The knowledge of nurses during the traquel intubation procedure is extremely important, aiming at the quality of care, and patient safety.(AU)

Objetivo: identificar el grado de conocimiento técnico y científico de las enfermeras en el procedimiento de intubación traqueal. Método: investigación de campo descriptiva-exploratoria y cuantitativa, habiendo identificado, a través del resultado de un cuestionario aplicado a 23 profesionales de enfermería, en un Hospital General del Valle de Paraíba, el grado de conocimiento técnico y científico sobre el procedimiento de intubación traqueal. Los datos fueron recolectados en septiembre y octubre de 2021. Resultados: La enfermería participa y juega un papel importante en el procedimiento de intubación, desde el diagnóstico hasta la evaluación continua de los principales signos y síntomas, estableciendo un plan de cuidados, intervenciones y actividades que permitan brindar la mejor atención al paciente. Conclusión: El conocimiento de las enfermeras durante el procedimiento deintubación de traquel es extremadamente importante, apuntando a la calidad de la atención y la seguridad del paciente.(AU)

Test predictores de vía aérea difícil y hallazgos bajo laringoscopia directa en sala de operaciones del hospital general esmeraldas sur delfina torres de concha / Difficult airway predictor tests and findings under direct laryngoscopy in the operating room of Esmeraldas Sur General Hospital Delfina Torres de Concha

La combinación de los test predictores de la vía área difícil durante la evaluación preanestésica y la preparación de los pacientes quirúrgicos es fundamental para reducir el índice de morbimortalidad. Objetivo: Analizar la relación entre los test predictores de vía aérea difícil y los hallazgos bajo laringoscopia directa en los pacientes que son intervenidos en la sala de operaciones del Hospital General Esmeraldas Sur Delfina Torres de Concha. La institución de salud en mención no registra previamente un estudio de estas características. Materiales y Métodos: El diseño de investigación que se aplicó fue cualitativo, de corte transversal con enfoque descriptivo. En consecuencia, se observaron y se tomaron datos del formulario de anestesiología de 150 historias clínicas de pacientes que fueron derivados a cirugía desde febrero de 2019 hasta julio de 2019. Las variables examinadas correspondieron a paciente adulto, vía aérea difícil, test predictores de VAD y laringoscopia directa. Resultados: Mostraron que el test que alertó más casos de VAD es el de protrusión mandibular con el 59,30%, seguido de la distancia tiromentoniana con el 40,00%. Asimismo, los hallazgos bajo laringoscopia derivaron en procedimientos de intubación difícil, guardando relación con otros test predictores de VAD. Conclusiones: La combinación de varios test de VAD facultan a los médicos a planificar respuestas oportunas ante la presencia de problemas(AU)

The combination of predictive tests of the difficult airway during the pre-anesthetic evaluation and the preparation of surgical patients is essential to reduce the morbidity and mortality rate. Objective: To analyze the relationship between the difficult airway predictive tests and the findings under direct laryngoscopy in patients who are operated on in the operating room of the Hospital General Esmeraldas Sur Delfina Torres de Concha. The aforementioned health institution has not previously registered a study of these characteristics. Materials and Methods: The research design that was applied was qualitative, cross-sectional with a descriptive approach. Consequently, data from the anesthesiology form of 150 medical records of patients who were referred for surgery from February 2019 to July 2019 were observed and collected. The variables examined corresponded to adult patients, difficult airway, VAD predictor tests and direct laryngoscopy. Results: They showed that the test that alerted more cases of VAD is mandibular protrusion with 59.30%, followed by thyromental distance with 40.00%. Likewise, the findings under laryngoscopy led to difficult intubation procedures, being related to other VAD predictive tests. Conclusions: The combination of several VAD tests empower physicians to plan timely responses to the presence of problems(AU)

Middle fingertip to rascette line measurement novel approach to endotracheal tube depth for Filipinos: A pilot study

@#A predetermined endotracheal tube depth prior to intubation ensures correct tube placement relative to the carina. The objective of this study was to determine if the topographic measurement from the middle fingertip (MFT) to Rascette line (RL) or "wrist line" correlates with acceptable endotracheal tube (ET) depth during orotracheal intubation. This was a prospective, analytical cross-sectional pilot study of 54 adult Filipino patients who underwent general anesthesia with orotracheal intubation. The middle fingertip to Rascette line measurement was utilized as the basis for endotracheal tube depth with ET secured on the right corner of the mouth. After intubation, a chest x-ray was performed to measure the distance from the endotracheal tube tip to the carina. The study showed that the average middle fingertip to Rascette line measurement among Filipinos was 18.79cm (± 1.08) which resulted in 85.19% of patients with ET tip to carina within the acceptable distance of 2-Scm, with a mean value of 3.17cm. The mean MFT to RL measurement in females was 18.28cm and 19.81 cm in males. The mean distance of ET tip to carina in females was 2.91 cm and 3.66cm in males. There was a significant positive correlation between the middle fingertip to Rascette line measurement and height. This study also documented the total length from the right corner of the mouth to carina, by adding middle fingertip to Rascette line measurement and the distance from ET tip to carina, resulting in a mean value of 23.46cm (±2.06) in males and 21.19 cm (±1 .73) in females. In conclusion, middle fingertip to Rascette line measurement is an acceptable technique to determine individualized endotracheal tube depth during orotracheal intubation. This topographic measurement resulted in 96.29% of ET tip :?: 1 cm above the carina.

Mobile remote technology in the learning of laryngoscopy in intubation in a training hospital / La tecnología móvil a distancia en el aprendizaje de laringoscopia en la intubación en un hospital de entrenamiento

Abstract: Introduction: Simulation-based training has become a comprehensive practice to improve skill levels in procedures such as intubation. Clinicians performing endotracheal intubation must be competent to perform this technical skill safely. Objective: Determine the success of the use of mobile remote technology in learning intubation laryngoscopy during training in the hospital. Material and methods: Experimental, cross-sectional, comparative, non-blind, randomized study which was made up of 117 students of the Bachelor of Medicine degree at the Autonomous University of Nuevo Leon. Results: Group A with conventional laryngoscopy achieved successful intubation in an average of 106.86 ± 84.87 seconds, group B in 62.90 ± 65.81 and when crossing the groups in the technique, the time of video laryngoscopy was taken, where group A reported an average time of 64.25 ± 34.23, while the time recorded in group B was 84.25 ± 55.67 seconds. Conclusion: The use of mobile remote technology is effective for the preparation of doctors and future doctors when performing an orotracheal intubation. Videolaryngoscopy was significant to conventional laryngoscopy when performed in inexperienced personnel.

Resumen: Introducción: El entrenamiento basado en simulación se ha convertido en una práctica integral para mejorar los niveles de habilidad en procedimientos como la intubación. Los médicos que realizan intubación endotraqueal deben ser competentes. Objetivo: Determinar el éxito del uso de la tecnología remota móvil en el aprendizaje de la laringoscopía de intubación durante la formación en el hospital. Material y métodos: Estudio experimental, transversal, comparativo, no ciego, aleatorizado que contó con 117 estudiantes de la Licenciatura en Medicina de la Universidad Autónoma de Nuevo León. Resultados: El grupo A con laringoscopía convencional logró intubación exitosa en un promedio de 106.86 ± 84.87 segundos, el grupo B en 62.90 ± 65.81 y al cruzar los grupos en la técnica se tomó el tiempo de videolaringoscopía, donde el grupo A reportó un tiempo promedio de 64.25 ± 34.23, mientras que el tiempo registrado en el grupo B fue de 84.25 ± 55.67 segundos. Conclusión: El uso de tecnología remota móvil es efectivo para la preparación de médicos y futuros médicos a la hora de realizar una intubación orotraqueal. La videolaringoscopía fue significativa para la laringoscopía convencional cuando se realizó en personal sin experiencia.

Respuesta hemodinámica post intubación orotraqueal en pacientes sometidos a cirugía abdominal electiva que reciben clonidina o lidocaína previo a la inducción anestésica / Hemodynamic response after orotracheal intubation in patients undergoing elective abdominal surgery that receive clonidine or lidocaine after anesthesia indutction

Se realizó un ensayo clínico controlado simple ciego con el objetivo de evaluar la respuesta hemodinámica post intubación orotraqueal y efectos adversos con clonidina versus lidocaína en pacientes sometidos a cirugía abdominal electiva con anestesia general en el Hospital Central Universitario Dr. Antonio María Pineda durante el período mayo ­ agosto de 2018. Cincuenta pacientes conformaron la muestra distribuidos aleatoria y equitativamente en dos grupos: el grupo A recibió clonidina a una dosis de 1.5 mcg/kg endovenoso, 20 minutos previos a la inducción anestésica y el grupo B recibió lidocaína a una dosis de 1.5 mg/kg, 90 segundos previos a la inducción anestésica. La edad promedio de los pacientes varió entre 31,6 ± 12,2 años de edad, con predominio del sexo femenino. Los efectos adversos fueron hipotensión al minuto y tres minutos post intubación; sólo dos pacientes del grupo A presentaron bradicardia a los tres minutos. Se observó una diferencia estadísticamente significativa entre ambos grupos en relación a la presión arterial sistólica, diastólica y media y frecuencia cardíaca inmediatamente posterior a la intubación, al minuto y a los tres minutos. Estos resultados confirman que el uso de clonidina es eficaz para atenuar la respuesta hemodinámica posterior a la intubación en pacientes sometidos a cirugía abdominal electiva bajo anestesia general(AU)

A single-blind controlled clinical trial was carried out with the aim to evaluate the hemodynamic response after orotracheal intubation in patients that receive clonidine or lidocaine in patients undergoing elective abdominal surgery with general anesthesia at the Hospital Central Universitario Dr. Antonio María Pineda during the period May - August 2018. Fifty patients were distributed randomly and equitably in two (2) groups: group A received clonidine in a dose of 1.5 mcg/kg intravenously, 20 minutes before anesthetic induction and group B received lidocaine at a dose of 1.5 mg/kg, 90 seconds before anesthetic induction. Median age of patients was 31.6 ± 12.2 years with a predominance of female sex. Most common adverse effect was hypotension in both groups at one and three minutes post intubation; only two patients in the clonidine group showed bradycardia at three minutes. There was a statistical significant difference between both groups in regards to the mean values of systolic, diastolic and mean arterial pressure and heart rate at all time points measured after intubation. These results confirm that clonidine is effective in reducing hemodynamic response after intubation in patients that undergo elective abdominal surgery under general anesthesia(AU)

Técnica EXIT como manejo de la vía aérea en masas gigantes congénitas de cuello / Ex-Utero Intrapartum Treatment for airway management in congenital giant neck masses

Resumen: Introducción: Las masas congénitas de cabeza y cuello se asocian a asfixia perinatal e injuria cerebral con elevada mortalidad. La técnica EXIT (Ex Útero Intrapartum Treatment) consiste en asegurar la vía aérea del neonato, sin interrumpir la oxigenación y perfusión materno-fetal a través del soporte placentario. Esta técnica no ha sido estandarizada en países de medianos ingresos. Objetivo: Describir el caso clínico de 2 neonatos manejados mediante la técnica EXIT. Caso Clínico: Se reportan dos casos, uno con malformación linfática diagnosticada a la semana 20 gestación y el segundo con tiromegalia y polihidramnios diagnosticados a la semana 35 de gestación. En ambos casos, duran te la cesárea se realizó la técnica EXIT con un equipo conformado por neonatólogo, ginecólogo, anestesiólogo, cirujano pediatra, otorrinolaringólogo, enfermero y terapeuta respiratorio. En los dos pacientes se logró asegurar la vía aérea mediante intubación orotraqueal al primer intento. En el caso 1 se confirmó la malformación linfática y recibió escleroterapia, y en el caso 2 se diagnosticó hipotiroidismo congénito asociado a bocio, que fue manejado con levotiroxina. Los pacientes se mantuvieron 7 y 9 días con ventilación mecánica invasiva respectivamente y egresaron sin complicaciones respiratorias. Conclusiones: La técnica EXIT en estos casos fue un procedimiento seguro, llevado a cabo sin inconvenientes. Se necesita un equipo multidisciplinario y la disponibilidad de una unidad de cuidados intensivos neonatales, con el objetivo de reducir potenciales complica ciones y garantizar el manejo postnatal. Para lograr su ejecución, es indispensable el diagnóstico prenatal oportuno.

Abstract: Introduction: Congenital head and neck masses are associated with perinatal asphyxia and brain injury, increasing the risk of death. The EXIT (Ex Utero Intrapartum Treatment) technique con sists of ensuring the newborn's airway while is still receiving placental support. This technique has not been standardized in developing countries. Objective: To describe the clinical outcomes of two infants who underwent the EXIT technique. Clinical Case: We present two cases, one with lymphatic malformation diagnosed at 20 weeks of gestational age (WGE) and the second one, a preterm newborn with thyromegaly and polyhydramnios, diagnosed at 35 WGE. In both cases, during the C-section, the EXIT technique was performed with a team of a neonatologist, a gyne cologist, an anesthesiologist, a pediatric surgeon, an otolaryngologist, a nurse, and a respiratory therapist. In both patients, the neonatologist achieved to secure the airway through orotracheal intubation at the first attempt. In the first case, lymphatic malformation was confirmed and re ceived sclerotherapy, and the second one was diagnosed with congenital hypothyroidism which was managed with levothyroxine. The patients needed invasive mechanical ventilation for 7 and 9 days, respectively, and were discharged without respiratory complications. Conclusions: In these patients, the EXIT technique was a safe procedure, carried out without inconvenience. A multi disciplinary approach and the availability of a neonatal intensive care unit are needed to reduce potential complications and ensure postnatal management. Timely prenatal diagnosis is essential to perform this technique.

Effectiveness of magnesium sulfate compared to rocuronium for rapid sequence tracheal intubation in adults: clinical randomized trial / Efetividade do sulfato de magnésio comparado ao rocurônio para intubação em sequência rápida em adultos: ensaio clínico randomizado

Abstract Introduction and objectives: Magnesium sulphate has been used in anesthesia because it has relevant clinical features such as: analgesia, autonomic response control and muscle relaxation. Using the agent to establish adequate conditions for tracheal intubation remains controversial. The aim of the study was to compare the effectiveness of magnesium sulfate and rocuronium for rapid sequence tracheal intubation in adults. Methods: Double blind, randomized, unicentric, prospective study assessed 68 patients, ASA 1 or 2, over 18 years, scheduled for appendectomy under general anesthesia. Patients were divided into two groups. GM patients received 50 mg.kg-1magnesium sulfate and GR patients, 1 mg.kg-1 rocuronium immediately before anesthesia induction. Arterial Blood Pressure (BP) and Heart Rate (HR) were measured in both groups at five times related to the administration of the drugs studied. The primary variable was the clinical status of tracheal intubation. Trial Registry: RBR-4xr92k. Results: GM was associated with no significant hemodynamic parameter change after injection. GM showed 85% (29/34) poor intubation clinical status, 15% (5/34) good, and 0% excellent (< 0.0001). Conclusion: Magnesium sulfate did not provide adequate clinical status when compared to rocuronium at a dose of 50 mg.kg-1 for rapid sequence intubation in adult patients.

Resumo Justificativa e objetivos: O sulfato de magnésio vem sendo utilizado em anestesia por apresentar características relevantes à prática clínica como: analgesia, controle dos reflexos autonômicos e relaxamento muscular. A utilização deste agente para garantir condições adequadas para a intubação traqueal permanece controverso. O objetivo deste trabalho é determinar a efetividade do sulfato de magnésio comparado ao rocurônio para intubação orotraqueal em sequência rápida em pacientes adultos. Métodos: Este estudo duplamente encoberto, aleatorizado, unicêntrico e prospectivo avaliou 68 pacientes, ASA 1 ou 2, maiores de 18 anos, escalados para cirurgias de apendicectomia sob anestesia geral. Foram alocados em dois grupos, o GM recebeu 50 mg.kg-1 de sulfato de magnésio e o GR, 1 mg.kg-1 de rocurônio imediatamente antes da indução anestésica. Os valores de Pressão Arterial (PA) e Frequência Cardíaca (FC) foram aferidos nos dois grupos em cinco momentos relacionados com a administração dos fármacos do estudo. A variável primária foi condição clínica da intubação. Registro: RBR-4xr92k. Resultados: O GM não apresentou alteração significativa dos parâmetros hemodinâmicos após infusão. O GM apresentou 85% (29/34) de condição pobre, 15% (5/34) condição clínica boa e 0% condição clínica excelente (< 0,0001). Conclusão: O sulfato de magnésio não propiciou condições clínicas aceitáveis quando comparado ao rocurônio para intubação orotraqueal em sequência rápida em pacientes adultos quando utilizada a dose de 50 mg.kg-1.

Dental complications associated with neonatal intubation in preterm infants

This paper describes the potential oral complications in preterm infants who have undergone orotracheal intubation. Neonatal intubation may have adverse effects on the developing deciduous teeth, oral soft tissues, and even the permanent teeth. However, endotracheal intubation may be essential for the survival of premature infants, owing to incomplete tracheal development. Excessive pressure to the oral tissue must be avoided, in cases where orotracheal intubation is inevitable. Moreover, the potential oral complications must be considered when neonatal intubation is performed for the patient's survival, and subsequent reevaluation and proper oral health care are needed.

Dexamethasone treatment for bilateral lingual nerve injury following orotracheal intubation

Lingual nerve injury is a rare complication of general anesthesia. The causes of lingual nerve injury following general anesthesia are multifactorial; possible mechanisms may include difficult laryngoscopy, prolonged anterior mandibular displacement, improper placement of the oropharyngeal airway, macroglossia and tongue compression. In this report, we have described a case of bilateral lingual nerve injury that was associated with orotracheal intubation for open reduction and internal fixation of the left distal radius fracture in a 61-year-old woman. In this case, early treatment with dexamethasone effectively aided the recovery of the injured lingual nerve.

La vía respiratoria en la reanimación cardiopulmonar y cerebral / Respiratory airway in brain and cardiopulmonary resuscitation

Introducción: acceder a la vía respiratoria constituye un elemento de vital importancia en la parada cardiaca. Tanto cuando los principios básicos establecidos para la reanimación eran el ABC por sus siglas en inglés (airway, breathing and circulation), como los del actual CAB (circulation, airway and breathing). Existen controversias entre la técnica utilizar de manera que se garantice de la mejor forma la ventilación: ¿intubación orotraqueal o dispositivos supraglóticos? Objetivo: realizar una actualización sobre las técnicas para acceder a la vía respiratoria en la reanimación cardiopulmonar y cerebral. Método: se visitó la página web de la Biblioteca Médica Nacional de los Estados Unidos (PubMed), con las siguientes palabras clave en inglés: airway AND reanimation y con el filtro activado para los últimos cinco años, en humanos y a texto completo. Conclusiones: la intubación traqueal requiere entrenamiento y práctica regular para evitar complicaciones. El personal poco entrenado no siempre tiene suficientes habilidades para lograrlo y no deberían perder tiempo realizando estos procedimientos y sí centrarse en las compresiones torácicas de alta calidad, la ventilación con bolsa y mascarilla, hasta la llegada de reanimadores expertos(AU)

Introduction: Accessing the airway is an element of vital importance in cases of cardiac arrest. Both when the basic principles established for resuscitation were the ABC (English acronym for airway, breathing and circulation), and for those of the current CAB (circulation, airway and breathing). There are controversies between the technique used to ensure ventilation the best way: orotracheal intubation or supraglottic devices? Objective: To carry out an update on the techniques to access the airway in cardiopulmonary and cerebral resuscitation. Method: We visited the website of the National Medical Library of the United States ( PubMed) with the following keywords in English: airway AND reanimation, and with the filter activated for the last five years, in humans and in full text. Conclusions: Tracheal intubation requires regular training and practice to avoid complications. The untrained staff members do not always have enough skills to achieve it and should not waste time doing these procedures, but focus on high-quality chest compressions, the ventilation bag and mask, instead, until the arrival of rescuer experts(AU)

¿El uso de alto flujo de oxígeno disminuye la necesidad de intubación comparado con el empleo de ventilación mecánica no invasiva en el paciente con síndrome de insuficiencia respiratoria aguda (SIRA) leve? / Does using high-flow oxygen reduce the need for intubation compared with the use of non-invasive ventilation in the patient with mild acute respiratory distress syndrome (ARDS)? / O uso de alto fluxo de oxigênio reduz a necessidade de intubação em comparação com o uso de ventilação mecânica não invasiva no paciente com sira leve?

Resumen: Actualmente existen dispositivos de alto flujo para tratar la insuficiencia respiratoria. El objetivo fue evaluar si el uso de alto flujo de oxígeno disminuye la necesidad de intubación comparado con el empleo de ventilación mecánica no invasiva en el paciente con síndrome de insuficiencia respiratoria aguda (SIRA) leve. Realizamos una búsqueda exhaustiva en la literatura actual, que dio como resultado 14 artículos relevantes. Se analizaron y se excluyeron los artículos de revisión, los casos clínicos y los de población pediátrica. Quedaron únicamente tres artículos. Conclusión: No existe evidencia suficiente de buena calidad metodológica que apoye que el uso de puntas nasales de alto flujo disminuya la intubación orotraqueal.

Summary: There are currently high-flow devices to treat respiratory failure. Our objective was to assess whether the use of high flow oxygen reduces the need for intubation compared with the use of noninvasive ventilation in patients with mild acute respiratory distress syndrome (ARDS). We conducted a comprehensive search of the literature, which resulted in 14 items. We analyzed and excluded review articles, clinical cases and those with pediatric population, which left us with only three items. Conclusion: There is insufficient evidence of good methodological quality to support that the use of high flow nasal tips decreases endotracheal intubation.

Resumo: Atualmente existem dispositivos de alto fluxo para tratar a insuficiência respiratória. O objetivo foi avaliar se o uso de alto fluxo de oxigênio reduz a necessidade de intubação em comparação com o uso de ventilação mecânica não invasiva em paciente com SIRA leve. Realizamos uma pesquisa abrangente na literatura atual resultando 14 artigos relevantes. Eles foram analisados e excluídos artigos de revisão, os casos clínicos e de população pediátrica. Permanecendo apenas 3 artigos. Conclusão: Não existe evidência suficiente, de boa qualidade metodológica, que apoie o uso do catéter nasal de alta fluxo para diminuir a intubação orotraqueal.

Application of different concentrations of chlorhexidine oral care solution in patients with orotracheal intubation / 中国感染控制杂志

Objective To study application effectiveness of different concentrations of chlorhexidine oral care solu-tion in patients with orotracheal intubation.Methods A total of 120 patients who were admitted to the general in-tensive care unit (ICU)of a hospital and undergoing mechanical ventilation via orotracheal intubation for >48 hours between January 2012 and December 2013 were included in the study,they were divided randomly into three groups,40 in each group.Trial group,control group I,and control group II were provided with 2%,0.2%,and 0.12% chlorhexidine oral care solution,respectively.Differences in halitosis,oral mucosal infection,onset time and incidence of ventilator-associated pneumonia (VAP ) among three groups were observed and compared. Results There were significant difference in incidence of VAP and early-onset VAP between trial group and control group I,trial group and control group II,respectively(both P <0.05 );incidence of VAP in control group II was higher than trial group(47.50% vs 20.00%,P =0.009).Conclusion 2% chlorhexidine oral rinsing and swabbing can effectively reduce incidence of VAP in patients with orotracheal intubation.

Access to the tracheal pulmonary pathway in small rodents / Vias de acesso traqueopulmonar em pequenos roedores

ABSTRACT The tracheal pulmonary route is used in diverse experimental models for the study of drugs, infectious agents, and diseases. In view of its importance and associated difficulties, the present article proposes to give research groups up-to-date information on techniques to access the tracheal pulmonary pathway of small rodents.

RESUMO As vias de acesso traqueopulmonar vêm sendo utilizadas em diversos modelos experimentais que estudam a ação de fármacos e agentes infecciosos, além de enfermidades. Tendo em vista a sua importância e as dificuldades associadas, o presente artigo de atualização propõe-se a dar ao pesquisador as informações necessárias para o emprego das técnicas de acesso traqueopulmonar em pequenos roedores.

Establishment of a mouse model of acid aspiration-induced lung injury / 中国实验动物学报

Objective To establish a non-traumatic mouse model of acid aspiration-induced lung injury which al-lows longitudinal studies.Method C57BL/6 mice were anesthetized and orotracheally intubated with a 20 gauge angio-catheter guided by optical fiber.The mice were subsequently placed in the right lateral decubitus position and external com-pression to the left lung was manually applied.A polyethylene catheter was advanced into the right lung and used to instill either hydrochloric acid (2.5μL/g, 0.1 mol/L, pH 1.5) or saline as control.Then the mice were recovered with supple-mental oxygen for 4 hours.The pulmonary physiological function and survival of mice within 2 weeks after surgery were as-sessed.Results Methylene blue instillation showed that the staining fluid went into the right lung of the non-traumatically intubated mice.The survival rate of the mice with non-traumatic instillation was 80%, statistically significantly higher than those with tracheostomy instillation.Histological examination and lung function ( wet/dry ratio, elastance and arterial oxy-gen saturation) assay demonstrated that acid instillation caused a profound pathological changes and functional impairment of the lung.Besides, acid aspiration into the mouse lung caused a significant increase in neutrophil infiltration in mouse pulmonary alveoli and high concentrations of inflammatory factors (TNF-α, IL-6, CXCL1 and CXCL2) in the bronchoalve-olar lavage fluid.Conclusions We successfully established a mouse model of acid aspiration-induced lung injury, which may serve as a reliable model for longitudinally studying pulmonary immune-inflammatory mechanism in humans.

Impact of orotracheal intubation by Macintosh laryngoscopy versus Shikani optical stylet on blood pressure and heart rate / 实用医学杂志

Objective To compare the hemodynamic response to orotracheal intubation by Macintosh laryngoscopy (MAC) with Shikani optical stylet (SOS). Methods Forty neurosurgical patients, ASA physical status Ⅰ~Ⅲ, were prospectively randomized to MAC group (n = 20) and SOS group (n = 20) according to the method of orotracheal intubation. Heart rate (HR) and invasive systolic blood pressure (SBP) were recorded at pre- and post-intubation. Results The intubation time was significantly longer in SOS group than in MAC group [(22 ± 8) s vs. (17 ± 8) s, P < 0.05]. SBP in both groups decreased significantly after induction (P < 0.05) and increased greatly at 1 and 2 min post-intubation (P < 0.05), but did not differ at 3, 4 and 5 min. HR in both groups did not differ significantly between the SBP after induction. HR in both groups increased greatly at 1 and 2 min post-intubation (P < 0.05), but did not differ markedly at 3, 4 and 5 min after induction. There were no significant differences in the peak SBP and HR between the two groups. Conclusion MAC and SOS cause similar hemodynamic responses to orotracheal intubation.

Endoscropic assist in rat orotracheal intubation / 中国比较医学杂志

Objective To investigate endoscropic assist in rat orotracheal intubation.Methods 40 rats were randomly divided into two groups.The procedure time, total time, intubation frequency,the success rate of the first intubation and the survival rate in 24h were compared between the conventional group and the endoscropic group.Results The total time in two groups were nearly the same.But the procedure time and frequency of intubation were significantly less in the endoscropic group than those in the conventional group.The success rate of the first intubation in the endoscropic group was obviously higher than that of the conventional group.There was no obviously difference between the survival rate after extubation in 24h between groups.Conclusion Endoscropic assist is superior to the conventional method and worth promoting.

Clinical dysphagia risk predictors after prolonged orotracheal intubation

OBJECTIVES: To elucidate independent risk factors for dysphagia after prolonged orotracheal intubation. METHODS: The participants were 148 consecutive patients who underwent clinical bedside swallowing assessments from September 2009 to September 2011. All patients had received prolonged orotracheal intubations and were admitted to one of several intensive care units of a large Brazilian school hospital. The correlations between the conducted water swallow test results and dysphagia risk levels were analyzed for statistical significance. RESULTS: Of the 148 patients included in the study, 91 were male and 57 were female (mean age, 53.64 years). The univariate analysis results indicated that specific variables, including extraoral loss, multiple swallows, cervical auscultation, vocal quality, cough, choking, and other signs, were possible significant high-risk indicators of dysphagia onset. The multivariate analysis results indicated that cervical auscultation and coughing were independent predictive variables for high dysphagia risk. CONCLUSIONS: Patients displaying extraoral loss, multiple swallows, cervical auscultation, vocal quality, cough, choking and other signs should benefit from early swallowing evaluations. Additionally, early post-extubation dysfunction recognition is paramount in reducing the morbidity rate in this high-risk population. .

A Case of Bilateral Peripheral Tapia's Syndrome Subsequent to Coronary Artery Bypass Graft / 대한이비인후과학회지

The Tapia's syndrome means symptom complex that result from unilateral vago-hypoglossal nerve paralysis. This syndrome is rare disease entity, bilateral attack is extremely rare. Only three cases have been reported in English literature. A-66-year-old man received the coronary artery bypass graft in our hospital. After the operation, he complained of severe dyspnea, voice change and drooling. The laryngoscopic findings showed the bilateral vocal cord palsy. He could not move the tongue toward any directions. We diagnosed as bilateral Tapia's syndrome. Usually, unilateral Tapia's syndrome is related to the complications of anesthesia and position of the patient's head during surgery. Otherwise, our case may be associated with the complications of operation and anesthesia. The patient's recovered three months later, but the right vocal cord palsy is persistent. We report the very unique disease entity with literature review.

Comparación de la presión del manguito del tubo orotraqueal estimada por palpación frente a la medición tomada con un manómetro / Comparison of the Orotracheal Tube Cuff Pressure Estimated by Palpation vs. the Measurement Taken with a Manometer / Comparação da pressão do balonete do tubo endotraqueal vs. palpação estimou a medida realizada com um manômetro

La presión que ejerce el manguito del tubo orotraqueal (TOT) sobre la mucosa al ser insuflado debe mantenerse en un rango de seguridad que evite complicaciones por sobreinflación o por desinsuflación. En nuestro medio, los instrumentos de medición objetiva no son de uso común. Objetivo: evaluar la concordancia de la presión del manguito del TOT estimada por palpación frente al uso de un manómetro manual en pacientes adultos sometidos a anestesia general. Materiales y métodos: se realizó un estudio de corte transversal que incluyó a 40 pacientes, a quienes, una vez intubados, dos anestesiólogos enmascarados, diferentes al que los intubó, palparon el manguito del TOT categorizándolo como sobreinflado, normal o desinflado; posteriormente, uno de los investigadores registró la medida con un manómetro en fase inspiratoria y espiratoria. Se consideró como rango normal de 20 a 30 cm H2O. Resultados: la concordancia de la estimación por palpación entre los dos anestesiólogos fue débil (Kappa = 0,21, ES: 0,11). La concordancia entre la estimación por palpación y la medición con el manómetro manual fue muy débil. Entre el primer anestesiólogo y el investigador en fase inspiratoria, k 0,08 (ES: 0,09), y en espiración, k 0,08 (ES: 0,07). Entre el segundo anestesiólogo y el investigador, k 0,05 (ES: 0,07) y 0,02 (ES: 0,06), respectivamente. Conclusión: el estudio muestra que la concordancia entre los métodos subjetivo y objetivo para determinar si el manguito del TOT está adecuadamente inflado fue débil. Se sugiere el empleo de métodos más objetivos para su determinación.

The pressure exerted by the cuff of endotracheal tube (ETT) on the mucosa to be blown, should be kept in a safe range to avoid complications by on inflation or deflation. In our context, the objective measurement instruments are not commonly used. Objective: To evaluate the correlation between ETT cuff pressure estimated by palpation, and that obtained with a manual gauge in adult patients undergoing general anesthesia. Materials and methods: It was performed a cross-sectional study by obtaining the sample of adult patients undergoing general anesthesia requiring endotracheal intubation. We included forty patients who were intubated and then two blind anesthesiologists, other than the one who intubated, estimated insufflation of ETT cuff by palpation categorizing as over-inflated, normal or deflated. One of the observers subsequently, carried out the measurement of pressure with a manometer, both in inspiration and expiration. It was considered as normal pressure range 20 to 30 cm H2O. Results: The correlation of the estimation by palpation between the two anesthesiologists was weak (Kappa = 0.21, ES: 0.11). The correlation of the estimation by palpation and measurement with manual gauge was very weak. Between the first anesthesiologist and observers, in inspiration the k was 0.08 (ES: 0.09), in expiration was 0.08 (ES: 0.07), also between the second anesthesiologist and the observers, k 0.05 (ES: 0.07) and 0.02 (ES: 0.06) respectively. Conclusion: The study shows that the correlation between subjective and objective methods to determine if the cuff of ETT is properly inflated was weak. It suggests the use of more objective methods for its determination.

A pressão que exerce o manguito do tubo orotraqueal (TOT) sobre a mucosa ao ser insuflado deve manter-se em um rango de segurança que evite complicações por sobre inflação ou por desinsuflação. Em nosso meio, os instrumentos de medição objetiva não são de uso comum. Objetivo: avaliar a concordância da pressão do manguito do TOT estimada por palpação versus o uso de um manômetro manual, em pacientes adultos submetidos à anestesia geral. Materiais e métodos: realizou-se um estudo de corte transversal que incluiu 40 pacientes aos quais, uma vez intubados, dois anestesiologistas mascarados, diferentes ao que intubou, palparam o manguito do TOT categorizando-lhe como super-inflado, normal ou desinflado, posteriormente um dos pesquisadores registrou a medida com um manômetro em fase inspiratória e expiratória. Considerou-se como rango normal de 20 a 30 cmH2O. Resultados: a concordância da estimação por palpação entre os dois anestesiologistas foi fraca (kappa = 0.21, ES: 0.11). A concordância entre a estimação por palpação e s medição com o manômetro manual foi muito fraca. Entre o primeiro anestesiologista e o pesquisador em fase inspiratória, k 0.08 (ES: 0.09) e em expiratória, k 0.08 (ES: 0.07). Entre o segundo anestesiologista e o pesquisador k 0.05 (ES: 0.07) y 0.02 (ES: 0.06) respectivamente. Conclusão: o estudo mostra que a concordância entre os métodos subjetivo e objetivo para determinar se o manguito do TOT está adequadamente inflado foi fraco. Sugere-se o emprego de métodos mais objetivos para sua determinação.

Intubação orotraqueal e a técnica da sequência rápida: uma revisão para o clínico / Orotracheal intubation and rapid sequence technique: a review for the internist

JUSTIFICATIVA E OBJETIVOS: O médico clínico frequentemente se depara com a necessidade do acesso a via aérea em situações de urgência e emergência. O objetivo deste estudo foi rever as principais publicações sobre acesso às vias aéreas nessas situações descrevendo as melhores evidências para a execução deste procedimento.CONTEÚDO: Foram selecionados artigos na base de dados Medline (1950-2010), por meio das palavras-chave: intubação orotraqueal, sequência rápida, laringoscopia. Adicionalmente,referências desses artigos, capítulos de livros e artigos históricos foram avaliados. Foram identificados e revisados 68 artigos. Foram considerados ensaios clínicos da língua inglesa, estudos retrospectivose de revisão. Os artigos foram avaliados por análisede método e determinação de limitações de desenho. Por se tratar de uma revisão narrativa, foram apresentadas as conclusões mais relevantes dos principais estudos e metanálises, sem a interferência direta da análise pessoal dos autores deste estudo.CONCLUSÃO: A técnica de acesso a via aérea é indispensável para o clínico. Os conhecimentos sobre sua anatomia, condição ideal para a laringoscopia envolvendo o melhor posicionamento e técnicas que podem ser utilizadas deve ser rotineiro ao clínico. O clinico pode se deparar muitas vezes com o paciente com risco de aspiração pulmonar e deve conhecer também a técnica de sequência rápida envolvendo todas as suas particularidades e aspectos de segurança.(AU)

BACKGROUND AND OBJECTIVES: The internist frequently comes across with the necessity for emergency airway access.The objective of this study was to review the major publications about airway access in these conditions describing the best evidencesto execute this procedure.CONTENTS: We selected articles in Medline (1950-2010), by means of keywords: orotracheal, rapid sequence intubation and laryngoscopy. Additionally, references to these articles, chapters of books and historical articles were evaluated. We identified and reviewed 68 articles. We considered clinical trials, retrospective studies and clinical reviews in English. Articles were analyzing basedin methods and determination of design limitations. As a narrative review, we presented the most relevant findings of major studiesand meta-analyses without involving our personal point of view.CONCLUSION: The technique of airway access is a vital procedureto the internist. Knowledge of the airways anatomy and ideal scenario for laryngoscopy involving the best positioning and techniques,that can should be used as a routine for the clinical practice. The internist many times may get with the patient at risk for pulmonary aspiration and should know the technique of rapid sequence intubation,involving all its particularities and safety aspects.(AU)