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1.
Arch. argent. pediatr ; 118(1): e72-e76, 2020-02-00. ilus
Article in Spanish | LILACS (Americas), BINACIS | ID: biblio-1096164

ABSTRACT

La estenosis traqueal adquirida es muy poco frecuente en la edad pediátrica y puede responder a múltiples causas; la estenosis posintubación y la secundaria a traqueotomía son las más comunes.El manejo de la estenosis traqueal adquirida sigue siendo controvertido. El tratamiento endoscópico proporciona el alivio inmediato de los síntomas, pero se asocia a una alta tasa de recurrencia, y el uso de prótesis endoluminales puede incrementar la longitud de la estenosis y complicar una cirugía futura. Por el contrario, se han documentado buenos resultados a largo plazo con la resección traqueal con anastomosis primaria.Se describe nuestra experiencia con la resección traqueal con anastomosis término-terminal para el tratamiento de la estenosis traqueal posintubación en 8 pacientes.


Acquired tracheal stenosis is a very infrequent lesion in the pediatric age group and may be due to diverse causes, being post-intubation stenosis and stenosis secondary to tracheostomy the most common ones.The management of acquired tracheal stenosis remains controversial. Endoscopic treatment provides immediate relief of symptoms but it is associated with a high recurrence rate, and the use of endoluminal prostheses can increase the length of the stricture complicating future surgery. Conversely, good long-term results have been documented with tracheal resection and primary anastomosis.We describe our experience with tracheal resection followed by end-to-end anastomosis for the treatment of post-intubation tracheal stenosis in 8 patients.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Tracheal Stenosis/surgery , Tracheal Stenosis/therapy , Endoscopy , Intubation, Intratracheal/adverse effects
2.
Article in English | WPRIM (Western Pacific) | ID: wprim-811203

ABSTRACT

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.


Subject(s)
Palatal Expansion Technique , Intubation, Intratracheal , Maxilla
3.
Clin. biomed. res ; 40(1): 33-36, 2020.
Article in English | LILACS (Americas) | ID: biblio-1116973

ABSTRACT

High flow nasal cannula oxygen therapy (HFNC) has become frequent in the treatment of patients with acute hypoxemic respiratory failure. Methods. Eleven patients with acute exacerbation of fibrotic interstitial lung disease (ILD) were treated with HFNC after failure of conventional therapy (SatO2 < 90% offering 100% FiO2 by non-rebreathing mask or noninvasive ventilation). Ten patients had success with HFNC (not requiring orotracheal intubation) during emergency department admission. HFNC significantly improves clinical variables after 2h: respiratory rate decreased from 33 ± 6 breaths/ min to 23 ± 3 breaths/min; PaO2 increased from 48.7 (38-59) mmHg to 81.1 (76-90) mmHg; PaO2/FiO2 ratio increased from 102.4 ± 32.2 to 136.6 ± 29.4; SatO2 increased from 85 (66-92)% to 96 ± (95-97)%. HFNC could be an effective alternative in the treatment of acute respiratory failure from acute exacerbations of fibrotic ILD.(AU)


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Respiratory Insufficiency , Lung Diseases, Interstitial , Cannula , Laryngeal Masks , Respiratory Rate , Intubation, Intratracheal
4.
Rev. chil. fonoaudiol. (En línea) ; 18: 1-14, nov. 2019. tab, graf
Article in Spanish | LILACS (Americas) | ID: biblio-1095115

ABSTRACT

La evidencia internacional recomienda diferente presión de 'cuff' a utilizar en usuarios con vía aérea artificial. En Chile,algunas instituciones sanitarias han creado protocolos internos referenciando dicha evidencia. Sin embargo, no existe una guía nacional, por lo que distintos profesionales utilizan diferentes criterios. El objetivo de este trabajo fue crear un cuestionario válido y confiable sobre el uso de técnicas y manejo de la presión del 'cuff' en usuarios adultos con vía aérea artificial por parte de profesionales de salud en Chile. Para ello, se utilizó un diseño cualitativo-cuantitativo, descriptivo y longitudinal. El proceso fue dividido en tres fases. En la fase A sedesarrolló un cuestionario en inglés que fue traducido al español con ayuda de tres hablantes hispanos nativos. En la fase B diez expertos chilenos en el manejo de usuarios con vía aérea artificial analizaron la herramienta y recomendaron modificaciones de algunos componentes del cuestionario. Después dedichos cambios, la herramienta fue validada a través de un Índice de Validez de Contenido. En la fase C treinta y tres profesionales de la salud chilenos respondieron voluntariamente el cuestionario en dos ocasiones con un lapso de treinta días entre respuestas, con el fin de medir la confiabilidad a través de 'test-retest'. El cuestionario desarrollado tuvo una validez de 0,93 mientras que 72,73% y 27,27% de sus ítems tuvieron excelente y buena confiabilidad respectivamente. Lo anterior permite concluir que este cuestionario cumple con su objetivo y servirá para conocer las técnicas y presiones del 'cuff' que profesionales de la salud en Chile utilizan para el manejo de usuarios adultos con vía aérea artificial.


International evidence recommends different cuff pressure to use with patients with an artificial airway. In Chile, some health institutions have created internal protocols referencing this evidence. However, there is no national guidelines, thus different health professionals use different criteria to manage these patients. The present researched aimed at creating a valid and reliable questionnaire on the use and management of the cuff pressure in adult patients with an artificial airway for health professionals in Chile. A qualitative-quantitative, descriptive and longitudinal design was implemented. This process was divided in three phases. In phase A, a draft of the questionnaire was developed in English and then translated to Spanish by three native Spanish speakers. In phase B, ten Chilean, ten clinical experts in the management of users with artificial airway analysed the tool and recommended modifications of some of the questionnaire. After the modifications, the tool was validated through a Content Validity Index form. In phase C, thirty-three Chilean health professional voluntarily responded the questionnaire twice, with a period of thirty days between responses, to measure the reliability of the tool through 'test-retest'. The questionnaire had a validity of .93, while 72.73% and 27.27% of the items had an excellent reliability and good reliability, respectively. This allows us to conclude that this questionnaire meets its objectives and will serve to know the techniques and pressure of the cuff that health professionals in Chile use for the management of adult patients with an artificial airway.


Subject(s)
Humans , Surveys and Questionnaires , Clinical Competence , Health Personnel , Intubation, Intratracheal/instrumentation , Pressure , Respiration, Artificial , Tracheostomy , Chile , Reproducibility of Results , Longitudinal Studies , Airway Management
5.
Notas enferm. (Córdoba) ; 19(33): 29-39, jun.2019.
Article in Spanish | LILACS (Americas), BDENF, BINACIS, UNISALUD | ID: biblio-1008163

ABSTRACT

Introducción. Cuidado seguro se defne como causa o consecuencia de las intervenciones de enfermería. La seguridad en el paciente es un tema de interés en los últimos años, no obstante, hablar del recién nacido pretérmino (RNPT) con tubo endotraqueal (TET), es enfrentarse a una población vulnerable por sus características biofsiológicas. La Unidad de Cuidado Intensivo Neonatal (UCIN) representa un medio ambiente complejo, en estos escenarios es de importancia conocer los factores que pueden contribuir al "Cuidado Seguro" evitando un evento adverso(EA)y sus repercusiones para la vida. Objetivo: Describir y dar a conocer aspectos encontrados a nivel mundial sobre el cuidado seguro al RNPT con TET. Desarrollo: Se realizó una búsqueda en distintas bases de datos: Pubmed, Scielo, BVS, LILACS, Elsevier, utilizando (DeCs)/ (MeSH), rescatando artículos nacionales e internacionales, idioma español, inglés y portugués, de 5 años a la fecha, con títulos relacionados al cuidado del neonato. Tres rubros fueron los explorados: posición corporal en el RNPT, cuidado de enfermería omitido, eventos adversos (EAs) en la UCIN. Conclusiones: La función respiratoria del RNPT con TET se optimiza con el factor posición corporal. El cuidado omitido ha sido poco estudiado en el área neonatal. Los EAs que prevalecen son: los relacionados a la terapia de infusión, termorregulación, infecciones asociadas y extubación no programada (ENP). El cuidado seguro debe ser abordado a profundidad a fn de emitir recomendaciones específcas para este grupo vulnerable de la población(AU)


Introduction. Safe Care is the cause or consequence of nursing interventions. Patient safety is a topic of interest in recent years, however, to speak of the preterm newborn (RNPT) with endotracheal tube (ETT), is to confront a vulnerable population due to its biophysiological characteristics. Te Neonatal Intensive Care Unit (NICU) represents a complex environment, in these scenarios it is important to know the factors that can contribute to "Safe Care" avoiding an adverse event (AD) and its repercussions for life. Objective: Describe and publicize aspects found around the world on the Safe Care of RNPT with TET. Development: A search was made in different databases: Pubmed, Scielo, VHL, LILACS, Elsevier, using (DeCs) / (MeSH), rescuing national and international articles, Spanish, English and Portuguese, from 5 years to date , with titles related to the care of the newborn. Tree items were explored: body position in the RNPT, nursing care omitted, adverse events (AEs) in the NICU. Conclusions: Te respiratory function of RNPT with TET is optimized with the body position factor. Te omitted care has been little studied in the neonatal area. Te EAs that prevail are: those related to infusion therapy, thermoregulation, associated infections and unscheduled extubation (ENP). Safe Care must be approached in depth in order to issue specifc recommendations for this vulnerable group of the population(AU)


Introdução. Safe Care é a causa ou consequência das intervenções de enfermagem. A segurança do paciente é um tema de interesse nos últimos anos, no entanto, falar do recém-nascido pré-termo (RNPT) com tubo endotraqueal (TET) é confrontar uma população vulnerável devido às suas características biofsiológicas. A Unidade de Terapia Intensiva Neonatal (UTIN) representa um ambiente complexo, nesses cenários é importante conhecer os fatores que podem contribuir para o "Cuidado Seguro" evitando um evento adverso (DA) e suas repercussões para a vida. Objetivo: Descrever e divulgar aspectos encontrado em todo o mundo sobre o Cuidado Seguro do RNPT com o TET. Desenvolvimento: Pesquisa realizada em diferentes bases de dados: Pubmed, Scielo, BVS, LILACS, Elsevier, utilizando (DeCs) / (MeSH), resgatando artigos nacionais e internacionais, espanhol, inglês e português, a partir de 5 anos, com títulos relacionados ao cuidado do recém-nascido. Três itens foram explorados: posição corporal no RNPT, cuidados de enfermagem omitidos, eventos adversos (EAs) na UTIN. Conclusões: A função respiratória do RNPT com TET é otimizada com o fator de posição corporal. O cuidado omitido tem sido pouco estudado na área neonatal. Os EAs que prevalecem são: aqueles relacionados à terapia de infusão, termorregulação, infecções associadas e extubação não programada (ENP). Cuidados Seguros devem ser abordados em profundidade, a fm de emitir recomendações específcas para este grupo vulnerável da população(AU)


Subject(s)
Humans , Infant, Newborn , Quality of Health Care , Infant, Premature , Intensive Care, Neonatal , Intubation, Intratracheal , Safety Management
6.
Autops. Case Rep ; 9(1): e2018072, Jan.-Mar. 2019. ilus
Article in English | LILACS (Americas) | ID: biblio-987500

ABSTRACT

Endotracheal intubation injuries are rare, but may be devastating­mostly among the pediatric patients or when these occur in the distal trachea. Such complications typify a therapeutic challenge, which, besides requiring intellectual and technical resources, takes a long time to reach a resolution. The authors present the case of a 15-year-old girl admitted with an abnormal state of consciousness due to diabetic ketoacidosis. She was submitted to endotracheal intubation with hyperinflation of the tube cuff, which rendered tracheal necrosis and detachment of the tracheal mucosa, and consequent obstruction. Later, she developed scarring retraction and stenosis. The patient was successfully treated with an endotracheal prosthesis insertion. The aim of this report is to illustrate a preventable complication.


Subject(s)
Humans , Female , Adolescent , Tracheal Stenosis/prevention & control , Intubation, Intratracheal/adverse effects , Diabetic Ketoacidosis/complications
7.
Rev. bras. ter. intensiva ; 31(1): 79-85, jan.-mar. 2019. tab
Article in Portuguese | LILACS (Americas) | ID: biblio-1003630

ABSTRACT

RESUMO Objetivo: Determinar a incidência, os fatores de risco e os desfechos da extubação não planejada em pacientes adultos. Métodos: Conduzimos estudo prospectivo de coorte de pacientes adultos intubados admitidos em ala de atendimento gratuito em um hospital governamental terciário de ensino nas Filipinas. Incluíram-se tanto pacientes em cuidados de terapia intensiva quanto fora dela. Os pacientes foram seguidos até a alta ou até o sétimo dia após a extubação. Resultados: Os desfechos dos 191 pacientes incluídos foram: extubação planejada (35%), extubação não planejada (19%), óbito (39%) e alta a pedido (7%). A regressão de riscos competitivos demonstrou que o sexo masculino (OR bruta de 2,25; IC95% 1,10 - 4,63) e a idade (OR bruta: 0,976; IC95%: 0,957 - 0,996) foram fatores basais significantes. O turno da noite (OR bruta: 24,6; IC95%: 2,87 - 211) também teve associação consistente com maior ocorrência de extubação não planejada. Dentre os desfechos após a extubação, ocorreram significantemente mais, entre os pacientes com extubação não planejada, reintubação (extubação não planejada, com 61,1%, versus extubação planejada, com 25,4%), insuficiência respiratória aguda (extubação não planejada, com 38,9%, versus extubação planejada, com 17,5%) e eventos cardiovasculares (extubação não planejada, com 8,33%, versus extubação planejada, com 1,49%). A admissão à unidade de terapia intensiva não se associou com risco menor de extubação não planejada (OR bruta de 1,15; IC95% 0,594 - 2,21). Conclusão: Muitos pacientes intubados tiveram extubação não planejada. Os pacientes admitidos em outras unidades, que não a de terapia intensiva, não tiveram tendências mais elevadas de extubação não planejada.


ABSTRACT Objective: We aimed to determine the incidence, risk factors, and outcomes of unplanned extubation among adult patients. Methods: We conducted a prospective cohort study of adult intubated patients admitted to the charity wards of a government tertiary teaching hospital in the Philippines. Patients managed in both intensive care and nonintensive care settings were included. Patients were followed-up until discharge or until seven days postextubation. Results: The outcomes of the 191 included patients were planned extubation (35%), unplanned extubation (19%), death (39%), and discharge against advice (7%). Competing risk regression showed that male sex (Crude OR: 2.25, 95%CI: 1.10 - 4.63) and age (Crude OR 0.976, 95%CI: 0.957 - 0.996) were significant baseline factors. The night shift (Crude OR: 24.6, 95%CI: 2.87 - 211) was also consistently associated with more unplanned extubations. Among postextubation outcomes, reintubation (unplanned extubation: 61.1% versus planned extubation: 25.4%), acute respiratory failure (unplanned extubation: 38.9% versus planned extubation: 17.5%), and cardiovascular events (unplanned extubation: 8.33% versus planned extubation: 1.49%) occurred significantly more often among the unplanned extubation patients. Admission in an intensive care unit was not associated with a lower risk of unplanned extubation (Crude OR 1.15, 95%CI: 0.594 - 2.21). Conclusion: Many intubated patients had unplanned extubation. Patients admitted in nonintensive care unit settings did not have significantly higher odds of unplanned extubation.


Subject(s)
Humans , Male , Female , Adult , Aged , Respiration, Artificial/statistics & numerical data , Airway Extubation/statistics & numerical data , Intensive Care Units/statistics & numerical data , Intubation, Intratracheal/statistics & numerical data , Philippines , Incidence , Prospective Studies , Risk Factors , Cohort Studies , Follow-Up Studies , Tertiary Care Centers , Hospitals, Teaching , Middle Aged
8.
Pediatr. (Asunción) ; 46(2): 185-190, Mayo-Agosto 2019.
Article in Spanish | LILACS (Americas) | ID: biblio-1026407

ABSTRACT

Introducción: La intubación endotraqueal en pacientes críticamente enfermos es un procedimiento de riesgo que requiere alta competencia en el manejo de la vía aérea. Es esencial conocer las habilidades de los médicos de emergencia pediátrica en el manejo avanzado de vías aéreas y de vías aéreas difíciles. Objetivo: Describir el manejo avanzado de vías aéreas y vías aéreas difíciles en un departamento de emergencia pediátrico. Materiales y Métodos: Estudio observacional, descriptivo y prospectivo en pacientes de 0 a 18 años que requirieron intubación endotraqueal en el periodo comprendido desde el 10 de mayo del 2018 al 31 de mayo del 2019. Se evaluó diagnóstico fisiopatológico, prevalencia de vía aérea difícil, aplicación de secuencia de intubación rápida, herramienta utilizada para la intubación, tiempo de intubación, intentos, operador y complicaciones. Se definió éxito al paciente intubado en dos intentos. Resultados: Se incluyeron 93 pacientes, la mediana de edad fue 10 (0.7-192) meses . En 19 (20,4%) pacientes se identificó predicción de vía aérea difícil, se realizó secuencia de intubación rápida en 91 (97,8%) pacientes. El porcentaje de éxito fue 83,9% (78/93). En el primer intento 59,1% (55/93) y en el segundo 50% (19/38). Se requirió cambio de operador en 19 oportunidades. Todos fueron intubados por laringoscopia convencional. La mediana para el tiempo de intubación fue 3 (2-5.5) minutos. La media del número de intentos fue 1,8 (± 1,3). La complicación observada fue la desaturación de oxígeno en 23 (24,7%) pacientes. Conclusión: La primera causa de intubación según el diagnóstico fisiopatológico fue la falla cardiopulmonar y la identificación de vía aérea difícil se presentó con relativa frecuencia.


Introduction: Endotracheal intubation in critically ill patients is a risky procedure that requires a high level of competence in airway management. It is essential to know the skills of pediatric emergency physicians in the advanced management of airways and difficult airways. Objective: To describe the advanced management of difficult airways and airways in a pediatric emergency department. Materials and Methods: This was an observational, descriptive and prospective study in patients from ages 0 to 18 years who required endotracheal intubation from May 10, 2018 to May 31, 2019. We evaluated pathophysiological diagnosis, prevalence of difficult airway, rapid intubation sequence intubation application, tools used for intubation, intubation time, attempts, operator characteristics and complications. Successful intubation patients was defined as intubation in two attempts. Results: 93 patients were included, the median of age was 10 (0.7-192) months. In 19 (20.4%) patients, difficult airway prediction was identified, rapid intubation sequence was performed in 91 (97.8%) patients. The percentage of success was 83.9% (78/93). In the first attempt 59.1% (55/93) and in the second 50% (19/38). Operator change was required 19 times. All were intubated by conventional laryngoscopy The median for intubation time was 3 (2-5.5) minutes. The average number of attempts was 1.8 (± 1.3). The complication observed was oxygen desaturation in 23 (24.7%) patients. Conclusion: The first cause of intubation according to the diagnosis pathophysiological was cardiopulmonary failure. Difficult airway identification was relatively frequent.


Subject(s)
Airway Management , Pediatric Emergency Medicine , Intubation, Intratracheal
9.
Article in Korean | WPRIM (Western Pacific) | ID: wprim-739847

ABSTRACT

PURPOSE: To investigate the differences in postoperative sore throat and hoarseness by adjustment of endotracheal tube cuff pressure (CP) during nitrous oxide (N2O) and air anesthesia. METHODS: A one-equivalent control group pretest-posttest design was used. Data were collected from August 8 to October 19, 2017 and analyzed using the independent t-test and repeated measures ANOVA. Eighty-four participants were enrolled and divided into three groups: 28 in the Control Group (CP adjusted every 30 minutes using N2O), 28 in Experimental Group 1 (CP adjusted every 10 minutes using N2O), and 28 in Experimental Group 2 (non-adjusted CP using air), all of whom underwent urologic, gynecologic, and orthopedic surgeries at the G University hospital. Sore throat was assessed using a numeric rating scale; hoarseness was evaluate using the Stout classification at 1, 6, and 24 hours after surgery. RESULTS: Scores for sore throat and hoarseness were significantly different between the groups at each measurement time, and scores were consistently higher in the control group. During subsequent measurements, sore throat and hoarseness scores were significantly lower at 6 hours. Cuff pressure changed significantly using air anesthesia (χ2=10.41, p=.015) up to 2 hours after induction. Severe sore throat and hoarseness was observed for up to 6 hours after surgery. CONCLUSION: Cuff pressure adjustment at short time intervals would be helpful in reducing postoperative sore throat and hoarseness. Nursing intervention focused on prevention of sore throat and hoarseness should be required up to 6 hours postoperatively in patients undergoing endotracheal intubation.


Subject(s)
Anesthesia , Classification , Hoarseness , Humans , Intubation , Intubation, Intratracheal , Nitric Oxide , Nitrous Oxide , Nursing , Orthopedics , Pharyngitis
10.
Singapore medical journal ; : 110-118, 2019.
Article in English | WPRIM (Western Pacific) | ID: wprim-777546

ABSTRACT

Since the first use of the flexible fibreoptic bronchoscope, a plethora of new airway equipment has become available. It is essential for clinicians to understand the role and limitations of the available equipment to make appropriate choices. The recent 4th National Audit Project conducted in the United Kingdom found that poor judgement with inappropriate choice of equipment was a contributory factor in airway morbidity and mortality. Given the many modern airway adjuncts that are available, we aimed to define the role of flexible fibreoptic intubation in decision-making and management of anticipated and unanticipated difficult airways. We also reviewed the recent literature regarding the role of flexible fibreoptic intubation in specific patient groups who may present with difficult intubation, and concluded that the flexible fibrescope maintains its important role in difficult airway management.


Subject(s)
Airway Management , Methods , Airway Obstruction , Anesthesia , Methods , Bronchoscopy , Methods , Equipment Design , Fiber Optic Technology , Humans , Intubation, Intratracheal , Methods , Laryngoscopes , Manikins , Obesity , Respiratory System , Skull Fractures
11.
Article in English | WPRIM (Western Pacific) | ID: wprim-764398

ABSTRACT

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.


Subject(s)
Humans , Infant, Newborn , Infant, Premature , Intubation , Intubation, Intratracheal , Oral Health , Tooth , Tooth, Deciduous
12.
Article in English | WPRIM (Western Pacific) | ID: wprim-764391

ABSTRACT

Mounier-Kuhn syndrome (MKS) is a disease characterized by dilation of the trachea and mainstem bronchi. Due to the risk of airway leakage, pulmonary aspiration, and tracheal damage, MKS can be fatal in patients undergoing tracheal intubation. Moreover, MKS may not be diagnosed preoperatively due to its rarity. In this case, a patient undergoing neurosurgery was incidentally diagnosed with MKS during general anesthesia. During anesthesia induction, difficulties in airway management led the anesthesiologist to suspect MKS. Airway leakage was resolved in this case using oropharyngeal gauze packing. Anesthesiologists should be aware of the possibility of MKS and appropriate management of the airways.


Subject(s)
Airway Management , Anesthesia , Anesthesia, General , Bronchi , Humans , Intubation , Intubation, Intratracheal , Neurosurgery , Trachea , Tracheobronchomegaly
13.
Article in Korean | WPRIM (Western Pacific) | ID: wprim-760114

ABSTRACT

BACKGROUND AND OBJECTIVES: Acute epiglottitis is a life-threatening condition that can result in airway obstruction. The present study reports clinical features, management and patient outcomes in an acute epiglottitis. SUBJECTS AND METHOD: Included in our retrospective study were 315 patients who were admitted with the diagnosis of acute epiglottitis between January 2006 and July to the department Otolaryngology-Head and Neck surgery, Hallym University Sacred Heart Hospital 2018. The diagnosis of acute epiglottitis was established by confirmation of inflamed epiglottis using laryngoscope or computed tomography. RESULTS: Among 315 patients, 89 cases (28%) and 83 cases (26%) were found in the fifth and fourth decades, respectively. The mean age of patients was 45.0±13.94 years. The male to female ratio was 1.33:1. A total of 75 patients (23.8%) had co-morbidities, with hypertension (13.6%) being the most common. Fever was relatively uncommon, whereas most patients complained of sore throat. Ceftriaxone was the most common empirical antibiotic regimen prescribed and the use of steroids did not affect the length of hospital stay. Nine patients required airway intervention, including eight who underwent endotracheal intubation and one emergency tracheostomy. In patients who need airway intervention, systolic blood pressure, body temperature, respiratory rate, heart rate, white blood cells and the proportion of dyspnea were significantly higher in comparison to the patients without airway intervention. CONCLUSION: Although acute epiglottitis often has nonspecific symptoms, it may lead to sudden dyspnea and unstable vital signs, so an in-depth understanding of this disease is needed.


Subject(s)
Airway Obstruction , Anti-Bacterial Agents , Blood Pressure , Body Temperature , Ceftriaxone , Clinical Study , Diagnosis , Dyspnea , Emergencies , Epiglottis , Epiglottitis , Female , Fever , Heart , Heart Rate , Humans , Hypertension , Intubation, Intratracheal , Korea , Laryngoscopes , Length of Stay , Leukocytes , Male , Methods , Neck , Pharyngitis , Respiratory Rate , Retrospective Studies , Steroids , Tracheostomy , Vital Signs
14.
Article in English | WPRIM (Western Pacific) | ID: wprim-759502

ABSTRACT

BACKGROUND: Compared to an equivalent sized polyvinyl chloride (PVC) double-lumen tube (DLT), a silicone DLT has a shorter endobronchial segment. The aim of this study was to compare the incidence of clinically significant displacement of left-sided PVC and silicone DLTs after a positional change to a lateral position from a supine position and determine its effect on the need for DLT repositioning for successful lung separation in patients undergoing thoracic surgery. METHODS: One hundred eight adult patients requiring one-lung ventilation were randomly divided into group P (PVC DLT, n = 54) and group S (Silicone DLT, n = 54). The position of the DLT was observed before and after lateral positioning to assess the effect of the position change. The incidence of clinically significant displacement (>10 mm) of DLT was compared between the groups. RESULTS: DLTs were clinically significantly displaced in group P (17/48, 35.4%) and group S (18/52, 34.6%) after lateral positioning (p = 0.933). A proximal displacement (31.3% [group P] and 25.0% [group S]) was more common than distal displacement (4.2% [group P] and 9.6% [group S]), with no significant intergroup difference (p = 0.494). After lateral positioning, critical malposition of DLT with bronchial herniation to the right main bronchus was 8.3% (group P) and 7.9% (group S, p = 0.906). CONCLUSION: Left-sided PVC and silicone DLTs produced comparable incidences of clinically significant displacement and, consequently, required similar rates of repositioning for successful lung separation after lateral positioning.


Subject(s)
Adult , Bronchi , Bronchoscopy , Humans , Incidence , Intubation, Intratracheal , Lung , One-Lung Ventilation , Polyvinyl Chloride , Polyvinyls , Posture , Silicon , Silicones , Supine Position , Thoracic Surgery , Thoracic Surgical Procedures
15.
Article in English | WPRIM (Western Pacific) | ID: wprim-759501

ABSTRACT

BACKGROUND: Geriatric patients are susceptible to respiratory and hemodynamic adverse events during endotracheal intubation and extubation due to anatomic and physiological changes with aging. Supraglottic airway devices (SADs) provide reduced airway morbidity and increased hemodynamic stability in adults. However, studies that have compared the clinical performance of SADs in geriatric patients are limited. Therefore, we evaluated the clinical performance of airway management with i-gel® and laryngeal mask airway Supreme (LMA Supreme™) in geriatric patients. METHODS: The subjects were American Society of Anesthesiologists physical status classification I–III geriatric (65–85 years) patients who underwent elective surgery with general anesthesia and were randomly allocated into the i-gel® group and the LMA Supreme™ group. We compared the time for successful insertion on a first attempt as a primary outcome, and the secondary outcomes were success rate, ease of insertion, maneuver for successful ventilation, oropharyngeal leak pressure, gastric insufflation, fiberoptic view grades, ventilator problems, and adverse events. RESULTS: Insertion time was significantly shorter for the i-gel® than the LMA Supreme™ (21.4 ± 6.8 vs. 29.3 ± 9.9 s; P = 0.011). The i-gel® was also easier to insert than the LMA Supreme™ (P = 0.014). Gastric insufflation was less frequent with the i-gel® than the LMA Supreme™ (0% vs. 31.3%; P = 0.013). Other measurements were comparable between groups. CONCLUSIONS: Both devices can be safely applied to geriatric patients with similar success rates and oropharyngeal leak pressures. However, inserting the i-gel® was faster and easier compared to the LMA Supreme™ in geriatric patients.


Subject(s)
Adult , Aging , Airway Management , Anesthesia, General , Classification , Hemodynamics , Humans , Insufflation , Intubation , Intubation, Intratracheal , Laryngeal Masks , Prospective Studies , Ventilation , Ventilators, Mechanical
17.
Article in Korean | WPRIM (Western Pacific) | ID: wprim-758479

ABSTRACT

OBJECTIVE: The UE Video Stylet VL400-S2 (UE Medical Devices, Newton, MA, USA) and Ambu aScope (Ambu, Copenhagen, Denmark) were recently introduced rigid video stylets and single-use fiberoptic bronchoscopes, respectively. To compare the utility of the two sets of equipment, this study conducted a randomized cross-over study using a manikin. METHODS: Twenty-eight novice doctors performed tracheal intubation on an airway trainer manikin (Laerdal, Stavanger, Norway). The sequence of intubation devices was randomized. The following data were measured and recorded: time to complete tracheal intubation (primary end point), overall success rate, time to see the glottis, and time to tube passage. RESULTS: The video stylet (24 seconds; interquartile range [IQR] 18–36) showed a significantly shorter completion time of the tracheal intubation than the fiberoptic bronchoscope (43 seconds; IQR, 32–84) (P<0.001). The overall success rate of tracheal intubation was 96.4% (27/28) in the video stylet and 82.1% (23/28) in the fiberoptic bronchoscope, and the cumulative success rate over time to complete intubation was significantly higher in the video stylet (P<0.001). CONCLUSION: The video stylet was superior to the fiberoptic bronchoscope in terms of the time to complete and the cumulative success rate of intubation for novice operators in manikin model. Further research will be needed to determine the degree of education required to use fiberoptic bronchoscopy.


Subject(s)
Bronchoscopes , Bronchoscopy , Cross-Over Studies , Education , Glottis , Intubation , Intubation, Intratracheal , Manikins , Microscopy, Video
18.
Article in English | WPRIM (Western Pacific) | ID: wprim-758434

ABSTRACT

OBJECTIVE: Endotracheal intubation (ETI) is the most reliable way to manage the airway. Stepwise deliberate practice and mastery training is essential in maintaining and promoting the skill of intubation. This study was conducted to identify differences in examiners' expectations regarding competent skill performance and to develop learner-adjusted assessment tools with appropriate levels according to student and resident learners based on the expectations and limited observation of performance by examiners. METHODS: This was an exploratory, psychometric study using a simple airway part task trainer. The draft ETI assessment tool from the literatures, previous tools, and the preliminary learner-adjusted assessment tool for students and residents were developed and analyzed. Knowledge-based and competence-based items for each learner group were identified based on experts' expectations. The final learner-adjusted tools were refined through analyzing the content validity, internal consistency, and interrater reliability based on assessing the observed performance of 14 students and 12 residents by ten experts. RESULTS: The preliminary student-adjusted assessment tool and resident-adjusted assessment tool had 12 items on the checklist with a ternary scoring system and a ternary scoring checklist including 15 items, and an overall Global Rating Scale. The final student-adjusted assessment tool was composed of a ternary scoring checklist including 9 items (total CVI, 86.6%; Cronbach's α, 0.83; interrater reliability, 0.64). The resident-adjusted assessment, on the other hand, was also composed of a ternary scoring checklist including 12 items (total CVI, 86.4%; Cronbach's α, 0.7; interrater reliability, 0.78), in addition to global rating scale including ‘rating of the overall process’. CONCLUSION: The experts had different expectations regarding the level of competence in each step according to learner groups with different levels of difficulty. Understanding the factors influencing assessments can provide a guide for teaching and objectively assessing to the examiner.


Subject(s)
Checklist , Hand , Humans , Intubation , Intubation, Intratracheal , Mental Competency , Psychometrics
19.
Article in English | WPRIM (Western Pacific) | ID: wprim-762258

ABSTRACT

BACKGROUND: Endotracheal intubation often causes sore throat and coughing. The aim of this study was to decrease the incidence and severity of cough, sore throat, and hemodynamic changes after extubation by endotracheal administration of 1% lidocaine. METHODS: Sixty patients physical status American Society of Anesthesiologists classes I, II, and III who received a surgery under general anesthesia were randomly divided into two groups. L group was given 1% lidocaine 0.5 mg/kg by endotracheal administration. The other group, N group, received the same volume of normal saline. The number of cough, the severity of sore throat with numerical rating score (NRS), incidence of local anesthetic systemic toxic reaction, laryngospasm, and hoarseness were recorded. In addition, the number of coughs was divided into three levels by its severity, and it was converted into an indicator of cough score. RESULTS: L group had a significantly lower number of cough and sore throat NRS (P value < 0.05) than the N group, and also hoarseness did not occur. The changes in the hemodynamic parameters, before and after the emergence of anesthesia, were more stable in the L group than those in the N group, but not statistically significant. CONCLUSIONS: The results of this study suggest that endotracheal administration of 1% lidocaine is effective and safe method to reduce cough and sore throat caused by extubation.


Subject(s)
Anesthesia , Anesthesia, General , Cough , Hemodynamics , Hoarseness , Humans , Incidence , Intubation, Intratracheal , Laryngismus , Lidocaine , Methods , Pharyngitis
20.
Article in English | WPRIM (Western Pacific) | ID: wprim-762255

ABSTRACT

BACKGROUND: The current evidence on the safe use of supraglottic airway for pediatric laparoscopic surgeries is limited. Although i-gel has been successfully used in adult laparoscopic surgeries, to our knowledge, no studies have compared it to the endotracheal tube (ETT) in pediatric laparoscopic surgeries. This study evaluated the effectiveness of i-gel over ETT with regards to the respiratory and hemodynamic parameters during pediatric laparoscopic surgeries. METHODS: A total of 60 pediatric patients undergoing elective laparoscopic surgeries were randomly allocated to either the i-gel or ETT groups. Anesthetics used included ketamine, sevoflurane, and rocuronium. The primary outcome measured was the peak airway pressure (PAP) and the secondary outcomes measured were leak fraction, end-tidal CO₂, respiratory rate, insertion time, heart rate, blood pressure and perioperative complications. RESULTS: The PAP during surgeries was higher in the ETT group than in the i-gel group. There were no statistically significant differences in the leak fraction, end-tidal CO₂, and respiratory rate. The i-gel group had a shorter insertion time compared with the ETT group. The changes in heart rate were comparable in both groups. However, systolic and diastolic pressures were higher in the ETT group following intubation, before and after the creation of pneumoperitoneum. The incidence of perioperative complications was similar in both groups. CONCLUSIONS: The i-gel provided adequate ventilation with lower PAP compared with ETT. In addition, it provided minimal hemodynamic changes compared with ETT. Therefore, the i-gel may provide a suitable alternative to ETT in pediatric laparoscopic surgeries.


Subject(s)
Adult , Anesthetics , Blood Pressure , Heart Rate , Hemodynamics , Humans , Incidence , Intubation , Intubation, Intratracheal , Ketamine , Laparoscopy , Pediatrics , Pneumoperitoneum , Respiratory Rate , Ventilation
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