Application of three airway devices during emergency medical training by health care providers--a manikin study.

OBJECTIVE: The aim of this study was to evaluate the use of the Combitube (Kendall, Neustadt, Germany), Easytube (Rüsch, Kernen, Germany), and Laryngeal tube (VBM, Sulz, Germany) by health care providers with different experience in airway management. METHODS: This manikin study consisted of 2 sessions. In the first session, each participant received training in the use of the Combitube, Easytube, and Laryngeal tube. In the second session, each participant repeated the initial trial 4 weeks after the first session without further instruction or training. Time until successful insertion, success rate, level of education, and professional experience were recorded. RESULTS: The median time for insertion of the Combitube (P < .001) or the Easytube (P < .001) was significantly longer than for the Laryngeal tube. Success rate for the Combitube (P < .001) and the Easytube (P < .001) was lower than for the Laryngeal tube. There was no correlation between either years of professional experience and median time for successful insertion, or level of education and the number of unsuccessful insertions. Furthermore, there was no significant difference in the time for insertion between the first and the second sessions. CONCLUSION: Regarding the time required for successful placement and success rate, Laryngeal tube seems to be superior compared to Combitube and Easytube in a manikin model. The use of all 3 devices can be easily learned and is independent of previous experience in airway management. The present findings suggest good skill retention for the Laryngeal tube.

Goal-directed fluid management reduces vasopressor and catecholamine use in cardiac surgery patients.

OBJECTIVE: We examined whether guiding therapy by an algorithm based on optimizing the global end-diastolic volume index (GEDVI) reduces the need for vasopressor and inotropic support and helps to shorten ICU stay in cardiac surgery patients. DESIGN AND SETTING: Single-center clinical study with a historical control group at an university hospital. PATIENTS: Forty cardiac bypass surgery patients were included prospectively and compared with a control group. INTERVENTIONS: In the goal-directed therapy (GDT) group hemodynamic management was guided by an algorithm based on GEDVI. Hemodynamic goals were: GEDVI above 640 ml/m2, cardiac index above 2.5 l/min/m2, and mean arterial pressure above 70 mmHg. The control group was treated at the discretion of the attending physician based on central venous pressure, mean arterial pressure, and clinical evaluation. RESULTS: In the GDT group duration of catecholamine and vasopressor dependence was shorter (187+/-70 vs. 1458+/-197 min), and fewer vasopressors (0.73+/-0.32 vs. 6.67+/-1.21 mg) and catecholamines (0.01+/-0.01 vs. 0.83+/-0.27mg) were administered. They received more colloids (6918+/-242 vs. 5514+/-171ml). Duration of mechanical ventilation (12.6+/-3.6 vs. 15.4+/4.3 h) and time until achieving status of fit for ICU discharge (25+/-13 vs. 33+/-17h) was shorter in the GDT group. CONCLUSIONS: Guiding therapy by an algorithm based on GEDVI leads to a shortened and reduced need for vasopressors, catecholamines, mechanical ventilation, and ICU therapy in patients undergoing cardiac surgery.