Clinical utility of rapid shallow breathing index in predicting successful weaning: secondary analysis of the COBRE-US trial.

OBJECTIVE: To assess the predictive capacity of the Rapid Shallow Breathing Index (RSBI) for success in spontaneous breathing trials (SBT) and extubation in critically ill patients. We evaluated the association between RSBI, duration of mechanical ventilation, and ventilator-free time at 28 days. DESIGN: Prospective multicenter observational study. Secondary analysis of the COBRE-US study. SETTING: Intensive care unit (ICU). PATIENTS OR PARTICIPANTS: 367 patients in the ICU receiving invasive mechanical ventilation. INTERVENTIONS: Assessment of RSBI at the end of SBT. MAIN VARIABLES OF INTEREST: RSBI, SBT, duration of mechanical ventilation, and ventilator-free time at 28 days were evaluated. RESULTS: 367 patients in the ICU under invasive mechanical ventilation were evaluated, of whom 59.7% were male with a median age of 61 years (IQR: 49-72). A total of 456 SBT were conducted with a success rate of 76.5%. RSBI had a ROC-curve of 0.53 for SBT success and a ROC-curve of 0.48 for extubation. The Spearman correlation coefficient between RSBI and duration of ventilation was 0.117 (p = 0.026), while for ventilator-free time at 28 days, it was -0.116 (p = 0.028). CONCLUSIONS: RSBI was not associated with success in SBT or extubation, regardless of the cutoff point used. Correlation analyses showed weak associations between RSBI and both the duration of ventilation and ventilator-free time at 28 days.

Machine learning models based on ultrasound and physical examination for airway assessment.

PURPOSE: To demonstrate the utility of machine learning models for predicting difficult airways using clinical and ultrasound parameters. METHODS: This is a prospective non-consecutive cohort of patients undergoing elective surgery. We collected as predictor variables age, sex, BMI, OSA, Mallampatti, thyromental distance, bite test, cervical circumference, cervical ultrasound measurements, and Cormack-Lehanne class after laryngoscopy. We univariate analyzed the relationship of the predictor variables with the Cormack-Lehanne class to design machine learning models by applying the random forest technique with each predictor variable separately and in combination. We found each design's AUC-ROC, sensitivity, specificity, and positive and negative predictive values. RESULTS: We recruited 400 patients. Cormack-Lehanne patients≥III had higher age, BMI, cervical circumference, Mallampati class membership≥III, and bite test≥II and their ultrasound measurements were significantly higher. Machine learning models based on physical examination obtained better AUC-ROC values than ultrasound measurements but without reaching statistical significance. The combination of physical variables that we call the "Classic Model" achieved the highest AUC-ROC value among all the models [0.75 (0.67-0.83)], this difference being statistically significant compared to the rest of the ultrasound models. CONCLUSIONS: The use of machine learning models for diagnosing VAD is a real possibility, although it is still in a very preliminary stage of development. CLINICAL REGISTRY: ClinicalTrials.gov: NCT04816435.

Pulmonary strain and end-expiratory lung volume during apnea test: a comparative analysis using electrical impedance tomography / Stress pulmonar y volumen pulmonar de fin de es piración durante el test de apnea: estudio compara tivo utilizando tomografía por impedancia eléctrica

Abstract The apnea test, employed for brain death assessment, aims to demonstrate the absence of respiratory drive due to hypercapnia. The tracheal oxygen insufflation apnea test mode (I-AT) involves disconnecting the pa tient from invasive mechanical ventilation (iMV) for ap proximately 8 minutes while maintaining oxygenation. This test supports the diagnosis of brain death based on a specified increase in PaCO2. Common complications include hypoxemia and hemodynamic instability, and lung collapse-induced reduction in end-expiratory lung volume (EELV). In our case series utilizing electrical impedance to mography (EIT), we observed that continuous positive airway pressure during the apnea test (CPAP-AT) effec tively mitigated lung collapse. This resulted in improved pulmonary strain compared to the disconnection of iMV. These findings suggest the potential benefits of routine CPAP-AT, particularly for potential lung donors, emphasizing the relevance of our study in providing quantitative insights into EELV loss and its association with pulmonary strain and potential lung injury.

Resumen La prueba de apnea es una técnica diagnóstica am pliamente utilizada para la evaluación de la muerte cerebral, con el objetivo de demostrar la ausencia de impulso respiratorio debido a la hipercapnia. La variante de la prueba de apnea con insuflación de oxígeno traqueal (I-AT) implica desconectar al pacien te de la ventilación mecánica invasiva (iVM) durante aproximadamente 8 minutos, manteniendo la oxigena ción mediante un catéter de insuflación. Esta prueba respalda el diagnóstico de muerte cerebral cuando se determina un aumento de la PaCO2 superior a 20 mmHg en comparación con el valor inicial o un nivel de PaCO2 superior a 60 mmHg al final de la prueba. En nuestra serie de casos, la implementación de la tomografía de impedancia eléctrica (EIT) reveló que la prueba de apnea con presión positiva continua (CPAP-AT) mitiga eficazmente el colapso pulmonar. Este enfo que resulta en una mejora en la tensión pulmonar en comparación con la desconexión de iMV, demostrando su relevancia en el contexto de potenciales donantes de pulmones.

Evaluación del niño con estridor / Evaluation of the child with stridor

El estridor en niños es un síntoma que puede indicar una obstrucción en la vía aérea, siendo esencial comprender sus características y evolución. Este artículo destaca la importancia de la anamnesis detallada, la evaluación clínica y los estudios instrumentales para diagnosticar y tratar eficazmente las causas subyacentes del estridor. Se discuten las características del estridor, los signos de gravedad y los pasos para una evaluación adecuada, incluyendo la nasofaringolaringoscopía flexible y la laringotraqueobroncoscopía. Se concluye que una evaluación integral es fundamental para abordar el estridor en niños de manera óptima.

Stridor in children is a symptom that may indicate an obstruction in the airway, and it is essential to understand its characteristics and evolution. This article highlights the importance of a detailed history, clinical evaluation, and instrumental studies in effectively diagnosing and treating the underlying causes of stridor. The characteristics of stridor, signs of severity, and steps for proper evaluation, including flexible nasopharyngolaryngoscopy and laryngotracheobronchoscopy, are discussed. It concludes that a comprehensive evaluation is essential to address stridor in children optimally.

Executive Summary of the Spanish Society of Anesthesiology, Reanimation and Pain Therapy (SEDAR) Spanish Society of Emergency and Emergency Medicine (SEMES) and Spanish Society of Otolaryngology, Head and Neck Surgery (SEORL-CCC) Guideline for difficult airway management.

The Airway section of the Spanish Society of Anesthesiology, Reanimation and Pain Therapy (SEDAR), Spanish Society of Emergency and Emergency Medicine (SEMES) and Spanish Society of Otolaryngology, Head and Neck Surgery (SEORL-CCC) present the Guidelines for the integral management of difficult airway in adult patients. This document provides recommendations based on current scientific evidence, theoretical-educational tools and implementation tools, mainly cognitive aids, applicable to the treatment of the airway in the field of anesthesiology, critical care, emergencies and prehospital medicine. Its principles are focused on the human factors, cognitive processes for decision-making in critical situations and optimization in the progression of the application of strategies to preserve adequate alveolar oxygenation in order to improve safety and quality of care.

Mean airway pressure as a parameter of lung-protective and heart-protective ventilation.

Mean airway pressure (MAP) is the mean pressure generated in the airway during a single breath (inspiration + expiration), and is displayed on most anaesthesia and intensive care ventilators. This parameter, however, is not usually monitored during mechanical ventilation because it is poorly understood and usually only used in research. One of the main determinants of MAP is PEEP. This is because in respiratory cycles with an I:E ratio of 1:2, expiration is twice as long as inspiration. Although MAP can be used as a surrogate for mean alveolar pressure, these parameters differ considerably in some situations. Recently, MAP has been shown to be a useful prognostic factor for respiratory morbidity and mortality in mechanically ventilated patients of various ages. Low MAP has been associated with a lower incidence of 90-day mortality, shorter ICU stay, and shorter mechanical ventilation time. MAP also affects haemodynamics: there is evidence of a causal relationship between high MAP and low perfusion index, both of which are associated with poor prognosis in mechanically ventilated patients. Elevated MAP values have also been associated with high central venous pressure and lactate, which are indicative of ventilator-associated right ventricular failure and tissue hypoperfusion, respectively. MAP, therefore, is an important parameter to measure in clinical practice. The aim of this review has been to identify the determinants of MAP, the pros and cons of using MAP instead of traditional protective ventilation parameters, and the evidence that supports the use of MAP in clinical practice.

Guía de la Sociedad Española De Anestesiología, Reanimación y Terapéutica del Dolor (SEDAR), Sociedad Española de Medicina de Urgencias y Emergencias (SEMES) y Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (SEORL-CCC) para el manejo de la vía aérea difícil. Parte I / Spanish Society of Anesthesiology, Reanimation and Pain Therapy (SEDAR) Spanish Society of Emergency and Emergency Medicine (SEMES) and Spanish Society of Otolaryngology, Head and Neck Surgery (SEORL-CCC) Guideline for difficult airway management. Part I

La sección de Vía Aérea de la Sociedad Española De Anestesiología, Reanimación y Terapéutica del Dolor (SEDAR), la Sociedad Española de Medicina de Urgencias y Emergencias (SEMES) y la Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (SEORL-CCC) presentan la Guía para el manejo integral de la vía aérea difícil en el paciente adulto. Sus principios están focalizados en el factor humano, los procesos cognitivos para la toma de decisiones en situaciones críticas y la optimización en la progresión de la aplicación de estrategias para preservar una adecuada oxigenación alveolar con el objeto de mejorar la seguridad y la calidad asistencial. El documento proporciona recomendaciones basadas en la evidencia científica actual, herramientas teórico/educativas y herramientas de implementación, fundamentalmente ayudas cognitivas, aplicables al tratamiento de la vía aérea en el campo de la anestesiología, cuidados críticos, urgencias y medicina prehospitalaria. Para ello se realizó una amplia búsqueda bibliográfica según las directrices PRISMA-R y se analizó utilizando la metodología GRADE. Las recomendaciones se formularon de acuerdo con esta metodología. Las recomendaciones de aquellas secciones con evidencia de baja calidad se basaron en la opinión de expertos mediante consenso alcanzado a través de un cuestionario Delphi.(AU)

The Airway Management section of the Spanish Society of Anesthesiology, Resuscitation, and Pain Therapy (SEDAR), the Spanish Society of Emergency Medicine (SEMES), and the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) present the Guide for the comprehensive management of difficult airway in adult patients. Its principles are focused on the human factor, cognitive processes for decision-making in critical situations, and optimization in the progression of strategies application to preserve adequate alveolar oxygenation in order to enhance safety and the quality of care. The document provides evidence-based recommendations, theoretical-educational tools, and implementation tools, mainly cognitive aids, applicable to airway management in the fields of anesthesiology, critical care, emergencies, and prehospital medicine. For this purpose, an extensive literature search was conducted following PRISMA-R guidelines and was analyzed using the GRADE methodology. Recommendations were formulated according to the GRADE methodology. Recommendations for sections with low-quality evidence were based on expert opinion through consensus reached via a Delphi questionnaire.(AU)

Guía de la Sociedad Española De Anestesiología, Reanimación y Terapéutica del Dolor (SEDAR), Sociedad Española de Medicina de Urgencias y Emergencias (SEMES) y Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (SEORL-CCC) para el manejo de la vía aérea difícil. Parte II / Spanish Society of Anesthesiology, Reanimation and Pain Therapy (SEDAR) Spanish Society of Emergency and Emergency Medicine (SEMES) and Spanish Society of Otolaryngology, Head and Neck Surgery (SEORL-CCC) Guideline for difficult airway management. Part II

La sección de Vía Aérea de la Sociedad Española De Anestesiología, Reanimación y Terapéutica del Dolor (SEDAR), la Sociedad Española de Medicina de Urgencias y Emergencias (SEMES) y la Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (SEORL-CCC) presentan la Guía para el manejo integral de la vía aérea difícil en el paciente adulto. Sus principios están focalizados en el factor humano, los procesos cognitivos para la toma de decisiones en situaciones críticas y la optimización en la progresión de la aplicación de estrategias para preservar una adecuada oxigenación alveolar con el objeto de mejorar la seguridad y la calidad asistencial. El documento proporciona recomendaciones basadas en la evidencia científica actual, herramientas teórico/educativas y herramientas de implementación, fundamentalmente ayudas cognitivas, aplicables al tratamiento de la vía aérea en el campo de la anestesiología, cuidados críticos, urgencias y medicina prehospitalaria. Para ello se realizó una amplia búsqueda bibliográfica según las directrices PRISMA-R y se analizó utilizando la metodología GRADE. Las recomendaciones se formularon de acuerdo con esta metodología. Las recomendaciones de aquellas secciones con evidencia de baja calidad se basaron en la opinión de expertos mediante consenso alcanzado a través de un cuestionario Delphi.(AU)

The Airway Management section of the Spanish Society of Anesthesiology, Resuscitation, and Pain Therapy (SEDAR), the Spanish Society of Emergency Medicine (SEMES), and the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) present the Guide for the comprehensive management of difficult airway in adult patients. Its principles are focused on the human factor, cognitive processes for decision-making in critical situations, and optimization in the progression of strategies application to preserve adequate alveolar oxygenation in order to enhance safety and the quality of care. The document provides evidence-based recommendations, theoretical-educational tools, and implementation tools, mainly cognitive aids, applicable to airway management in the fields of anesthesiology, critical care, emergencies, and prehospital medicine. For this purpose, an extensive literature search was conducted following PRISMA-R guidelines and was analyzed using the GRADE methodology. Recommendations were formulated according to the GRADE methodology. Recommendations for sections with low-quality evidence were based on expert opinion through consensus reached via a Delphi questionnaire.(AU)

Carpogenic germination of Sclerotinia sclerotiorum sclerotia in Brassica oleracea var gemmifera (VN: Brussels sprouts) in North Patagonia, Argentina.

In August 2018, symptoms of apical and basal rot resembling those caused by Sclerotinia sclerotiorum infection were observed in a commercial Brussels sprouts field in North Patagonia, Argentina. The incidence of apical and basal rot was 23.30% and 2.30%, respectively. Carpogenic germination of sclerotia was detected in shaded, highly humid soil areas. To our knowledge, this is the first report of carpogenic germination of sclerotia from S. sclerotiorum in North Patagonia.

Guía de la Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor (SEDAR), Sociedad Española de Medicina de Urgencias y Emergencias (SEMES) y Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (SEORL-CCC) para el manejo de la vía aérea difícil. Parte I

The Airway Management section of the Spanish Society of Anesthesiology, Resuscitation, and Pain Therapy (SEDAR), the Spanish Society of Emergency Medicine (SEMES), and the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) present the Guide for the comprehensive management of difficult airway in adult patients. Its principles are focused on the human factors, cognitive processes for decision-making in critical situations, and optimization in the progression of strategies application to preserve adequate alveolar oxygenation in order to enhance safety and the quality of care. The document provides evidence-based recommendations, theoretical-educational tools, and implementation tools, mainly cognitive aids, applicable to airway management in the fields of anesthesiology, critical care, emergencies, and prehospital medicine. For this purpose, an extensive literature search was conducted following PRISMA-R guidelines and was analyzed using the GRADE methodology. Recommendations were formulated according to the GRADE methodology. Recommendations for sections with low-quality evidence were based on expert opinion through consensus reached via a Delphi questionnaire.

ChatGPT's learning and reasoning capacity in anesthesiology

Introduction: Over the past few months, ChatGPT has raised a lot of interest given its ability to perform complex tasks through natural language and conversation. However, its use in clinical decision-making is limited and its application in the field of anesthesiology is unknown. Objective: To assess ChatGPT's basic and clinical reasoning and its learning ability in a performance test on general and specific anesthesia topics. Methods: A three-phase assessment was conducted. Basic knowledge of anesthesia was assessed in the first phase, followed by a review of difficult airway management and, finally, measurement of decision-making ability in ten clinical cases. The second and the third phases were conducted before and after feeding ChatGPT with the 2022 guidelines of the American Society of Anesthesiologists on difficult airway management. Results: On average, ChatGPT succeded 65% of the time in the first phase and 48% of the time in the second phase. Agreement in clinical cases was 20%, with 90% relevance and 10% error rate. After learning, ChatGPT improved in the second phase, and was correct 59% of the time, with agreement in clinical cases also increasing to 40%. Conclusions: ChatGPT showed acceptable accuracy in the basic knowledge test, high relevance in the management of specific difficult airway clinical cases, and the ability to improve after learning.

Introducción: En los últimos meses, ChatGPT ha suscitado un gran interés debido a su capacidad para realizar tareas complejas a través del lenguaje natural y la conversación. Sin embargo, su uso en la toma de decisiones clínicas es limitado y su aplicación en el campo de anestesiología es desconocido. Objetivo: Evaluar el razonamiento básico, clínico y la capacidad de aprendizaje de ChatGPT en una prueba de rendimiento sobre temas generales y específicos de anestesiología. Métodos: Se llevó a cabo una evaluación dividida en tres fases. Se valoraron conocimientos básicos de anestesiología en la primera fase, seguida de una revisión del manejo de vía aérea difícil y, finalmente, se midió la toma de decisiones en diez casos clínicos. La segunda y tercera fases se realizaron antes y después de alimentar a ChatGPT con las guías de la Sociedad Americana de Anestesiólogos del manejo de la vía aérea difícil del 2022. Resultados: ChatGPT obtuvo una tasa de acierto promedio del 65 % en la primera fase y del 48 % en la segunda fase. En los casos clínicos, obtuvo una concordancia del 20 %, una relevancia del 90 % y una tasa de error del 10 %. Posterior al aprendizaje, ChatGPT mejoró su tasa de acierto al 59 % en la segunda fase y aumentó la concordancia al 40 % en los casos clínicos. Conclusiones: ChatGPT demostró una precisión aceptable en la prueba de conocimientos básicos, una alta relevancia en el manejo de los casos clínicos específicos de vía aérea difícil y la capacidad de mejoría secundaria a un aprendizaje.

Should videolaryngoscopy be routinely used for airway management? An approach from different scenarios in medical practice

During the past two decades, the videolaryngoscope (VDL) has become a valuable and effective tool for the management of the airway, not just in the realm of anesthesiology, but also in other medical specialties in clinical scenarios requiring tracheal intubation. In countries such as the United States, this represents over 15 million cases in the operating room and 650,000 outside the OR. The overall accumulated incidence of difficult airway is 6.8% events in routine practice and between 0.1 and 0.3 % of failed intubations, both associated with complications such as desaturation, airway injury, hemodynamic instability and death. Notwithstanding the fact that the VDL has proven advantages such as improved visualization of the glottis, higher first attempt success rates, and a shortened learning curve, most of the time its use is limited to rescue attempts or as a secondary option. The aim of this article is to comment the advantages and limitations of the VDL vs. the direct laryngoscope in a wide range of clinical settings, including the operating room, intensive care units, emergency departments, pediatrics, obstetrics, and Covid-19 to consider its routine use.

En las últimas dos décadas, el videolaringoscopio (VDL) se ha convertido en una herramienta valiosa y eficaz para el manejo de la vía aérea no solo en el ámbito de anestesiología, sino en otras especialidades médicas durante escenarios clínicos que requieren la intubación traqueal y las cuales, en países como Estados Unidos corresponden anualmente a más de 15 millones dentro de salas de cirugía y 650.000 fuera de ella. Aproximadamente, hay una incidencia global acumulada de 6,8 % de eventos de vía aérea difícil en la práctica rutinaria y 0,1 al 0,3 % de intubaciones fallidas, ambas asociadas a complicaciones como desaturación, daño en la vía aérea, inestabilidad hemodinámica y muerte. Pese a que el VDL ha demostrado ventajas como mejoría de la visualización de la glotis, aumento de tasa de éxito al primer intento y menor curva de aprendizaje, su uso en la mayoría de las veces se ve limitado como dispositivo de rescate o de manera secundaria. El propósito de este artículo es comentar acerca de las ventajas y limitaciones del VDL vs. el laringoscopio directo en un variado número de escenarios clínicos, como salas de cirugía, unidades de cuidado intensivo, emergenciología, pediatría, obstetricia y covid-19, con el fin de considerar si su uso debiera hacerse de manera rutinaria.

Cambios en Mecánica Respiratoria en Usuarios Pediátricos en Ventilación Mecánica Post Cirugía de Cardiopatía Congénita Sometidos a Kinesiología Respiratoria versus Succión Endotraqueal. Revisión Estructurada / Changes in Respiratory Mechanics in Pediatric Users on Mechanical Ventilation Post Congenital Heart Disease Surgery Undergoing Respiratory Kinesiology versus Endotracheal Suction. Structured Review

Introducción. Las cardiopatías congénitas (CC) en Chile corresponden a la segunda causa de muerte en menores de 1 año, requiriendo cirugías paliativas y/o correctivas el 65% de estas. En el post operatorio frecuentemente se utiliza ventilación mecánica invasiva (VM) y succión endotraqueal (SET) para remover secreciones. Sin embargo, la kinesiología respiratoria (KTR) ha mostrado mejoras significativas en la distensibilidad toracopulmonar (Cest) y resistencia de vía aérea (Rva) en otros grupos de usuarios pediátricos y adultos en VM. Objetivo. Comparar los cambios en la Cest y Rva en usuarios pediátricos en VM post cirugía de cardiopatía congénita (CCC) sometidos a KTR versus SET exclusiva. Métodos. Revisión sistemática de estudios publicados en bases de datos PUBMED, PeDro, Scielo y Google Scholar que comparan el uso de KTR ó SET sobre los cambios en mecánica ventilatoria en usuarios pediátricos en VM post cirugía de cardiopatía congénita, limitados a inglés, español y portugués, excluyendo a sujetos con traqueostomía o con oxigenación por membrana extracorpórea. Se utilizó guía PRISMA para la selección de artículos. Se revisaron 397 artículos y se seleccionó 1 artículo extra de los artículos sugeridos. Se eliminó 1 artículo por duplicidad. Por títulos y resúmenes se seleccionaron 2 artículos, los cuales al leer el texto completo fueron retirados debido a que la población no correspondía a cardiópatas. Resultados. El final de artículos seleccionados fue de 0 artículos, debido a lo cual se removió el operador Booleano "NOT", y se removió la población de cardiopatías. De este modo quedaron 2 artículos seleccionados para la revisión cualitativa final donde se compara KTR versus SET, y KTR en kinesiólogos especialistas y no especialistas, mostrando ambos aumento en la Cest y disminución de la Rva a favor de la KTR, hasta los 30 minutos post intervención. Conclusiones. No se encontraron artículos que demuestren cambios en Cest y Rva con el uso de KTR + SET versus SET exclusiva, en usuarios pediátricos ventilados posterior a CCC. Con la remoción de filtros seleccionamos 2 artículos que demuestran aumento de Cest y disminución de Rva en sujetos pediátricos en VM, uno comparando con SET, y por grupos de especialistas y no especialistas en respiratorio. Se sugieren estudios primarios para evaluar los efectos de esta intervención en esta población.

Introduction. Congenital heart diseases (CHD) are the second general cause for children death under 1 year. In Chile, approximately 65% CHD need surgery, could was palliative or corrective. In the postoperative period, invasive mechanical ventilation (MV) is frequently used as a life support method, but it is associated with complications. Tracheal suction (SET) is regularly used to remove secretions; however, respiratory chest physiotherapy (KTR) has shown significant improvements in thoraco-pulmonary compliance and airway resistance in other groups of pediatrics and adult's users in MV. Objetive. to compare changes in thoraco-pulmonary compliance and airway resistance in pediatric subjects under mechanical ventilation after congenital heart disease surgery comparing chest physiotherapy and exclusive tracheal suction. Methods. systematic review of studies published in PUBMED, PeDro, Scielo and Google Scholar databases who compares KTR or SET use on changes in ventilatory mechanics in pediatric users under MV after congenital heart disease surgery, limited to English, Spanish and Portuguese languages, excluding user with tracheostomy or extracorporeal membrane of oxygenation. It was use the PRISMA guide to articles selection. A search was carried out, with a total of 397 articles reviewed (English: PubMed = 3, PeDro = 8, Scholar = 383; Spanish: Scholar = 3, Scielo = 0; and Portuguese: Scielo = 0). One extra article was selected from the suggested articles, and 1 article was eliminated due to duplication. By titles and abstracts, 2 articles were selected, but the population did not correspond to heart disease. Results. the final selected articles were 0 articles. By this reason, it were removed: Boolean operator "NOT", and congenital heart disease population. Thus, 2 articles were selected for the final qualitative review where it was compares KTR versus SET, and KTR by specialist and non-specialist. Both articles shown improvement in compliance and resistance until 30 minutes post intervention. The CC population was in a 40 to 60% range in both studies. Conclusions. it was no found articles that demonstrate changes in compliance and resistance in the airway with the use of KTR + SET versus exclusive SET in pediatric users after CCC connected to MV. After filter remotion, we found 2 studies shown improves in increase compliance and reduce resistance in pediatric user in MV, ones comparing with SET, and the other one comparing between specialists in respiratory pediatric physiotherapy and not specialists. It suggests to made primary clinical studies about this intervention in CC population.

Spanish Society of Anesthesiology, Reanimation and Pain Therapy (SEDAR), Spanish Society of Emergency and Emergency Medicine (SEMES) and Spanish Society of Otolaryngology, Head and Neck Surgery (SEORL-CCC) Guideline for difficult airway management. Part I.

The Airway Management section of the Spanish Society of Anesthesiology, Resuscitation, and Pain Therapy (SEDAR), the Spanish Society of Emergency Medicine (SEMES), and the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) present the Guide for the comprehensive management of difficult airway in adult patients. Its principles are focused on the human factors, cognitive processes for decision-making in critical situations, and optimization in the progression of strategies application to preserve adequate alveolar oxygenation in order to enhance safety and the quality of care. The document provides evidence-based recommendations, theoretical-educational tools, and implementation tools, mainly cognitive aids, applicable to airway management in the fields of anesthesiology, critical care, emergencies, and prehospital medicine. For this purpose, an extensive literature search was conducted following PRISMA-R guidelines and was analyzed using the GRADE methodology. Recommendations were formulated according to the GRADE methodology. Recommendations for sections with low-quality evidence were based on expert opinion through consensus reached via a Delphi questionnaire.

Spanish Society of Anesthesiology, Reanimation and Pain Therapy (SEDAR), Spanish Society of Emergency and Emergency Medicine (SEMES) and Spanish Society of Otolaryngology, Head and Neck Surgery (SEORL-CCC) Guideline for difficult airway management. Part II.

The Airway Management section of the Spanish Society of Anesthesiology, Resuscitation, and Pain Therapy (SEDAR), the Spanish Society of Emergency Medicine (SEMES), and the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) present the Guide for the comprehensive management of difficult airway in adult patients. Its principles are focused on the human factors, cognitive processes for decision-making in critical situations, and optimization in the progression of strategies application to preserve adequate alveolar oxygenation in order to enhance safety and the quality of care. The document provides evidence-based recommendations, theoretical-educational tools, and implementation tools, mainly cognitive aids, applicable to airway management in the fields of anesthesiology, critical care, emergencies, and prehospital medicine. For this purpose, an extensive literature search was conducted following PRISMA-R guidelines and was analyzed using the GRADE methodology. Recommendations were formulated according to the GRADE methodology. Recommendations for sections with low-quality evidence were based on expert opinion through consensus reached via a Delphi questionnaire.

Extubation failure: Upper airway obstruction by chewing gum. A case report.

Extubation failure can result from different complications, mostly well described in the literature such as laryngeal edema. Airway obstruction by foreign bodies is a less frequent and unexpected complication and its detection remains a challenge to healthcare professionals. In this case-report, we describe a patient admitted in an intensive care unit following a motor vehicle accident and who underwent an extubation failure and tracheostomy placement due to a misdiagnosed obstruction of a foreign body in the upper airway. Thus, screening of foreign bodies should be considered with a careful interpretation of medical imagery and clinical evaluation in these patients. Finally, cuff leak test, ultrasonography and videolaryngoscopy can be important adjuvants to the identification of suspected foreign bodies.

Tumor glómico de la vía aérea y resección carinal, a propósito de un caso

Introducción: describir caso infrecuente de tumor glómico pulmonar que compromete tráquea y bronquio principal derecho con síntomas respiratorios. Los tumores glómicos (GT) de la tráquea son una enfermedad infrecuente, se originan a partir de células musculares lisas modificadas. Los pacientes presentan síntomas inespecíficos como tos, disnea o hemoptisis. Se han reportado tratamientos quirúrgicos, incluyendo toracotomía y resección por fibrobroncoscopia. No hay duda de que la cirugía es el tratamiento de elección, sin embargo, pocos estudios han evaluado el tratamiento ideal para los (GT) traqueales. Caso Clínico: Describimos un caso de (GT) originado en la vía aérea, mujer de 62 años que presentó tos y expectoración durante 7 días, había sido diagnosticada de tumor endotraqueal por tomografía computada. La resección tumoral se intentó mediante broncoscopía, pero presentó bordes positivos, por lo que se realizó resección traqueal quirúrgica y anastomosis. La paciente logró buenos resultados y no se observó recurrencia en un seguimiento de 10 meses. Este es el tercer informe de (GT) originado en vía aérea (tráquea y bronquio principal derecho).

Introduction: Glomus tumors (GTs) of the trachea are a rare soft tissue disease, originating from modified smooth muscle cells. Patients are usually presented with nonspecific symptoms such as cough, dyspnea or hemoptysis. Surgical treatment has been reported, including thoracotomy and bronchoscopic electrocautery, there is no doubt that surgery is the treatment of choice, however few studies have evaluated the ideal treatment for tracheal GTs. Case Report: We describe a case of glomus tumor originated at large airway, a 62-year-old woman who presented with cough, and expectoration for 7 days, had been diagnosed as having a tracheal tumor by thoracic computed tomography. Tumor resection was attempted by fiberoptic bronchoscopy but there were positive edges, therefore surgical tracheal resection and anastomosis were performed. The patient achieved good results and no recurrence was observed during a 10-month follow-up. This is the third report of glomus tumor of the tracheal originated at large airway (trachea and right main bronchus).

Complicaciones y grado de dificultad de la intubación orotraqueal en la unidad de cuidados intensivos pre-post instauración de un protocolo de intubación para el paciente crítico. Estudio prospectivo y observacional / Complications and degree of difficulty of orotracheal intubation in the intensive care unit before and after the establishment of an intubation protocol for critically ill patients: A prospective, observational study

Objetivo: El objetivo de nuestro estudio fue comparar el grado de dificultad y las complicaciones relacionadas con la intubación orotraqueal en una unidad de cuidados intensivos (UCI), pre y post instauración de un protocolo de intubación basado en la guía de práctica clínica para el manejo de la vía aérea difícil específica para el paciente crítico, publicada en 2018 por la Difficult Airway Society (Reino Unido). Métodos: Estudio prospectivo, observacional, comparando todas las intubaciones realizadas en nuestra UCI en un periodo pre-protocolo (enero 2015-enero 2019) con un periodo post-protocolo (febrero 2019-julio 2022). Durante el procedimiento se registró el material utilizado para la intubación, el grado de dificultad de la intubación y las complicaciones asociadas. Resultados: Durante el periodo de estudio fueron intubados 661 pacientes: 437 en el periodo pre-protocolo (laringoscopia directa 96%) y 224 en el post-protocolo (laringoscopia directa 53%, videolaringoscopio 46%). En el periodo post-protocolo observamos una mejoría de la visión laringoscópica en comparación con el pre-protocolo (Cormack-Lehane ≥2b en el 7,6% vs 29,8%, p<0,001), y una disminución de las intubaciones calificadas de dificultad moderada-severa (6,7% vs 17,4%, p<0,001). La intubación al primer intento fue del 92,8% en el periodo post-protocolo frente al 90,2% pre-protocolo (p=0,508). No encontramos diferencias significativas en las complicaciones en los dos periodos estudiados. Conclusiones: Las intubaciones realizadas en el periodo post-protocolo se han asociado a una mejoría de la visión laringoscópica y a una menor dificultad de intubación en comparación con el periodo pre-protocolo.(AU)

Objective: The objective of our study was to compare the degree of difficulty and complications related to tracheal intubation in an intensive care unit (ICU) before and after the introduction of an intubation protocol based on the Difficult Airway Society guidelines for the management of tracheal intubation in critically ill adults, published in 2018. Methods: Prospective, observational study comparing all intubations performed in our ICU over two periods: pre-protocol (January 2015-January 2019) and post-protocol (February 2019-July 2022). The material used for intubation, the degree of difficulty, and intubation-related complications were recorded. Results: During the study period, 661 patients were intubated —437 in the pre-protocol period (96% by direct laryngoscopy) and 224 in the post-protocol period (53% with direct laryngoscopy, 46% with video laryngoscopy). We observed an improvement in laryngeal view in the post-protocol period compared to the pre-protocol period (Cormack-Lehane ≥2b in 7.6% vs 29.8%, P<.001), and a decrease in the number of moderate-to-severely difficult intubations (6.7% vs 17.4%, P<.001). The first-pass success rate was 92.8% in the post-protocol period compared to 90.2% pre-protocol (P=.508). We did not find significant differences in complications between the periods studied. Conclusions: Intubations performed in the post-protocol period were associated with improved laryngeal view and fewer cases of difficult intubation compared with the pre-protocol period.(AU)

Uso de una guía de punta flexible (FlexTip) para manejar el fallo del primer intento de intubación con el videolaringoscopio C-MAC D-Blade en la unidad de cuidados intensivos: serie prospectiva de casos / Use of a flexible tip bougie (FlexTip) in the management of the first-attempt failure intubation with the C-MAC D-Blade videolaryngoscope in the intensive care unit: A prospective, case series

Describimos una serie de 11 casos en los que hemos utilizado la nueva guía de punta flexible (FlexTip) como rescate tras el fallo de un primer intento de intubación con el videolaringoscopio C-MAC D-Blade en nuestra UCI. Durante un periodo de 16 meses se recogieron datos de todas las intubaciones donde se utilizó el videolaringoscopio C-MAC D-Blade. Noventa y un pacientes fueron incluidos en el estudio, donde 79 (86,8%) fueron intubados al primer intento, 11 (12,1%) necesitaron 2 intentos, y un paciente necesitó 3 intentos. Entre los 12 pacientes que necesitaron más de un intento de intubación, en un paciente se utilizó una guía «Frova», y en el resto, la nueva guía de punta flexible (FlexTip). En la presente investigación observamos que la nueva guía de punta flexible (FlexTip) puede ser una buena opción para aquellos casos en los que con un videolaringoscopio no somos capaces de intubar en el primer intento.(AU)

We describe a series of 11 cases in which we used the new flexible tip (FlexTip) bougie as a rescue device following first-attempt failure at intubation with the C-MAC D-Blade video laryngoscope in our UCI. We collected data from all intubations performed using the C-MAC D-Blade video laryngoscope over a 16-month period. Ninety six patients were included in the study: 79 (86.8%) were intubated at the first attempt; 11 (12.1%) required 2 attempts; and one patient required 3 attempts. The Frova Intubating Introducer was used in one of the 12 patients requiring more than one intubation attempt, and the FlexTip was used in the remaining 11. This study shows that the new FlexTip bougie is a good rescue device when the first attempt at video laryngoscope intubation fails.(AU)

Improvement in intubation success during COVID-19 pandemic with a simple and low-cost intervention: A quasi-experimental study / Mejoría del éxito en la intubación durante la pandemia covid-19 con una intervención simple y de bajo costo: estudio cuasi-experimental

Objectives: primary objective: to improve the FPS rates after an educational intervention. Secondary objective: to describe variables related to FPS in an ED and determine which ones were related to the highest number of attempts.Design it was a prospective quasi-experimental study. Setting done in an ED in a public Hospital in Argentina. Patients there were patients of all ages with intubation in ED. Interventionsin the middle of the study, an educational intervention was done to improve FPS. Cognitive aids and pre- intubation Checklists were implemented. Main variables of interest the operator experience, the number of intubation attempts, intubation judgment, predictors of a difficult airway, Cormack score, assist devices, complications, blood pressure, heart rate, and pulse oximetry before and after intubation All the intubations were done by direct laryngoscopy (DL). Results data from 266 patients were included of which 123 belonged to the basal period and 143 belonged to the post-intervention period. FPS percentage of the pre-intervention group was 69.9% (IC95%: 60.89–77.68) whereas the post-intervention group was 85.3% (IC95%: 78.20–90.48). The difference between these groups was statistically significant (p=0.002). Factors related to the highest number of attempts were low operator experience, Cormack-Lehane 3 score and no training. Conclusions a low-cost and simple educational intervention in airway management was significantly associated with improvement in FPS, reaching the same rate of FPS than in high income countries. (AU)

Objetivos: objetivo principal: mejorar la tasa de éxito de intubación luego de una intervención educativa. Objetivo secundario: describir las variables asociadas con el éxito en el primer intento (EPI) y determinar cuáles se relacionaron con mayor número de intentos. Diseño estudio prospectivo cuasi-experimental. Ámbito: realizado en un SE de un Hospital público de Argentina. Pacientes se incluyeron todos aquellos pacientes intubados en el SE en el período de estudio. Intervención en la mitad del estudio, se realizó una intervención educativa, se implementaron ayudas cognitivas y listas de verificación preintubación. Todas las intubaciones se realizaron por laringoscopia directa. Variables de interés principales experiencia del operador, número de intentos de intubación, criterios de intubación, predictores de vía aérea difícil, grado de Cormack, dispositivos facilitadores utilizados, complicaciones y los signos vitales antes y después de la intubación. Resultados se incluyeron datos de 266 pacientes de los cuales 123 pertenecían al período basal y 143al período postintervención. El porcentaje de éxito del grupo preintervención fue del 69,9% (IC95%: 60,89-77,68) mientras que el grupo postintervención fue del 85,3% (IC95%: 78,20-90,48). La diferencia entre estos grupos fue estadísticamente significativa (p=0,002). Los factores relacionados con el mayor número de intentos fueron la baja experiencia del operador, el grado de Cormack-Lehane 3 y la falta de capacitación. Conclusiones una intervención educativa simple y de bajo costo en el manejo de la vía aérea se asoció significativamente con la mejora en el éxito del primer intento de intubación, alcanzando los porcentajes de los países de altos ingresos. (AU)