Temat: intubation - Prolib Integro

Skocz do pozycji: 1.

Tytuł:: A proposal of a cheap and simple method of medical personnel protection for endotracheal intubation of patients with a suspected or confirmed COVID-19 infection
Autorzy:: Gaszyński, Tomasz
Fedorczak, Michał
Pondel, Jakub
Tematy:: intubation
infection
personal protective equipment
airway management
COVID-19
intubation barrier; Pokaż więcej
Wydawca:: Instytut Medycyny Pracy im. prof. dra Jerzego Nofera w Łodzi
Powiązania:: https://bibliotekanauki.pl/articles/2086093.pdf Link otwiera się w nowym oknie
Opis:: ObjectivesThe COVID-19 pandemic has created additional risks to healthcare providers, especially those who perform aerosol generating procedures (AGPs) like endotracheal intubation. Endotracheal intubation is one of the procedures mostly generating aerosol and, therefore, requiring full protection of medical personnel against the infection.Material and MethodsIn this paper, basing on a literature review, the recommended intubation procedure is presented together with recommendations for personal protection during intubation. Additionally, a proposal of a simple and cheap protective barrier is described against spreading aerosol outside the intubation area. The aim was to propose a simple and cheap method to increase the safety of medical personnel performing AGPs in patients infected or suspected of being infected with COVID-19, which could be easily introduced into clinical practice.ResultsThe presented method is the authors’ own idea, based on their experience gathered from working in an operating room. Judging from their clinical experience, the presented method is effective and safe for patients.ConclusionsEndotracheal intubation is one of the most common AGPs and adequate actions must be taken in order to protect medical personnel against the infection and to prevent the spreading of aerosol around the intubation area. The proposed barrier is easy to set with disposable materials and standard equipment available in every operating room.
Dostawca treści:: Biblioteka Nauki

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Skocz do pozycji: 2.

Tytuł:: Evaluation of ultrasound guided measurement of tongue thickness in predicting difficult intubation in obese patients
Autorzy:: Kachru, Nisha
Singh, Dheeraj
Yadav, Rupesh
Gupta, Jyoti
Saraswat, Namita
Wydawca:: Towarzystwo Pomocy Doraźnej
Cytata wydawnicza:: Singh D, Kachru N, Gupta J, Saraswat N, Yadav R. Evaluation of ultrasound guided measurement of tongue thickness in predicting difficult intubation in obese patients. Crit. Care Innov. 2024; 7(4): 23-31. DOI: 10.32114/CCI.2024.7.4.23.31
Opis:: INTRODUCTION: Managing the airway presents a significant challenge in anesthesia, particularly in obese patients, and is a leading cause of morbidity and mortality associated with anesthesia. Although increased tongue thickness in the obese is generally assumed to be associated with a difficult intubation. So that aim of this study was to evaluate ultrasound guided measurement of tongue thickness in predicting difficult tracheal intubation in obese patients. MATERIALS AND METHODS: Study included 45 patients aged 18 to 65 of any gender. These patients, classified as American Society of Anesthesiologists Grade I and II, had a Body mass index exceeding 30 kg/m2. Tongue thickness was evaluated using ultrasound, measuring the distance from the tongue surface to the submental skin, while also documenting the modified Mallampatti score (MMP). Number of attempts for intubation, time taken for intubation and use of any alternate device or technique were noted. RESULTS: The tongue thickness cutoff for predicting difficult intubation was determined to be 6.5 cm. The Receiver operating characteristic (ROC) curve analysis revealed an AUC (Area under the ROC Curve) of 0.920 (Standard Error: 0.230, 95% Confidence interval: 0.850-0.950) for a cutoff value exceeding 6.5 cm, indicating excellent predictive capability. Tongue thickness demonstrated a combined diagnostic accuracy of 95.5%, with sensitivity and specificity of 75% and 97.5% respectively. MMP grade was compared with tongue thickness, a positive correlation was seen with co-efficient of 0.45. There was a statistically significance (p value <0.001). CONCLUSIONS: This study concludes that ultrasound guided measurement of tongue thickness > 6.5 cm can reliably predict difficult tracheal intubation in obese patients.
Dostawca treści:: Repozytorium Centrum Otwartej Nauki

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Skocz do pozycji: 3.

Tytuł:: Efficacy of three different doses of esmolol to attenuate the response of hemodynamic stress to laryngoscopy and endotracheal intubation in general anaesthesia surgeries - a controlled randomized comparative study
Autorzy:: Yadav, Rupesh
Singla, Pooja
Chaudhary, Lalita
Wydawca:: Towarzystwo Pomocy Doraźnej
Cytata wydawnicza:: Crit. Care Innov. 2025; 8(2): 12-20
Opis:: INTRODUCTION: Laryngoscopy and endotracheal intubation are essential procedures in patients undergoing surgery under general anaesthesia. However, they are invariably associated with a hemodynamic stress response, characterised by cardiovascular alterations such as tachycardia, hypertension, and a range of cardiac arrhythmias. In vulnerable individuals, these responses may have serious consequences, including perioperative myocardial ischemia, acute heart failure, and cerebrovascular accidents. Consequently, the present study aims to evaluate the efficacy of three different doses of Esmolol in attenuating the hemodynamic stress response to laryngoscopy and endotracheal intubation. MATERIALS AND METHODS: A prospective, randomised, comparative study was conducted involving 54 patients, who were randomly assigned to three groups of 18 each using a computer generated randomization sequence: Group E1 received a single intravenous (IV) bolus dose of Esmolol 0.8 mg/kg, Group E2 received Esmolol 1 mg/kg IV, and Group E3 received Esmolol 1.5 mg/kg IV. The study drugs by administered as a bolus injection two minutes after Vecuronium bromide. The hemodynamic parameters, heart rate (HR) and mean arterial pressure (MAP), were recorded at baseline (on arrival in the operating room), and at 1, 3, and 5 minutes after laryngoscopy and intubation. Additionally, venous blood samples were collected to assess serum cortisol and blood glucose levels at baseline and 5 minutes post-intubation. RESULTS: At baseline, MAP, HR, serum cortisol, and blood glucose levels were similar between the groups (p>0.05). At 1 minute after intubation, MAP was lower in Group E3 (68.4 mmHg) compared to Groups E1 (98.11 mmHg) and E2 (97.48 mmHg) (p<0.001). HR was highest in Group E1 (89.17 bpm), followed by Group E2 (85.56 bpm), and lowest in Group E3 (79.22 bpm) (p=0.006). At 5 minutes after intubation, both serum cortisol and blood glucose levels differed significantly between groups (p<0.001). CONCLUSIONS: All three Esmolol doses effectively attenuated the hemodynamic stress response to laryngoscopy and intubation. However, the 1.5 mg/kg dose was most effective, showing the greatest reduction in heart rate and blood pressure. It also causes a metabolic stress response but with lesser increases in serum cortisol and blood glucose.
Dostawca treści:: Repozytorium Centrum Otwartej Nauki

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Skocz do pozycji: 4.

Tytuł:: Emergency bronchoscopy in a child with critical airway stenosis after tracheostomy: a case report.
Autorzy:: Shubhra
Yadav, Amlendu
Yadav, Rupesh
Wydawca:: Towarzystwo Pomocy Doraźnej
Cytata wydawnicza:: Shubhra, Yadav A, Yadav R. Emergency bronchoscopy in a child with critical airway stenosis after tracheostomy: a case report. Crit. Care Innov. 2024; 7(2): 55-60.
Opis:: Tracheal stenosis can develop as a consequence of prolonged endotracheal intubation or tracheostomy. A 14-year-old child had a history of left frontotemporal craniotomy after a fall from height one month later and tracheostomy was performed on the sixth postoperative day and decannulation was performed 20 days later. On the fifth day of post-decannulation, the child came to the emergency department with a complaint of difficulty breathing since three days. The patient was immediately moved to emergency operation theater. The patient was intubated with a 6 mm endotracheal tube, but no adequate tidal volume was delivered. Bronchoscopy was performed in the operating room. It showed a smooth, circumferential web 2 cm above the carina (supracarinal stenosis). To achieve ventilatory goals, a 6 mm endotracheal tube was removed and a microlayrngoscopy tube (MLS) of size 5.5 mm was negotiated with deflated cuff. Since the MLS tube was longer, it reached the proximal limit of the narrowed portion of the trachea. There was improvement in ventilation. To achieve proper ventilation, circumferential web was planned. The patient underwent emergency balloon dilation of trachea through rigid bronchoscopy. The balloon catheter was introduced into the bronchoscope, and the balloon was then inflated. As the balloon was inflated, it leads to stretching of the soft tissue and widening of the supracarinal space. The dilatation procedure / ballooning improved the ventilation dynamics. An endotracheal tube of 6mm size was inserted, and endotracheal tube was fixed beyond the stenotic segment above the carina to prevent recurrence of narrowing due to edema after the procedure. After balloon dilation, the patient was shifted to intensive care unit (ICU). The patient was extubated 24 hours after surgery. On the second postoperative day, the patient shifts from the ICU to the ward and on the fifth postoperative day, the patient was discharged from the hospital with the advice that repeated dilation may be required and dates for future follow-up. We present a case of emergency bronchoscopy in a child with critical airway stenosis after tracheostomy that was successfully managed.
Dostawca treści:: Repozytorium Centrum Otwartej Nauki

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Skocz do pozycji: 5.

Tytuł:: Emergency bronchoscopy in a child with critical airway stenosis after tracheostomy: a case report
Autorzy:: Shubhra
Yadav, Amlendu
Yadav, Rupesh
Tematy:: Endotracheal intubation
tracheostomy
supracarinal stenosis
bronchoscopy; Pokaż więcej
Wydawca:: Towarzystwo Pomocy Doraźnej
Powiązania:: https://bibliotekanauki.pl/articles/55781364.pdf Link otwiera się w nowym oknie
Opis:: Tracheal stenosis can develop as a consequence of prolonged endotracheal intubation or tracheostomy. A 14-year-old child had a history of left frontotemporal craniotomy after a fall from height one month later and tracheostomy was performed on the sixth postoperative day and decannulation was performed 20 days later. On the fifth day of post-decannulation, the child came to the emergency department with a complaint of difficulty breathing since three days. The patient was immediately moved to emergency operation theater. The patient was intubated with a 6 mm endotracheal tube, but no adequate tidal volume was delivered. Bronchoscopy was performed in the operating room. It showed a smooth, circumferential web 2 cm above the carina (supracarinal stenosis). To achieve ventilatory goals, a 6 mm endotracheal tube was removed and a microlayrngoscopy tube (MLS) of size 5.5 mm was negotiated with deflated cuff. Since the MLS tube was longer, it reached the proximal limit of the narrowed portion of the trachea. There was improvement in ventilation. To achieve proper ventilation, circumferential web was planned. The patient underwent emergency balloon dilation of trachea through rigid bronchoscopy. The balloon catheter was introduced into the bronchoscope, and the balloon was then inflated. As the balloon was inflated, it leads to stretching of the soft tissue and widening of the supracarinal space. The dilatation procedure / ballooning improved the ventilation dynamics. An endotracheal tube of 6mm size was inserted, and endotracheal tube was fixed beyond the stenotic segment above the carina to prevent recurrence of narrowing due to edema after the procedure. After balloon dilation, the patient was shifted to intensive care unit (ICU). The patient was extubated 24 hours after surgery. On the second postoperative day, the patient shifts from the ICU to the ward and on the fifth postoperative day, the patient was discharged from the hospital with the advice that repeated dilation may be required and dates for future follow-up. We present a case of emergency bronchoscopy in a child with critical airway stenosis after tracheostomy that was successfully managed.
Dostawca treści:: Biblioteka Nauki

Artykuł

na półce

Skocz do pozycji: 6.

Tytuł:: Evaluation of ultrasound guided measurement of tongue thickness in predicting difficult intubation in obese patients
Autorzy:: Singh, Dheeraj
Kachru, Nisha
Gupta, Jyoti
Saraswat, Namita
Yadav, Rupesh
Tematy:: Difficult intubation
obesity
tongue thickness
ultrasound; Pokaż więcej
Wydawca:: Towarzystwo Pomocy Doraźnej
Powiązania:: https://bibliotekanauki.pl/articles/55994163.pdf Link otwiera się w nowym oknie
Opis:: INTRODUCTION: Managing the airway presents a significant challenge in anesthesia, particularly in obese patients, and is a leading cause of morbidity and mortality associated with anesthesia. Although increased tongue thickness in the obese is generally assumed to be associated with a difficult intubation. So that aim of this study was to evaluate ultrasound guided measurement of tongue thickness in predicting difficult tracheal intubation in obese patients. MATERIALS AND METHODS: Study included 45 patients aged 18 to 65 of any gender. These patients, classified as American Society of Anesthesiologists Grade I and II, had a Body mass index exceeding 30 kg/m2. Tongue thickness was evaluated using ultrasound, measuring the distance from the tongue surface to the submental skin, while also documenting the modified Mallampatti score (MMP). Number of attempts for intubation, time taken for intubation and use of any alternate device or technique were noted. RESULTS: The tongue thickness cutoff for predicting difficult intubation was determined to be 6.5 cm. The Receiver operating characteristic (ROC) curve analysis revealed an AUC (Area under the ROC Curve) of 0.920 (Standard Error: 0.230, 95% Confidence interval: 0.850-0.950) for a cutoff value exceeding 6.5 cm, indicating excellent predictive capability. Tongue thickness demonstrated a combined diagnostic accuracy of 95.5%, with sensitivity and specificity of 75% and 97.5% respectively. MMP grade was compared with tongue thickness, a positive correlation was seen with co-efficient of 0.45. There was a statistically significance (p value <0.001). CONCLUSIONS: This study concludes that ultrasound guided measurement of tongue thickness > 6.5 cm can reliably predict difficult tracheal intubation in obese patients.
Dostawca treści:: Biblioteka Nauki

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Skocz do pozycji: 7.

Tytuł:: Lyell’s syndrome as a factor which escalates the risk of laryngotracheal stenosis and atresia after intubation
Autorzy:: Nowak, Nel
Kotowski, Michał
Sroczyński, Jakub
Szydłowski, Jarosław
Tematy:: Lyell’s Syndrome
subglottic stenosis
intubation
laryngotracheal reconstruction; Pokaż więcej
Wydawca:: Index Copernicus International
Powiązania:: https://bibliotekanauki.pl/articles/1399653.pdf Link otwiera się w nowym oknie
Opis:: Toxic epidermal necrolysis (TEN) also known as Lyell’s Syndrome is a rare, acute hypersensitivity reaction characterized by cutaneous and mucosal necrosis covering more than 30% of surface [1]. Lyell’s syndrome is self limited, but potentially recurrent disease. The mortality for toxic epidermal necrolysis is approaching to 20–66% [2]. Lyell Syndrome is extremely rare diseases with an estimated overall incidence of 1–2 per 1 million inhabitants per year [3]. TEN is more common in women, it can occur at any age, whereas mostly occurs in older patients in their fifth to seventh decades. Death is caused either by sepsis or by respiratory distress which is either due to pneumoniae or damage to the linings of the airway [4]. Subglottic stenosis is the most common anomaly of larynx and trachea requiring tracheostomy in pediatric population [5]. Subglottic part of larynx is the narrowest section of laryngotracheal area of airways in childhood [5]. It is estimated that most of subglottic stenosis cases is acquired and developed as a result of injury caused by long-term use of endotracheal tube,only 5% of subglottic stenosis is congenital [6]. Latest improvements about construction of endotracheal tube and rules of procedures reduced frequency of subglottic stenosis to less than 1%. There are no statistics or medical reports about tracheal atresia caused by intubation or Lyell’s syndrome. This situation forced us to recognise Lyell’s syndrome and endotracheal intubation overlapping on each other as a cause of medical state of our 2 years old patient.
Dostawca treści:: Biblioteka Nauki

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Skocz do pozycji: 8.

Tytuł:: Comparison of intubating conditions during rapid sequence induction between rocuronium with magnesium sulphate pretreatment and succinylcholine in patients undergoing elective surgery under general anaesthesia - prospective randomized study.
Autorzy:: Yadav, Nidhi
Yadav, Rupesh
Kachru, Nisha
Rajasekaran, Nivedha
Wydawca:: Towarzystwo Pomocy Doraźnej
Cytata wydawnicza:: Rajasekaran N, Kachru N, Yadav N, Yadav R. Comparison of intubating conditions during rapid sequence induction between rocuronium with magnesium sulphate pretreatment and succinylcholine in patients undergoing elective surgery under general anaesthesia - prospective randomized study. Crit. Care Innov. 2024; 7(4): 1-10. DOI: 10.32114/CCI.2024.7.4.1.10
Opis:: INTRODUCTION: Rapid sequence induction is a conventional method used for airway management during anesthesia. Succinylcholine is considered standard neuromuscular blocking agent in rapid sequence induction but avoid the side effects of succinylcholine, rocuronium used as an alternative. Magnesium given as pretreatment before standard dose of rocuronium shortens the duration of onset of action of rocuronium and improve the intubating conditions. Aim of the study was to compare intubating conditions during rapid sequence induction between rocuronium with magnesium sulphate pretreatment, and succinylcholine in patients undergoing elective surgery under general anaesthesia. MATERIALS AND METHODS: In this Prospective comparative study, 150 patients were divided into 2 groups of 75 each. Group 1 patients were pretreated with magnesium sulphate 50 mg/kg in 100 ml 0.9% normal saline before induction and administration of rocuronium 0.6 mg/kg for intubation. Group 2 patients were given 100ml 0.9% normal saline before induction and succinylcholine 1.5 mg/kg was given for intubation. Intubating conditions were graded as excellent (score 8- 9), good (score 6-7), fair (3-5), poor (0-2) according to Cooper’s criteria. RESULTS: In 74 patients in each group, jaw relaxation was easy and in 1 patient in each group, it was fair (p=1). Vocal cords were found to be abducted in 70 patients (93.3%) in group 1 and 74 patients (98.7%) in group 2. Vocal cords were moving in 5 patients (6.6%) and 1 patient (1.3%) in group 1 and 2 respectively (p=0.209). There was no response to intubation in 67 patients (89.3%) and 73 patients (97.3%) in group 1 and 2 respectively. 8 patients (10.6%) in group 1 and 2 patients (2.7%) in group 2 had slight diaphragmatic movement. (p=0.097). 71 patients (94.6%) in group 1 and 74 patients (98.7%) in group 2 had excellent intubating conditions. 4 patients in group 1 and 1 patient in group 2 had good intubating conditions. Intubating conditions were comparable between both the groups (p=0.366). CONCLUSIONS: The study concluded that magnesium pretreatment before 0.6 mg/kg rocuronium provides clinically acceptable intubating conditions similar to succinylcholine making it suitable for rapid sequence induction with mild adverse effects which resolve spontaneously without any treatment.
Dostawca treści:: Repozytorium Centrum Otwartej Nauki

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Skocz do pozycji: 9.

Tytuł:: Comparison of intubating conditions during rapid sequence induction between rocuronium with magnesium sulphate pretreatment and succinylcholine in patients undergoing elective surgery under general anaesthesia - prospective randomized study
Autorzy:: Rajasekaran, Nivedha
Kachru, Nisha
Yadav, Nidhi
Yadav, Rupesh
Tematy:: Magnesium sulphate
rocuronium
succinylcholine
intubation
rapid sequence induction; Pokaż więcej
Wydawca:: Towarzystwo Pomocy Doraźnej
Powiązania:: https://bibliotekanauki.pl/articles/55994160.pdf Link otwiera się w nowym oknie
Opis:: INTRODUCTION: Rapid sequence induction is a conventional method used for airway management during anesthesia. Succinylcholine is considered standard neuromuscular blocking agent in rapid sequence induction but avoid the side effects of succinylcholine, rocuronium used as an alternative. Magnesium given as pretreatment before standard dose of rocuronium shortens the duration of onset of action of rocuronium and improve the intubating conditions. Aim of the study was to compare intubating conditions during rapid sequence induction between rocuronium with magnesium sulphate pretreatment, and succinylcholine in patients undergoing elective surgery under general anaesthesia. MATERIALS AND METHODS: In this Prospective comparative study, 150 patients were divided into 2 groups of 75 each. Group 1 patients were pretreated with magnesium sulphate 50 mg/kg in 100 ml 0.9% normal saline before induction and administration of rocuronium 0.6 mg/kg for intubation. Group 2 patients were given 100ml 0.9% normal saline before induction and succinylcholine 1.5 mg/kg was given for intubation. Intubating conditions were graded as excellent (score 8- 9), good (score 6-7), fair (3-5), poor (0-2) according to Cooper’s criteria. RESULTS: In 74 patients in each group, jaw relaxation was easy and in 1 patient in each group, it was fair (p=1). Vocal cords were found to be abducted in 70 patients (93.3%) in group 1 and 74 patients (98.7%) in group 2. Vocal cords were moving in 5 patients (6.6%) and 1 patient (1.3%) in group 1 and 2 respectively (p=0.209). There was no response to intubation in 67 patients (89.3%) and 73 patients (97.3%) in group 1 and 2 respectively. 8 patients (10.6%) in group 1 and 2 patients (2.7%) in group 2 had slight diaphragmatic movement. (p=0.097). 71 patients (94.6%) in group 1 and 74 patients (98.7%) in group 2 had excellent intubating conditions. 4 patients in group 1 and 1 patient in group 2 had good intubating conditions. Intubating conditions were comparable between both the groups (p=0.366). CONCLUSIONS: The study concluded that magnesium pretreatment before 0.6 mg/kg rocuronium provides clinically acceptable intubating conditions similar to succinylcholine making it suitable for rapid sequence induction with mild adverse effects which resolve spontaneously without any treatment.
Dostawca treści:: Biblioteka Nauki

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Skocz do pozycji: 10.

Tytuł:: "Keep it simple - a lesson from COVID-19" : highlighting the utility of chest X-rays in ARDS-associated illnesses through the Zonal Scoring System
Autorzy:: Saju, Bimal
Kurian, Athul Varghese
George, Arun
Joseph, Linda Ann
Menezes, Anna Rachel
Opis:: Purpose: The post-pandemic era calls for appropriate literature on chest X-ray score cut-offs, enabling swift categorization and faster radiological reporting of patients with acute respiratory distress syndrome (ARDS)-like illnesses, hence prompting healthcare equity in low-resource centres where extortionate modalities of imaging such as computed tomography (CT) are unavailable. In this study, we aim to bridge the literature gap using the versatile zonal scoring system. Material and methods: This retrospective cohort study uses data from 751 COVID-19 RT-PCR+ patients. Concordantchest radiograph (CXR) scores were reported, and inter-rater reliability was measured using kappa indices. receiver operating characteristic curves were used to establish cut-off scores for the outcomes of interest: mild or severe disease, admission to an intensive care unit (ICU), and intubation. Categorical data were expressed using means and percentages, and c2 or t-tests were used for comparison at an a level of 0.05. Unadjusted odds ratios for each outcome of interest vs. CXR score and comorbidity were then calculated using binary logistic regression. Results: CXR findings included infiltrates (46.07%), pleural effusions (7.05%), consolidation and fibrosis (4.43%), pneumothoraces (2.71%), and cardiomegaly (2.26%). Most patients had an index CXR score of 0 (54.19%). The index cut-off score of ≤ 1 (82.95, 81.68) was established for mild disease, ≥ 4 for severe disease (85.71, 83.99), ≥ 3 for ICU admission (86.90, 71.91), and ≥ 4 for intubation (87.61, 72.90). Hypertension, type 2 diabetes mellitus, hypothyroidism, history of ischaemic heart disease, and history of tuberculosis were independent risk factors for a high CXR index score, intubation, and ICU admission. Conclusions: CXR scores can be effectively used in low-resource settings for triaging patients, maintaining records, and disease prognostication.
Dostawca treści:: Repozytorium Uniwersytetu Jagiellońskiego

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