Anaesthesia
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Randomized Controlled Trial Clinical Trial
External high frequency oscillation in normal subjects and in patients with acute respiratory failure.
External high frequency oscillation was performed on 20 healthy volunteers using a cuirass-based system, the Hayek Oscillator. Five-min periods of oscillation were carried out on each subject at frequencies of 1, 2, 3, 4 and 5 Hz. Effective ventilation was measured in terms of the fall in alveolar partial pressure of carbon dioxide immediately after oscillation. ⋯ Using the same inspired oxygen fraction, the external high frequency oscillation replaced intermittent positive pressure ventilation for a 30-min period. External high frequency oscillation improved oxygenation by 16% and reduced the arterial carbon dioxide by 6%. These preliminary findings suggest that normal subjects and intensive care unit patients can be adequately ventilated by means of external high frequency oscillation.
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Randomized Controlled Trial Clinical Trial
SCOTI--a new device for identification of tracheal intubation.
A new lightweight device for the detection of placement of a tracheal tube in the trachea or oesophagus is described. The device utilises a sonic technique detecting resonating frequencies in an open (trachea) or closed (oesophagus) structure. Evaluation of the device in a clinical environment is described and it has been shown to be capable of verifying the correct placement of the tracheal tube in the trachea in 98% of patients studied. Further evaluation of this intubating aid appears justified.
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Clinical Trial Controlled Clinical Trial
Gastric regurgitation during general anaesthesia in different positions with the laryngeal mask airway.
Ninety patients, divided into three groups of 30, were investigated to determine the incidence of gastric regurgitation during general anaesthesia administered via the laryngeal mask airway in the supine, Trendelenburg and lithotomy positions. Fifteen minutes before induction of anaesthesia each patient swallowed a 75 mg methylene blue capsule. At the end of surgery, the LMA and the oropharynx were inspected for bluish discoloration which was considered to be a sign of gastric regurgitation. No blue dye was detected in the supine group but it was observed in one patient in each of the other two groups.
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All patients discharged from a general intensive care unit over a 4.5 year period were sent a questionnaire 3 months after discharge which investigated aspects of their health and physical abilities. Replies were compared on the basis of age, diagnosis and sickness severity on admission. Five hundred and four questionnaires were analysed. ⋯ Patients aged 76 years or older were more likely to perceive their health as 'better than average' than younger patients (p < 0.01). Eight percent of patients would be unwilling to undergo intensive care again. An unacceptable health status after intensive care cannot be predicted in any group of patients.
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Most paediatric tracheal tubes are marked in centimetres from the tip. In 105 children, nasotracheal tube length was set at the level of the vocal cords such that all 3.0 and 3.5 mm internal diameter tubes were placed with the 3 cm mark at the cords, all 4.0 and 4.5 tubes were set at 4 cm at the cords and all 5.0 and 5.5 tubes were set at 5 cm at the cords. ⋯ Neither bronchial intubation nor accidental extubation occurred in any subject. This is an effective method to determine tracheal tube length which may be used for both oral and nasal intubation.