Acta clinica Croatica
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Acta clinica Croatica · Mar 2016
Multicenter StudyVERTEBRAL OSTEOMYELITIS IN ADULT PATIENTS--CHARACTERISTICS AND OUTCOME.
The aim of the study was to assess disease characteristics and outcome in patients with vertebral osteomyelitis (VO). A two medical centre retrospective cohort study was performed by chart review after discharge of 110 patients with confirmed VO treated during a 5-year period. Patients were divided in two groups: patients with uncomplicated VO and patients with complicated VO. ⋯ High CCI scores were more frequently associated with positive blood cultures due to bacteremia because of impaired immunity. Patients with complicated VO were longer treated with antibiotics parenterally and more often surgically treated for phlegmon and abscess formation. Liver cirrhosis and degenerative spine disease, which were more often found in patients with complicated VO, obviously impacted the course of the disease.
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The Macintosh laryngoscope has been the most widely used device for intubation since its invention by Foregger in the 1940s. Recently, video and optic laryngoscopy assisted tracheal intubation has been used widely in patients with difficult airways. ⋯ This review will summarize some of the newly available devices to assist tracheal intubation, with their advantages and disadvantages when compared with conventional laryngoscopes. It also presents the reasons to support their use in both elective and emergency airway management.
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Acta clinica Croatica · Mar 2016
Review Comparative StudyFIBEROPTIC BRONCHOSCOPY VERSUS VIDEO LARYNGOSCOPY IN PEDIATRIC AIRWAY MANAGEMENT.
The primary goal of pediatric airway management is to ensure oxygenation and ventilation. Routine airway management in healthy pediatric patients is normally easy in experienced hands. Really difficult pediatric airway is rare and usually is associated with anatomically and physiologically important findings such as congenital abnormalities and syndromes, trauma, infection, swelling and burns. ⋯ Do we really need video laryngoscopy? If we look at numbers, we might estimate that conventional laryngoscopy is successful and effective in around 98.5% of cases. Do we need to replace Macintosh laryngoscope with video laryngoscope completely in our routine practice? Should video laryngoscope be available to replace fiberoptic intubation in pediatric airway management? According to the algorithm, fiberoptic-assisted tracheal intubation combined with extraglottic airway devices is the standard of care. Establishment of protocols for equipping and maintaining airway trolleys and regular training in their use must be provided to avoid tissue hypoxia in children with compromised airway.
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The author provides an overview of the history of optical instruments for airway management in anesthesiology. It systematically demonstrates the development of laryngoscope down to the present time when video laryngoscope has been introduced in clinical practice.
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Airway management is basic for anesthesia practice, and sometimes it can represent a really dramatic scenario for both the patient and the physicians. Laryngoscopy has been the gold standard of airway visualization for more than 60 years, showing its limitations and failure rates with time. ⋯ Nevertheless, each new technology needs time to be tested and considered reliable, and pitfalls and limitations may come out with careful and long lasting analysis, so it is probably not the right time yet to promote video assisted approach as a new gold standard for airway visualization, despite the fact that it certainly offers some new prospects. In any case, whatever the visualization approach, no patient dies because of missed airway visualization or failed intubation, but due to failed ventilation, which remains without doubt the gold standard of any patient safety goal and airway management technique.