Articles: intubation.
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Int J Occup Med Environ Health · May 2021
ReviewA proposal of a cheap and simple method of medical personnel protection for endotracheal intubation of patients with a suspected or confirmed COVID-19 infection.
The 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. ⋯ Endotracheal 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. Int J Occup Med Environ Health. 2021;34(2):301-5.
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To investigate whether the optimal time to tracheal intubation (TTI) during cardiopulmonary resuscitation would differ by different blood gas phenotypes. Adult patients experiencing in-hospital cardiac arrest (IHCA) from 2006 to 2015 were retrospectively screened. Early intra-arrest blood gas analysis, performed within 10 min of resuscitation, was used to define different phenotypes. ⋯ Non-severe acidosis (pH≧7.15) was associated with favourable neurological outcome (odds ratio [OR]: 4.60, 95% confidence interval [CI] 1.63-12.95; p value = 0.004) and survival (OR: 3.25, 95% CI 1.72-6.15; p value < 0.001) in the multivariable logistic regression analyses. In the interaction analysis, normal blood gas phenotype (pH: 7.35-7.45, PCO2: 35-45 mm Hg, HCO3- level: 22-26 mmol/L) × TTI ≦ 6.3 min (OR: 20.40, 95% CI 2.53-164.75; p value = 0.005) and non-severe acidosis × TTI ≦ 6.3 min (OR: 3.35, 95% CI 1.00-11.23; p value = 0.05) were associated with neurological recovery while metabolic acidosis × TTI ≦ 5.7 min (OR: 3.63, 95% CI 1.36-9.67; p value = 0.01) and hypercapnic acidosis × TTI ≦ 10.4 min (OR: 2.27, 95% CI 1.20-4.28; p value = 0.01) were associated with survival. Intra-arrest blood gas analysis may help guide TTI during for patients with IHCA.
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Randomized Controlled Trial Comparative Study
A pilot study comparing three bend angles for lighted stylet intubation.
For successful lighted stylet intubation, bending the lighted stylet with an appropriate angle is a prerequisite. The purpose of this study was to compare three different bend angles of 70, 80, and 90 degrees for lighted stylet intubation. ⋯ The bend angle of the lighted stylet affected the time required for tracheal intubation and POST in our study. 80 and 90 degrees as a bend angle seem to be acceptable for clinicians in regard to success rate of lighted stylet intubation. Considering the success rate of lighted stylet intubation and POST, the bend angle of 80 degrees might be better than 70 and 90 degrees.
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Case Reports Observational Study
An initial learning experience of tracheal intubation with video laryngoscope: Experiences from a novice PGY.
Tracheal intubation is an essential technique for many healthcare professionals and one of the mega code simulations in advanced cardiac life support. In recent years, video laryngoscopy (VL) has provided a rescue for difficult airways during intubation and has proven to have higher success rates. Moreover, VL facilitates a more rapid learning curve for inexperienced doctors. ⋯ In this learning project, we found that limitation of mouth opening (<2.5 fingers wide) is an important risk factor for predicting the initial difficulty of tracheal intubation on the novice trainee. For inexperienced doctors, VL produces high first-shot success rates for tracheal intubation and may be useful for training their performance in a short period of time. In addition, mouth opening <3 fingers wide may result in difficult intubation by novice doctors.