Articles: intubation.
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Ventilator autocycling can occur with any ventilator if the sensitivity is improperly set or if a gas leak exists in the respiratory system which creates a negative change in proximal airway pressure. We report a case of ventilator autocycling in a paralyzed patient secondary to an endotracheal cuff leak which was misconstrued as assisted ventilation. We believe this is the first report of autocycling due to a cuff leak.
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Ischemic tracheal complications due to the ETT cuff occur in approximately 10 percent of mechanically ventilated critically ill patients despite the use of high-volume, low-pressure ETT cuffs. Using a laboratory model, we studied the effects of airway pressure on three different ETT cuff designs, including two "low pressure" designs. ⋯ Increases in airway pressure caused by decreased lung compliance resulted in higher cuff inflation pressures in all three groups, with the smallest increase occurring in the design that had the longest tracheal contact length. We conclude that the current high-volume, low-pressure ETT cuff design currently used does not guarantee low cuff pressure when high airway pressures occur, and an alternative design should be developed.
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We studied the cardiovascular responses to laryngoscopy and intubation in 30 patients who received continuous infusion of either diltiazem 10 micrograms.kg-1.min-1, 40 micrograms.kg-1.min-1 or saline as control group during 20 min before induction. Heart rate, arterial pressure, rate pressure product (RPP), pressure rate quotient (PRQ) were measured starting 20 min before induction to 3 min after tracheal intubation. The increases in arterial pressure and RPP following tracheal intubation were reduced significantly in patients receiving diltiazem 40 micrograms.kg-1.min-1, but they were not reduced in patients receiving diltiazem 10 micrograms.kg-1.min-1 compared with control. We conclude that continuous infusion of diltiazem during 20 min before induction is effective for preventing the increases in arterial pressure and RPP following tracheal intubation, and the optimal infusion rate is from 10 to 40 micrograms.kg-1.min-1.