Articles: intubation.
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Critical care medicine · Dec 1990
Randomized Controlled Trial Clinical TrialIncidence of colonization, nosocomial pneumonia, and mortality in critically ill patients using a Trach Care closed-suction system versus an open-suction system: prospective, randomized study.
Eighty-four intubated, mechanically ventilated patients were prospectively evaluated for incidences of colonization and nosocomial pneumonias dependent on whether they received endotracheal suctioning by an "open" suction method vs. "closed" suction (Trach Care Closed Suction System) method. Results show that closed suctioning is associated with a significant (67% vs. 39% p less than .02) increase in colonization compared with open suctioning. ⋯ Survival analysis demonstrated that the probability of survival without developing nosocomial pneumonia was greater among closed-suctioning patients vs. open-suctioned patients (p less than .03). This study shows that suctioning performed via the Trach Care closed-suction system increases the incidence of colonization but not the incidence of nosocomial pneumonia, and may actually decrease mortality when compared with open-suction systems.
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J Cardiothorac Anesth · Dec 1990
The effective tracheal diameter that causes air trapping during jet ventilation.
Jet ventilation consists of injection of gas at high flow rates through a small-diameter tracheal catheter. Air trapping (increase in end-expiratory lung volume) can occur during jet ventilation if the diameter of the trachea proximal to the tracheal catheter tip is too small (at least at one point in the trachea) to permit complete exhalation of the tidal volume around the tracheal catheter (ie, through the effective tracheal diameter). A mechanical lung model was used to determine the critical effective tracheal diameter at which air trapping starts to occur during jet ventilation. ⋯ As A to D increased and E decreased, y increased. More importantly, exhalation time was measured over the full range of values for A to E, and it was found that for every possible combination of values for A to D, there was always a unique critical effective tracheal diameter, 4.0 to 4.5 mm, that began to cause a very large increase in expiratory time (and with a sufficiently rapid respiratory rate [greater than 12 beats/min in this experiment], air trapping). Thus, when lung/jet ventilation factors tend to promote entry of jetted gas into the lungs (increased A to D, decreased E), even a small tidal volume has difficulty exiting the lung, if E is smaller than 4.5 mm.(ABSTRACT TRUNCATED AT 250 WORDS)
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Pediatric emergency care · Dec 1990
Accuracy of flexible fiberoptic endoscopy in identifying abnormal endotracheal tube positions.
This study was carried out to investigate the accuracy of a simple, nonmaneuverable, flexible fiberoptic catheter in identifying both normal and abnormal endotracheal tube (ETT) positions. In addition, the utility of flexible fiberoptic endoscopy (FFE) for ETT position determination in inexperienced hands was examined. One adult dog was sedated and instrumented in the esophagus and trachea with identical ETTs. ⋯ There was no difference in performance by investigator training level or endoscopy experience. We conclude that FFE is a rapid and accurate method for determining both normal and abnormal ETT locations. ETT position determination can be confidently performed by health professionals with minimal training.
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Ninety-one laser laryngeal procedures using the apneic technique of anesthesia were performed in 28 patients between 2 months and 64 years of age. Seventy-two procedures (79%) were performed on children and 19 on adults. There were no complications. ⋯ The apneic technique described in this paper provides a laser operative field free of an endotracheal tube, virtually eliminating the danger of a laser fire. It is a relatively safe and effective means of performing laser laryngeal surgery. In addition, the Laser-Flex endotracheal tube appears to be an acceptable alternative to a metallic tape-wrapped endotracheal tube.