Articles: intubation.
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Critical care medicine · Dec 1990
Endotracheal tube cuff pressure assessment: pitfalls of finger estimation and need for objective measurement.
Estimation of endotracheal (ET) cuff pressure by finger palpation is one of the methods currently used in the clinical setting. We compared the accuracy of this method with instrumental intracuff pressure measurement in tracheal model tests by 20 members of our ICU team. ⋯ We observed differences in terms of sensitivity, specificity, and positive predictive power between different tubes reflecting differences in tube characteristics and interobserver variability. We conclude that precise intracuff pressure measurement is mandatory to prevent complications of over- or underinflation.
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Critical care medicine · Dec 1990
Case ReportsSwallowing disorders in patients with prolonged orotracheal intubation or tracheostomy tubes.
Eleven patients were tested for swallowing dysfunction after prolonged orotracheal intubation. Ten had a tracheostomy tube. Mean duration of orotracheal intubation was 19.9 days, mean age 65 yr, and no patient had a concomitant neurologic deficit. ⋯ We concluded that prolonged orotracheal intubation with or without tracheostomy may cause prolonged and severe swallowing dysfunction. The deficits improve with time. The presence of a gag reflex does not confer protection against aspiration of pharyngeal contrast.
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The laryngoscopic conditions of 62 diabetic patients who underwent renal transplantation or vitrectomy were studied. Anaesthesia was induced with fentanyl and a sleep dose of thiopentone. Conditions for direct laryngoscopy after 0.1 mg/kg vecuronium were scored from 0 to 3 (easy-very difficult). ⋯ The correlation coefficient between these two factors was r = 0.6 (p less than 0.001). Our study shows that joint rigidity possibly caused by tissue glycosylation may also involve laryngeal and cervical areas resulting in a strenuous laryngoscopy. A defective palm print is a warning sign for difficult laryngoscopy.
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The effects of ventilator rate and inspired humidity on the large airway epithelium of newborn lambs have been studied using scanning electron microscopy. Significant deciliation, denudation and necrosis occurred at both high and conventional rates if the inspired gas had low humidity. The damage observed was mild in the high humidity groups.