Articles: intubation.
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Seven patients with status asthmaticus intubated for respiratory failure who had elevated airway pressures and persistent respiratory acidosis were successfully ventilated using a mixture of 60 percent helium and 40 percent oxygen. All patients experienced a rapid reduction in airway pressures, CO2 retention, and resolution of acidosis while breathing a helium-oxygen mixture. ⋯ Helium's beneficial effects are due to its high kinematic viscosity, high binary diffusion coefficient for CO2, and high diffusivity. Helium-oxygen mixtures should be considered for use in mechanically ventilated asthmatics with respiratory acidosis who fail conventional therapy.
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The efficiency of a foam cuffed tracheal tube has been studied in protecting the pulmonary tree from aspiration of oropharyngeal and gastric contents. Following instillation of methylene blue dye above the cuff, subsequent fibreoptic bronchoscopy revealed no instance of dye staining of the tracheal mucosa. A "bench" study was undertaken subsequently to estimate the likely pressure that the cuff would exert on the tracheal mucosa as a result of elastic recoil properties of the foam. The results suggested that, under normal clinical conditions, the pressure is not likely to exceed a value at which impairment of the mucosal blood supply would occur.
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A kit for difficult intubation can be assembled quickly from vascular catheters and sheaths commonly available in surgical facilities. The kit provides for continuous oxygen administration throughout all phases of its application in difficult upper airway management. Such applications include stylet-guided endotracheal intubation, cricothyroid puncture, transtracheal ventilation, and translaryngeal catheter-guided retrograde tracheal intubation. A technical description of the Difficult Intubation Kit and guidelines for its use in difficult airway management are presented.