Articles: intubation.
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Randomized Controlled Trial Clinical Trial Controlled Clinical Trial
Effect of nicardipine on the cardiovascular response to tracheal intubation.
We studied the cardiovascular responses to laryngoscopy and intubation in 30 patients who received nicardipine 15 micrograms kg-1 or 30 micrograms kg-1, or saline placebo 60 s before the start of laryngoscopy. Anaesthesia was induced with thiamylal 5 mg kg-1 i.v. and tracheal intubation was facilitated with vecuronium 0.2 mg kg-1. Patients receiving saline showed a significant increase in mean arterial pressure (MAP) and rate-pressure product (RPP) associated with tracheal intubation. The increases in MAP and RPP following tracheal intubation were reduced in both groups of patients who received nicardipine.
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The purpose of this study was to determine the effectiveness and associated problems of emergency intubation in 605 injured infants and children admitted to the Children's Hospital of Pittsburgh in 1987. We identified 63 patients (10.4%) undergoing endotracheal intubation at the scene of injury, at a referring hospital or in our emergency department. Injuries were to the head (90.5%), abdomen (12.7%), face (11.1%), chest (6.3%), neck (3.2%); or were orthopedic (19%) or multiple (39.7%). ⋯ Head injury with coma is the most common setting for emergency intubation. Airway complications are common, and are more frequent in treatment attempt at the scene. Despite endotracheal intubation, injured children in our series remain at high risk for hypoxemia, elevated arterial PCO2, and major airway complications, all of which contribute to secondary brain injury.
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Critical care medicine · Feb 1990
Factors affecting accidental extubations in neonatal and pediatric intensive care patients.
All patients intubated in the neonatal (NICU) and pediatric (PICU) ICUs over a 3-yr period were evaluated prospectively to determine the incidence of accidental extubation (AE) and contributing factors. Two thousand two hundred patients (age range 26 wk gestation to 18 yr) were intubated for a total of 21,222 days. In the PICU and NICU, a total of 153 patients experienced 195 AE. ⋯ One death occurred as an indirect consequence of AE. The data are being reported as a function of number of days intubated in an attempt to standardize reporting techniques. The use of standardized reporting and the identification of high-risk factors may be useful for education and modification of patient care practices.