Articles: intubation.
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Critical care medicine · Apr 1984
Pulmonary ventilation by continuous flow using a modified Carlen's tube.
Carlen's tubes were modified by introducing a manometer line into each lumen to allow both bronchi to be insufflated continuously. During such continuous-flow ventilation (CFV) with a gas flow of 1 L/kg body weight X min in 6 anesthetized dogs, both CO2 and O2 homeostasis were maintained. ⋯ The mean PaO2 was stable at 80 torr and 451 torr using air and oxygen, respectively, as the insufflating gas. When the CFV was reduced to 0.75 L/kg X min, there was a rise in mean PaCO2 from 34 to 53 torr in 12 min; PaCO2 was then reduced to 40 torr when 4 breath/min was introduced with a mean tidal volume of 375 ml.
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Acute epiglottitis in adults is usually treated by close observation or tracheostomy. In the last decade, this therapeutic attitude has been challenged by the impressive results obtained by nasotracheal intubation in the treatment of pediatric cases. ⋯ Three conditions have to be met before safe nasotracheal intubation can be considered: interested anesthesiological service, supportive otolaryngological assistance, and dependable nursing care. The case of a young woman treated by close observation proceeding to nasotracheal intubation, as the sole way to secure the airway is presented.
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Br Med J (Clin Res Ed) · Mar 1984
Randomized Controlled Trial Clinical TrialEndotracheal cuff pressure and tracheal mucosal blood flow: endoscopic study of effects of four large volume cuffs.
Large volume, low pressure endotracheal tube cuffs are claimed to have less deleterious effect on tracheal mucosa than high pressure, low volume cuffs. Low pressure cuffs, however, may easily be overinflated to yield pressures that will exceed capillary perfusion pressure. Various large volume cuffed endotracheal tubes were studied, including Portex Profile, Searle Sensiv, Mallinkrodt Hi-Lo, and Lanz. ⋯ It was found that these cuffs when overpressurised impaired mucosal blood flow. This impairment of tracheal mucosal blood flow is an important factor in tracheal morbidity associated with intubation. Hence it is recommended that a cuff inflation pressure of 30 cm H2O (22 mm Hg) should not be exceeded.
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One-hundred thirty mobile intensive care unit paramedics were trained in the technique of direct laryngoscopic endotracheal intubation of cardiac arrest or deeply comatose patients. Three attempts at intubation were permitted. Of the 779 patients studied, 701 (90.0 percent) were successfully intubated: 57.9 percent on the first attempt, 26.1 percent and 5.5 percent on the second and third respectively. ⋯ There were three unrecognized esophageal intubations. The success rate rose to more than 94 percent toward the end of the study. It is concluded that endotracheal intubation of deeply comatose patients is a field procedure safely and skillfully performed by well-trained and monitored paramedical personnel, with success and complication rates at least comparable to other invasive airway techniques.