Articles: intubation.
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A three-part study identified factors essential to accurate determination of pressure exerted against the lateral wall of the trachea by three types of endotracheal tube cuffs. Part I compared 31 mercury sphygmomanometer measurements of tracheal cuff pressures to those of pressure-sensitive aneroid Portex manometer during simulated intubation and found 99.28% of mercury manometer readings accurate to within 2 mm Hg of Portex readings. ⋯ Part III compared two methods of obtaining tracheal cuff pressure readings with the mercury sphygmomanometer during simulated intubation. Accurate measurement was made only with a stopcock system that simultaneously opened to the cuff, the manometer, and the inflator syringe and when a separate cuff distensibility factor was used in the computation.
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critically ill infants receiving supplemental oxygen for their hypoxemia may become significantly compromised by hypoxemia and bradycardia when supplemental oxygenation is interrupted to carry out laryngoscopy and tracheal intubation. It would, therefore, be desirable to devise a means of maintaining supplemental oxygenation during the procedure. A modified laryngoscope blade achieved this objective simply and efficiently. ⋯ The procedure of intubation was less stressful both to the patient and to the operator. It would seem appropriate to use the modified laryngoscope blade in all situations where hypoxemia threatens. It would seem to have a particular place in intubation of the difficult airway.
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Comparative Study
The oesophageal obturator airway: A study of cadaver lund ventilation through obturator airways and tracheal tubes.
Ventilation of cadaver lungs using a Pneupac ventilator through oesophageal obturator airways (EOA), oesophageal gastric tube airways (EGTA), and tracheal tubes was studied in 23 subjects. The mean tidal volume obtained through tracheal tubes was 381 ml compared with a mean tidal volume of 156 ml obtained through the EOA and a mean tidal volume of 237 ml through the EGTA. ⋯ This represents adequate ventilation in these very stiff lungs. Subject to modification of the device and prevention of leakage the oesophageal gastric tube airway is a useful alternative to tracheal intubation in certain adverse conditions.
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End-expiratory pressure is often used to improve arterial oxygenation and prevent atelectasis in intubated spontaneously breathing patients. To compare the effect of extubation from low levels of expiratory positive airway pressure (EPAP) of extubation from ambient airway pressure, functional residual capacity (FRC) and arterial blood oxygen tension (Pao2) were measured in 12 spontaneously breathing patients during three conditions in the peri-extubation period: 1) intubated at 5 cm H2O EPAP (EPAP 5); 2) intubated at ambient airway pressure (EPAP 0); and 3) within one hour after extubation. ⋯ The magnitude of increase in FRC and Pao2 on extubation from EPAP 0 varied inversely with the patient's lung thorax compliance (r = -0.84, P less than 0.005). It was concluded that a period of EPAP 0 is not necessary in the weaning period, and that it may be deleterious in patients with compromised lung thorax mechanics.