جستجوی مقالات مرتبط با کلیدواژه « endotracheal intubation » در نشریات گروه « پزشکی »

Endotracheal intubation is a potentially high-risk aerosol-generating procedure. So, an intubation box (I-Box) is designed for personal protection during intubation. This study aimed to compare the outcomes of endotracheal intubation with and without an I-box in COVID-19 patients.

In this study, 60 COVID-19 patients (30 patients in each group) with and without I-box groups were included. outcomes of intubation including duration of intubation, first-pass success intubation, suitable visibility of airways, restriction of movement in the neck, the need to surface maneuvering of the airway, and the number of attempts for successful intubation were compared between the two groups.

The time of intubation was significantly longer in the I-box group (15.27±2.6 seconds) than without the I-box group (8.37±1.3 seconds) (p<0.001). All patients (100%) were intubated in the first attempt in the without I-box group while the rate of first-pass success intubation was 50% in the I-box group (p <0.001). The visibility of the airway was significantly better in the without I-box group than the I-box group (without I-box: 23 patients (76.7%), I-box: 15 patients (50%), p= 0.032). The frequency of need to optimizing maneuver of the airway was in without and with I-box was 23.3% and 50% respectively (p=0.032).

However, the I-box as a physical barrier can protect healthcare workers but its use increased the time to intubation and the number of attempts for successful intubation and reduced the rate of first-pass success intubation and visibility.

Neuromuscular blocking drugs (NMBD) have paved the way for the conduct of every known surgical procedure. However, the hunt for optimum NMD with appropriate intubating circumstances is continuous. Rocuronium and cisatracurium are amongst the newer NMBDs. We aim to compare the onset of action, intubating conditions, duration of action, and recovery features in a dose twice the ED95 in patients having abdominal surgery.

A total 60 American Society of Anesthesiology (ASA) I and II adult patients were randomized equally into Group A and Group B. Group A received Inj. Rocuronium 0.6 mg/kg and Group B received Inj. Cisatracurium 0.10 mg/kg. We assessed the intubating conditions after ensuring jaw relaxation using both the clinical criteria and neuromuscular monitoring whereas onset time, duration of action and recovery time were assessed using neuromuscular monitoring only.

In Group A, a significant rapid onset of action of muscle relaxant was seen compared to Group B (2.4±0.30 mins versus 4.0±0.09 mins, p= 0.00). 93% patients had excellent intubating conditions in Group A compared to 73% patients in Group B (p= 0.038). The duration of action in Group A was 36.73±1.05 mins and in Group B was 47.40 ±1.33mins (p=0.00). Similarly, early mean duration of recovery was found in Group A-45.30±1.29mins versus Group B -57.77±1.19 mins, p= 0.00).

Rocuronium provides rapid onset of action with excellent intubating conditions, and shorter duration of action with an early recovery time compared to cisatracurium.

Endotracheal intubation is employed to create a safe airway in patients requiring mechanical ventilation. The relatively high prevalence rate of unplanned displacement of the endotracheal tube (ETT) can be associated with serious complications. This study was conducted to evaluate the effectiveness of a newly designed tube holder in Iran (Irafit), the Thomas ETT holder and the traditional method using adhesive tape.

The present manikin‑based study was performed on the human mannequin. For this purpose, the mannequin was first subjected to oral intubation by a skilled emergency medicine specialist. Then, three methods of adhesive tape, Irafit‑ETT holder, and Thomas‑ETT holder were used. The mean of displacement in width of the mouth, length of the ETT, and depth as well as ETT removal was recorded.

The results of the present study revealed that the displacement in depth was significantly less in the Irafit‑ETT holder as compared with the other two groups following the application of a tug (P < 0.001). The displacement in the length of the ETT with and without the application of a tug was significantly less in the Irafit‑ETT holder and Thomas‑ETT holder groups as compared with the adhesive tape group (P < 0.001).

According to the results of the present study, it can be stated that both ETT holder devices (Thomas vs. Irafit) were not distinct in terms of displacements in length and width; however, the Iranian model was more successful in minimizing the displacement in depth.

 The purpose of this study was to compare the GlideScope and Macintosh laryngoscopes for cardiovascular response to laryngoscopy and endotracheal intubation in elderly patients undergoing gynecological procedures.

 In this clinical trial, endotracheal intubation was performed using a GlideScope (study group; n=35) and Macintosh laryngoscope (control group; n=35). Hemodynamic parameters were recorded, before induction of anesthesia (baseline), 30 and 15 seconds after starting the laryngoscopy, and every minute up to 5 minutes after intubation. Intubation time and complications of laryngoscopy and intubation were compared between two study groups.

 Systolic blood pressure (SBP) in 1 (P=0.002), 2 (P=0.003) and 3 (P=0.003) minutes were significantly lower in the study group than that of the control group. The duration of laryngoscopy and intubation was not statistically different between two study groups. The frequency of hypertension after endotracheal intubation in the study group (20%) was significantly lower than that of patients in the control group (45.7%) (P=0.02). There was no significant difference in terms of postoperative complications related to laryngoscopy and intubation (hoarseness and sore throat) between two study groups (P>0.05).

 This study showed that the use of GlideScope better attenuated cardiovascular responses to laryngoscopy and intubation compared to Macintosh laryngoscope in elderly patients undergoing gynecologic surgery. Also, the frequency of hypertension following laryngoscopy and endotracheal intubation was lower with GlideScope compared to Macintosh laryngoscope. Durations of laryngoscopy, intubation and postoperative complications related to airway management (hoarseness and sore throat) were similar.

Intratracheal intubation is associated with many side effects. Different groups of drugs have been used to control these side effects, but there is still no consensus on the most suitable drugs.
This study aimed to compare the effect and possible side effects of fentanyl, remifentanil, and atropine plus remifentanil on the vital signs of preterm infants in non-emergency intratracheal intubation.
In this randomized clinical trial study, 75 neonates with a gestational age of 27 to 34 weeks who required temporary intubation were included in the study and divided into three groups by computer randomization. Then, the effects and possible side effects of remifentanil, fentanyl, and remifentanil with atropine on clinical parameters (blood pressure, heart rate, and arterial oxygen saturation) were investigated.
A total of 75 neonates with a mean gestational age of 30.4 weeks were studied. There was no significant difference between study groups in terms of changes in the systemic blood pressure and heart rate, but the mean oxygen saturation in all three groups was significantly different at different measurement times (P-value: 0.036). The group receiving remifentanil plus atropine reported minimal changes in oxygen saturation and their oxygen saturation was significantly higher than the other groups 30 min after extubation.
The use of remifentanil with atropine in preterm infants is associated with lower changes in oxygen saturation and higher arterial oxygen saturation 30 min after extubation. The use of remifentanil or remifentanil with atropine or fentanyl has no significant effect on the blood pressure and heart rate of neonates in non-emergency intratracheal intubation.

Sore throat is one of the most common complications of endotracheal intubation, which interferes with patient's normal breathing and oral feeding process. This may ultimately delay the patient's discharge from the hospital. The aim of this study was to determine effect of warm normal saline solution gargling on sore throat in open heart surgery patients after estuation.

This clinical trial was performed in 2016 on 60 patients undergoing open heart surgery at the Amir Al-Momenin Hospital in Kordkoy, Northeast of Iran. The subjects were selected by convenience sampling method and randomly assigned to an intervention and a control group. Patients with sore throat were assessed using the Numerical Pain Rating Scale (NPRS 0–10) one hour after endotracheal tube removal and then every 6 hours for 24 hours. An overall score of zero, 1-3, 4-6, and 6-10 indicated no pain, mild pain, moderate pain, and severe pain, respectively. Data were analyzed with SPSS (version 18) using the Shapiro–Wilk test, independent t-test, Fisher's exact test, Chi-square test, and Friedman test. All analyses were carried out at significance of 0.05.

At the beginning of the study, there was no statistically significant difference between the two groups in terms of age, sex, ethnicity, history of addiction, and sore throat severity (p> 0.05). Six hours after the intervention, pain intensity did not differ significantly between the two groups (p <0.05). However, pain intensity was significantly lower in the intervention group compared with the control group 12, 18, and 24 hours after the intervention (p<0.001).

The results indicate that warm normal saline solution gargling after removal of the endotracheal tube is a practical, simple, and cheap approach to relieve sore throat in patients undergoing open heart surgery.

The SARS-CoV-2 pandemic is one of the most significant challenges for healthcare providers, particularly in the critical care setting. The timing of intubation in COVID-19 patients seems to be challenging. Therefore, we aimed to investigate how it may have a survival benefit, and we determined which clinical characteristics were associated with outcomes.

This cross-sectional study was conducted in the Imam Khomeini Hospital Complex. We randomly selected patients admitted to intensive care units and, based on intubation status, categorized them into three subgroups (early, late, and not intubated). Early intubation is defined as intubation within 48 hours of ICU admission, and late intubation is defined as intubation after 48 hours of ICU admission.

Early-intubated patients were more likely to have dyspnea than late-intubated patients, and late-intubated patients had a higher mean heart rate than early-intubated patients. The neutrophil/lymphocyte ratio was significantly (P < 0.05) lower in not-intubated patients than in other patients. There was no difference in NLR between early- and late-intubated patients. Mean serum creatine phosphokinase and troponin I levels were higher in late-intubated patients than in early- and not-intubated patients. Early-intubated patients had a lower ROX index than late-intubated patients. Patients with higher scores of APACHE 2, respiratory rates, and neutrophil to lymphocyte ratio were more likely to be intubated. Increasing APACHE and SOFA scores were associated with decreased odds of survival.

There were no statistically significant differences in total mortality between early- and late-intubated patients. APACHE 2 scores, NLR, RR, and history of ischemic heart disease are some of the appropriate predictors of intubation. Higher respiratory rates (tachypnea) can be an indicator of early intubation. The ROX index is one of the most sensitive and capable tools for predicting intubation. Intubation status is a potent predictor of in-hospital mortality.

The body position change, as a common intervention in the intensive care unit (ICU), may affect endotracheal tube cuff pressure changes.

This study investigated the effect of body position change and vital signals on endotracheal tube cuff pressure in children after bidirectional Glenn shunt surgery.

This randomized controlled trial was conducted on 29 children with an oral endotracheal tube hospitalized in the ICU after Glenn shunt surgery. The endotracheal tube cuff pressure was measured at the patient’s bed placed at a 30-degree angle. Other positions included right and left lateral in bed at a 30° upward angle as well as right and left lateral in bed angle at a 45° angle, respectively. The measurements were repeated every 10 min three times in different positions. Vital signals were measured in each group. The data were analyzed using SPSS 20.

The results showed a significant relationship (P<0.001) between the body position change and level of cuff pressure after positioning patient’s body on their right side at an angle of 30˚, left side at an angle of 30° (P=0.004), and right side at an angle of 45° (P=0.010). The results showed no significant correlation between vital signals and endotracheal tube cuff pressure, except in mean arterial pressure.Implications for Practice: It is recommended that endotracheal tube cuff pressure in patients should be checked and corrected (if necessary), after changing the patient’s body position.

The present study attempted to determine the antibiotic susceptibility of bacteria isolated from endotracheal tube culture on patients admitted to the intensive care units (ICUs) of Shahid Mohammadi hospital in Bandar Abbas.

This cross-sectional study was conducted on 114 patients hospitalized in the pulmonary ICU of Shahid Mohammadi hospital in Bandar Abbas from March 2018 to March 2019. The samples of the patients’ endotracheal tube secretions were collected for the culture purpose on the first and fifth days of hospitalization in the ICU where the disk diffusion method was used to determine antibiotic susceptibility.

The most common isolated microorganisms from the first day of culture were 26 Acinetobacter spp. isolates (22.8%), 10 Candida isolates (8.8%), and 9 Pseudomonas aeruginosa isolates (7.9%). The most common microorganisms which were isolated on the fifth day comprised Acinetobacter spp. with 57 isolates (51.8%), Candida with 6 isolates (5.5%), and P. aeruginosa with 6 isolates (5.5%). The highest resistant bacteria isolated from Acinetobacter spp. samples on the first-day were amikacin (92.3%) and meropenem (84.6%). The highest resistance of P. aeruginosa was against meropenem (77.8%), while the highest resistance of Acinetobacter spp. isolates was found to be amikacin (94.7%) and meropenem (86%) from the fifth-day samples. Further, P. aeruginosa isolates had the highest resistance in meropenem (83.3%), co-trimoxazole, and cefepime (66.7% for each of them).

Ventilator-associated pneumonia (VAP) is considered a warning condition due to multidrug-resistant bacteria. According to the present study, the most common VAP-causing bacteria are gram-negative, especially Acinetobacter, with high antibiotic resistance.

To assess the incidence and risk factors of sore throat, cough and hoarseness in180 patients undergoing general anaesthesia and endotracheal intubation.
Postoperative sore throat is one of the common adverse events after general anaesthesia and has a reported incidence from 21 to 71%. Though it is not a life threatening complication, it is an important cause of postoperative morbidity and patient dissatisfaction during the hospital stay.

A prospective observational study was conducted on 180 patients ASA PS 1 and 2, in the age group of 18-65 years of both gender, undergoing general anaesthesia and endotracheal intubation. Preoperatively h/o smoking and tobacco chewing were recorded. Intraoperatively number of attempts of intubation, duration of laryngoscopy, presence of throat pack and ryle’s tube, position of head during surgery and duration of surgery were recorded. Post operatively complaints of sore throat, cough and hoarseness were recorded at 6hrs and 24 hrs using 4-point scale.Data were analysed with SPSS 22 version software, p value of <0.05 was considered as statistically significant after assuming all the rules of statistical tests.

The incidence of sore throat was 30.6%, hoarseness was 4.4% and cough was 2.8% in our study in patients undergoing general anaesthesia and endotracheal intubation.

The incidence of sorethroat was 30.6%, hoarseness 4.4%, and cough 2.8% in our study. Tube lubrication, position of head extension with pillow under shoulder and presence of throat pack shows higher incidence of POST.

Unilateral lung collapse (ULC) is a clinical challenge in the intensive care unit and requires sophisticated treatment approaches, especially if the collapse continued over several hours. If not responded to ordinary measures such as postural drainage and bronchoscopy, it may require insertion of a double‑lumen endotracheal tube and independent lung ventilation or high‑pressure manual re‑expansion of the collapsed lung which may result in lung injury. In this article, a safe and gradual re‑expansion method using airway pressure release ventilation is presented for the treatment of a ULC.

Endotracheal intubation is known as the best and challenging procedure to airway control for patients in shock or with unprotected airways. Failed intubation can have serious consequences and lead to high morbidity and mortality of the patients. Videolaryngoscope is a new device that contains a miniaturized camera at the blade tip to visualize the glottis indirectly. Fewer failed intubations have occurred when a videolaryngoscope was used. Other types of videolaryngoscopes were then developed; all have been shown to improve the view of the vocal cords. It may be inferred that for the professional group, including emergency physicians, paramedics, or emergency nurses, video laryngoscopy may be a good alternative to direct laryngoscopy for intubation under difficult conditions. The incidence of complications was not significantly different between the C-MAC 20% versus direct laryngoscopy 13%. The main goal of this review was to compare the direct laryngoscopy with the (indirect) video laryngoscopy in terms of increased first success rate and good vision of the larynx to find a smooth induction of endotracheal intubation.

Currently available evidence on MEDLINE, PubMed, Google scholar and Cochrane Evidence Based Medicine Reviews, in addition to the citation reviews by manual search of new anesthesia and surgical journals related to laryngoscopies and tracheal intubation.

This review of recent studies showed that the laryngoscopic device design would result in smooth approach of endotracheal intubation by means of good visualization of glottis and the best success rates in the hands of both the experienced and novice. Video laryngoscopes may improve safety by avoiding many unnecessary attempts when performing tracheal intubation with DL compared to VL as well as easy learning of both direct and indirect laryngoscopy.

The comparative studies of different video laryngoscopes showed that DL compared with VL, reveal that video laryngoscopes reduced failed intubation in anticipated difficult airways, improve a good laryngeal view and found that there were fewer failed intubations using a videolaryngoscope when the intubator had equivalent experience with both devices, but not with DL alone. And therefore, knowledge about ETI and their skills, are crucial in increasing the rate of survival.

The emergence of video laryngoscopy in the management of pediatric airways has been invaluable as it has been known that these patients are prone to airway complications. Video laryngoscopes are proven to improve glottic view in both normal and difficult airways in pediatric patients. The time taken to intubate using these devices is inconsistent.

This study was designed to compare the time to intubate using two common video laryngoscopes, C-MAC® , and GlideScope® , aimed at pediatric patients age 3 - 12 years old.

A Randomized controlled trial was conducted in 65 ASA I or II patients, aged 3 - 12 years old who underwent elective surgery using endotracheal tube. They were divided into group 1 patients who were intubated using C-MAC® video laryngoscope versus group 2 patients who were intubated with GlideScope® video laryngoscope. Laryngoscopists were all anesthetists with experience in both C-MAC® and GlideScope® intubation. Time to intubate and intubation attempts were measured. Any extra maneuver, airway complications, and laryngoscopist satisfaction scores were also recorded.

Total time to intubate was significantly longer in GlideScope® group than in C-MAC® group (P < 0.001). Both devices managed to achieve excellent glottic views. The first pass attempt success rate was similar between both devices. There was no difference between requirement of extra maneuvers to assist intubations. There were also no adverse events associated with all the intubations. The satisfaction score of anesthetists was comparable to each other.

Even though intubation time using GlideScope® is longer, both devices give excellent glottic view, comparable success intubation, and anesthetists satisfaction score.