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

Neonatal respiratory distress syndrome (RDS) is a common and urgent condition in newborns, caused by a lack of surfactant production and secretion. This study aimed to compare two non-invasive methods, nasal continuous positive airway pressure (nCPAP) and high-flow nasal cannula (HFNC), for managing RDS. The study was conducted in the Neonatal Intensive Care Unit (NICU) of Shahid Sadoughi Hospital between 2020 and 2021 and included 49 premature neonates (with gestation ≤34 weeks and birth weight ≤2,000 g) diagnosed with RDS. The neonates were randomly assigned to either the HFNC group (n = 24) or the nCPAP group (n = 25). No significant differences in demographic features were observed between the two groups. The HFNC group had lower rates of intubation, shorter hospitalization duration, and less need for full nutritional support and oxygen therapy compared to the nCPAP group, but these differences were not statistically significant. Additionally, there were no significant differences in complications such as traumatic nasal injury, apnea, necrotizing enterocolitis (NEC), bronchopulmonary dysplasia (BPD), pneumothorax, pulmonary hemorrhage, and mortality between the two groups. The results of this study suggest that both HFNC and nCPAP are equally effective in treating premature neonates with RDS, with no significant differences in clinical outcomes. Given the cost-effectiveness of HFNC, medical staff expertise, and equipment accessibility, this approach could be considered a viable alternative to nCPAP.

Although endotracheal intubation is an emergency procedure that is frequently performed in neonatal care, there is still uncertainty about the best method for the estimation of the optimal depth of the endotracheal tube (ETT) in neonates. We aimed to compare two different methods of estimation of ETT insertion depth in neonates.
This study was conducted on 120 neonates needing intubation. The ETT insertion depth was estimated in 60 neonates according to the oro-helical length (OHL) method and it was estimated in the other 60 neonates according to the Tochen’s formula method. Both groups were compared in correct estimation of the proper ETT position in chest radiography.
The incidence of ETT malposition did not differ significantly between the OHL group (31.7 %) and the Tochen’s formula group (45 %) (P > 0.05). There was also no significant difference in chest expansion in both groups in chest X ray.  Two neonates in the OHL group developed air leaks (3.3 %) versus 3 neonates in Tochen’s formula group (5 %) with no significant difference (P > 0.05). Furthermore, there was no significant difference between both methods regarding the incidence of accidental extubation, There was a positive correlation between the estimated ETT insertion depth by OHL measurement and weight and gestational age (p < 0.001).
The OHL measurement can be used as an alternative to Tochen’s formula for estimation of the optimal ETT insertion depth especially in emergency situations when the weight of the baby is not known.

The role of caffeine as a brain stimulant in improving the respiratory characteristics of patients under mechanical ventilation is unclear. This study aimed at determining the effect of oral caffeine in helping to release (Liberation) from the ventilator in intubated patients under mechanical ventilation admitted to the intensive care unit.
General ICU patients with more than 48 hours of dependency on a ventilator were randomly divided into two groups. The intervention group received 200mg caffeine tablets twice a day through a gastric tube, while the control group received a placebo of the same amount. Every day, patients were assessed for the likelihood of being disconnected from the device. If their clinical condition was deemed suitable, the device mode was switched to spontaneous, and their Rapid Shallow Breathing Index (RSBI) was calculated. Based on this information, a decision was made regarding whether to proceed with weaning.
Caffeine use in ICU patients significantly reduced the airway resistance index of patients (P <0.05). However, although this drug reduced the length of hospital stay in the ICU and the duration of intubation of patients, these changes were not statistically significant (P> 0.05).
Caffeine may improve respiratory status and reduce the duration of intubation and hospitalization in the ICU.

Accidental esophageal intubation is a preventable human error that complicates airway management and continues to occur despite advances in medical devices. Perforation of the stomach has been associated with esophageal intubation in several case reports.This report presents a case of an elderly woman suspected of having COVID-19-related pneumonia. She was intubated due to respiratory dysfunction. In the initial few minutes, the patient became desaturated, leading to a second intubation. An hour later, the patient’s abdomen was distended, and the chest computed tomography (CT) showed a massive pneumoperitoneum. During laparotomy, a 6 cm long rupture was found in the lesser curvature, which was attributed to accidental esophageal intubation. To avoid such a fatal condition, it is imperative for physicians to ensure the correct positioning of the endotracheal tube. To achieve this goal, further investigation into readily available and highl y sensitive techniques is recommended.

 Tracheal intubation is a common technique used to secure a patient’s airway, which is crucial in anesthesia. Successful tracheal intubation depends on various factors, including the assessment of the patient’s airway before the procedure. In recent years, scoring systems, such as LEMON (an acronym for the assessment of the airway’s appearance, identification of any dental issues, evaluation of Mallampati classification, assessment of airway obstruction, and examination of neck mobility) and intubation difficulty scale (IDS) have gained attention. This study aimed to investigate the relationship between the LEMON criteria and IDS in tracheal intubation. The goal was to provide valuable insights that can assist medical professionals in optimizing their approach to airway management by analyzing clinical data, assessing patient outcomes, and evaluating the consistency between these scoring systems.

 This study was based on a descriptive-analytical study involving a group of patients requiring intubation. This study examined 105 patients scheduled for elective surgeries, aged between 19 and 60 years, without specific underlying diseases, such as laryngeal cancer, temporomandibular joint stiffness, or significant tongue enlargement, and with a body mass index (BMI) below 40 kg/m². Initially, expert anesthesiologists assessed the patients using the LEMON criteria, and then the degree of intubation difficulty was measured using the IDS scoring system. Finally, these two criteria were compared.

 In this study, there was a significant correlation between the LEMON score and the IDS score (P < 0.001). The difficult intubation group (IDS score higher than 0) had higher LEMON scores (with the highest score equal to 4) than the non-difficult intubation group (IDS score of 0) (P = 0.017). The average LEMON and IDS scores were 3.11 and 1.35, respectively. Among the participants, 96.2% had an intubation difficulty score of ≤ 5; nevertheless, 3.8% had a score of > 5. Additionally, limited neck mobility emerged as the sole independent predictor of intubation difficulty (P = 0.002, odds ratio = 6.152).

 The LEMON score is associated with difficult intubation in adult patients requiring intubation.

MONTH Difficult Laryngoscopy Score was developed for effectively identifying difficult intubations in the emergency department (ED). This study aimed to evaluate the accuracy of MONTH Score in predicting difficult intubations in ED.

 We prospectively collected data on all patients undergoing intubation in the ED of Ramathibodi Hospital, Bangkok, Thailand. The screening performance characteristics of the MONTH score in identifying the difficult intubation in ED were analyzed. All data were analyzed using STATA software version 18.0.

  324 intubated patients with the median age of 73 (63-82) years were studied (63.58% male). The proportion of difficult intubations was 19.44%. The sensitivity and specificity of MONTH in predicting difficult intubations were 74.6% (95% CI: 61.6%-85.0%) and 92.8% (95% CI: 89.0%-95.6%), respectively. These measures in subgroup of patients with Intubation Difficulty Scale (IDS) score ≥ 6 were 44.1% (95%CI: 31.2-57.6) and 98.5% (95% CI: 96.2%- 99.6%), respectively. The area under the receiver operation characteristic (ROC) curve of MONTH in predicting difficult intubations was 0.895 (95% CI: 0.856- 0.926).

 It seems that the MONTH Difficult Laryngoscopy Score could be considered as a tool with high specificity and positive predictive values in identifying cases with difficult intubations in ED.

Intubation is a crucial procedure used to maintain an open airway in patients who are deeply sedated, unconscious, or under anesthesia. It enables controlled ventilation and administration of oxygen during surgeries, severe illnesses, extensive trauma, or following cardiac arrest. Difficult intubation poses a significant risk to patients’ well-being and necessitates comprehensive training programs for healthcare providers. With the rise of online teaching, it is essential to explore and understand the complications associated with difficult intubation to develop effective online training programs.

A literature review was conducted to examine the relevant literature on intubation complications and online teaching approaches. Electronic databases, including PubMed, Embase, and Scopus, were searched using keywords such as “intubation complications”, “difficult airway”, “online teaching”, and related terms. Studies published from January 2018 to September 2022 were included. The selection criteria focused on articles that addressed the complications of intubation, online teaching strategies, and their impact on healthcare provider training.

The literature review identified 23 relevant studies that met the inclusion criteria. The findings highlighted the significance of understanding and addressing the complications associated with difficult intubation in online teaching programs. Various approaches were explored, including virtual simulations, video-based modules, and interactive online platforms. These methods demonstrated promising results in improving healthcare providers’ knowledge and skills related to intubation, ultimately enhancing the patients’ safety.

This literature review emphasizes the importance of integrating the complications of difficult intubation into online teaching programs for healthcare providers. The findings support the utilization of virtual simulations, video-based modules, and interactive online platforms as effective tools in enhancing training outcomes. Online teaching provides a flexible and accessible platform for healthcare providers to learn and practice intubation techniques in a simulated environment, thus improving their preparedness for real-life scenarios.

The aim of the study is to evaluate the effect of metformin in complication improvement of hospitalized patients with COVID-19.

This was a randomized clinical trial that involved 189 patients with confirmed COVID-19 infection. Patients in the intervention group received metformin-500 mg twice daily. Patients who received metformin before admission were excluded from the control group. Patients who were discharged before taking at least 2000 mg of metformin were excluded from the study. Primary outcomes were vital signs, need for ICU admission, need for intubation, and mortality.

Data showed that patients with diabetes with previous metformin in their regimen had lower percentages of ICU admission and death in comparison with patients without diabetes (11.3% vs. 26.1% (P = 0.014) and 4.9% vs. 23.9% (P ≤ 0.001), respectively). Admission time characteristics were the same for both groups except for diabetes and hyperlipidemia, which were significantly different between the two groups. Observations of naproxen consumption on endpoints, duration of hospitalization, and the levels of spO2 did not show any significant differences between the intervention and the control group. The adjusted OR for intubation in the intervention group versus the control group was 0.21 [95% CI, 0.04-0.99 (P = 0.047)].

In this trial, metformin consumption had no effect on mortality and ICU admission rates in non-diabetic patients. However, metformin improved COVID-19 complications in diabetic patients who had been receiving metformin prior to COVID-19 infection, and it significantly lowered the intubation rates.

A decision-making guideline on when to intubate an older person based on predictors of intubationoutcome would be extremely beneficial. This study aimed to identify the associated factors that could predict the out-comes of endotracheal intubation among older adults in the Emergency Department (ED).

In this retrospec-tive cross-sectional study, patients aged≥65 years intubated at the ED of University of Malaya Medical Centre, KualaLumpur, Malaysia, from 2015 to 2019 were studied. The association between age, gender, place of inhabitation, Identifi-cation of Seniors at Risk (ISAR) score for frailty, Charlson Comorbidity Index (CCI), Acute Physiology and Chronic HealthEvaluation-II (APACHE-II) score, indication for intubation, and diagnosis on admission with in-hospital mortality (pri-mary outcome) and duration of ventilation, and length of stay (secondary outcomes) were evaluated using univariateanalysis and Cox’s regression survival analysis.

889 cases aged 65 years and above were studied (61.5% male).The rate of in-hospital mortality was 71.4%. There was a significant association between age (p < 0.001), nursing homeresidency (p = 0.008), CCI≥5 (p = 0.001), APACHE-II (p < 0.001), pre-intubation Glasgow Coma Scale (GCS) (p < 0.001),cardiac arrest as indication of intubation (p < 0.001), diagnosis on admission (p < 0.001), length of stay (p < 0.001), andlength of ventilation (p = 0.003) and in-hospital mortality. Age≥85 years (HR= 1.270; 95%CI=1.074 to 1.502) and 75 to84 years (HR=1.642; 95%CI=1.167 to 2.076), cardiac arrest as indication of intubation (HR: 1.882; 95% CI: 1.554 – 2.279),and APACHE-II scores 25 – 34 (HR: 1.423; 95% CI: 1.171 - 1.730) and≥35 (HR: 1.789; 95%CI: 1.418 - 2.256) were amongstthe independent predictive factors of in-hospital mortality.

Nearly three out of four individuals aged≥65years intubated at the ED died during the same admission. Older age, cardiac arrest as indication of intubation, andAPACHE-II score were independent predictors of in-hospital mortality.

Preoperative airway assessment is necessary to identify airway difficulties to the earliest, ensure adequate preparation to airway management before induction and to avoid airway related complications. Various Imaging techniques have been studied for prediction of the difficult airway. the ultrasound is a quick and simple technique. Aim of the study was to evaluate ultrasound guided measurement of tongue thickness in predicting difficult tracheal intubation in patients undergoing elective surgery.

Sixty-one patients American Society of Anesthesiologist class I and II,18-65 years of age, either sex, were included. Tongue thickness was measured by ultrasound as the distance from the surface of tongue to the submental skin. Modified mallampatti score was also recorded.

Receiver operating characteristic (ROC) curve of tongue thickness showed an AUC of 0.879 for a cut off value of >6 cm. This shows it has an excellent predictive value. Tongue thickness (>6cm) was found to have 90.16% combined diagnostic accuracy with 75% sensitivity and 94.74% specificity for prediction of difficult intubation. No correlation between tongue thickness and modified mallampatti score. (Correlation coefficient was 0.013, p value 0.920).

We conclude that ultrasound guided measurement of tongue thickness> 6 cm can reliably predict difficult tracheal intubation in patients undergoing elective surgery.

 Tracheal intubation is used for most operations under general anesthesia. Prolonged hyperinflation of the tube cuff can compromise tracheal mucosal perfusion, and low pressure of the cuff may cause some other complications. The aim of this study was the evaluation of changes in intra-cuff pressure in patients undergoing cardiac surgeries under cardiopulmonary bypass.

 In an observational study 120 patient’s candidate to cardiac operations under cardiopulmonary bypass were enrolled. After induction of anesthesia and tracheal intubation by same tracheal tubes, tracheal tube cuff pressure was adjusted to 20-25 mm Hg (T0). Then the cuff pressure was measured at beginning of CPB (Cardio Pulmonary Bypass) (T1), at 30º hypothermia (T2) and after separation from CPB (T3).

 The mean cuff pressure was 33.5±7.3, 28.9±5.4, 25.6±5.2 and 28.1±3.7 at T0, T1, T2 and T3 respectively. Intra- cuff pressure changed significantly during cardiopulmonary bypass.

 The mean intra-cuff pressure was decreased during hypothermic cardiopulmonary bypass. The decrease in cuff pressure may protect the tracheal mucosa against hypotensive ischemic injury in these patients.

Direct laryngoscopy is the standard method for intubation in pediatric patients. The introduction of video laryngoscopy brought a paradigm shift in managing pediatric airways.

We compared the tracheal intubation technique between direct and video laryngoscopy with McIntosh Blade 2 in pediatric patients 2 - 8 years of age requiring airway management. The glottic view and the first pass success rate were compared and analyzed.

An observational cross-sectional study was conducted with 120 children between 2 - 8 years with normal airways. They were divided into video laryngoscopy (Group V) and direct laryngoscopy (Group D). The primary outcome measures included time taken for intubation, number of attempts required, Cormack-Lehane glottic view, use of optimization maneuvers, the requirement of tube repositioning, and hemodynamic parameters before and after intubation.

The time taken for intubation was longer in the video laryngoscopy group (group D, 24.28 sec vs. group V, 27.65 seconds (P = 0.01). The Cormack-Lehane glottic view was grade 1 in all the patients in the video laryngoscopy group, while only 35 children showed grade 1 in the direct laryngoscopy group. (P< 0.001).We observed a significant increase in both heart rate andmeanarterial pressure in the video laryngoscopy group at 1, 3, 5, and 10 min after intubation (P < 0.001, P < 0.05).

The time taken for intubation was more in group V, but the glottic view was much better, and the requirement for external maneuvers was also less. Pressure response to intubation was more in group V compared to group D.

Schwartz-Jampel syndrome (SJS) is a rare autosomal recessive disease characterized by muscle weakness and stiffness, abnormal bone development, short stature, joint contractures, and facial dysmorphisms. Myopathy, anatomical deformities, and malignant hyperthermia are challenging for anesthesiologists.

This case report describes one case of SJS. The female patient was scheduled for Blepharoplasty in Rasuol Akram General Hospital.

These patients may have difficult intubation and be prone to malignant hyperthermia. We managed this patient by applying Rocuronium, propofol, and C-MAC video laryngoscopy.

Considering the lack of studies to investigate the effect of atropine administration on delirium incidence in a postanesthesia care unit (PACU) in children, this study was conducted with the aim of investigating the effect of atropine administration on delirium incidence and other complications in children undergoing surgery.

The present double-blind, randomized clinical trial was conducted on 70 children aged 1 - 6 years that were candidates for lower abdominal surgery. The patients were assigned to two groups, each consisting of 35 patients. Before induction of anesthesia, 0.02mg/kgof atropineand0.02mg/kgof normal saline were administered intravenously in the first (atropine)andsecond (control) groups, respectively. Patients’ mean arterial blood pressure (MAP), heart rate (HR), and incidence of complications after surgery were recorded.

The results of the present study revealed that the two groups had no significant difference in terms of the mean MAP in any of the studied times (P-value> 0.05). However, themeanHRduring surgerywassignificantly higher in the atropinegroupcompared with the control group (P-value < 0.05). In addition, although the incidence and severity of delirium in the atropine group were insignificantly higher than that of the control group, respiratory complications such as decreased saturation and laryngospasm were lower in the atropine group compared with the control group (P-value > 0.05). The volume of suctioned secretions in the atropine group, with a mean of 6.26 ± 2.47 cc was significantly lower than its volume in the control group, with a mean of 14.57 ± 4.27 cc (P-value < 0.001).

According to the findings of the present study, although the administration of atropine slightly increased delirium incidence, it could reduce the incidence of respiratory complications and secretions after surgery. However, more studies are required to make a more definitive conclusion in this respect.

Endotracheal intubation is the basic method of providing a safe cross‑sectional airway area and the incorrect placement can be dangerous and causes complications. So this study aimed to access the diagnostic value of color Doppler epigastric ultrasound and linear probe suprasternal notch ultrasound in comparison with standard capnography in confirmation of endotracheal tube (ETT) placement after intubation.

This diagnostic value study was conducted on 104 patients requiring intubation who were referred to the Emergency Department. After the intubation, color Doppler epigastric ultrasound and suprasternal notch ultrasound as well as the standard capnography were used to confirm the placement ETT.

The sensitivity and specificity of color Doppler epigastric ultrasound were 97.96% and 100%, for suprasternal notch ultrasound were 98.98% and 66.67%, and for combination of the both methods were 96.94% and 100% respectively that showed the significant diagnostic value in the confirmation of ETT placement (P < 0.001). The mean of elapsed time to confirm the ETT placement by the standard capnography method (17.95 ± 2.45 s) was significantly more than the two methods of epigastric ultrasound (10.38 ± 4.65 s) and suprasternal notch ultrasound (5.08 ± 4.45 s) as well as the combined method with the mean of 15.46 ± 8.31 s (P < 0.001).

The results of this study showed that although ultrasound is a potentially accurate, fast, and reliable method to confirm the endotracheal tube placement, but suprasternal notch ultrasound is considered to be a more appropriate diagnostic technique due to its higher sensitivity and less detection time compared to epigastric ultrasound and combined method.

Considering that the gold standard for intubation in children with a difficult airway is the use of fiberoptic bronchoscopy, and few studies have evaluated its application in children, the present study aimed at comparing two bronchoscopic techniques of nasal fiberoptic tracheal intubation (FOI-Nasal) and fiberoptic intubation via laryngeal mask airway (FOI-LMA) in children with a difficult airway.

A single-blind randomized clinical trial was performed on 40 six-month-old to six-year-old children that were divided into two groups each consisting of 20 patients. The participants were all candidates for elective surgery with clinical criteria for the anticipated difficult intubation. FOI-Nasal and FOI-LMA were performed in the first and second groups, respectively. Mean arterial pressure (MAP), heart rate (HR), and blood oxygen saturation levels (SpO2) were assessed and recorded before anesthesia (T1), immediately before bronchoscopy (T2), and immediately after intubation with endotracheal tube (T3). Moreover, ETCO2, the first successful insertion attempt, and the intubation time were recorded, as well.

The results of the present study revealed that parameters including MAP, HR, and SpO2 at times T1, T2, and T3 were not significantly different between the two groups after adjusting for potential confounding factors (P> 0.05). However, ETCO2 in FOI-Nasal group with a mean of 38.40 ± 3.57 was significantly higher than that of the FOI-LMA group with a mean of 34.35 ± 3.15 (P = 0.001). In addition, the intubation time in the FOI-LMA group with a mean of 32.40 ± 7.45 was significantly shorter than that of the FOI-Nasal group with a mean of 51.75 ± 9.97 (P <0.001). The success rate in the first attempt in the FOI-Nasal group with the value of 70% was lower than that of the FOI-LMA group with the value of 90%; however, this difference was not statistically significant (P> 0.05).

According to the results of the present study, the intubation time in the FOI-LMA group was significantly shorter than that of the FOI-Nasal group. Moreover, the success rate of the first attempt in the FOI-LMA group was higher than that of the FOI-Nasal group. Therefore, it can be stated that FOI-LMA as compared to FOI-Nasal can be regarded as an easier technique, with a shorter intubation time, a higher success rate, and a greater stability of children’s hemodynamic parameters.