Airway Extubation: Removal of an endotracheal tube from the patient.Ventilator Weaning: Techniques for effecting the transition of the respiratory-failure patient from mechanical ventilation to spontaneous ventilation, while meeting the criteria that tidal volume be above a given threshold (greater than 5 ml/kg), respiratory frequency be below a given count (less than 30 breaths/min), and oxygen partial pressure be above a given threshold (PaO2 greater than 50mm Hg). Weaning studies focus on finding methods to monitor and predict the outcome of mechanical ventilator weaning as well as finding ventilatory support techniques which will facilitate successful weaning. Present methods include intermittent mandatory ventilation, intermittent positive pressure ventilation, and mandatory minute volume ventilation.Intubation, Intratracheal: A procedure involving placement of a tube into the trachea through the mouth or nose in order to provide a patient with oxygen and anesthesia.Airway Obstruction: Any hindrance to the passage of air into and out of the lungs.Airway Remodeling: The structural changes in the number, mass, size and/or composition of the airway tissues.Laryngeal Edema: Abnormal accumulation of fluid in tissues of any part of the LARYNX, commonly associated with laryngeal injuries and allergic reactions.Device Removal: Removal of an implanted therapeutic or prosthetic device.Airway Resistance: Physiologically, the opposition to flow of air caused by the forces of friction. As a part of pulmonary function testing, it is the ratio of driving pressure to the rate of air flow.Respiration, Artificial: Any method of artificial breathing that employs mechanical or non-mechanical means to force the air into and out of the lungs. Artificial respiration or ventilation is used in individuals who have stopped breathing or have RESPIRATORY INSUFFICIENCY to increase their intake of oxygen (O2) and excretion of carbon dioxide (CO2).Anesthesia Recovery Period: The period of emergence from general anesthesia, where different elements of consciousness return at different rates.Respiratory Insufficiency: Failure to adequately provide oxygen to cells of the body and to remove excess carbon dioxide from them. (Stedman, 25th ed)Tracheostomy: Surgical formation of an opening into the trachea through the neck, or the opening so created.Anesthesia, General: Procedure in which patients are induced into an unconscious state through use of various medications so that they do not feel pain during surgery.Bronchi: The larger air passages of the lungs arising from the terminal bifurcation of the TRACHEA. They include the largest two primary bronchi which branch out into secondary bronchi, and tertiary bronchi which extend into BRONCHIOLES and PULMONARY ALVEOLI.Respiratory System: The tubular and cavernous organs and structures, by means of which pulmonary ventilation and gas exchange between ambient air and the blood are brought about.Positive-Pressure Respiration: A method of mechanical ventilation in which pressure is maintained to increase the volume of gas remaining in the lungs at the end of expiration, thus reducing the shunting of blood through the lungs and improving gas exchange.Intensive Care Units: Hospital units providing continuous surveillance and care to acutely ill patients.Bronchial Hyperreactivity: Tendency of the smooth muscle of the tracheobronchial tree to contract more intensely in response to a given stimulus than it does in the response seen in normal individuals. This condition is present in virtually all symptomatic patients with asthma. The most prominent manifestation of this smooth muscle contraction is a decrease in airway caliber that can be readily measured in the pulmonary function laboratory.Airway Management: Evaluation, planning, and use of a range of procedures and airway devices for the maintenance or restoration of a patient's ventilation.Respiratory Distress Syndrome, Newborn: A condition of the newborn marked by DYSPNEA with CYANOSIS, heralded by such prodromal signs as dilatation of the alae nasi, expiratory grunt, and retraction of the suprasternal notch or costal margins, mostly frequently occurring in premature infants, children of diabetic mothers, and infants delivered by cesarean section, and sometimes with no apparent predisposing cause.Continuous Positive Airway Pressure: A technique of respiratory therapy, in either spontaneously breathing or mechanically ventilated patients, in which airway pressure is maintained above atmospheric pressure throughout the respiratory cycle by pressurization of the ventilatory circuit. (On-Line Medical Dictionary [Internet]. Newcastle upon Tyne(UK): The University Dept. of Medical Oncology: The CancerWEB Project; c1997-2003 [cited 2003 Apr 17]. Available from: http://cancerweb.ncl.ac.uk/omd/)Respiratory Mucosa: The mucous membrane lining the RESPIRATORY TRACT, including the NASAL CAVITY; the LARYNX; the TRACHEA; and the BRONCHI tree. The respiratory mucosa consists of various types of epithelial cells ranging from ciliated columnar to simple squamous, mucous GOBLET CELLS, and glands containing both mucous and serous cells.Nose Deformities, Acquired: Abnormalities of the nose acquired after birth from injury or disease.Sleep Apnea, Obstructive: A disorder characterized by recurrent apneas during sleep despite persistent respiratory efforts. It is due to upper airway obstruction. The respiratory pauses may induce HYPERCAPNIA or HYPOXIA. Cardiac arrhythmias and elevation of systemic and pulmonary arterial pressures may occur. Frequent partial arousals occur throughout sleep, resulting in relative SLEEP DEPRIVATION and daytime tiredness. Associated conditions include OBESITY; ACROMEGALY; MYXEDEMA; micrognathia; MYOTONIC DYSTROPHY; adenotonsilar dystrophy; and NEUROMUSCULAR DISEASES. (From Adams et al., Principles of Neurology, 6th ed, p395)Polysomnography: Simultaneous and continuous monitoring of several parameters during sleep to study normal and abnormal sleep. The study includes monitoring of brain waves, to assess sleep stages, and other physiological variables such as breathing, eye movements, and blood oxygen levels which exhibit a disrupted pattern with sleep disturbances.Catheters, Indwelling: Catheters designed to be left within an organ or passage for an extended period of time.Catheters: A flexible, tubular device that is used to carry fluids into or from a blood vessel, hollow organ, or body cavity.Catheterization, Central Venous: Placement of an intravenous CATHETER in the subclavian, jugular, or other central vein.Catheterization: Use or insertion of a tubular device into a duct, blood vessel, hollow organ, or body cavity for injecting or withdrawing fluids for diagnostic or therapeutic purposes. It differs from INTUBATION in that the tube here is used to restore or maintain patency in obstructions.Catheterization, Peripheral: Insertion of a catheter into a peripheral artery, vein, or airway for diagnostic or therapeutic purposes.Nasal Obstruction: Any hindrance to the passage of air into and out of the nose. The obstruction may be unilateral or bilateral, and may involve any part of the NASAL CAVITY.MissouriDrug Agonism: Phenomena and pharmaceutics of compounds that selectively bind to a specific receptor and trigger a response. They mimic the action of endogenous biochemical molecules. Their effect can be countered by antagonists (DRUG ANTAGONISM).Tuberculosis, Laryngeal: Tuberculosis involving the larynx, producing ulceration of the VOCAL CORDS and the LARYNGEAL MUCOSA.Colostomy: The surgical construction of an opening between the colon and the surface of the body.Cyanosis: A bluish or purplish discoloration of the skin and mucous membranes due to an increase in the amount of deoxygenated hemoglobin in the blood or a structural defect in the hemoglobin molecule.Intensive Care Units, Neonatal: Hospital units providing continuing surveillance and care to acutely ill newborn infants.Respiratory Care Units: The hospital unit in which patients with respiratory conditions requiring special attention receive intensive medical care and surveillance.Anesthesiology: A specialty concerned with the study of anesthetics and anesthesia.Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures.Anesthetics, Dissociative: Intravenous anesthetics that induce a state of sedation, immobility, amnesia, and marked analgesia. Subjects may experience a strong feeling of dissociation from the environment. The condition produced is similar to NEUROLEPTANALGESIA, but is brought about by the administration of a single drug. (From Gilman et al., Goodman and Gilman's The Pharmacological Basis of Therapeutics, 8th ed)Authorship: The profession of writing. Also the identity of the writer as the creator of a literary production.Anesthetics, Inhalation: Gases or volatile liquids that vary in the rate at which they induce anesthesia; potency; the degree of circulation, respiratory, or neuromuscular depression they produce; and analgesic effects. Inhalation anesthetics have advantages over intravenous agents in that the depth of anesthesia can be changed rapidly by altering the inhaled concentration. Because of their rapid elimination, any postoperative respiratory depression is of relatively short duration. (From AMA Drug Evaluations Annual, 1994, p173)Tidal Volume: The volume of air inspired or expired during each normal, quiet respiratory cycle. Common abbreviations are TV or V with subscript T.Ventilators, Mechanical: Mechanical devices used to produce or assist pulmonary ventilation.Laryngeal Masks: A type of oropharyngeal airway that provides an alternative to endotracheal intubation and standard mask anesthesia in certain patients. It is introduced into the hypopharynx to form a seal around the larynx thus permitting spontaneous or positive pressure ventilation without penetration of the larynx or esophagus. It is used in place of a facemask in routine anesthesia. The advantages over standard mask anesthesia are better airway control, minimal anesthetic gas leakage, a secure airway during patient transport to the recovery area, and minimal postoperative problems.BooksLiterature, ModernLaryngoscopy: Examination, therapy or surgery of the interior of the larynx performed with a specially designed endoscope.Lawyers: Persons whose profession is to give legal advice and assistance to clients and represent them in legal matters. (American Heritage Dictionary, 3d ed)Ethical Analysis: The use of systematic methods of ethical examination, such as CASUISTRY or ETHICAL THEORY, in reasoning about moral problems.Principle-Based Ethics: An approach to ethics that focuses on theories of the importance of general principles such as respect for autonomy, beneficence/nonmaleficence, and justice.Anesthesia Department, Hospital: Hospital department responsible for the administration of functions and activities pertaining to the delivery of anesthetics.Pain Management: A form of therapy that employs a coordinated and interdisciplinary approach for easing the suffering and improving the quality of life of those experiencing pain.Pain: An unpleasant sensation induced by noxious stimuli which are detected by NERVE ENDINGS of NOCICEPTIVE NEURONS.

Risk factors and outcomes after unplanned extubations on the ICU: a case-control study. (1/49)

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Unplanned extubation in the ICU: a marker of quality assurance of mechanical ventilation. (2/49)

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Adaptive support ventilation for faster weaning in COPD: a randomised controlled trial. (3/49)

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Endotracheal tube extubation force: adhesive tape versus endotracheal tube holder. (4/49)

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Are guidelines for non-invasive ventilation during weaning still valid? (5/49)

Noninvasive ventilation (NIV) has gained increasing acceptance over the years to reduce endotracheal intubation, pneumonia and to prevent or treat respiratory failure in patients with different diagnoses. The international consensus conference, and the British society guidelines on NIV ventilation have analyzed its use during the weaning phase concluding that there were still conflicting results of its use. However, recent clinical trials have shown clear clinical benefits on the use of NIV in several patient populations during the weaning period. Acute respiratory failure (ARF) during the weaning process is the main object of recently published studies. The latest published randomized trials on the application of NIV for acute respiratory failure following extubation failed to demonstrate any favorable outcome. Even so, the use of NIV during the process of weaning in patients experiencing multiple weaning failure or as a preventive therapy in patients at higher risk of respiratory deterioration showed improved clinical outcomes only in chronic obstructive pulmonary disease and in particular in hypercapnic patients. Reduced invasive mechanical ventilation, tracheostomy and lower mortality rate at 90 days were the major advantages.  (+info)

Postextubation dysphagia is persistent and associated with poor outcomes in survivors of critical illness. (6/49)

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Bioresorbable distraction device for the treatment of airway problems for infants with Robin sequence. (7/49)

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Implications of extubation failure and prolonged mechanical ventilation in the postoperative period following elective intracranial surgery. (8/49)

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Macht M; Wimbish T; Clark BJ; Benson AB; Burnham EL; Williams A; Moss M Crit Care; 15(5): R231, 2011. INTRODUCTION: Dysphagia is common among survivors of critical illness who required mechanical ventilation during treatment. The risk factors associated with the development of postextubation dysphagia, and the effects of dysphagia on patient outcomes, have been relatively…
Initial RSBI was similar in Extubation Success and Extubation Failure groups (77.0 ± 4.8, 77.0 ± 4.8, p = ns). Nevertheless, RSBI tended to remain unchanged or decreased in the Extubation Success group; in contrast RSBI tended to increase in the Extubation Failure group because of either increased RR and/or decreased VT (p , 0.001 for mean percent change RSBI over time), indicating worsening of the respiratory pattern. Quantitatively, only 7/63 subjects of the Extubation Success group demonstrated increased RSBI ≥20% at any time during the SBT. In contrast, in the Extubation Failure group, RSBI increased in all subjects during the SBT, and eight of nine subjects demonstrated an increase greater than 20%. Thus, with a 2-h SBT the optimal threshold was a 20% increase (sensitivity = 89%, specificity = 89%). Similar results were obtained at 30 min (threshold = 5% increase). Percent change of RSBI predicted successful extubation even when initial values were ≥105.. ...
Sustained-release morphine sulfate (SRMS) is a painkiller used in oncology. The purpose of our study was to assess its efficacy on postoperative morphine requirements in elective spine surgery. This was a placebo-controlled, randomized, double-blind study. Adults scheduled for spine surgery under general anesthesia were orally administered SRMS (30 mg) or a placebo 2 h before surgery. Primary endpoint was postoperative cumulated morphine consumption through patient-controlled analgesia (PCA) during the 12 h following extubation. Statistical analysis was performed using a sequential method, the triangular test. The study was stopped after the sixth analysis (51 patients had been included; placebo: 26, SRMS: 25). Age, weight, sex ratio, type of surgery, intra-operative sufentanil consumption, anesthesia duration and time to extubation were similar in the two groups. Morphine consumption through PCA during the 12 h following extubation was significantly lower in the SRMS group (mean +/- SD: 10.5 ...
This quality improvement study assesses the association of a multicenter quality improvement initiative targeting all intubated neonatal and pediatric patients
This project was initiated with a voice of the customer survey to assess cultural readiness for change. During the define phase of this process improvement, the NICU moved from an open bay design to private rooms. The walking distance between patients and the size of the new single-patient room NICU (4 times the square footage of the open unit) required the staff to adjust to new workflows. This transition presented some initial difficulty, especially with the simultaneous implementation of some of the improvements. We anticipated that the 2 caregivers to turn model would be the most difficult to implement, but staff were able to adapt. Survey results demonstrated to our process improvement team that the culture did not support the perception that unplanned extubations were always an unpreventable event. The majority of respiratory and nursing staff reported that at least some of the unplanned extubations were preventable. The free text portion of the survey provided a number of comments from ...
Patients with failed extubation stay significantly longer in an intensive care unit (ICU) and have a higher mortality rate, than those intubated successfully. Reintubation is associated with life-threatening complications and a poor prognosis. Functional respiratory tests are frequently used as weaning parameters, however, they are not accurate enough to predict extubation failure. The incidence of swallowing dysfunction is underestimated, mainly among patients whose intubation lasts longer than 48 h.We previously observed that the assessment of the swallowing function and oropharyngeal motricity, conducted by the physiotherapist before extubation could be helpful for making decisions to extubate patients intubated for over 6 days. The objective of this study is to validate a scale previously devised and used for physiotherapist bedside evaluation of the swallowing function and oropharyngeal motricity, among patients intubated for over 6 days, to determine whether this scale is a good predictor ...
Study Objectives: Following extubation in the intensive care unit (ICU), upper airway (UA) edema and respiratory depressants may promote UA dysfunction. We tested the hypothesis that opioids increase the risk of sleep apnea early after extubation. Methods: 56 ICU patients underwent polysomnography the night after extubation. Airflow limitation during wakefulness was identified using bedside spirometry. Correlation and ordinal regression analyses were used to quantify effects of pre-extubation opioid dose on post-extubation Apnea-Hypopnea-Index (AHI) and severity of sleep apnea and whether or not inspiratory airway obstruction (ratio of maximum expiratory and inspiratory flow at 50% of vital capacity (MEF50/MIF50)≥1) during wakefulness predicts airway obstruction during sleep ...
Retrospective Clinical Studies: Using Existing Data to Inform Current Research (WEB2800): Online ASHA CEU course highlighting the article: "Postextubation Dysphagia in Critical Patients: A First Report from the Largest Step- Down Intensive Care Unit in Greece, by Malandraki, Markaki, Georgopoulos, Psychogios, & Nanas. Available at: https://shar.es/1RHdZh. Kantarcigil, C. & Malandraki, G.A. (2016). The Rise of Telehealth in the United States: The present and the future of dysphagia telerehabilitation. Invited article on Dysphagia Cafe website. Available at: http://dysphagiacafe.com/2016/08/24/rise-telehealth-united-states-present-future-dysphagia-telerehabilitation/. Purdue I-EaT Swallowing Research Lab Engagement Event Announcement. Pals of Cerebral Palsy. Media coverage by the Purdue Health Sciences media: Available at: http://www.purdue.edu/newsroom/releases/2015/Q2/open-house-event-to-focus-on-swallowing-disorders,-cerebral-palsy.html. Malandraki, G.A. (2014). International Faculty Spotlight ...
Venkataraman ST, Fuhrman BP, Howland DF, DeFrancisis MA. Positive end-expiratory pressure-induced, calcium-channel-mediated increases in pulmonary vascular resistance in neonatal lambs. Critical care medicine. 1993 Jul;21(7):1066-76.. Khan N, Brown A, Venkataraman ST. Predictors of extubation success and failure in mechanically ventilated infants and children. Critical care medicine. 1996 Sep 1;24(9):1568-79.. Venkataraman ST, Khan N, Brown A. Validation of predictors of extubation success and failure in mechanically ventilated infants and children. Critical care medicine. 2000 Aug 1;28(8):2991-6.. Randolph AG, Wypij D, Venkataraman ST, Hanson JH, Gedeit RG, Meert KL, Luckett PM, Forbes P, Lilley M, Thompson J, Cheifetz IM. Effect of mechanical ventilator weaning protocols on respiratory outcomes in infants and children: a randomized controlled trial. JAMA. 2002 Nov 27;288(20):2561-8.. ► Full listing on Pub Med ...
That leaves the final piece of the puzzle - that of monitoring - and this happens in the ED when the cardiac arrest victims arrive. Therein lies the weakest link - ourselves. How often, when we receive cardiac arrest victims, do actually think about, monitor, or make subtle changes to improve the quality of CPR? Do we check that the mechanical CPR on the patient is actually providing adequate flow? Or when manual CPR is performed, do we check on its quality? Do we aggressively check compression timing, depth, adequate recoil and minimal hands-off time? Do we routinely use end-tidal CO2 monitoring to guide CPR and assess cardiac output ...
An evaluation of the Global Assessment of Pediatric Patient Safety (GAPPS) trigger tool, which measures hospital-wide rates of adverse events (AE). Reviews of 3814 charts at 16 centers showed that experts agreed with the tool in the identification of an AE 92% of the time. Triggers included medications (e.g., vitamin K after warfarin or hepatotoxic medications with elevated transaminases), hospital care (e.g., pressure ulcer, low O2 sats), healthcare-associated infections, hospital outcomes like readmissions, surgical events (e.g., abrupt drop in hematocrit after surgery, return to surgery), and ICU-related events like unplanned extubations and neonatal IVH.. Landrigan 2016 (Pediatrics) , PubMed 27221286 , Author Search ...
Of course the doc told me everything that could go wrong. And everything he is at risk for due to his history and being hard to extubate. I already had a huge headache. And I didnt even meet the doc who did it, only the anethesiologist. So when it was over no one came in to tell me how it looked. They just called my name and told me I could go back. So I assumed they were able to extubate him ok, if he was in PACU instead of heading to PICU. I got back to him and he was wide awake! I was like, did you guys even take him back yet, this is so not Jaxson. Look at those wide eyes, fingers in the mouth ...
Assessment of maximum respiratory pressures is a common practice in intensive care because it can predict the success of weaning from ventilation. However, the reliability of measurements through an intubation catheter has not been compared with standard measurements. The aim of this study was to compare maximum respiratory pressures measured through an intubation catheter with the same measurements using a standard mouthpiece in extubated patients. A prospective observational study was carried out in adults who had been under ventilation for at least 24 h and for whom extubation was planned. Maximal respiratory pressure measurements were carried out before and 24 h following extubation. Ninety patients were included in the analyses (median age: 61.5 years, median SAPS2 score: 42.5 and median duration of ventilation: 7 days). Maximum respiratory pressures measured through the intubation catheter were as reliable as measurements through a standard mouthpiece (difference in maximal inspiratory pressure:
Post-extubation respiratory failure causes between 5-30% of patients to require reintubation, which is associated with increased mortality. Spontaneous breathing trials aim to evaluate when a patient is ready for extubation and involves a trial of T-tube, low level pressure support or continuous positive airway pressure for varying durations ranging from 30 to 120 minutes. It was hypothesised that a rest period after a spontaneous breathing trial will improve extubation rates.. Method. A parallel, two-arm, prospective, randomised controlled trial in 17 Spanish Medical-Surgical ICUs aimed to test this hypothesis. From October 2013 to January 2015, 470 mechanically ventilated patients who had been receiving Mechanical Ventilation for at least 12 hours were enrolled.. If spontaneous breathing trial (SBT) was successful they were either extubated immediately (Control group) or reconnected to the ventilator with the previous ventilator parameters for 1 hour of rest and then extubated (Rest ...
An interesting study by Tulaimat and Mokhlesi1 regarding the accuracy and reliability of extubation decisions that recently appeared in the Journal merits additional comment. The implicit study question is whether an informed decision to extubate following a successful spontaneous breathing trial is any better than random chance. By study design, the clinical vignettes were selected so that, if a decision to extubate was made by coin flip, without any clinical information, the sensitivity and specificity (as defined in the study) would be expected to reach 50%. It was disappointing that, overall, experienced clinicians performed marginally better than a coin flip in predicting extubation success (ie, 57% sensitivity), but they were highly inaccurate in predicting weaning failure (ie, 31% specificity).. In a post hoc analysis, clinicians whose extubation decision-making was relatively aggressive achieved a higher sensitivity (62%), whereas clinicians whose extubation decision-making was ...
Zenaida Carbon abstract presented on Benefits of early extubation after cardiovascular surgery at Euro Nursing 2019 | Conferenceseries Ltd
The average number of hospitalized newborns was 43.4 per day. The average number of newborns under MV was 22.4 per day. The average number of tracheostomized newborns was 4.4 per day, and the average number of intubated (non-tracheostomized) newborns was 17.9 per day. The mean duration of MV prior to UE was 11.2 days (range 1 to 39 days). Most UE (50%) occurred during the first 7 days of MV (Table 1). The following clinical signs suggested the occurrence of UE: audible weeping in 22 cases (26.8%), exteriorization of tubes in 22 cases (26.8%), cyanosis in 19 cases (23.2%), worsening of the respiratory pattern in 10 cases (12.2%), gastric contents in the ETT in six cases (7.3%), and bradycardia in three cases (3.7%). An average of 1.51 clinical signs were suggestive of UE per event. The following primary causes of UE were identified and analyzed in the present study: patient agitation in 30.8% of cases (24); inappropriate handling of patients during the performance of procedures (e.g., blood ...
There are two schools of thought about how to extubate patients at the conclusion of general anesthesia: Allow the patient to wake up with the endotracheal tube in place, gagging on the tube and flailing like a fish on a line, while someone behind the patients head bleats, "Open your eyes! Take a deep breath!" Or: Remove the endotracheal tube while the patient is still sleeping peacefully, which results in the smooth emergence ...
Using Optiflow Nasal High Flow therapy as a first-line treatment (both pre-intubation and post-extubation) may reduce patient escalation, across the care continuum, resulting in better patient outcomes.
Using Optiflow Nasal High Flow therapy as a first-line treatment (both pre-intubation and post-extubation) may reduce patient escalation, across the care continuum, resulting in better patient outcomes.
Resuscitation. 2014 Sep;85(9):1287-90. doi: 10.1016/j.resuscitation.2014.06.013. Epub 2014 Jun 28. Randomized Controlled Trial; Research Support, Non-U.S. Govt
The PASTrial is a non-commercial, multi-center, randomized, placebo-controlled, double blinded clinical trial. The study compares dexmedetomidine versus normal saline (placebo) in patients after intracranial surgery with delayed extubation. In dexmedetomidine group, infusion (0.4μg/kg/h) is started when patients are admitted to neuro-intensive care unit for postoperative recovery. In control group, patients receive normal saline infusion at the same rate and volume in dexmedetomidine group. The patients level of sedation is assessed by Sedation-Agitation Scale (SAS) per hour. Midazolam is administered in 0.3-0.5 mg bolus or continuous infusion as SAS above 4. The study is designed primarily to compare the percentage of patients with agitation and requiring midazolam infusion in the 2 study arms ...
BACKGROUND: The use of cuffed tracheal tubes (TTs) in small children is still controversial. The aim of this study was to compare post-extubation morbidity and TT exchange rates when using cuffed vs uncuffed tubes in small children. METHODS: Patients aged from birth to 5 yr requiring general anaesthesia with TT intubation were included in 24 European paediatric anaesthesia centres. Patients were prospectively randomized into a cuffed TT group (Microcuff PET) and an uncuffed TT group (Mallinckrodt, Portex, Rüsch, Sheridan). Endpoints were incidence of post-extubation stridor and the number of TT exchanges to find an appropriate-sized tube. For cuffed TTs, minimal cuff pressure required to seal the airway was noted; maximal cuff pressure was limited at 20 cm H(2)O with a pressure release valve. Data are mean (SD). RESULTS: A total of 2246 children were studied (1119/1127 cuffed/uncuffed). The age was 1.93 (1.48) yr in the cuffed and 1.87 (1.45) yr in the uncuffed groups. Post-extubation stridor ...
Among 60 patients, 29 cases developed respiratory failure within 48 h, and 14 cases were re-intubated or died within 1 week, respectively. Multivariate logistic regression analysis showed that E/Ea (average) after SBT [odds ratio (OR) 1.450, 95% confidence intervals (CI) 1.092-1.926, P = 0.01] and left ventricular ejection fraction were associated with respiratory failure. The AUC of E/Ea (average) after SBT was 0.789, and a cut-off value ≥ 12.5 showed the highest diagnostic accuracy with a sensitivity and specificity of 72.4% and 77.4%, respectively. Furthermore, in the respiratory failure subgroup only DE (average) after SBT was associated with re-intubation (OR 0.690, CI 0.499-0.953, P = 0.024). The AUC of DE (average) after SBT was 0.805, and a cut-off value ≤ 12.6 mm showed the highest diagnostic accuracy with a sensitivity and specificity of 80% and 68.4%, respectively.. CONCLUSIONS ...
Early extubation of cardiac surgery patients has become increasingly important. The assessment of the patient before an early extubation is crucial and the intensive care nurses (ICU nurses) in this estimation is there for very important.. The aim of this study was to examine critical care nurses knowledge of early extubation, and what view ICU nurse has about factors that affect the time to extubation of cardiac surgery patients.. A quantitative approach with descriptive and comparative design was used. Selection was all ICU nurses at a thoracic intensive care unit who were clinically active in patient care.. The study showed that ICU nurses had good knowledge of why an early extubation was essential. However, the knowledge about the units extubation criteria was low. ICU nurses felt that the criteria for the cardiac surgery patients on the unit was adequate. The time target of 90 minutes was reasonable. No relationship existed between professional experience and knowledge of the extubation ...
The cross-clamp is then released, and the remainder of the procedure is performed as the patient is warmed. The PTFE graft that was anastomosed to the inferior caval vein is now carried up to the undersurface of the pulmonary artery, to either the site of the prior atriopulmonary anastomosis or a site more medial, and a patch is placed on the site of the old atriopulmonary anastomosis. As the patient is warmed and started on low-dose inotropic support, the bidirectional superior cavopulmonary anastomosis is performed with running prolene suture. The patient is then ventilated and weaned from cardiopulmonary bypass, and the epicardial pacing system is placed with the heart beating. We have used bipolar steroid eluting leads for the atrial and ventricular lead placement. These are then connected to a dual-chamber device with atrial antitachycardia capabilities.14 The completed operation is shown in Figure 7.12. RESULTS. In our series, the operative mortality was 3 out of 149 patients (2%). One ...
Im happy to ferment stuff either on the counter or in the fridge (though I generally find that things ferment so slowly in the fridge that its not really worth the trouble). My kitchen is cool now, probably in the mid sixties, but should warm up to the seventies over the course of the month. My husband will be around to burp jars occasionally, but I dont expect him to remember to do it on the regular and I dont think hes up for anything more involved than that ...
Business leaders should take a step back and embrace diversity of thought in employees to unlock their full potential, says leadership expert.
The use of telemedicine here also promises interesting possibilities. If we can treat a patient remotely by telling somebody else what to do, does that mean anesthesiologists can work from home? Imagine hiring some medical student, or even a premed student to sit in the OR for you. Using telemedicine you can have him intubate the patient for you. You can then electronically monitor the patients vitals and tell the student what meds to give. At the end of the case the student will show you the train of fours and then you tell him to reverse and extubate the patient while you are sitting at home in your PJs watching CNBC on your 52 inch LCD. This would be even cheaper for the hospital than hiring a bunch of CRNAs ...
BCPA is increasingly used for interim palliation of complex cyanotic congenital heart disease.2 10 Excellent intermediate term palliation is achieved and the advantages over a systemic to pulmonary arterial shunt are well established.11-13 However, it is well recognised that progressive systemic arterial desaturation occurs and a number of factors have been proposed to explain this.14-16 This includes macroscopic PAVM which have long been recognised as a serious late complication of the cavopulmonary anastomosis.1 The finding of similar abnormalities in chronic liver disease lead to the suggestion that the loss of "hepatic factor" from the pulmonary circulation might be responsible for these changes.4 17If loss or reduced concentrations of hepatic factor are implicated in the development of PAVM, then pulmonary arteriovenous shunting (a right to left shunt) should occur early following BCPA, and PAVM merely represent the end stage of the process.. Various methods are now available for the ...
We reviewed evidence on the effectiveness of high-flow nasal cannula (HFNC) therapy in supporting childrens breathing. We found 11 studies in children.. Background. HFNC therapy delivers a mixture of air and oxygen via tubing that sits just inside the nostrils. For children hospitalized with breathing difficulties caused by conditions such as pneumonia or trauma or after surgery, HFNC therapy may help to support their breathing. This may reduce the need for other forms of breathing support such as life support. HFNC therapy can be used within the hospital ward setting, the emergency department or the intensive care unit. This Cochrane review is important because it assesses available evidence on the safety and effectiveness of HFNC compared with other forms of respiratory support, to help inform clinicians caring for children with breathing difficulties.. Search date. We searched medical databases from the 1950s until April 2013.. Study characteristics. We included studies on children from four ...
GONZALEZ-CASTRO, A. et al. Utility of the dead space fraction (Vd/Vt) as a predictor of extubation success. Med. Intensiva [online]. 2011, vol.35, n.9, pp.529-538. ISSN 0210-5691.. Purpose: To determine the value of Vd/Vt as a predictor of extubation failure in patients with mechanical ventilation admitted to the intensive care units. Design: A prospective, observational cohort study conducted from 1 September 2010 to 1 March 2011. Setting: General intensive care unit (G-ICU) of a third level university hospital. Patients or participants: The study included patients on mechanical ventilation (MV) for over 12hours, and who in the process of weaning were subjected to low-level pressure support. Exclusion criteria were age under 18 years, ventilation via tracheotomy and patients failing to cooperate for different reasons. During the study, 392 patients were admitted to the G-ICU; of these, 214 required MV. The weaning process was started in 154 cases. Fifty-four patients were excluded from the ...
The question regarding long-term outcome in patients with a functionally univentricular heart undergoing a Fontan procedure based on whether there is right or left ventricular morphological dominance is one that has been investigated for many years. The paper in this issue of the Journal by dUdekem et al. (1) from the Royal Childrens Hospital in Melbourne, Australia, found that in their nearly 30-year series reviewing 499 patients, right ventricular dominance was the single most important risk factor for death. Their other conclusion was that this risk factor seemed to be important only before the bidirectional superior cavopulmonary anastomosis (BSCPA). The interesting speculation is that earlier BSCPA may potentially modify the risk factor of right ventricular morphology. Both of these conclusions are important for clinicians to consider when guiding patients along a Fontan pathway, especially when considering timing of BSCPA and cardiac transplantation as an alternative.. Their review (1) ...
Objectives: To evaluate the impact of a mechanical ventilation protocol applied by a respiratory therapist (RT) on the outcomes in COPD patients.. Methods: A novel mechanical ventilation protocol was initiated by a respiratory therapist. Outcomes of patients during a 6-month period were compared to those of patients treated by physicians without a protocol during the preceding 6 months.. Results: A total of 170 patients were enrolled. Extubation success was higher (98% vs. 78%, p= 0.014) and median durations of weaning, mechanical ventilation (Figure 1) and ICU stay (Figure 2) were shorter in the protocol group (2 vs. 26 hours, log rank p , 0.001, 3.1 vs. 5 days, log rank p , 0.001 and 6 vs. 12 days, log rank p , 0.001 respectively). ...
FIGURE 2 Infants randomly assigned to nCPAP (black line) had significantly shorter duration of study support mode compared with infants randomly assigned to HHHFNC (gray line); P , .01. There were no significant differences between study groups for duration of ventilator support (dotted lines) or time to wean to room air (dashed lines) in the 7 days after study entry. RA, room air. ...
by winnineo , Nov 12, 2015 , Neonatal. In 2018 where do we stand on this question? Upcoming retrospective trials and work by EPIQ-4 may help to resolve this issue. In the meantime what does the existing evidence say?. The decision to extubate an extremely low birthweight infant is one of the most common sources of disagreement and anxiety in the NICU. As a resident, I recall an unwritten rule that "no baby under 750g will have a trial of extubation as they will most certainly fail". As time went on however, studies suggested that not only is this a false statement but also that the duration of intubation was directly correlated with risk of BPD. As Danan described, for infants less than a 1000g, delaying extubation when they had reached minimal settings did not result in lower rates of BPD. Moreover 60 - 70% of infants who have such extubation attempts are not reintubated within a week, so it is possible to have success.. The detractors however express concern about the 30-40% who do require ...
Matthew was weaned from his sedative last night at 6pm. He awoke around 9 pm and he had a rough night. He was awake; but the doctor didnt want to extubate him (I wont go into any details on this other than we had a very frustrated nurse and mom by morning). So all night he coughed and cried and fought the tube. Even though he is intubated, you can tell he is crying by his facial expressions. You cant hear it, but you can tell. So, I didnt sleep well because I was up and down with him trying to comfort him. I was happy when morning came because I was sure they would pull the tube. This morning, his lab work showed that his phenobarbital level (a medication used to control seizures) was still low in his blood. It was a little confusing to the neurologist because he was getting this medication twice a day orally and also daily IV boluses. His blood levels, though would not go up and had even decreased today. So they doubled his IV dose. Immediately after that dose he feel asleep and was ...
27 patients died or were successfully extubated within 48 h, and, as per our study design, were excluded from the study and statistical analysis. Patients receiving no sedation had significantly more days without ventilation (n=55; mean 13·8 days, SD 11·0) than did those receiving interrupted sedation (n=58; mean 9·6 days, SD 10·0; mean difference 4·2 days, 95% CI 0·3-8·1; p=0·0191). No sedation was also associated with a shorter stay in the intensive care unit (HR 1·86, 95% CI 1·05-3·23; p=0·0316), and, for the first 30 days studied, in hospital (3·57, 1·52-9·09; p=0·0039), than was interrupted sedation. No difference was recorded in the occurrences of accidental extubations, the need for CT or MRI brain scans, or ventilator-associated pneumonia. Agitated delirium was more frequent in the intervention group than in the control group (n=11, 20% vs n=4, 7%; p=0·0400 ...
Many cardiac surgery programs support early extubation of suitable CABG patients once they enter intensive care, based on clinical and economic benefits. Now some hospitals have shifted extubation to the cardiac operating room (OR) for a wide range of patients, young and old, with good results.
Comparison of the modifications of the Viennese method of manual perineal protection (VMPP) and hands-off delivery techniques by applying basic principles of mechanics with assessments of tensions within perineal structures using a novel biomechanical model of the perineum. Evaluation of the role of the precise placements of the accoucheur?s posterior (dominant) thumb and index finger in perineal tissue tension when performing a modified Viennese method of MPP ...
Decreasing the duration of invasive mechanical ventilation by early safe extubation is a major clinical goal in intensive care unit (ICU) [1]. Prolonged intubation increases the risk of ventilator-induced lung injury, ventilator-induced diaphragm dysfunction, myopathy and infections. Nonetheless, patients management in the post-extubation period can be challenging and every effort should be made to avoid re-intubation, which is associated with significantly increased morbidity and mortality [1].. To this end, in this issue of the "Annals of Intensive Care," Dr. Fernandez and colleagues report findings from a randomized controlled trial comparing low-flow oxygen supplied through nasal prongs or facial mask versus high-flow nasal cannula (HFNC) for 24 h after extubation as respiratory supports in patients at high risk of extubation failure [2]. This is the third large clinical trial recently published by the research group of Dr. Fernandez on the same topic, the other two being comparisons of ...
Selected from among 89 publications by Heart Center faculty between May 1, 2014, and October 1, 2014.. DeWitt ES, Abrams DJ. Implantable cardioverter-defibrillators in children. Arch Dis Child. 2014.. Goldberg CS, Lu M, Sleeper LA, Mahle WT, Gaynor JW, Williams IA, Mussatto KA, Ohye RG, Graham EM, Frank DU, Jacobs JP, Krawczeski C, Lambert L, Lewis A, Pemberton VL, Sananes R, Sood E, Wechsler SB, Bellinger DC, Newburger JW; Pediatric Heart Network Investigators. Factors associated with neurodevelopment for children with single ventricle lesions. J Pediatr. 2014;165(3):490-496.e8.. Emani S, Trainor B, Zurakowski D, Baird CW, Fynn-Thompson FE, Pigula FA, Emani SM. Aspirin unresponsiveness predicts thrombosis in high-risk pediatric patients after cardiac surgery. J Thorac Cardiovasc Surg. 2014;148(3):810-6.. Yuki K, DiNardo JA. Comparison of actual oxygen delivery kinetics to those predicted by mathematical modeling following stage 1 palliation just prior to superior cavopulmonary anastomosis. ...
Sixty-five children who underwent biventricular repair were extubated early (immediately after chest closure in the operating room) or were extubated later on intensive care unit (ICU). The results of these two different strategies were compared. Early extubation resulted in better cardiac output, fewer pleural effusion, and shorter stay in the ICU and hospital. The authors concluded that early extubation is safe and feasible and has a beneficial effect on the postoperative course.. ...
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At some point in the hospital graveyard shift, the word got out - "theres an anesthesiologist up and helping out!" That night, as I worked all through the hospital, putting in IVs, central and arterial lines, monitoring extubations and intubations, helping with sedation, altering pain orders and putting in the occasional epidural, I was left with a prevailing thought: With so much need and so many areas to share expertise, an anesthesiologist is never really unemployed in the hospital…. The next day, I thought about the economic impact of my overnight shift. In each instance, I helped patient care, but also I advanced each patient through his or her hospitalization, and in many cases probably saved a hospital day (if not a life). I made somebody some money out there, but this was largely unpaid work for me.. Should that altered-payment-model day ever come - and I believe it will - anesthesiologists will have a giant opportunity to influence hospital care in general, and hospital ...
Speaker Karsten Roberts MS, RRT, RRT-ACCS Date Mar 16, 2018 1:00 PM The speaker will discuss the Editors Choice of the March 2018 issue of RESPIRATORY CARE "Proactive use of high-flow nasal cannula with critically ill patients: A prospective, two-cohort study". The presentation will focus on the research design and interpretation of the results.. ...
Implementation of a multifaceted quality improvement intervention with daily checklists, goal setting, and clinician prompting did not reduce in-hospital mortality compared with routine care...
Prep the ingredients for this soup months in advance for a total hands-off meal thats ready when you are. Vegetarian lentils and vegan coconut milk make this soup creamy and pack in plenty of plant-based protein and a hearty amount of fiber. To keep it vegan, opt for vegetable broth instead of chicken broth.
After extubation, it might be necessary to maintain positive airway pressure by appropriate flows of a humidified oxygen/air ... The obstructive airway symptoms may be worse in the first postoperative weeks. Only a few patients have immediate relief of ... When the airway obstruction is significant there may be episodes of severe cyanosis ("blue baby") that can lead to ... Symptoms are caused by vascular compression of the airway, esophagus or both. Presentation is often within the first month ( ...
... (born 1942) is a pediatrician and the inventor of the INSURE (Intubation Surfactant Extubation) method combined ... "Nasal continuous positive airway pressure and early surfactant therapy for respiratory distress syndrome in newborns of less ... "Treatment of the idiopathic respiratory-distress syndrome with continuous positive airway pressure". The New England Journal of ... "Surfactant therapy and nasal continuous positive airway pressure for newborns with respiratory distress syndrome. Danish- ...
... of the safety of tracheal extubation using a pediatric airway exchange catheter for patients with a known difficult airway" ( ... The Airway Cam Guide to Intubation and Practical Emergency Airway Management (1st ed.). Wayne, Pennsylvania: Airway Cam ... Life-threatening airway obstruction may occur when a foreign body becomes lodged in the airway; this is especially common in ... Airway obstruction is also common in people who have suffered smoke inhalation or burns within or near the airway or ...
... and a patent upper airway are other criteria that should be met to increase extubation success. Patients should be assessed ...
Methods of airway management range from conservative airway management - consisting of close observation and intravenous ... Extubation, which is the removal of endotracheal tube to liberate the patient from mechanical ventilation, should only be done ... Airway management has been found to be the most important factor in treating patients with Ludwig's Angina, i.e. it is the " ... Airway control is compulsory if a surgical procedure is required.Flexible nasotracheal intubation require skills and experience ...
... of the safety of tracheal extubation using a pediatric airway exchange catheter for patients with a known difficult airway". ... and Sukhupragarn W, Management of the airway, pp. 751-92 *^ a b c d e Miller (2000), Stone DJ and Gal TJ, Airway management, pp ... The Airway Cam Guide to Intubation and Practical Emergency Airway Management (1st ed.). Wayne, Pennsylvania: Airway Cam ... a b c d e f g Benumof (2007), Hagberg CA, Georgi R and Krier C, Chapter 48: Complications of managing the airway, pp. 1181-218 ...
In these patients, PAP ventilation can prevent the need for tracheal intubation, or allow earlier extubation. Sometimes ... "VPAP" or "BPAP" (variable/bilevel positive airway pressure) provides two levels of pressure: inspiratory positive airway ... If these small airways and alveoli are allowed to collapse, significant pressures are required to re-expand them. This can be ... Positive airway pressure (PAP) is a mode of respiratory ventilation used in the treatment of sleep apnea. PAP ventilation is ...
As the airway reopens, breathing may cause a high-pitched sound called stridor. The episode seldom lasts over a couple of ... The spasm can happen often without any provocation, but tends to occur after tracheal extubation. In children, the condition ...
... maintains oxygenation and airway patency during management of the obstructed airway: an observational study". BJA: British ... Use and a neonatal early extubation protocol". Journal of Perinatology. 27 (12): 776-81. doi:10.1038/sj.jp.7211825. PMID ... The constant flush of the upper airway creates a reservoir that reduces room-air entrainment to such an amount that it becomes ... Its mechanism of action is the application of mild positive airway pressure and lung volume recruitment. HFT, the clinician can ...
Other tubes (such as the Bivona Fome-Cuf tube) are designed specifically for use in laser surgery in and around the airway. ... which can be used for suction of the nasopharngeal area and above the cuff to aid extubation (removal). This allows suctioning ... Tracheal tubes are commonly used for airway management in the settings of general anesthesia, critical care, mechanical ... who often wear this device during waking hours and remove it while sleeping to ensure a patent airway and reduce the risk of ...
The cause of death was usually asphyxia due to an obstructed airway. A tracheotomy was often a necessary procedure to save a ... His tubes and the accompanying instruments for intubation and extubation, with his methods for the care of these patients, came ... experimented with various approaches to keep the laryngeal airway open. At first, O'Dwyer experimented with his device on ...
For example, high levels of epinephrine causes smooth muscle relaxation in the airways but causes contraction of the smooth ... Davies MW, Davis PG (2002). "Nebulized racemic epinephrine for extubation of newborn infants". The Cochrane Database of ... Racemic adrenaline works by stimulation of the alpha adrenergic receptors in the airway, with resultant mucosal ...
Davies MW, Davis PG (2002). "Nebulized racemic epinephrine for extubation of newborn infants". The Cochrane Database of ... For example, high levels of epinephrine causes smooth muscle relaxation in the airways but causes contraction of the smooth ... Racemic adrenaline works by stimulation of the alpha adrenergic receptors in the airway, with resultant mucosal ...
The spasm can happen often without any provocation, but tends to occur after tracheal extubation.[1] In children, the condition ... As the airway reopens, breathing may cause a high-pitched sound called stridor. The episode seldom lasts over a couple of ...
In our reasoning, the size and location of the vascular lesion is more relevant for airway and ventilation compromise than the ... Patients allocated to the standard group received a PDT between day 7 and 14 from intubation if extubation, although aimed for ... Acknowledged advantages of a short tracheal cannula compared with a long orotracheal tube include less airway dead space and ... as well as more long-term disadvantages related to an indwelling artificial airway. It is widely agreed that TT should be ...
We investigated whether it also has the ability to attenuate airway and circulatory reflexes during emergence from anaest ... bolus injection of dexmedetomidine before tracheal extubation attenuates airway-circulatory reflexes during extubation.. ... during and after tracheal extubation. The time from tracheal extubation and emergence from anaesthesia were recorded. RESULTS: ... HR, SAP and DAP increased at extubation in both groups (P,0.05), but the increase was less significant with dexmedetomidine. ...
To compare extubation failure rate with two ranges of nasal continuous positive airway pressure (NCPAP) in oxygen dependent ... A randomized controlled trial of two nasal continuous positive airway pressure levels after extubation in preterm infants.. ... No infant developed pneumothorax during 96 hours post-extubation.. CONCLUSIONS: Extubation failure in preterm infants with ... Rates of extubation failure per criteria (24% vs 43%, P = .04, OR and 95% CI: 0.39 [0.16-0.96]) and re-intubation (17% vs 38%, ...
Respiratory and hemodynamic outcomes following exchange extubation with laryngeal mask airway as compared to traditional awake ... and hemodynamic outcomes following exchange extubation with laryngeal mask airway as compared to traditional awake extubation ... and that following exchange extubation of ETT by using a laryngeal mask airway (LMA).,/p,,p,,b,SETTINGS AND DESIGN: ,/b,This ... in traditional extubation while it was only 36.7% in exchange extubation group (P , 0.001). Hemodynamic response measured ...
CPAP for the post-extubation management of preterm infants with respiratory distress syndrome (RDS). STUDY DESIGN: A total ... To compare the efficacy and safety of bubble continuous positive airway pressure (CPAP) and Infant Flow Driver (IFD) ... A randomized controlled trial of post-extubation bubble continuous positive airway pressure versus Infant Flow Driver ... Continuous Positive Airway Pressure / instrumentation*, methods*. Enterocolitis, Necrotizing / mortality. Female. Humans. ...
1982) Post-extubation nasal continuous positive airway pressure. Am J Dis Child 136:359-361. ... AIM To determine whether extubation to nasal continuous airway pressure (NCPAP) results in a greater proportion of infants ... Randomised, controlled trial of nasal continuous positive airway pressure in the extubation of infants weighing 600 to 1250 g ... Randomised, controlled trial of nasal continuous positive airway pressure in the extubation of infants weighing 600 to 1250 g ...
In this article, we will provide a framework for identifying a difficult airway, criteria for safe extubation, as well as ... Difficult airway may be a consequence of patients anatomy or airway edema developed during the ICU stay and mechanical ... The incidence of failed airways and of cardiac arrest related to airway instrumentation in the ICU is much higher than that of ... Proficiency in identifying a potentially difficult airway and thorough familiarity with strategies and techniques of securing ...
The hollow catheter allows for oxygenation during airway exchange. ... Radiopaque airway exchange catheters are available in multiple size options. ... Cook Staged Extubation Set. Intended for staged extubation and subsequent reintubation.. Features and benefits. *The soft, ... Cooks comprehensive product offerings also cover intubation, airway exchange, and emergency airway access. ...
I would like to share with you the "Extubation Algorithm" that I have developed for major neck and upper airway surgery. I ... The recently published Difficult Airway Society Guidelines for the management of tracheal extubation and ASA Practice ... The "Extubation Algorithm" that is offered for your attention has served me well so far in my practice. Yet, it was developed 2 ... of patients due to postoperative laryngo-pharyngeal edema and airway obstruction. ...
airway extubation, endotracheal extubation, extubation, intra-tracheal, tracheal extubation. Date Deposited:. 20 Sep 2017 10:11 ... safe extubation of the patient with a potentially difficult airway has not received the same attention. Extubation is a ... Tracheal extubation of the adult intensive care patient with a predicted difficult airway - a narrative review ... Tracheal extubation of the adult intensive care patient with a predicted difficult airway - a narrative review. Anaesthesia, 72 ...
Keywords: At-risk extubation, difficult airway, intensive care. Fatma Y ld r m, Iskender Kara, Cengiz Bekir Demirel. Airway ... Airway Management of At-Risk Extubation in Intensive Care. Fatma Y ld r m1, Iskender Kara2, Cengiz Bekir Demirel2. 1Department ... upper airway surgery and cervical column operations are hazardous conditions affecting extubation success. Upper airway ... Extubation failure due to airway problems is rare in critically ill patients. Intensive care mortality and morbidity among ...
Cuff Leak Test Good at Ruling In Post-Extubation Airway Obstruction. December 7, 2018. by Dr. Clemens Leave a Comment ... "Post-extubation laryngeal edema can result in rapid progression to acute respiratory failure due to upper airway obstruction-a ... Because of its high specificity, a cuff leak test is better at ruling in than ruling out post-extubation airway obstruction in ... They updated a meta-analysis of the diagnostic accuracy of the CLT to predict post-extubation airway obstruction in adults in ...
Oral Pharyngeal Airways ✓ Nasal Pharyngeal Airways ✓ LMA ✓ Readiness for ExtubationExtubation ✓ Laryngoscopes ✓ Vid... ... Verify airway patency.. 6. Readiness for Extubation. 6.1. Deep vs awake. 6.2. recovery from neuromuscular block. 6.3. signs of ... 3. Oral Pharyngeal Airways. 3.1. Used to create patent airway. 3.2. Can stimulate coughing, vomiting, laryngospasm in semi- ... 7. Extubation. 7.1. Suction pharynx prior to extubation. 7.1.1. decreases risk for aspiration and laryngospasm ...
With knowledge of the purpose and function of artificial airways, mechanical ventilation, and chest tubes, nurses can readily ... Fenestrated tracheotomy tubes are used in some cases prior to extubation of the patient. This tube has an opening, or ... disruption of the airway epithelium, bronchospasm, atelectasis, and airway obstruction. When the upper airway is not bypassed, ... Artificial airways are used for a variety of patients who require assistance in maintaining a patent airway. The indications ...
Keywords: Airway extubation; Physical therapy modalities; Incidence; Infant, newborn; Intensive care units, neonatal ... The number of days the patients were maintained with an artificial airway was termed "patient-days with artificial airway". The ... extubation.(2,3) Patient maintenance using artificial airways is currently a safe practice, but it is not free from ... and motives/causes of the event on the day of the unplanned extubation event. RESULTS: Fifty-four unplanned extubations ...
Airway injuryAirway injury  Subglottic stenosis.  Edema of the cords after extubation (may result in hoarseness and stridor ... Steroids are not routine before extubation, but if there was prolonged intubation or previous failed attempts of extubation, a ... Accidental extubation.  Obstruction of endotracheal tube. * 23. NNC Module: Basics of Mechanical Ventilation in Neonates ... If strider caused by laryngeal edema develops after extubation, racemic epinephrine aerosols and steroids may be helpful. ...
Endotracheal intubation and extubation. *Open suctioning of airways. *Cardiopulmonary resuscitation. *Autopsies. Although some ... Using closed suctioning systems for airways suction in intubated patients. Using high efficiency particulate filters on ... and using closed suctioning systems for airways suction in intubated patients. ...
open suctioning of airways. *sputum induction. *cardiopulmonary resuscitation. *endotracheal intubation and extubation ...
Airway management related injuries. 62. Extubation of the difficult airway. 63. Airway management for massive subcutaneous/ ... 6. Airway ultrasound imaging. Part II. Basic Airway Management:. 7. Airway management for procedural sedation. 8. Airway ... Fiberoptic-guided airway exchange through supraglottic airway devices. 65. Accidental extubation. Index. ... Airway management for a large bronchopleural fistula. 34. Airway management in patients with Montgomery T-Tubes. 35. Airway ...
Two staff members should perform extubation.. *The same level of PPE should be worn for extubation as is worn by the Airway ... Difficult Airway Society Extubation Guidelines G, Popat M, Mitchell V, Dravid R, Patel A, Swampillai C, et al. Difficult Airway ... Airway rescue. If airway management is challenging, standard airway rescue interventions should be applied where they do not ... Airway Assistant. This should be an experienced clinician, to pass airway equipment to the Airway Operator, and help with ...
Non-invasive ventilation after extubation in patients with chronic obstructive airways disease: a randomised controlled trial. ... and patients with do-not-reintubate order at time of extubation or unplanned extubation (accidental or self extubation). ... The day of extubation is a critical time during an intensive care unit (ICU) stay because in case of extubation failure, ... We therefore decided to consider extubation failure in case of reintubation within the 7 days following planned extubation. ...
Case 23: Airway Leak in a Prone Patient --. Case 24: Difficulty in Extubation --. Case 25: Tonsillectomy --. Case 26: An ... Case 23: Airway Leak in a Prone Patient --. Case 24: Difficulty in Extubation --. Case 25: Tonsillectomy --. Case 26: An ... Case 85: A Surprising Solution to an Airway Emergency --. Case 86: An Airway Leak in the ICU --. Case 87: Pediatric Dental ... Case 85: A Surprising Solution to an Airway Emergency --. Case 86: An Airway Leak in the ICU --. Case 87: Pediatric Dental ...
A comparative study of the effect of dexmedetomidine and lignocaine on hemodynamic and airway responses following extubation. ... Attenuation of airway responses to extubation after intracranial surgeries under general anesthesia. Materials and methods: ... A comparative study of the effect of dexmedetomidine and lignocaine on hemodynamic and airway responses following extubation. ... A comparative study of the effect of dexmedetomidine and lignocaine on hemodynamic and airway responses following extubation. ...
Weaning from mechanical ventilation in COPD patients: interest to measure, in post-extubation, the airway occlusion pressure ( ... They presented, in 72 h post-extubation, a markup of PaCO2 of at least 20% as compared to the value measured post-extubation, ... in post-extubation, the airway occlusion pressure (P0.1), in order to indicate non-invasive pressure support ventilation (NIPSV ... to compare parameters measured just before extubation, then in post-extubation, between COPD patients who have benefitted from ...
... administered before extubation, was more effective in attenuating airway reflex responses to tracheal extubation as compared ... A Comparative Study of Dexmedetomidine and Fentanyl on Airway Reflexes and Hemodynamic Responses to Tracheal Extubation in ... 2020). A Comparative Study of Dexmedetomidine and Fentanyl on Airway Reflexes and Hemodynamic Responses to Tracheal Extubation ... Keywords: Dexmedetomidine, tracheal extubation, nasal surgery Abstract. Background: Extubation at light levels of anesthesia or ...
  • After determining the rate and causes of unplanned extubation, a program was developed consisting of education and a formalized endotracheal tube taping policy. (hindawi.com)
  • Extubation Success in Premature Infants With Respiratory Dis. (lww.com)
  • Previous investigations have shown that the rate of unplanned extubations in infants and children in the PICU ranges from 0.114 to 4.36 per 100 ventilated days [ 5 , 6 ]. (hindawi.com)
  • In this study, 27 very low birth weight infants who were ½ to 28 days old at the time of extubation were randomly divided into two groups. (aappublications.org)
  • The use of inhaled nebulized epinephrine after extubation in newborn infants is not supported or refuted by evidence from randomised controlled trials. (cochrane.org)
  • Because epinephrine can decrease swelling and its effect has been proven in the treatment of croup in infants, it has been used immediately after extubation to prevent breathing problems. (cochrane.org)
  • CONCLUSION: In our cohort of extremely premature infants, the earlier the first extubation attempt the sooner the patient was discharged home and the less likely to develop BPD. (iospress.com)
  • The meta-analysis with sequential analysis was designed to evaluate the efficacy and safety of airway administration (inhalation or instillation) of corticosteroids for preventing bronchopulmonary dysplasia (BPD) in premature infants. (biomedcentral.com)
  • Participants practice the most important skills and reinforce their learning with Code Airway™ simulations. (theairwaysite.com)
  • Although potentially lifesaving, IPPV is associated with clinically significant morbidity, including chronic lung disease, damage to the upper airway, and systemic and pulmonary infection. (bmj.com)
  • Invasive airway rescue -- PART B. Lower Airway -- Section I. Interventional Pulmonary -- Section II. (stanford.edu)
  • The main indications for positive airway pressure are congestive heart failure and chronic obstructive pulmonary disease. (wikipedia.org)
  • Neonates who failed extubation had a greater median postoperative length of stay (33 vs 23 days, P (ovid.com)
  • The primary objective was to assess whether nebulized epinephrine administered immediately after extubation in neonates weaned from IPPV decreases the need for subsequent additional respiratory support. (cochrane.org)
  • Neonates have to breathe through their nose because the entire length of their tongue abuts against the hard and soft palates, and because the high position of their epiglottis (at the level of the third and fourth cervical vertebrae compared with the fifth and sixth vertebrae in adults) causes increased resistance of the oral airway. (cmaj.ca)
  • Stridor is a harsh sound produced usually at or near the larynx by the vibration of upper airway structure, and is predominantly inspiratory. (authorstream.com)
  • Managing the airway in the intensive care unit (ICU) is complicated by a wide array of physiologic factors. (umassmed.edu)
  • The course, which is ideally suited for the anesthesiologists, critical care, emergency medicine, and ENT physician, provides participants with the essential evidence-based knowledge and technical skills to manage anticipated and unanticipated difficult airway in the operating room, emergency department, and intensive care unit, as well as in diverse clinical settings. (stanford.edu)
  • We tested the hypothesis that earlier extubation attempts would decrease length of hospital stay and BPD. (iospress.com)
  • Progressive mucosal thickening narrows the airways and gradual stiffening of the thoracic cage contributes to respiratory insufficiency, the most common cause of death. (nih.gov)