Ventilator Weaning
Intubation, Intratracheal
Airway Remodeling
Laryngeal Edema
Airway Resistance
Respiration, Artificial
Anesthesia Recovery Period
Respiratory Insufficiency
Tracheostomy
Anesthesia, General
Bronchi
Respiratory System
Positive-Pressure Respiration
Intensive Care Units
Bronchial Hyperreactivity
Airway Management
Respiratory Distress Syndrome, Newborn
Continuous Positive Airway Pressure
Respiratory Mucosa
Risk factors and outcomes after unplanned extubations on the ICU: a case-control study. (1/49)
(+info)Unplanned extubation in the ICU: a marker of quality assurance of mechanical ventilation. (2/49)
(+info)Adaptive support ventilation for faster weaning in COPD: a randomised controlled trial. (3/49)
(+info)Endotracheal tube extubation force: adhesive tape versus endotracheal tube holder. (4/49)
(+info)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)
(+info)Bioresorbable distraction device for the treatment of airway problems for infants with Robin sequence. (7/49)
(+info)Implications of extubation failure and prolonged mechanical ventilation in the postoperative period following elective intracranial surgery. (8/49)
(+info)Airway extubation is a medical procedure in which an endotracheal tube is removed from a patient's airway. The endotracheal tube is typically inserted during intubation, which is performed to maintain a secure airway and ensure proper ventilation and oxygenation of the lungs during surgery or other medical procedures.
Extubation is usually done when the patient is able to breathe on their own and no longer requires mechanical ventilation. The procedure involves carefully removing the tube while ensuring that the patient's airway remains open and protected. This may involve suctioning secretions from the airway, providing oxygen supplementation, and monitoring the patient's vital signs closely.
Extubation can be a routine procedure in some cases, but it can also carry risks such as respiratory distress, laryngospasm, or aspiration of stomach contents into the lungs. As such, it is typically performed by trained medical professionals in a controlled setting, with appropriate monitoring and equipment available to manage any potential complications.
Ventilator weaning is the process of gradually reducing the amount of support provided by a mechanical ventilator to a patient, with the ultimate goal of completely withdrawing the mechanical assistance and allowing the patient to breathe independently. This process is typically initiated when the patient's underlying medical condition has improved to the point where they are able to sustain their own respiratory efforts.
The weaning process may involve reducing the frequency and duration of ventilator breaths, decreasing the amount of oxygen supplied by the ventilator, or adjusting the settings of the ventilator to encourage the patient to take more frequent and deeper breaths on their own. The rate at which weaning is attempted will depend on the individual patient's condition and overall progress.
Close monitoring of the patient's respiratory status, oxygenation, and work of breathing is essential during the weaning process to ensure that the patient is able to tolerate the decreased level of support and to identify any potential complications that may arise. Effective communication between the healthcare team and the patient is also important to provide education, set expectations, and address any concerns or questions that may arise during the weaning process.
Intubation, intratracheal is a medical procedure in which a flexible plastic or rubber tube called an endotracheal tube (ETT) is inserted through the mouth or nose, passing through the vocal cords and into the trachea (windpipe). This procedure is performed to establish and maintain a patent airway, allowing for the delivery of oxygen and the removal of carbon dioxide during mechanical ventilation in various clinical scenarios, such as:
1. Respiratory failure or arrest
2. Procedural sedation
3. Surgery under general anesthesia
4. Neuromuscular disorders
5. Ingestion of toxic substances
6. Head and neck trauma
7. Critical illness or injury affecting the airway
The process of intubation is typically performed by trained medical professionals, such as anesthesiologists, emergency medicine physicians, or critical care specialists, using direct laryngoscopy or video laryngoscopy to visualize the vocal cords and guide the ETT into the correct position. Once placed, the ETT is secured to prevent dislodgement, and the patient's respiratory status is continuously monitored to ensure proper ventilation and oxygenation.
Airway obstruction is a medical condition that occurs when the normal flow of air into and out of the lungs is partially or completely blocked. This blockage can be caused by a variety of factors, including swelling of the tissues in the airway, the presence of foreign objects or substances, or abnormal growths such as tumors.
When the airway becomes obstructed, it can make it difficult for a person to breathe normally. They may experience symptoms such as shortness of breath, wheezing, coughing, and chest tightness. In severe cases, airway obstruction can lead to respiratory failure and other life-threatening complications.
There are several types of airway obstruction, including:
1. Upper airway obstruction: This occurs when the blockage is located in the upper part of the airway, such as the nose, throat, or voice box.
2. Lower airway obstruction: This occurs when the blockage is located in the lower part of the airway, such as the trachea or bronchi.
3. Partial airway obstruction: This occurs when the airway is partially blocked, allowing some air to flow in and out of the lungs.
4. Complete airway obstruction: This occurs when the airway is completely blocked, preventing any air from flowing into or out of the lungs.
Treatment for airway obstruction depends on the underlying cause of the condition. In some cases, removing the obstruction may be as simple as clearing the airway of foreign objects or mucus. In other cases, more invasive treatments such as surgery may be necessary.
Airway remodeling is a term used to describe the structural changes that occur in the airways as a result of chronic inflammation in respiratory diseases such as asthma. These changes include thickening of the airway wall, increased smooth muscle mass, and abnormal deposition of extracellular matrix components. These alterations can lead to narrowing of the airways, decreased lung function, and increased severity of symptoms. Airway remodeling is thought to be a major contributor to the persistent airflow obstruction that is characteristic of severe asthma.
Laryngeal edema is a medical condition characterized by the swelling of the tissues in the larynx or voice box. The larynx, which contains the vocal cords, plays a crucial role in protecting the airways, regulating ventilation, and enabling speech and swallowing. Laryngeal edema can result from various causes, such as allergic reactions, infections, irritants, trauma, or underlying medical conditions like angioedema or autoimmune disorders.
The swelling of the laryngeal tissues can lead to narrowing of the airways, causing symptoms like difficulty breathing, noisy breathing (stridor), coughing, and hoarseness. In severe cases, laryngeal edema may obstruct the airway, leading to respiratory distress or even suffocation. Immediate medical attention is necessary for individuals experiencing these symptoms to ensure proper diagnosis and timely intervention. Treatment options typically include medications like corticosteroids, antihistamines, or epinephrine to reduce swelling and alleviate airway obstruction.
"Device Removal" in a medical context generally refers to the surgical or nonsurgical removal of a medical device that has been previously implanted in a patient's body. The purpose of removing the device may vary, depending on the individual case. Some common reasons for device removal include infection, malfunction, rejection, or when the device is no longer needed.
Examples of medical devices that may require removal include pacemakers, implantable cardioverter-defibrillators (ICDs), artificial joints, orthopedic hardware, breast implants, cochlear implants, and intrauterine devices (IUDs). The procedure for device removal will depend on the type of device, its location in the body, and the reason for its removal.
It is important to note that device removal carries certain risks, such as bleeding, infection, damage to surrounding tissues, or complications related to anesthesia. Therefore, the decision to remove a medical device should be made carefully, considering both the potential benefits and risks of the procedure.
Airway resistance is a measure of the opposition to airflow during breathing, which is caused by the friction between the air and the walls of the respiratory tract. It is an important parameter in respiratory physiology because it can affect the work of breathing and gas exchange.
Airway resistance is usually expressed in units of cm H2O/L/s or Pa·s/m, and it can be measured during spontaneous breathing or during forced expiratory maneuvers, such as those used in pulmonary function testing. Increased airway resistance can result from a variety of conditions, including asthma, chronic obstructive pulmonary disease (COPD), bronchitis, and bronchiectasis. Decreased airway resistance can be seen in conditions such as emphysema or after a successful bronchodilator treatment.
Artificial respiration is an emergency procedure that can be used to provide oxygen to a person who is not breathing or is breathing inadequately. It involves manually forcing air into the lungs, either by compressing the chest or using a device to deliver breaths. The goal of artificial respiration is to maintain adequate oxygenation of the body's tissues and organs until the person can breathe on their own or until advanced medical care arrives. Artificial respiration may be used in conjunction with cardiopulmonary resuscitation (CPR) in cases of cardiac arrest.
The anesthesia recovery period, also known as the post-anesthetic care unit (PACU) or recovery room stay, is the time immediately following anesthesia and surgery during which a patient's vital signs are closely monitored as they emerge from the effects of anesthesia.
During this period, the patient is typically observed for adequate ventilation, oxygenation, circulation, level of consciousness, pain control, and any potential complications. The length of stay in the recovery room can vary depending on the type of surgery, the anesthetic used, and the individual patient's needs.
The anesthesia recovery period is a critical time for ensuring patient safety and comfort as they transition from the surgical setting to full recovery. Nurses and other healthcare providers in the recovery room are specially trained to monitor and manage patients during this vulnerable period.
Respiratory insufficiency is a condition characterized by the inability of the respiratory system to maintain adequate gas exchange, resulting in an inadequate supply of oxygen and/or removal of carbon dioxide from the body. This can occur due to various causes, such as lung diseases (e.g., chronic obstructive pulmonary disease, pneumonia), neuromuscular disorders (e.g., muscular dystrophy, spinal cord injury), or other medical conditions that affect breathing mechanics and/or gas exchange.
Respiratory insufficiency can manifest as hypoxemia (low oxygen levels in the blood) and/or hypercapnia (high carbon dioxide levels in the blood). Symptoms of respiratory insufficiency may include shortness of breath, rapid breathing, fatigue, confusion, and in severe cases, loss of consciousness or even death. Treatment depends on the underlying cause and severity of the condition and may include oxygen therapy, mechanical ventilation, medications, and/or other supportive measures.
A tracheostomy is a surgically created opening through the neck into the trachea (windpipe). It is performed to provide an airway in cases where the upper airway is obstructed or access to the lower airway is required, such as in prolonged intubation, severe trauma, or chronic lung diseases. The procedure involves making an incision in the front of the neck and creating a direct opening into the trachea, through which a tracheostomy tube is inserted to maintain the patency of the airway. This allows for direct ventilation of the lungs, suctioning of secretions, and prevention of complications associated with upper airway obstruction.
General anesthesia is a state of controlled unconsciousness, induced by administering various medications, that eliminates awareness, movement, and pain sensation during medical procedures. It involves the use of a combination of intravenous and inhaled drugs to produce a reversible loss of consciousness, allowing patients to undergo surgical or diagnostic interventions safely and comfortably. The depth and duration of anesthesia are carefully monitored and adjusted throughout the procedure by an anesthesiologist or certified registered nurse anesthetist (CRNA) to ensure patient safety and optimize recovery. General anesthesia is typically used for more extensive surgical procedures, such as open-heart surgery, major orthopedic surgeries, and neurosurgery.
"Bronchi" are a pair of airways in the respiratory system that branch off from the trachea (windpipe) and lead to the lungs. They are responsible for delivering oxygen-rich air to the lungs and removing carbon dioxide during exhalation. The right bronchus is slightly larger and more vertical than the left, and they further divide into smaller branches called bronchioles within the lungs. Any abnormalities or diseases affecting the bronchi can impact lung function and overall respiratory health.
The Respiratory System is a complex network of organs and tissues that work together to facilitate the process of breathing, which involves the intake of oxygen and the elimination of carbon dioxide. This system primarily includes the nose, throat (pharynx), voice box (larynx), windpipe (trachea), bronchi, bronchioles, lungs, and diaphragm.
The nostrils or mouth take in air that travels through the pharynx, larynx, and trachea into the lungs. Within the lungs, the trachea divides into two bronchi, one for each lung, which further divide into smaller tubes called bronchioles. At the end of these bronchioles are tiny air sacs known as alveoli where the exchange of gases occurs. Oxygen from the inhaled air diffuses through the walls of the alveoli into the bloodstream, while carbon dioxide, a waste product, moves from the blood to the alveoli and is exhaled out of the body.
The diaphragm, a large muscle that separates the chest from the abdomen, plays a crucial role in breathing by contracting and relaxing to change the volume of the chest cavity, thereby allowing air to flow in and out of the lungs. Overall, the Respiratory System is essential for maintaining life by providing the body's cells with the oxygen needed for metabolism and removing waste products like carbon dioxide.
Positive-pressure respiration is a type of mechanical ventilation where positive pressure is applied to the airway and lungs, causing them to expand and inflate. This can be used to support or replace spontaneous breathing in patients who are unable to breathe effectively on their own due to conditions such as respiratory failure, neuromuscular disorders, or sedation for surgery.
During positive-pressure ventilation, a mechanical ventilator delivers breaths to the patient through an endotracheal tube or a tracheostomy tube. The ventilator is set to deliver a specific volume or pressure of air with each breath, and the patient's breathing is synchronized with the ventilator to ensure proper delivery of the breaths.
Positive-pressure ventilation can help improve oxygenation and remove carbon dioxide from the lungs, but it can also have potential complications such as barotrauma (injury to lung tissue due to excessive pressure), volutrauma (injury due to overdistention of the lungs), hemodynamic compromise (decreased blood pressure and cardiac output), and ventilator-associated pneumonia. Therefore, careful monitoring and adjustment of ventilator settings are essential to minimize these risks and provide safe and effective respiratory support.
An Intensive Care Unit (ICU) is a specialized hospital department that provides continuous monitoring and advanced life support for critically ill patients. The ICU is equipped with sophisticated technology and staffed by highly trained healthcare professionals, including intensivists, nurses, respiratory therapists, and other specialists.
Patients in the ICU may require mechanical ventilation, invasive monitoring, vasoactive medications, and other advanced interventions due to conditions such as severe infections, trauma, cardiac arrest, respiratory failure, or post-surgical complications. The goal of the ICU is to stabilize patients' condition, prevent further complications, and support organ function while the underlying illness is treated.
ICUs may be organized into different units based on the type of care provided, such as medical, surgical, cardiac, neurological, or pediatric ICUs. The length of stay in the ICU can vary widely depending on the patient's condition and response to treatment.
Bronchial hyperresponsiveness (BHR) or bronchial hyperreactivity (BH) is a medical term that refers to the increased sensitivity and exaggerated response of the airways to various stimuli. In people with BHR, the airways narrow (constrict) more than usual in response to certain triggers such as allergens, cold air, exercise, or irritants like smoke or fumes. This narrowing can cause symptoms such as wheezing, coughing, chest tightness, and shortness of breath.
BHR is often associated with asthma and other respiratory conditions, including chronic obstructive pulmonary disease (COPD) and bronchiectasis. It is typically diagnosed through a series of tests that measure the degree of airway narrowing in response to various stimuli. These tests may include spirometry, methacholine challenge test, or histamine challenge test.
BHR can be managed with medications such as bronchodilators and anti-inflammatory drugs, which help to relax the muscles around the airways and reduce inflammation. It is also important to avoid triggers that can exacerbate symptoms and make BHR worse.
Airway management is a set of procedures and techniques used to maintain or restore the flow of air into and out of the lungs, ensuring adequate ventilation and oxygenation of the body. This is critical in medical emergencies such as respiratory arrest, cardiac arrest, trauma, and other situations where a patient may have difficulty breathing on their own.
Airway management includes various interventions, such as:
1. Basic airway maneuvers: These include chin lift, jaw thrust, and suctioning to clear the airway of obstructions.
2. Use of adjuncts: Devices like oropharyngeal (OPA) and nasopharyngeal airways (NPA) can be used to maintain an open airway.
3. Bag-valve-mask (BVM) ventilation: This is a technique where a mask is placed over the patient's face, and positive pressure is applied to the bag to help move air in and out of the lungs.
4. Endotracheal intubation: A flexible plastic tube is inserted through the mouth or nose and advanced into the trachea (windpipe) to secure the airway and allow for mechanical ventilation.
5. Supraglottic airway devices (SADs): These are alternatives to endotracheal intubation, such as laryngeal mask airways (LMAs), that provide a temporary seal over the upper airway to facilitate ventilation.
6. Surgical airway: In rare cases, when other methods fail or are not possible, a surgical airway may be established by creating an opening through the neck (cricothyrotomy or tracheostomy) to access the trachea directly.
Proper airway management requires knowledge of anatomy, understanding of various techniques and devices, and the ability to quickly assess and respond to changing clinical situations. Healthcare professionals, such as physicians, nurses, respiratory therapists, and paramedics, receive extensive training in airway management to ensure competency in managing this critical aspect of patient care.
Respiratory Distress Syndrome (RDS), Newborn is a common lung disorder in premature infants. It occurs when the lungs lack a substance called surfactant, which helps keep the tiny air sacs in the lungs open. This results in difficulty breathing and oxygenation, causing symptoms such as rapid, shallow breathing, grunting noises, flaring of the nostrils, and retractions (the skin between the ribs pulls in with each breath). RDS is more common in infants born before 34 weeks of gestation and is treated with surfactant replacement therapy, oxygen support, and mechanical ventilation if necessary. In severe cases, it can lead to complications such as bronchopulmonary dysplasia or even death.
Continuous Positive Airway Pressure (CPAP) is a mode of non-invasive ventilation that delivers pressurized room air or oxygen to maintain airway patency and increase functional residual capacity in patients with respiratory disorders. A CPAP device, which typically includes a flow generator, tubing, and a mask, provides a constant positive pressure throughout the entire respiratory cycle, preventing the collapse of the upper airway during inspiration and expiration.
CPAP is commonly used to treat obstructive sleep apnea (OSA), a condition characterized by repetitive narrowing or closure of the upper airway during sleep, leading to intermittent hypoxia, hypercapnia, and sleep fragmentation. By delivering positive pressure, CPAP helps to stent open the airway, ensuring unobstructed breathing and reducing the frequency and severity of apneic events.
Additionally, CPAP can be used in other clinical scenarios, such as managing acute respiratory distress syndrome (ARDS), chronic obstructive pulmonary disease (COPD) exacerbations, or postoperative respiratory insufficiency, to improve oxygenation and reduce the work of breathing. The specific pressure settings and device configurations are tailored to each patient's needs based on their underlying condition, severity of symptoms, and response to therapy.
Respiratory mucosa refers to the mucous membrane that lines the respiratory tract, including the nose, throat, bronchi, and lungs. It is a specialized type of tissue that is composed of epithelial cells, goblet cells, and glands that produce mucus, which helps to trap inhaled particles such as dust, allergens, and pathogens.
The respiratory mucosa also contains cilia, tiny hair-like structures that move rhythmically to help propel the mucus and trapped particles out of the airways and into the upper part of the throat, where they can be swallowed or coughed up. This defense mechanism is known as the mucociliary clearance system.
In addition to its role in protecting the respiratory tract from harmful substances, the respiratory mucosa also plays a crucial role in immune function by containing various types of immune cells that help to detect and respond to pathogens and other threats.
Black Creek Canal orthohantavirus
Positive airway pressure
Tracheobronchitis
Double aortic arch
Mechanical ventilation
Tracheal intubation
Negative-pressure pulmonary edema
Intubation granuloma
Heated humidified high-flow therapy
Bronchopulmonary dysplasia
Rapid shallow breathing index
Henrik Verder
Infant respiratory distress syndrome
Ludwig's angina
Stridor
Laryngospasm
Dexmedetomidine
Aerosol-generating procedure
Tracheal tube
Joseph O'Dwyer
Postoperative residual curarization
Recurrent laryngeal nerve
Epinephrine (medication)
Post-extubation11
- However, the same basic principles of planning, preparation and post-extubation care still apply. (ccam.net.au)
- If airway oedema is suspected in an intensive care patient, either because of findings at nasendoscopy, or because of a poor or absent cuff leak, there is good evidence that steroids can decrease the incidence of post-extubation stridor and re-intubation. (ccam.net.au)
- To date there is very little consensus on what is considered the "best non-invasive ventilation mode" to be used post-extubation. (biomedcentral.com)
- Patient removed from ventilation and discharged 5 days post-extubation in good condition. (wikipedia.org)
- Post extubation croup. (studystack.com)
- The specific conditions where recommendations were made include exacerbation of chronic obstructive pulmonary disease, cardiogenic pulmonary oedema, de novo hypoxaemic respiratory failure, immunocompromised patients, chest trauma, palliation, post-operative care, weaning and post-extubation. (ersjournals.com)
- While the results of previous meta-analyses have shown beneficial effects of corticosteroid therapy on post-extubation stridor and extubation failure in adults, these results might not be generalizable to children because of the differences in anatomy and structure. (springeropen.com)
- Outcomes included post-extubation stridor indicating laryngeal edema and extubation failures. (springeropen.com)
- A total of ten randomized controlled trials with 591 pediatric patients were included: seven of the ten studies for post-extubation stridor/suspected upper airway obstruction and nine of the ten studies for extubation failure. (springeropen.com)
- The estimate of pooled odds ratios (ORs) for post-extubation stridor/suspected upper airway obstruction was 0.40 (95% CI: 0.21-0.79). (springeropen.com)
- Despite a relatively small sample size in each randomized controlled trial and wide ranges of ages and steroid administration regimens, our results suggest that the use of corticosteroids for prevention of post-extubation stridor and extubation failure could be considered to be acceptable in pediatric patients. (springeropen.com)
Intubation15
- Eligible infants included patients weighing 600 to 1500 gm at birth who required tracheal intubation within 48 hours of birth and who met specific predetermined criteria for extubation by day 14 of life. (nih.gov)
- Airway reflexes can be affected by tracheal intubation, drugs and illness. (ccam.net.au)
- The airway can be injured during surgery, tracheal intubation or by repetitive shearing forces caused by the tube, especially in agitated patients in the ICU. (ccam.net.au)
- An example of an 'at risk' patient due to airway factors would be a patient who has had neck surgery after awake fibre optic intubation for previous surgery and radiotherapy. (ccam.net.au)
- Tracheostomy is necessary if the patient has failed extubations despite appropriate medical management or if intubation is prolonged. (medscape.com)
- In many situations, supraglottic airway devices (SGAs) can be used instead of endotracheal intubation to manage a patient's airway. (ebmedicine.net)
- Demonstrate effective skills in airway management to include intubation, extubation, suctioning, artificial ventilation via resuscitation bag, and tracheostomy care. (sinclair.edu)
- Practice Guidelines for Management of the Difficult Airway," published by the American Society of Anesthesiologists (ASA), defines a difficult airway as "the clinical situation in which a conventionally trained anesthesiologist experiences difficulty with face mask ventilation of the upper airway, difficulty with tracheal intubation or both. (rtmagazine.com)
- Mark Grzeskowiak, RRT, manager of education and quality, Long Beach Memorial Medical Center, Long Beach, Calif, says some practitioners define difficult airway management by the number of intubation attempts. (rtmagazine.com)
- Grzeskowiak says craniofacial conditions-such as Pierre Robin or Apert's syndrome and a predisposition toward laryngeal webs (multiple strands of tissue that connect one side of the airway to the other)-make intubation of pediatric patients difficult, as can the disproportionate size of a child's tongue and tonsils, which can block airways. (rtmagazine.com)
- Not much recognition is given to the complications of AD compared to accidental extubation following translaryngeal intubation (White et al. (bartleby.com)
- Concerns include that placing a tube in the patient's airway (intubation) before surgery or removing it at the end (extubation) may produce a fine mist of small particles (called aerosols) and spread the COVID-19 virus to nearby staff. (bristol.ac.uk)
- We detected no increases in aerosolised particles during face-mask ventilation, airway suction or repeated attempts at intubation. (bristol.ac.uk)
- Like intubation, it helps with breathing, prevents airway from being obstructed/block, prevent unwanted material from getting into the lungs and may be more comfortable for the patient. (sgicu.com)
- Laryngeal edema can cause acute upper airway obstruction and is one of the life-threatening sequelae associated with mechanical ventilation under endotracheal intubation. (springeropen.com)
Ventilation17
- or = 7.20, severe apnea, or predefined clinical deterioration, and extubation success was predefined as the ability to remain free of a requirement for mechanical ventilation for 7 days and a 66% reduction in the need for supplemental oxygen. (nih.gov)
- Adult patients at moderate to high risk of postoperative pulmonary complications who had undergone major abdominal surgery using lung-protective ventilation were randomly assigned using a computer-generated sequence to receive either HFNC oxygen therapy or standard oxygen therapy (low-flow oxygen delivered via nasal prongs or facemask) directly after extubation. (nih.gov)
- Airway reflexes, spontaneous ventilation, and cardiovascular function are maintained. (medscape.com)
- The patient may not be able to maintain airway reflexes or spontaneous ventilation, but cardiovascular function is preserved. (medscape.com)
- We present the successful use of the CobraPLUS (a new second generation CobraPLA™ extraglottic airway device) for anaesthetic management of a child who suffered from tracheomalacia necessitating prolonged mechanical ventilation during prior anaesthesia. (ispub.com)
- Due to the patient's history of prolonged ventilation following each surgery, we decided to use an extraglottic device for his airway management and we specifically chose the new CobraPLUS™ airway (Engineered Medical Systems, Indianapolis, IN). (ispub.com)
- EF was defined as the need for ventilatory support (non-invasive ventilation or reintubation) or death within 48 h following extubation. (frontiersin.org)
- Extubation, the process of removing an artificial airway to liberate a patient from mechanical ventilation (MV), leads to non-negligible risks due to significant respiratory and circulatory changes. (frontiersin.org)
- To ensure effective and safe airway management, proper ventilation and oxygenation, it is recommended to follow the ISA (Initial Size Approximation) approach when choosing the oropharyngeal airway size in medical education, training, and clinical settings. (aaem.pl)
- Determination of the appropriate oropharyngeal airway size in adults: Assessment using ventilation and an endoscopic view. (aaem.pl)
- Due to the increment in the number of patients receiving protracted mechanical ventilation through artificial airway, much attention is needed to focus on how to reduce the morbidity and mortality rate of accidental decannulation. (bartleby.com)
- We included trials comparing extubation and immediate application of noninvasive ventilation with continued invasive weaning in adults on mechanical ventilation. (cmaj.ca)
- Although it is effective, invasive ventilation is associated with complications including respiratory muscle weakness, upper airway pathology, ventilator-associated pneumonia 1 and sinusitis. (cmaj.ca)
- To address this lack of evidence, the authors conducted real-time, high-resolution environmental monitoring in ultraclean ventilation operating theatres during anaesthesia procedures for insertion and removal of the tube from the patient's airway. (bristol.ac.uk)
- The authors also studied procedures such as suction of the airway and 'mask ventilation' when the anaesthetist takes over the patients breathing before tube insertion. (bristol.ac.uk)
- and the absence of heart failure, moderate-to-severe chronic obstructive pulmonary disease, airway patency issues, and prolonged mechanical ventilation. (the-hospitalist.org)
- The 2017 American Thoracic Society/European Respiratory Society guidelines on mechanical ventilation for acute respiratory distress syndrome (ARDS) [ 1 ] failed to address airway-pressure release ventilation (APRV). (medscape.com)
Respiratory5
- Pre-existing respiratory compromise and some conditions like the brachycephalic obstructive airway syndrome can make airway management challenging in small animal anaesthesia. (ivis.org)
- When laryngospasm is severe, complete airway obstruction may result in the loss of stridor as there is no longer any gas flowing across the vocal cords, despite continued respiratory effort. (ahrq.gov)
- The ability of respiratory therapists to manage difficult airways impacts the quality of anesthesia delivery and success of patient outcomes. (rtmagazine.com)
- Durbin says airway management includes a range of respiratory services. (rtmagazine.com)
- How to fine-tune the ventilator settings to manage patients with restrictive or obstructive respiratory disease and How to get your patient ready for extubation . (usmlematerials.net)
Successful extubation6
- We also sought to determine whether varying the duration of nasopharyngeal CPAP influenced the likelihood of successful extubation. (nih.gov)
- After stratification by birth weight, there were no significant differences in the rates of successful extubation among the treatment groups. (nih.gov)
- We conclude that nasopharyngeal CPAP does not improve the likelihood of successful extubation of very low birth weight infants who are ready for extubation within the first 2 weeks of life. (nih.gov)
- RESULTS There was no difference in successful extubation at 72 hours, 1 and 2 weeks, between the groups in terms of the number of reventilation episodes, reventilation days, or in total days of CPAP. (bmj.com)
- So et al 7 found that nasal CPAP facilitated successful extubation in babies under 1500 g of birthweight. (bmj.com)
- 001). The APRV group had a high rate of successful extubation and shorter intensive care stays. (medscape.com)
Obstruction9
- 1 The majority of these were due to airway obstruction, with a variety of causes including laryngospasm, occlusion of an airway device by patient biting, blood in the airway or airway swelling. (ccam.net.au)
- Airway reflexes can also be exaggerated, resulting in coughing, laryngospasm and in severe cases, post-obstruction pulmonary oedema. (ccam.net.au)
- Presence of sound: Yes - incomplete airway obstruction No - laryngospasm! (studystack.com)
- 2,3,4 The classic presentation of laryngospasm is with high-pitched inspiratory stridor, which indicates that airway obstruction is incomplete. (ahrq.gov)
- During airway obstruction, the abdomen moves out while the chest moves in because of the negative pressure created within the thorax. (ahrq.gov)
- 5 This type of complete airway obstruction needs to be corrected emergently to prevent negative pressure pulmonary edema and/or hypoxic cardiac arrest. (ahrq.gov)
- Hypoxemia with hypoxic cardiac arrest, hypoxic ischemic encephalopathy and death may occur if airway obstruction is complete and not treated in a timely manner. (ahrq.gov)
- Airway obstruction associated with the use of the Guedel airway. (aaem.pl)
- In physical examination, the patient normally shows a volume increasing hard to palpation in the sublingual, submandibular region bilaterally and submental region, which can extend in many times to the suprahyoid region, leading to the elevation of the oral floor and the falling of the tongue towards the posterior direction with risk of obstruction of the airways 4,10 . (bvsalud.org)
Continuous positive4
- We conducted a prospective, randomized controlled trial to determine whether extubation of very low birth weight infants was facilitated by the use of nasopharyngeal continuous positive airway pressure (CPAP). (nih.gov)
- AIM To determine if a weaning regimen on flow driver continuous positive airway pressure (CPAP) would decrease the number of ventilator days but increase the number of CPAP days when compared with a rescue regimen. (bmj.com)
- The objective of this study was to compare the effectiveness of biphasic nasal continuous positive airway pressure (BP-NCPAP) vs. NCPAP in facilitating sustained extubation in infants ≤ 1,250 grams. (biomedcentral.com)
- It has been hypothesized that earlier extubation and use of nasal continuous positive airway pressure (NCPAP) may decrease lung inflammation and reduce the incidence of BPD [ 7 ]. (biomedcentral.com)
Patient's2
- The oropharyngeal airway, also known as the Guedel airway, is a crucial medical device used for over a century as a basic way to maintain a patient's airway open and secure. (aaem.pl)
- Figure B: Photograph of the patient's 7.5 centimeter polyvinyl endotracheal tube following extubation with an acute angle luminal narrowing evident at the 19-centimeter marking. (apsf.org)
Ready for extubation1
- These investigators recruited mechanically ventilated adult patients who were ready for extubation and who met the criteria for low risk for reintubation. (the-hospitalist.org)
Distended abdomen1
- An example of an 'at risk' patient due to general factors might be a patient after surgery for ruptured aortic aneurysm, where haemodynamic instability, metabolic derangement, potential full stomach and distended abdomen would make early extubation challenging. (ccam.net.au)
Tracheostomy1
- Tracheostomy is rarely necessary unless injury or trauma to the airway has caused scarring and documented narrowing of the airway. (medscape.com)
Intensive care3
- When planning to extubate an intensive care patient, there are many questions that need to be answered - see the CCAM Extubation Checklist below. (ccam.net.au)
- Patients who underwent extubation in the Medical Information Mart for Intensive Care (MIMIC)-IV database were included. (frontiersin.org)
- Adult intubated and ventilated patients who are victims of trauma and are being cared for on the Trauma Intensive Care Unit will be considered eligible for the study when they are considered fit for extubation. (who.int)
Mean airway pressure1
- Birthweight, gestational age, race, day of first extubation, antenatal or postnatal steroids, patent ductus arteriosus status and maximal mean airway pressure used were of no value in predicting success or failure at 72 hours, 1, or 2 weeks. (bmj.com)
Outcomes1
- Among patients undergoing major abdominal surgery, early preventive application of high-flow nasal cannula oxygen therapy after extubation did not result in improved pulmonary outcomes compared with standard oxygen therapy. (nih.gov)
Supraglottic airway2
- This issue reviews the use of supraglottic airway devices in pediatric patients including common devices, indications and techniques for placement, and complications associated with their use. (ebmedicine.net)
- The use of supraglottic airway devices in the patient with a difficult airway is also discussed. (ebmedicine.net)
Patient13
- The strategy should include a plan for the timing and technique of extubation, and the disposition and ongoing care of the patient. (ccam.net.au)
- It may be beneficial, for example, to arrange for an intensive physiotherapy regime after extubation of a patient who has a lot of secretions or a borderline cough. (ccam.net.au)
- Twelve days after admission patient showed extreme improvement in airway management. (wikipedia.org)
- This issue reviews indications and techniques for SGA placement, provides evidence-based recommendations for their use, and discusses the use of SGAs in the patient with a difficult airway. (ebmedicine.net)
- Using different craniofacial anatomical landmarks to select the size of the oropharyngeal airway can yield significantly varied results for the same adult patient, thus posing a potentially fatal threat. (aaem.pl)
- Charles Durbin, MD, professor of anesthesiology and surgery, University of Virginia, Charlottesville, describes a difficult airway management case that left his patient feeling fine but gave him heart palpitations. (rtmagazine.com)
- The difficult airway represents a complex interaction between patient factors, the clinical setting and the skills of the practitioner," it adds. (rtmagazine.com)
- In our case study, the treating medics were limited in their options for treatment, mostly due to the inability to secure the airway due to the patient locking down his jaw. (bartleby.com)
- The WHO surgical checklist requires practitioners to confirm details such as patient 's identity, surgical site, allergies, consent and airway issues. (ipl.org)
- When the patient was fully anaesthetised the author assisted the anaesthetist to secure the airway by passing size 4 Laryngoscope and size 8 endotracheal tube (ETT). (ipl.org)
- After 120 minutes following surgical start, the patient developed an acute sustained elevation in peak airway pressure (PIP) from 33 cm H20 to 62 cm H20. (apsf.org)
- This narrative review describes the main applications of de la ultrasonografía en ultrasound in anesthesia, ultrasound-guided techniques, and current trends in the perioperative anesthetic management of anestesia the surgical patient. (bvsalud.org)
- The infestation can present as increasingly likely to be encountered by extubation the patient was transferred to a wide range of symptoms: intestinal clinicians because of the growing rates the surgical ward where she underwent perforation or occlusion, cholangitis, of travel to developing countries and an unremarkable recovery. (who.int)
Resuscitation1
- Equipment should include resuscitation and difficult airway trolleys, wire cutters if the jaw has been wired, and clip removers if there is a risk of haematoma formation around the airway, for example, after thyroid surgery. (ccam.net.au)
Incidence3
- The primary outcome was the incidence of sustained extubation for 7 days. (biomedcentral.com)
- The incidence of sustained extubation was not statistically different between the BP-NCPAP vs. NCPAP group (67% vs. 58%, P = 0.27). (biomedcentral.com)
- Appropriate oropharyngeal suctioning can reduce the incidence of laryngospasm after extubation. (ahrq.gov)
Acute2
- However, Chan and Greenough 9 found no difference in extubation success between nasal CPAP or headbox oxygen in infants with acute or chronic lung disease. (bmj.com)
- This advanced course is designed for intensivists and for hospitalists who are responsible for emergency airway management of acute inpatients. (theairwaysite.com)
Bronchoscopy1
- Before each prior extubation trial he became agitated and had a tendency to airway collapse due to tracheomalacia, with near total airway collapse confirmed by fiberoptic bronchoscopy on several separate occasions. (ispub.com)
Adequate airway1
- Maintenance of an adequate airway is of primary importance. (medscape.com)
Reintubation2
- Does the use of high-flow oxygen therapy for 24 hours following extubation reduce the risk of reintubation in low-risk patients? (the-hospitalist.org)
- Using high-flow nasal cannula oxygen therapy for 24 hours following extubation of patients who are already at low risk of reintubation further reduces the risk of reintubation. (the-hospitalist.org)
Oxygen5
- After extubation they were randomly allocated to receive CPAP for 72 hours (n=29) according to a weaning regimen, or were placed in headbox oxygen and received CPAP only if preset "start CPAP" criteria were met (n=29, rescue group). (bmj.com)
- Tapia et al 11 also found no difference in extubation outcome in babies extubated to CPAP or headbox oxygen, although this study included a group who had pre-extubation endotracheal CPAP which worsened extubation outcome. (bmj.com)
- Humidified oxygen is preferable is the airway is deemed to be at risk. (ccam.net.au)
- Since the last extubation, he was maintained on oxygen by nasal cannula at 2 l/min. (ispub.com)
- Using concealed allocation, these patients were randomized to receive either conventional oxygen therapy or high-flow oxygen therapy for 24 hours following extubation. (the-hospitalist.org)
Ventilator-associate2
- Extubation failure (EF) can lead to an increased chance of ventilator-associated pneumonia, longer hospital stays, and a higher mortality rate. (frontiersin.org)
- However, premature extubation in unprepared patients will cause extubation failure (EF), leading to a higher risk of ventilator-associated pneumonia, extended hospital stays, and higher mortality (25-50%) ( 4 , 5 ). (frontiersin.org)
Management13
- If Airway Management Education Center (AMEC) is required to cancel a course due to safety concerns, all attendees will receive a 100% refund or may transfer to another course. (theairwaysite.com)
- Every doctor involved with airway management should take this course. (theairwaysite.com)
- SGAs provide an alternative method for pediatric airway management that is relatively easy to learn, with a high success rate. (ebmedicine.net)
- Airway management in ex premature babies suffering from chronic lung disease and tracheomalacia is challenging. (ispub.com)
- He thinks the quality of available technology plays an important role in airway management, saying, "If you've got the world's greatest equipment at your disposal, then difficult may not be so difficult. (rtmagazine.com)
- Durbin says factors that determine the degree of airway management difficulty include the visibility of the pharynx, ease of jaw movement, and side-to-side neck mobility. (rtmagazine.com)
- Durbin says patients immobilized by halo traction devices present the greatest challenges to airway management. (rtmagazine.com)
- Pediatric management of difficult airways may require a strategy other than "a primary approach," state the practice guidelines. (rtmagazine.com)
- Airway management. (uttv.ee)
- Chairmen: Mansukh Popat (UK), Indulis Vanags ( LV) 08:30 - 08:50 Management of Obstructed Airway. (uttv.ee)
- Ravi Dravid (UK) 09:10 - 09:30 Pediatric Airway Management. (uttv.ee)
- Josef Holzki (DE) 09:30 - 09:50 Management of Difficult Airway in the Critically Ill Patients. (uttv.ee)
- Use the most experienced clinician for airway management. (crit.cloud)
Prediction1
- Automated prediction of extubation success in extremely preterm infants: the APEX multicenter study. (nih.gov)
Infants2
Controlled trials1
- Randomized controlled trials and observational studies on the efficacy of systemic corticosteroid administration given prior to elective extubation in mechanically ventilated pediatrics were eligible. (springeropen.com)
Occlusion1
- Although rare, polyvinyl endotracheal tube occlusion caused by kinking may cause profound physiologic perturbations and as such requires prompt identification followed by the rapid restoration of a patent airway. (apsf.org)
Artificial1
- The Hewitt airway - the first known artificial oral 'air-way' 101 years since its description. (aaem.pl)
Assessment2
- Featuring a dynamic and interactive learning environment, the Course emphasizes airway assessment and decision-making to build the capacity to manage all airway situations - and to do so with great confidence. (theairwaysite.com)
- Assessment of Extubation Readiness Using Spontaneous Breathing Trials in Extremely Preterm Neonates. (nih.gov)
Patency1
- González RR, García JT, Lomas A. Importance of size of the Guedel in the patency of the airway during MRI in children. (aaem.pl)
ANESTHESIA2
- These folks are fine when they're awake, but upon induction of anesthesia, they lose their airway and stop breathing. (rtmagazine.com)
- In anesthesiology, rapid and accurate the main applications of ultrasound in anes- diagnostic tools are for surgical emergen- thesia as airway evaluation, vascular access, cies, and ultrasound has become a neces- regional anesthesia, pulmonary ultrasound, sary and routine tool2. (bvsalud.org)
Difficult Airways1
- Durbin's story illustrates the challenges of managing difficult airways, common among obese patients, neonates, young children, and men with beards. (rtmagazine.com)
Critical Care1
- The Difficult Airway Course: Critical Care™ focuses exclusively on the airway challenges posed by critically ill inpatients. (theairwaysite.com)
Oropharyngeal6
- This study aims to compare three techniques for selecting the appropriate oropharyngeal airway size using craniofacial anatomical landmarks. (aaem.pl)
- Depending on the measurement technique used, different results of average lengths and thus approximate sizes of oropharyngeal airway were obtained. (aaem.pl)
- This indicated that depending on which technique is used for measuring purposes, differences in the size of the oropharyngeal airway can be up to 2-3 cm, with a high degree of statistical significance. (aaem.pl)
- Arthur Guedel and the oropharyngeal airway. (aaem.pl)
- Castro D, Freeman LA. Oropharyngeal Airway. (aaem.pl)
- Gusti V, Vaghadia H. Hybrid nasopharyngeal and oropharyngeal airway for improving upper airway and capnography in sedated patients. (aaem.pl)
Failure1
- Preparation for extubation should include gathering the right personnel and equipment in case of failure. (ccam.net.au)
Procedures1
- This section of the course covers how we assess patients for extubation and device exchange, and how we perform these procedures safely. (ccam.net.au)
Extraglottic2
Secretions2
- Consider extubation when bacterial tracheitis appears to be resolving, especially with decreased secretions suctioned from the endotracheal tube. (medscape.com)
- Most patients are extubated before leaving the operating room and soon become able to clear secretions from their airway. (msdmanuals.com)
Tube1
- He says, "It's important to distinguish managing a difficult airway from placing an endotracheal tube. (rtmagazine.com)