Airway Patency Research Articles

Tracheal Resection Anastomosis: A Retrospective Analysis of 33 Cases

ABSTRACT Introduction Laryngotracheal stenosis (LS) is most commonly caused by iatrogenic injury, namely, tracheal intubation. The goal of treatment is the maintenance of a patent airway, which is mostly achieved by surgical intervention. Our objective was to study the effect of perioperative variables on tracheal resection anastomosis (TRA)/cricotracheal resection anastomosis (CTRA) surgical outcomes by identifying statistically significant factors associated with postoperative complications and failure of surgery, i.e., restenosis. Methods Data from the medical records of 33 patients who underwent TRA/CTRA was analyzed by univariate and multivariate logistic regression. The data included perioperative variables such as the etiology of stenosis, comorbidities, and postoperative or long-term complications. Results The study included nine females and 24 males, and most (29, 87.88%) were intubated prior to surgery. Nineteen patients (57.57%) developed one or more postoperative complications, including, but not limited to, surgical site infection and hematoma. Of all patients, six (18.18%) developed long-term restenosis. Multiple factors were significantly associated with the development of postoperative complications. Univariate analysis revealed the following factors as statistically significant: age (p = 0.05), diabetes (p = 0.00001), hypertension (p = 0.00001), and myocardial infarction (p = 0.03). Multivariate analysis showed that age (p = 0.046) and myocardial infarction (p = 0.00001) were independent factors. The study had an overall survival of 97%. Conclusion TRA/CTRA is a complex surgical procedure, and its outcomes can be affected by many factors. More studies with bigger sample sizes are needed to better understand contributing factors and to confirm the already established associations.

Evaluation of nasal airway resistance in a cohort of children with primary snoring and maxillary deficiency.

The aim of this study was to test whether rapid palatal expansion is effective to improve nasal airway patency in a sample of pediatric patients with primary snoring. A group of 21 subjects, 11 girls (52%) and 10 boys (48%), with a mean age of 7.1 years (SD=1.3; range 4-9 years) were treated with a rapid maxillary expansion (RME) device. Nasal airway resistance was assessed via rhinomanometric exam before (pre-) and 6 months after (post-) the rapid palatal expansion treatment. Data analysis showed a statistically significant increase in the mean scores of the results of the rhinomanometric exam between the pre- and post-measurements with a significant reduction in total inspiratory and expiratory air resistance values after rapid palatal expansion. Our results show that RME treatment is associated with an improvement in nasal airway resistance due to a substantial reduction in nasal resistance associated with the orthopedic action of the orthodontic device.

Comparison of laryngeal mask airway (LMA) insertion with and without muscle relaxant in pediatric anesthesia; a randomized clinical trial

IntroductionThis study aimed to evaluate the effectiveness of using muscle relaxant on the ease of laryngeal mask airway (LMA) insertion and possibility of its related complications. MethodsThis double-blind, randomized clinical trial was performed on 60 children aged 1–4 years with ASA (American Society of Anesthesiology) I or II with upper limb injuries who were candidates for surgery. The patients were randomly allocated to the two groups receiving atracurium group as muscle relaxant (MR) or saline group (S). ResultsRegarding ease of placement, the LMA was inserted in 66.7% and 63.3% of patients straightforwardly in the MR and S groups, respectively. While it was performed with one maneuver in 23.3% and 26.7% of cases in the MR and S groups, respectively (p = 0.955). Moreover, LMA dislodgment in the two groups was 36.7% in the MR group and 20.0% in the S group without a meaningful difference (P = 0.152). The only complication observed in the two groups was laryngospasm, which occurred in 0.10% and 13.3% in the MR and S groups, respectively (p = 0.688). ConclusionIn some pediatric anesthesia, the use of atracurium, as a muscle relaxant had no significant effect on capability of LMA insertion, maintaining airway patency, LMA seal pressure and oxygenation variations. Moreover, it did not have a preventive effect on the occurrence of complications such as laryngospasm.

Efficiency of using a short-acting β2-agonist for the relief of acute cold bronchospasm in asthma patients with cold airway hyperresponsiveness

Excessive sensitivity of the respiratory tract to physical and chemical environmental triggers can vary for many reasons, reducing the therapy effectiveness in a patient with asthma. Aim of the study was to investigate the effectiveness of a short-acting bronchodilator in patients with asthma for the relief of acute cold bronchospasm after a test of isocapnic cold air hyperventilation (ICHV). Material and methods. In 281 (161 women; 120 men, p > 0.05) asthma patients with cold airway hyperresponsiveness (CAHR), the change in airway patency (FEV1) and the efficacy of short-acting β2-agonists (SABA) after a 3-minute isocapnic hyperventilation with cold (–20 ºС) air. Results. According to clinical data, patients had persistent asthma, mean age 35 (26; 44) years, 49 % of patients smoked, ACT 16 (12; 20) points, FEV1 90.0 ± 1.0 % predicted, FEV1/VC 71.4 ± 0.6 %, the increase in FEV1 after inhalation of SABA (∆FEV1β) was 11.1 (5.1; 20.5) %. The change in FEV1 for the ICHV varied within –16 (–22.0; –12.0) %. The use of SABA after the IHCV showed different efficacy for relief of an attack of cold bronchospasm. The median value of ∆FEV1β after ICHV was 21.1 (11.6; 33.3) %, with a range of –48.6 to 108.2 %. In the general group, there was a direct relationship between the level of asthma control in terms of ACT points and the baseline FEV1 (Rs = 0.17; p = 0.007), MEF25-75 (Rs = 0.18; p = 0.008), ∆FEV1β in response to SABA (Rs = –0.17; p = 0.0104), as well as the severity of the bronchial response to the ICHV (Rs = 0.15; p = 0.014). The latter, in turn, correlated with ∆FEV1β after ICHV (Rs = –0.28; p < 0.0001) after HCI. Conclusions. There is a differentiated airway response to SABA after acute cold bronchoprovocation. The results obtained can serve as an important tool for phenotyping of asthma patients with CAHR for the medication correction of сold bronchospasm.

Comparing Fentanyl Dosages of 1 Microgram per Kilogram of Body Weight and of 1.5 Micrograms per Kilogram of Body Weight in Relation to Cough Suppression during Bronchoscopy Procedures

BACKGROUND: Anaesthesia at bronchoscopy is a unique challenge for the anaesthesiologist as both the anaesthesiologist and operator work in the same airway. It is essential that administration of sedative agents must achieve the desired depth of sedation without risking airway patency, ventilation function and cardiovascular function. About 25% of bronchoscopy patients cite cough as the most unpleasant effect of this procedure. Fentanyl is widely chosen for a sedative agent because of their analgesic, sedative, and antitussive effects, however there has been no data regarding the optimal dose of fentanyl to suppress cough in bronchoscopy procedures. METHODS: We designed a research with 18 subjects received fentanyl in a dose of 1 μg / kgBW, 18 subjects received fentanyl in a dose of 1.5 μg / kgBW and 18 subjects received propofol in a dose of 2 mg / kgBW as a control group. We observed the depth of sedation using the Ramsay sedation score and duration of cough suppression in their bronchoscopy procedures. We also observed the alteration of blood pressure, pulse rate, respiratory rate and oxygen saturation. RESULTS: There was a significant difference in the depth of patient sedation between the control group and the treatment groups; as patients without fentanyl treatment were sedated deeper on the Ramsay 4 scale, patients in the treatment groups with either fentanyl of 1 µg / kgBW or 1.5 µg / kgBW had the depth of sedation on the Ramsay 2 scale and unable to reach moderate sedation as expected. Subjects with fentanyl treatments showed significantly better suppression effects against coughing compared to control group patients. As there also was a significance difference in suppression effects for coughing between the group receiving fentanyl treatment of 1 µg / kgBW and the group receiving fentanyl treatment of 1.5 µg / kgBW, we noticed a fentanyl treatment of 1 µg / kgBW was adequate to suppress cough although a dose of 1.5 µg / kgBW would show better cough suppression effect. Subjects in control group with 2 mg / kgBW of propofol experienced a more significant alteration in vital signs than the fentanyl group, either with a dose of 1 µg / kgBW or 1.5 µg / kgBW. Comparing and statistically analysing the two treatment groups of different dose of fentanyl, we found no significant difference in vital signs alteration between the two groups. DISCUSSION: Our study revealed that as fentanyl significantly suppressed cough reflex and larger dose would provide longer period of suppression. Subjects with fentanyl treatment showed more favourable altercation in systolic and diastolic blood pressure, pulse rate, respiratory rate and oxygen saturation compared to subjects in control group with 2 mg / kgBW of propofol, but comparing and statistically analysing the two groups of different dose of fentanyl, we found no significant difference in vital signs alteration

Technical standards for pulmonary function tests: impulse oscillometry

Impulse oscillometry (IOS) is a method for measuring respiratory impedance based on the forced oscillation technique (FOT). The IOS measurement requires only quiet tidal breathing, which is simple, suitable for a wide range of people and provides various respiratory physiological parameters. For promoting the standardization and clinical application of IOS measurement in China, based on the relevant research evidence and the updated technical standards by European Respiratory Society, this article provided a brief introduction to the background of IOS technique and the current situation of its clinical application in China, as well as the recommendations and interpretations on the indications and contraindications, device calibration, testing protocols, quality control requirements including acceptability and repeatability criteria, measurement parameters and graphs, testing results interpretation, references values and normal limits, report template, clinical application including assessment of airway patency, airway reversibility and responsiveness, small airway function and so on. It also offered recommendations on the relevant thresholds of diagnosis and evaluation.

Chronic tracheostomy care of ventilator-dependent and -independent children: Clinical practice patterns of pediatric respirologists in a publicly funded (Canadian) healthcare system.

To describe the current clinical practice patterns of Canadian pediatric respirologists at pediatric tertiary care institutions regarding chronic tracheostomy tube care and management of home invasive ventilation. A pediatric respirologist/pediatrician with expertise in tracheostomy tube care and home ventilation was identified at each Canadian pediatric tertiary care center to complete a 59-item survey of multiple choice and short answer questions. Domains assessed included tracheostomy tube care, caregiver competency and home monitoring, speaking valves, medical management of tracheostomy complications, decannulation, and long-term follow-up. The response rate was 100% (17/17) with all Canadian tertiary care pediatric centers represented and heterogeneity of practice was observed in all domains assessed. For example, though most centers employ Bivona™ (17/17) and Shiley™ (15/17) tracheostomy tubes, variability was observed around tube change, re-use, and cleaning practices. Most centers require two trained caregivers (14/17) and recommend 24/7 eyes on care and oxygen saturation monitoring. Discharge with an emergency tracheostomy kit was universal (17/17). Considerable heterogeneity was observed in the timing and use of speaking valves and speech-language assessment. Inhaled anti-pseudomonal antibiotics are employed by most centers (16/17) though the indication, agent, and protocol varied by center. Though decannulation practices varied considerably, the requirement of upper airway patency was universally required to proceed with decannulation (17/17) independent of ongoing ventilatory support requirements. Considerable variability in pediatric tracheostomy tube care practice exists across Canada. These results will serve as a starting point to standardize and evaluate tracheostomy tube care nationally.

RECANNULATION OF COMPLETELY OCCLUDED BRONCHUS INTERMEDIUS WITH A DIODE LASER

RECANNULATION OF COMPLETELY OCCLUDED BRONCHUS INTERMEDIUS WITH A DIODE LASER

S2274 Bravo Capsule Aspiration

Introduction: Bravo wireless capsule is a catheter-free pH monitoring system used to diagnose GERD in patients who fail anti-secretory therapy. Several adverse events have been reported in the literature; these include nose or throat discomfort and dislocation from positioned sites. Case Description/Methods: A 72-year-old man with a history of GERD, prostate cancer, hypothyroidism, obstructive sleep apnea, presented for esophagogastroduodenoscopy (EGD) with Bravo™ placement due to persistent esophageal reflux symptoms despite appropriate therapy. The Bravo™ capsule (Medtronic, Minneapolis, MN) with a delivery system was introduced through the mouth and advanced into the esophagus. The device was placed with visual confirmation; however, the patient had severe a coughing fit. Suction was applied and the delivery system was then withdrawn. Repeat EGD was performed and no Bravo™ was seen in esophagus, stomach, or duodenum. Due to suspicion of dislodgement, a chest x-ray was performed and Bravo™ was seen in the left lung (figure 1, panel A). The patient was admitted to the hospital, and the pulmonology service was consulted for device removal. Bronchoscopy was performed successfully with the extraction of a capsule from the left main bronchus (Figure 1, panel B). After 24 hours observation, the patient did not have any symptoms or signs of aspiration pneumonitis and was discharged home. Discussion: We present a case of an adult patient with aspiration of the capsule into the lungs. This is an unusual complication with pH monitoring techniques(3). Given the limited number of cases of Bravo™ aspiration, there are no definite guidelines or gold-standard treatment up to date. A patent airway and good oxygenation must be maintained. The initial diagnostic evaluation includes chest radiographs, since the Bravo™ capsule is radiopaque(4).Once located, bronchoscopic tools can usually reveal the capsule, as was done with our patient.Figure 1.: Panel A, left: X-ray showing bravo capsule in left lung panel B, right: bronchoscopy showing reveals bravo capsule in left main bronchus.

S368 Chronic Tracheoesophageal Fistula Successfully Treated Using an Amplatzer Closure Device Under Endoscopic Visualization

Introduction: In tertiary care centers, where advanced endoscopic expertise is available, the placement of an Amplatzer septal occluder is practical and safe. This allows for potential fistula closure, especially in patients with severe comorbidities or in critical condition or those with chronic or recurrent tracheoesophageal fistulas (TEF). Case Description/Methods: A 72-year-old man with a history of gastroesophageal reflux disease (GERD) and well-differentiated esophageal adenocarcinoma who presented for dysphagia and cough. Social history was negative for smoking, smokeless tobacco, alcohol ingestion and illicit drug use. Home medications include famotidine. He had no known significant family history. The patient had undergone numerous esophagogastroduodenoscopies (EGD) since 2017 for recurrent strictures requiring TTS balloon dilations, intralesional triamcinolone acetonide injections and esophageal stenting complicated by formation of a tracheoesophageal fistula (TEF) at the anastomotic site. The TEF was initially treated with stenting 3 months prior to presentation. The patient underwent EGD and bronchoscopy with visualization of a 5 mm fistula. He was then evaluated by the surgery team for consideration of surgical repair, however the patient declined surgical intervention. Given the clinical condition of the patient with recurrent aspiration events, failed endoscopic management and refusal of surgical intervention, it was decided to remove the esophageal stent and attempt placement of an Amplatzer septal occluder. An 18 mm Amplatzer device (AD) was successfully placed with satisfactory closure of the TEF. Repeat endoscopy 5 months later, showed that the device had remained in the correct position and the patient remained asymptomatic following advancement of his diet. Discussion: Acquired TEF is a rare complication, the incidence in the US has yet to be reported. Amplatzer occluder devices, originally designed for transcatheter closure of cardiac defects, have shown promise in the treatment of TEFs. It is suggested that the placement of the AD induces granulation tissue formation around the device allowing for complete closure of the fistula without compromising airway patency. Upon review of current literature only one other case report was found where an AD was used for the management of refractory TEF. In the setting of large or difficult to manage TEFs and patients who are not surgical candidates, Amplatzer septal occluder devices can be used to successfully treat complicated TEFs. Watch the video at https://tinyurl.com/ACGAbstractS368Figure 1.: Amplatzer device deployed with successful tracheoesophageal fistula closure.

ROLE OF VENOVENOUS EXTRACORPOREAL MEMBRANE OXYGENATION IN SALVAGE THERAPY FOR CENTRAL AIRWAY OBSTRUCTION: A CASE REPORT

ROLE OF VENOVENOUS EXTRACORPOREAL MEMBRANE OXYGENATION IN SALVAGE THERAPY FOR CENTRAL AIRWAY OBSTRUCTION: A CASE REPORT

Cephalometric Assessment of Pharyngeal Airway Dimensions in Sagittal and Vertical Growth Patterns

Setting: Determination of patency of airway in sagittal and vertical growth patterns in patients visiting LUMHS Institute of Dentistry, Jamshoro. Methods: This cross-sectional study took place in the Orthodontic Department, Institute of Dentistry, LUMHS Jamshoro. Patients in the age group of 12 to 28 years were included. All subjects were categorized into two groups: Group 1 consists of patients with vertical growth, and Group 2 consists of patients with horizontal growth. Measurements were done by McNamara analysis; the skeletal type was analyzed using ANB, FMA, and SN-GOGN measurements were plotted on the Y-axis, measuring the angle between the S-N plane and sella-gnathion. Results: A total of 62 patients were studied; their mean age was 20.74+3.36 years. The majority were females 77.4% and males 22.6%. two groups were made according to growth patterns, group 1 consisted of vertical growers and group 2 was of horizontal grower patients. 37.1% of patients were found to have an obstructive lower pharyngeal airway. Mean ANB, FMA, Y-Axis, SN-GOGN, upper pharyngeal airway, and lower pharyngeal airway was 5.42±3.52 degree, 27.90±7.93 degree, 66.31±6.56 degree, 34.24±7.95 degree, 14.5±2.24 mm and 9.2±2.04mm respectively. The results show a positive and negligible correlation between ANB and pharyngeal airways. Conclusion: There was a positive and negligible correlation between sagittal growth patterns and pharyngeal airway, with class II cases having obstructive pharyngeal airway and class III cases having patent pharyngeal airway. Keywords: Patency of Airway, Sagittal, Skeletal Discrepancies, Vertical

Iatrogenic massive hemorrhagic edema of the tongue: a case report

BackgroundLingual edema is usually the result of infectious etiology, angioedema, and less commonly of traumatic etiology.As for the therapeutic approach, the first priority excluding airway compromise or ensuring airway safety. Antibiotic treatment should be administered for tongue swelling of inflammatory etiology while standard therapy with epinephrine, steroids, and antihistamines is recommended for cases of anaphylaxis. In addition, in case of injury causing lingual edema, one of the treatment options is surgical intervention.Aim of workThe aim of our work is to present a rare and simultaneously instructive case of traumatic hemorrhagic edema of the tongue, leading to airway obstruction.Case presentationWe report a case of hemorrhagic traumatic lingual edema, initially without symptoms of upper airway obstruction on admission. However, immediate intervention and airway securing was necessary due to rapid growth of the edema.Then, as long as patient was hemodynamically stable and airway patency was ensured, the diagnosis of iatrogenic tongue hematoma was confirmed. The challenge was to decide the appropriate treatment for the patient. Following, she was taken for 24 h to the ICU due to lactic acidosis while the bleeding was treated conservatively.Afterward, she was transferred to the clinic, hemodynamically stable, and was discharged uneventfully.ConclusionsHemorrhagic edema of the tongue may become a life-threatening condition. Its rapid growth can lead to obstruction of the upper respiratory way; therefore, special wariness in its management is required. Treatment can be conservative or surgical, depending on the size and tendency of hematoma to increase.

Comparing the Ease of Intubation between C-MAC, McGrath, and Conventional Macintosh Laryngoscope in a Simulated Difficult Airway of a Laerdal Mannequin

Tracheal intubation is an essential skill for doctors. Tracheal intubation is done in patients with questionable airway patency, poor respiratory drive, hypercarbia, or hypoxia. The objective of this study was to compare the ease of tracheal intubation using MacintoshLaryngoscopes, C-MAC, and McGrath on a simulated difficult airway mannequin. The rationale of the study was to identify the easiest device to use for tracheal intubation. This randomized clinical trial was done at the Teluk Intan Hospital, Perak, Malaysia, from March 2020 to February 2021. Sixty-five medical officers participated in this study. The results showed that the mean time for tracheal intubation was significantly shorter when the participants were using the C-MAC than the conventional direct laryngoscope and McGrath. (C-MAC: 20.8 seconds, Direct Laryngoscope: 27.7 seconds, McGrath: 34.6 seconds) The results showed that C-MAC andMcGrath had a better first-attempt success rate than conventional direct laryngoscopes. C-MAC scored the highest first-attempt success rate, followed by McGrath. (95% compared to 83%) Regarding Cormack-Lehane grading, the C-MAC device showed a better view than McGrath and Direct Laryngoscope. The preferred device by medical officers for tracheal intubation was the C-MAC. (45% compared to other devices) In conclusion, the C-MAC device was superior in first attempt success rate and was the most preferred device compared to McGrath and direct laryngoscope. However, using the C-MAC device must be accompanied by adequate training and practice.

Comparative Study of Endoscopic and Conventional Septoturbinoplasty in Patients with Nasal Airway Obstruction

Objectives: The goal of our study was to perform endoscopic septoplasty with or without turbinate reduction and also to determine its postoperative subjective and objective improvements. Methods: This was a hospital-based pre and post clinical trial study of 63 patients with nasal septal deviation treated with endoscopic and conventional septoplasty with or without turbinoplasty from 2013 to 2016. Nasal airway patency was recorded before and 2.7 months after surgical treatment using a visual analogue scale (VAS), Glatzel mirror test and bilateral peak nasal inspiratory flow (PNIF) measure. Results: Endoscopic (27 patients) and conventional septoturbinoplasty (36 patients) was performed on 63 patients (40 males; 23 females) with a mean age of 35 years. The results showed a significant improvement of nasal passage condition in scales of VAS, Glatzel mirror test, and bilateral PNIF values after surgery in both groups. In both surgical techniques septoplasty with turbinate reduction showed better improvement in VAS and bilateral PNIF scores than septoplasty alone. Conclusion: The application of endoscopic technology has an advantage of precise visualization and is a valuable tool especially when it is used for educational reasons. Subjective and objective improvements were confirmed equally in both endoscopic and conventional groups.

Novel Therapy for Acquired Tracheomalacia with a Tissue-Engineered Extraluminal Tracheal Splint and Autologous Mesenchymal-Derived Chondrocytes.

Introduction Acquired tracheomalacia (ATM) is characterized by a loss of structural strength of the tracheal framework, resulting in airway collapse during breathing. Near half of the patients undergoing prolonged invasive mechanical ventilation will suffer tracheal lesions. Treatment for ATM includes external splinting with rib grafts, prosthetic materials, and tracheal resection. Failure in the use of prosthetic materials has made reconsidering natural origin scaffolds and tissue engineering as a suitable alternative. Objective To restore adequate airway patency in an ovine model with surgically-induced ATM employing a tissue-engineered extraluminal tracheal splint (TE-ETS). Methods In the present prospective pilot study, tracheal rings were partially resected to induce airway collapse in 16 Suffolk sheep ( Ovis aries ). The TE-ETS was developed with autologous mesenchymal-derived chondrocytes and allogenic decellularized tracheal segments and was implanted above debilitated tracheal rings. The animals were followed-up at 8, 12, and 16 weeks and at 1-year postinsertion. Flexible tracheoscopies were performed at each stage. After sacrifice, a histopathological study of the trachea and the splint were performed. Results The TE-ETS prevented airway collapse for 16 weeks and up to 1-year postinsertion. Tracheoscopies revealed a noncollapsing airway during inspiration. Histopathological analyses showed the organization of mesenchymal-derived chondrocytes in lacunae, the proliferation of blood vessels, and recovery of epithelial tissue subjacent to the splint. Splints without autologous cells did not prevent airway collapse. Conclusion It is possible to treat acquired tracheomalacia with TE-ETS without further surgical removal since it undergoes physiological degradation. The present study supports the development of tissue-engineered tracheal substitutes for airway disease.

A PRELIMINARY STUDY TO EVALUATE THE EFFECTIVENESS OF LARYNGEAL MASK AIRWAYS IN ANESTHETIZED BIGHORN SHEEP (OVIS CANADENSIS) LAMBS.

Chemical immobilization of wildlife, required for many biological studies and management events, often induces hypoxemia and respiratory depression. Laryngeal mask airways (LMAs) have shown promise as an efficient method of airway protection during anesthesia. Nineteen wild bighorn sheep (Ovis canadensis) lambs were immobilized using an IM combination of medetomidine (0.16 ± 0.062 mg/kg), azaperone (0.20 ± 0.058 mg/kg), and alfaxalone (0.54 ± 0.21 mg/kg) via remote injection. Upon recumbency, arterial blood gas parameters, minute ventilation (VE), tidal volume (VT), and respiratory rate were measured before and after LMA placement. The VE and VT were measured via respirometer. Time to LMA placement, cuff pressure, cuff volume, and ease of placement were measured. Medetomidine was reversed with IM atipamezole at five times the medetomidine dose upon completion of procedures. Pre- and post-LMA measurements were compared using a t test or a Wilcoxon signed-rank test based on normality of the data. The LMA provided a patent airway in all lambs with a significant (P < 0.0001) increase in VE (mean [95% CI]; pre-LMA: VE = 17.3 [16.2-18.5] L/min, post-LMA: VE = 19.8 [18.6-21.0] L/min) but did not have a significant impact on partial pressure of oxygen (PaO2; pre-LMA: corrected PaO2 = 45.2 [41.2-49.2] mm Hg, post-LMA: corrected PaO2 = 47.5 [43.3-51.7] mm Hg; P = 0.19) or partial pressure of carbon dioxide (PaCO2; pre-LMA: PaCO2 = 50.4 [46.6-53.2] mm Hg, post-LMA: PaCO2 = 51.6 [48.8-55.7] mm Hg; P = 0.035) following placement. This study demonstrated that the LMA is a viable option for airway protection in wild bighorn sheep.

Simulated slide tracheoplasty for congenital tracheal stenosis using three-dimensional printed models.

The slide tracheoplasty (STP) is the standard treatment for severe congenital tracheal stenosis (CTS). Understanding the features of the tracheal stenosis in each case and choosing an appropriate incision design are very important for successfully executing the procedure. The present study aimed to evaluate the advantages of three-dimensional (3D) printed models of the trachea for improving CTS. Three-D tracheal models were created using computed tomography (CT) data from ten patients undergoing STP for CTS. Simulated surgery was performed using the hollow models after reinforcing with them with a coating of gum spray. Clinical outcomes, including patient survival, postoperative surgical interventions, and time required for STP, were compared with the corresponding values in the last ten patients before the introduction of 3D model simulations. All ten patients for whom simulated surgery using a 3D tracheal model were conducted achieved good airway patency after their STP. The surgeons reported feeling that the 3D model simulations were highly effective although there was no significant difference in the clinical outcomes of the groups with or without simulated STP. The models were useful not only for surgical planning but also for sharing important information among the multidisciplinary team and the patients' family. Our experience using 3D tracheal models demonstrated several features enabling improvement in the surgical treatment of CTS.

Unit Knowledge and Practice of Emergency Nursing Interventions at a Tertiary Public Cardiac Health Center in Uganda

Background: Research suggests that many of the millions of deaths and long-term disabilities resulting from acute cardiovascular events and other emergency conditions are preventable if effective emergency care services were readily available. Effective emergency care requires trained and competent staff, including registered nurses. Most educational pathways do not adequately prepare nurses to deliver sensitive health care services for those with acute illness and injury. This includes Uganda, where few capacity-building initiatives have targeted emergency nursing care delivery, leading to knowledge and practice gaps.&#x0D; Purpose: This study aimed to assess emergency nursing knowledge and clinical practice at a tertiary public cardiac health facility in Uganda.&#x0D; Method: This was a single-center, descriptive cross-sectional survey of a convenience sample of nurses working in the emergency department.&#x0D; Results: A total of 49 emergency care nurses completed the survey (response rate of 81.6%). Among the participants, 75.5% were females, 65.3% had a bachelor's degree, 28.6% had Basic Life Support training, and 12.2% were certified in Advanced Cardiac Life Support. Additionally, 75% of the respondents had low proficiency in assessing critically ill patients, 100% could not perform safety checks, 50% were unable to maintain patent airways or complete patient handover, and only 50% could connect a patient to a defibrillator.&#x0D; Conclusion: We report that the most significant gap in nurse-provided emergency care is the application of practical skills. Capacity-building initiatives are required to improve the knowledge and practice of nurses in emergency care delivery.

Paraphenylenediamine (Hair Dye) Poisoning: A Prospective Study on the Clinical Outcome and Side Effects Profile.

Background: Systemic poisoning with paraphenylenediamine (PPD) also known as Kalapathar, is an emerging suicidal trend in developing south Asian and African countries. The clinical distinction of hair dye toxicity comprises severe angioedema of the face and neck, tongue swelling resulting in upper airway obstruction, acute liver injury, myocarditis, and rhabdomyolysis complicating to acute kidney injury.Aim: To raise awareness, document the characteristic clinical spectra, and prevent and predict the outcome of poisoning (suicidal or accidental) with PPD (hair-dye) based on clinical complications, early baseline laboratory results and creatine phosphokinase (CPK) levels monitoring.Place and duration: Department of Medicine and Emergency, Sheikh Zayed Hospital, Rahim Yar Khan. One year of study from August 19, 2021 to August 17, 2022.Methods: A total of 103 patients, with no comorbidities, who presented with acute PPD poisoning were included in this study. The demographic profile, clinical features, laboratory results, route and mode of intoxication were noted in a special proforma. Furthermore, clinical outcomes in the form of need for tracheostomy or mechanical ventilation, mortality and mean hospital stay were also documented. The percentages were calculated for categorical data like demographic profile, clinical features and clinical outcomes. Mean and standard deviation was calculated for continuous variables, i.e., laboratory parameters.Results: Out of 103 patients, 88 (85.4%) were females who belonged to a low socioeconomic class (89%). The mean age of the patients was 26.39 ± 3.41 years. The majority of cases were suicidal self-poisoning (98%), and the route was oral (98%). In 82 (79.6%) of the patients, the characteristic cervicofacial angioedema, dysphagia, dysphonia, tongue swelling and stridor were noted. Clinical complications such as rhabdomyolysis (67.9%), chocolate-colored urine (82.5%), hepatitis (58.2%), and acute kidney injury (22.3%) were noted in the later clinical stages of PPD poisoning. Emergency tracheostomy was performed in 77.6% of patients. The mortality rate in this study stands at 12.6% and the mean hospital stay at 6.25 ±3.99 days. The mean and standard deviation of serum creatinine, CPK, alanine aminotransferase (ALT), aspartate aminotransferase (AST), total leukocyte count (TLC), and serum potassium were, respectively, noted at 2.431 ± 2.275 mg/dL, 1090.8 ± 218.6 IU/L, 476.8 ± 1038.8 IU/L, 639.1 ± 1006, 11100 ± 4124.1 cells/mm3, and 4.8 ± 1.061 mmol/L.Conclusion: PPD is emerging as the poison of choice in suicidal young female patients due to its easy, low-cost availability and higher mortality. The cervicofacial angioedema, tongue swelling and rhabdomyolysis impending acute kidney injury are hallmarks of PPD poisoning. The treatment is largely supportive with no specific antidote available. Early clinical diagnosis and supportive therapeutic management in the form of maintenance of airway patency, timely tracheostomy with post-operative tube care, intravenous medications (fluids, steroids, antihistamine), and renal dialysis can save lives and may lead to full recovery. In addition, strict legal measures should be endorsed to ban the sale and use of lethal PPD in hair dyes.