Airway Suctioning Research Articles

THE ROLE OF BRONCHOSCOPY IN INTENSIVE CARE MEDICINE, CASE REPORT

Purpose. Airway maintenance, adequate ventilation, and pulmonary gas exchange are crucial for critically ill patients. The challenges of performing in intensive care patients often differ significantly from routine surgical procedures in the operating room. The aim of our study was to assess the effectiveness of bronchoscopic aspiration in improving respiratory function in a patient on prolonged artificial ventilation. Material/Methods. A 69-year-old male was admitted to the ICU six days after an open cystoprostatectomy, presenting with respiratory failure. Initial treatment included blind airway suctioning, nebulization, chest physiotherapy, and empirical antibiotics. Due to persistent atelectasis and respiratory failure, bronchoscopic aspiration was performed. A total of nine bronchoscopies with bronchoalveolar lavage (BAL) were conducted for aspiration and microbiological testing, guiding adjustments in antibiotic therapy. After 61 days in the ICU, the patient was transferred to the Department of Urology and later discharged. Results. Bronchoscopic aspiration significantly improved the patient's condition, with noticeable improvements after the first bronchoalveolar lavage (BAL). Pulmonary imaging on X-ray and blood oxygenation showed clear progress, with better lung function and enhanced ventilation parameters. These changes allowed for a reduction in oxygen concentration and improved gas exchange. After 61 days in the ICU, the patient was successfully transferred to the Department of Urology and later discharged in stable condition. Conclusions. Bronchoscopic aspiration is a highly effective method for improving ventilation and oxygenation in patients on prolonged mechanical ventilation. It plays a crucial role in managing airway obstructions atelectasis, and enhancing microbiological diagnostics.

Nursing Interventions Related to the Need for Oxygenation in Severe COVID-19 Disease in Hospitalized Adults: A Retrospective Study.

To describe the nursing interventions related to the need for oxygenation in hospitalized adults with severe COVID-19 disease in the Intensive Care Unit. This was an observational, retrospective and descriptive study in a population of 2205 patients with a convenience sample of n = 430 and based on the North American Nursing Diagnosis Association (NANDA), the Nursing Interventions Classification (NIC) and the Nursing Outcomes Classification (NOC). The analysis was performed with a non-parametric test to determine the association between the nursing interventions and the need for oxygenation. The findings are aimed at improving nursing interventions with statistical associations as follow: oxygen therapy (p < 0.000), airway suctioning (p < 0.000), airway management (p = 0.029), invasive mechanical ventilation (p < 0.000) and non-invasive mechanical ventilation (p = 0.022). NOC taxonomy expected outcomes in ventilation, 34% (146), alteration in gas exchange, 33.7% (145), and respiratory status, 558.9% (253), were severely compromised. The nursing interventions to maintain the respiratory status are focused on airway care and oxygen therapy in order to increase the oxygen saturation level and decrease the severity of the need for oxygenation.

Intensive Care Nurses' Performance of Open versus Closed Endotracheal Suction on Critically Ill Patients in Ismailia City.

Endotracheal Tube Suctioning (ETS), which involves either an open or closed suctioning system, is a crucial practice for mechanically ventilated patients. The nursing practice of airway suctioning is inevitable. This study was designed to compare the intensive care nurses' performance of open versus closed endotracheal suction on critically ill patients in Ismailia City. A non-participant structured observational study design was conducted on a convenient sample (N = 63) at intensive care units at a teaching hospital through March and August 2022 to evaluate how nurses practice different procedures in open suctioning compared with the closed suctioning system of Endotracheal Suction (ES) through a 32-item structured checklist. Additionally, authors compared their levels of knowledge in both suctioning systems. Approximately 75% and 65% of the study participants had a satisfactory level of knowledge about the open system compared with the closed system, respectively. The total percentage of patients who achieved a satisfactory level of practice was 72% for the open-system group, compared with 56% for the closed-system group. Overall, there were significant differences between total nurses' performances in the open-system and closed-system systems. Independent sample t-tests revealed a statistically significant correlation between overall nurses' performance in both systems (t = 6.04, p < 0.001). The findings revealed significant differences in nurses' performance between open and closed-system suctioning. The researchers recommend in-service-led training programs to improve nurses' performance, and other studies with larger sample sizes should be supported.

Application of an Automatic Suction Device to a Patient with A Tracheostomy Tube in the General Ward: A Case Report

The A-1000 (Elmeca, Co. Ltd., Seoul, Korea) electrical automatic airway suction device, was designed to operate as a customizable repeated closed suction device. It can be used for patients with intubation or tracheostomy tubes. This is the first recorded case of the use of the A-1000 in a general ward patient with a tracheostomy tube. A 91-year-old man presented having attempted suicide by hanging and was admitted to this institution. Although extubation was performed in the intensive care unit, the patient required 2 reintubations. The tracheostomy was performed, and the A-1000 was applied. After weaning from mechanical ventilation, the patient was transferred to the General Ward with a tracheostomy tube in place for effective removal of sputum by the A-1000. The tracheostomy tube was successfully removed, and the patient was discharged. The effectiveness and safety of the A-1000 needs further study by expanding the applications of this device.

The Epidemiology of Out-of-Hospital Pediatric Airway Management in the 2019 ESO Data Collaborative

Objectives Airway management is a fundamental skill that Emergency Medical Services (EMS) clinicians must be prepared to perform on patients of any age. We performed one of the first epidemiological studies of out-of-hospital pediatric airway management utilizing the ESO data set. Methods We used the 2019 ESO Data Collaborative public release research data set. We performed a descriptive analysis of all patients <18 years receiving at least one of the following airway management interventions: nasopharyngeal airway, oropharyngeal airway, noninvasive positive pressure ventilation (NIPPV), airway suctioning, bag-valve-mask ventilation (BVM), tracheal intubation (TI), supraglottic airway (SGA) or surgical airway placement. We determined the success rates for BVM, TI and SGA. Results Among 7,422,710 911 EMS activations, there were 346,912 pediatric encounters that resulted in patient care. Airway management occurred in 27,071 encounters (7,803 per 100,000 pediatric EMS patient care events). Use of BVM, intubation or supraglottic airway insertion occurred in 3,496 encounters (1,007 per 100,000 pediatric EMS patient care events). Ventilation with BVM occurred in 2,226 encounters (642 per 100,000 pediatric EMS patient care events), TI in 935 pediatric EMS patient care encounters (270 per 100,000 patient care encounters), and supraglottic airway insertion in 335 patient encounters (97 per 100,000 patient care encounters). Overall TI success was 71.4%, rapid sequence intubation success was 86.3%, and SGA success was 87.2%. Overall TI first pass success rate was 63.1%. Conclusions In the ESO cohort, advanced airway management of children occurred in only 5.9 in 10,000 911 emergency encounters. Overall and first pass success rates for TI were low. These data provide contemporary perspectives of pediatric prehospital airway management in the United States.

Development of a Cost-Effective 3D-Printed Airway Suction Simulator for Respiratory Therapy Students.

Three-dimensional (3D)-printed models are cost-effective and can be customized by trainers. This study designed a 3D-printed airway suction simulator for use by respiratory therapy (RT) students. The objective was to demonstrate the cost-effectiveness and application of 3D-printed models in respiratory care training, aiming to enhance the educational experience for RT students. This study developed a 3D-printed airway suction simulator that was cost-effective. A randomized controlled trial was conducted involving RT students to compare effectiveness in a 3D-model group and a control group. Skill assessments and written examinations were used to evaluate the participants' knowledge and skills. A total of 38 second-year RT students were randomly assigned to either the 3D-model group (n = 19) or the control group (n = 19). One participant in the 3D-model group was lost to follow-up during the planned direct observation of procedural skills (DOPS) assessment and satisfaction questionnaire completion. The posttest written examination scores were significantly higher in the 3D-model group than in the control group (100% vs 80%, P = .02). The scores from the DOPS and satisfaction questionnaire were comparable in the 2 groups. This study demonstrated that 3D printing can be used to create a safe and cost-effective airway suction simulator for use by RT students, with potential to enhance training methods. Further research is necessary.

Tracheostomy care for adults and the elderly in the home environment: a scoping review.

To map out scientific knowledge regarding tracheostomy care for adults and the elderly carried out by individuals, famies or caregivers in home environments. Scoping review, conducted in February 2023, according to the methodology of the Joanna Briggs Institute. The guiding question was: what and how should adult/elderly tracheostomy care be carried out by the individual/family/caregiver in the home environment? Studies published in Portuguese, English and Spanish were considered. The databases consulted were: Lilacs; Medline, via PubMed; Cinahl; Cochrane Library; PEDro; Embase; Scopus and Web of Science. 2158 articles were identified, of which 81 were read in full and 14 included in the review. The main types of care identified included psychobiological needs: airway suction, changing the tracheostomy attachment, cleaning the endocannula and sanitizing the peristomal skin. As for psychosocial needs, incentives for communication and autonomy were identified. There were no recommendations for care related to psychospiritual needs. The findings prioritize biological care, few studies have detailed how to carry out such care at home.

Knowledge of Nurses Regarding Airway Suctioning in Tertiary Care Karachi Pakistan

Proper suctioning is too essential to clear the patient's airway. Nurses should have correct knowledge regarding proper suctioning according to current recommendations to prevent complications. Objective: To assess nurses' knowledge regarding proper suctioning for adult patients. Methods: This cross-sectional study was conducted at a tertiary care hospital in Karachi, Pakistan. A 50 males and females were selected through convenient sampling by using a cross-sectional study. A self-made questionnaire was used for the data collection. Results: The study findings revealed that 50 participants participated, of which 60% were male and 40% were female. The findings also show that 40% had poor knowledge, 20 had moderate and 40% had high knowledge regarding g airway suctioning. Conclusions: Specifically, 40% of the staff demonstrated poor knowledge, 20% had moderate knowledge, and 40% exhibited a high level of knowledge concerning airway suctioning techniques. Further training and educational interventions may be necessary to improve the overall knowledge and standardize proper suctioning practices among the nurses in the hospital.

Anesthesia Management of Severe Hypoxemia During Total Arch Replacement for Acute Aortic Dissection: A Case Report

Background: Acute aortic dissection poses a life-threatening condition that typically necessitates immediate surgical intervention, such as total arch replacement. However, hypoxemia is a severe complication in such surgeries, potentially resulting in organ dysfunction, prolonged hospital stays, and even mortality. Hypoxemia presents significant challenges to anesthesiologists. Through this case, we can enhance our comprehension of anesthetic management for total arch replacement. Case presentation: A 43-year-old man with acute type A aortic dissection underwent total arch replacement. After a smooth surgery, severe hypoxemia occurred during weaning off cardiopulmonary bypass. Initial interventions, including airway suction and recruitment maneuvers, failed to improve oxygenation. Further investigations found left lung atelectasis and pleural effusion on transesophageal echocardiography, with minimal improvement after drainage. Fiberoptic bronchoscopy revealed extensive tenacious secretions occluding the airways. Conventional suctioning was ineffective due to high sputum viscosity. Ultimately, techniques including pulmonary lavage, bronchoscopic suctioning, and repeated lung recruitment controlled the refractory hypoxemia. The patient recovered after treatment in the intensive care unit. Conclusions: It is worth noting that our case highlights the challenges posed by severe hypoxemia during total arch replacement surgery. The successful management of this complication underscores the importance of a multidisciplinary approach and close monitoring during the perioperative period. Individualized anesthetic management plays a critical role in addressing severe hypoxemia during total arch replacement surgery.

Video-Recorded Airway Suctioning of Clear and Meconium-Stained Amniotic Fluid and Associated Short-Term Outcomes in Moderately and Severely Depressed Preterm and Term Infants.

The aim of this study was to investigate delivery room airway suctioning and associated short-term outcomes in depressed infants. This is a single-centre prospective observational study of transcribed video recordings of preterm (gestational age, GA < 37 weeks) and term (GA ≥ 37 weeks) infants with a 5 min Apgar score ≤ 7. We analysed the association between airway suctioning, breathing, bradycardia and prolonged resuscitation (≥10 min). For comparison, non-suctioned infants with a 5 min Apgar score ≤ 7 were included. Two hundred suction episodes were performed in 19 premature and 56 term infants. Breathing improved in 1.9% of premature and 72.1% of term infants, and remained unchanged in 84.9% of premature and 27.9% of term infants after suctioning. In our study, 61 (81.3%) preterm and term infants who were admitted to the neonatal intensive care unit experienced bradycardia after airway suctioning. However, the majority of the preterm and more than half of the term infants were bradycardic before the suction procedure was attempted. Among the non-airway suctioned infants (n = 26), 73.1% experienced bradycardia, with 17 non-airway suctioned infants being admitted to the neonatal intensive care unit. There was a need for resuscitation ≥ 10 min in 8 (42.1%) preterm and 32 (57.1%) term infants who underwent airway suctioning, compared to 2 (33.3%) preterm and 19 (95.0%) term infants who did not receive airway suctioning. In the infants that underwent suctioning, breathing improved in most term, but not preterm infants. More non-suctioned term infants needed prolonged resuscitation. Airway suctioning was not directly associated with worsening of breathing, bradycardia, or extended resuscitation needs.

Implementing paediatric appropriate use criteria for endotracheal suction to reduce complications in mechanically ventilated children with respiratory infections

BackgroundEndotracheal suction is used to maintain endotracheal tube patency. There is limited guidance to inform clinical practice for children with respiratory infections. ObjectiveThe objective of this study was to determine whether implementation of a paediatric endotracheal suction appropriate use guideline Paediatric AirWay Suction (PAWS) is associated with an increased use of appropriate and decreased use of inappropriate suction interventions. MethodsA mixed-method, pre-implementation–post-implementation study was conducted between September 2021 and April 2022. Suction episodes in mechanically ventilated children with a respiratory infection were eligible. Using a structured approach, we implemented the PAWS guideline in a single paediatric intensive care unit. Evaluation included clinical (e.g., suction intervention appropriateness), implementation (e.g., acceptability), and cost outcomes (implementation costs). Associations between implementation of the PAWS guideline and appropriateness of endotracheal suction intervention use were investigated using generalised linear models. ResultsData from 439 eligible suctions were included in the analysis. Following PAWS implementation, inappropriate endotracheal tube intervention use reduced from 99% to 58%, an absolute reduction (AR) of 41% (95% confidence interval [CI]: 25%, 56%). Reductions were most notable for open suction systems (AR: 48%; 95% CI: 30%, 65%), 0.9% sodium chloride use (AR: 23%; 95% CI: 8%, 38%) and presuction and postsuction manual bagging (38%; 95% CI: 16%, 60%, and 86%; 95% CI: 73%, 99%), respectively. Clinicians perceived PAWS as acceptable and suitable for use. ConclusionsImplementation of endotracheal tube suction appropriate use guidelines in a mixed paediatric intensive care unit was associated with a large reduction in inappropriate suction intervention use in paediatric patients with respiratory infections.

Is it feasible to avoid suction before spontaneous breathing is established?

Suctioning of the posterior pharynx immediately after birth during neonatal resuscitation can produce a vagal response resulting in bradycardia or apnea. The feasibility of delaying any airway suctioning and avoiding deep suctioning has not been studied. To test the hypothesis that newborn resuscitation is feasible with the following two guidelines: 1) avoiding any suctioning until the infant establishes spontaneous respiration, and 2) avoiding the use of deep suction with catheters. A quality improvement project was implemented using these two guidelines. Infants' mouth was cleaned with a dry cloth. No suction was started until infants establish spontaneous breathing. Then, bulb suction was used to clear secretions from the sides of the mouth and the nose without reaching the back of the pharynx. Deep suction using catheters was not used. Neonatal staff and physicians received biweekly training to support these changes. Resuscitation data before and after the practice change were compared. A total of 999 sequential cases were compared; of them 501 and 498 infants were resuscitated before and after the implementation of the new practice, respectively. Suction before spontaneous breathing occurred in 12.4% in the first cohort. There were no differences between groups except for less use of oxygen with the new guidelines (12.4% vs 4.4%, P < 0.001). Avoidance of any suction prior to spontaneous breathing and not applying deep suction with catheters are feasible during newborn resuscitation. These practices are associated with decreased exposure to oxygen in the delivery room.

The Influence of Stress on Student Performance during Simulation-based Learning: A Pilot Randomized Trial.

Simulation-based learning is an important educational medium that is being implemented increasingly for the purpose of improved patient care and safety. However, there is evidence to suggest that simulation-based education (SBE) may increase anxiety, as illustrated through self-reporting and physiological responses. Despite such data, no studies have investigated whether anxiety and stress can be manipulated through SBE scenario design and delivery to facilitate optimal learning conditions. This pilot study examined perceived anxiety and physiological stress experienced by entry-level physiotherapy students while learning a skill using SBE and the relationship between this anxiety and their subsequent skill performance. Final-year physiotherapy students were randomly allocated to one of three SBE experiences: low, medium, or high stress. The experiences were designed to induce increasing levels of stress and anxiety. Performance of the learned skill (endotracheal airway suctioning) was measured after the SBE using a bespoke assessment form. Cortisol levels, heart rate, and perceived anxiety measurements (State-Trait Anxiety Inventory and visual analog scale) were also collected. Twenty-seven participants completed the trial. There were significant differences in perceived stress and physiological response between the groups. The low-stress group demonstrated significantly better performance of airway suctioning than the higher-stress groups (P = 0.02). Higher anxiety was correlated with poorer skill performance (r = -0.410). Students report SBE to be stressful, and scenarios themselves can influence the stress and anxiety experienced. Greater stress is associated with poor learning outcomes during SBE. Healthcare educators involved in SBE scenario design need to consider the stress levels experienced. Future research to determine optimal stress and embed measurement of stress in SBE experiences is warranted.

Level and correlates of disrespect and abuse among newborns in selected public hospitals of Addis Ababa, Ethiopia

BackgroundThe provision of respectful and dignified maternal and newborn care is an important component of the quality of childbirth care. Although a growing body of evidence was generated on disrespect and abuse (D&A) of women during childbirth in the past decade there is limited evidence on D&A experienced by newborns. Our study aimed to determine the level of and factors associated with D&A among newborns.MethodsWe conducted the study in three public hospitals in Addis Ababa. We directly observed childbirth care starting from the first stage of labor through two hours after the birth of 498 mother–baby dyads. We used frequencies and percentages to describe different forms of D&A among newborns. We used binary and multivariable logistic regression analysis to assess the association between the D&A among newborns and independent variables.ResultAll of the newborns 496/496 (100%) experienced at least one form of D&A. Physical abuse was experienced by 41.1% of newborns in the form of unnecessary airway suctioning (23.2%) or slapping or holding upside down (33.5%). Additionally, 42.3% weren’t dried immediately after birth, 9.1% weren’t placed on the mother’s abdomen skin-to-skin, 61.7% had their cord cut before 1 min of birth, 34.9% weren’t breastfed within an hour of birth, 24.2% didn’t receive vitamin K and 1.8% didn’t receive tetracycline. All newborns who developed complications (69/69) received treatments without the consent of parents/caregivers. Moreover, 93.6% of parents/caregivers didn’t receive explanations regarding newborn care while the lack of breastfeeding counseling and thermal support during the immediate post-partum period was 87.3%. The likelihood of D&A was higher among newborns who were preterm (AOR = 2.02; 95% CI: 1.11–3.69), female (AOR = 2.01; 95% CI: 1.37–2.95), delivered assisted by instrument (AOR = 2.19; 95%CI: 1.20–3.99), whose mothers reside in rural areas (AOR = 1.97; 95%CI: 1.22–3.20), born from unmarried mothers (AOR = 2.77; 95%CI (1.26–6.06) and whose mothers received fewer than four-time antenatal care (ANC) visits (AOR = 2.37; 95%CI: 1.42–3.96).ConclusionOur study found a high magnitude D&A among newborns. Gestational age at birth, sex of the newborn, maternal residence, maternal marital status, number of ANC visits, and mode of delivery were statistically significantly associated with D&A among newborns.

Short-term and long-term effects of recurrent laryngeal nerve injury after robotic esophagectomy

BackgroundRobot-assisted minimally invasive esophagectomy (RAMIE) was reported to have superiority in upper mediastinal lymph nodes dissection than traditional approach, but related injuries to recurrent laryngeal nerve (RLNI) cannot be avoided. Considering that there is no study centering on RLNI during robotic manipulation, this study aimed to investigate the impact of RLNI on the short-term and long-term outcomes after RAMIE. MethodsPatients with esophageal cancer (EC) who underwent RAMIE from June 2015 to July 2019 were collated from a prospectively maintained database. Short-term and long-term outcomes of RLNI were analyzed. ResultsA total of 409 patients were included with the incidence of RLNI being 18.6% (76/409). A higher rate of postoperative pulmonary complications including pneumonia (P < 0.001) and acute respiratory distress syndrome (ARDS) (P = 0.041) was associated with RLNI, requiring more interventions for bronchoscopy airway suction (P < 0.001), tracheal reintubation (P = 0.013) and tracheostomy (P < 0.001). Patients with RLNI had a prolonged length of hospitalization and intensive care unit (ICU) stay (P < 0.001). With the median follow-up time of 48.7 (interquartile range [IQR]:27.6–60.9) months, recurrence in regional lymph nodes at mediastinum did not differ between groups (P = 0.351). Similarly, the Kaplan-Meier curves revealed no significant divergency for overall survival after RLNI (P = 0.452). ConclusionsRLNI after robotic esophagectomy is a serious morbidity associated with an increased rate of pulmonary complications, prolonged length of hospitalization with limited influence on long-term prognosis.

Artificial Airway Suctioning: A Systematic Review.

Airway suctioning is routinely performed in the majority of care circumstances, including acute care, subacute care, home-based settings, and long-term care. Using an artificial airway to suction the patient allows for the mobilization and evacuation of secretions. When a patient can't independently remove all of the secretions from their respiratory tract, suction is used. This can occur when the body produces excessive secretion or it is not eliminated quickly enough, causing the respiratory system's upper and lower respiratory secretions to accumulate. Airway blockage and inadequate breathing may result from this. Ultimately, this leads to a shortage of oxygen and carbon dioxide from the air, both of which are necessary for ideal cellular activity. Artificial airway suctioning is one of the most crucial components of airway care and a core competency for medical professionals trying to ensure airway patency. Artificial airway suctioning is a standard treatment carried out every day globally and is frequently done in both outpatient and inpatient patients. Therefore, specialists must know the safest and most efficient ways to perform surgery and any potential side effects. In ventilated infants and children, the removal of obstructive secretions by endotracheal suctioning is frequently done. It is unknown how suctioning affects the mechanics of breathing. This study used a prospective observational clinical design to examine the immediate impact of airway resistance in endotracheal suctioning, tidal volume, and dynamic lung regulation in mechanically ventilated adult patients and mechanically ventilated pediatric patients. The preparation, process, and indications for intraoperative fusion treatment in various circumstances are covered in this systematic review.

The Effect of Training the Nonverbal Pain Scale (NVPS) on the Ability of Nurses to Monitor the Pain of Patients in the Intensive Care Unit.

Pain in the intensive care unit is a silent fact. Considering the positive features of the nonverbal pain scale (NVPS) in assessing the pain of non-verbal patients, this study investigates the effect of training the NVPS on the ability of nurses to monitor the pain of patients in the intensive care unit. In this semi-experimental study, the effect of the NVPS training on the ability of 50 intensive care unit (ICU) nurses of Imam Khomeini Hospital affiliated to Ahvaz University of Medical Sciences was investigated. At first, the ability to diagnose the presence and intensity of pain was checked by a checklist. Then the nurses were taught how to use the scale correctly. After 2 weeks of training completion, the ability to correctly use the scale was measured again. Data analysis was performed using descriptive statistics (mean and standard deviation) and inferential statistics (McNemar, Chi-squared, paired t-test, and Fisher's exact test) in SPSS software version 16. After the training on the non-verbal pain scale, there was a significant difference between the intervention and control groups in diagnosing the presence of pain related to changing the patient's position (p = 0.023). Also, nurses ability to diagnose pain intensity during airway suction increased fourfold and for physiotherapy procedures twice as much as before training. Nonverbal pain scale training improves ICU nurses ability in diagnosing the presence and severity of pain in nonverbal patients. Ghayem H, Heidari MR, Aghaei B, Norouzadeh R. The Effect of Training the Nonverbal Pain Scale (NVPS) on the Ability of Nurses to Monitor the Pain of Patients in the Intensive Care Unit. Indian J Crit Care Med 2023;27(3):195-200.

COMPARISON OF THE EFFECTS OF FENTANYL VERSUS DEXMEDETOMIDINE ON AIRWAY REFLEXES AND HEMODYNAMIC RESPONSE TO TRACHEAL EXTUBATION FOLLOWING GENERAL ANESTHESIA

Laryngospasm, bronchospasm, cough and tachycardia are physiological responses during anesthesia emergence and endotracheal extubation. Tracheal extubation should be performed while patient is deeply anesthetized to reduce airway reexes. Dexmedetomidine and fentanyl both have sedative and analgesic effect. The purpose of this study is to compare the effectiveness of dexmedetomidine or fentanyl on airway reexes and hemodynamic response to tracheal extubation following general anesthesia. 30 pati Method: ents of ASA I and II, aged between 18 to 55 year undergoing general anesthesia on elective basis were randomly divided in two groups.15 patients received 0.5 µg/kg dexmedetomidine while other patient received 1µg/kg fentanyl. Fifteen minutes before expected last surgical suture inhalational agent cut off and equal amount of solution of drug was given. All patients were extubated and all were monitored after extubation. The airway reexes to extubation, level of sedation and hemodynamic response were noticed. For nonparametric data Chi-square test and for para Statistical Analysis: Result: metric data t test was used. Total 30 patients were involved in the study. Dexmedetomidine was associated with increase quality of extubation compared with fentanyl. After extubation in fentanyl group heart rate was higher compared with dexmedetomidine group. In the dexmedetomidine group heart rate was not signicantly increase after extubation. When compared to fentanyl, participants in the dexmedetomidine group demonstrated more drowsiness during airway suctioning and extubation. Fentanyl group post-extubation patients were awake, whereas dexmedetomidine group patients were arousable. The nding of current study show that Single-dosage dexmedetomidine 0.5 μg/kg Conclusion: given 15 min before extubation created better response against airway reaction to laryngoscopy and effective in maintaining hemodynamic stability. This resulted in better tracheal extubation without prolonging recovery in comparison to fentanyl 1 µg/kg iv

Retrospectively Assessed Muscle Tone and Skin Colour following Airway Suctioning in Video-Recorded Infants Receiving Delivery Room Positive Pressure Ventilation.

Recently, the International Liaison Committee on Resuscitation published a systematic review that concluded that routine suctioning of clear amniotic fluid in the delivery room might be associated with lower oxygen saturation (SpO2) and 10 min Apgar score. The aim of this study was to examine the effect of delivery room airway suctioning on the clinical appearance, including muscle tone and skin colour, of video-recorded term and preterm infants born through mainly clear amniotic fluid. This was a single-centre observational study using transcribed video recordings of neonatal stabilizations. All infants who received delivery room positive pressure ventilation (PPV) from August 2014 to November 2016 were included. The primary outcome was the effect of airway suctioning on muscle tone and skin colour (rated 0-2 according to the Apgar score), while the secondary outcome was the fraction of infants for whom airway suction preceded the initiation of PPV as a surrogate for "routine" airway suctioning. Airway suctioning was performed in 159 out of 302 video recordings and stimulated a vigorous cry in 47 (29.6%) infants, resulting in improvements in muscle tone (p = 0.09) and skin colour (p &lt; 0.001). In 43 (27.0%) infants, airway suctioning preceded the initiation of PPV. In this single-centre observational study, airway suctioning stimulated a vigorous cry with resulting improvements in muscle tone and skin colour. Airway suctioning was often performed prior to the initiation of PPV, indicating a practice of routine suctioning and guideline non-compliance.

Effects of Normal Saline Instillation on Haemodynamic Parameters and Oxygen Saturation after Suctioning of Mechanically Ventilated Patient

When patient is critically ill the function of removal of secretions may be compromised leading to excessive pulmonary secretions. Airway suction is one of the most popular methods of clearing airway secretion. This study aimed to assess effects of normal saline instillation on haemodynamic parameters and oxygen saturation before and after suctioning and to find out the association with demographic variable. Pre-experimental (one group pre-test post-test) study design was used; 52 patients were enrolled using convenient sampling from Intensive Care Units. Observation checklist was used to collect needed data on haemodynamic parameters and oxygen saturation before 5 min and after 5, 10 and 15 min of suctioning. As a part of intervention normal saline was instilled during suctioning. Paired t test values with regard to blood pressure (t=11.41), heart rate (t=1.50), systolic blood pressure (t=8.43) and respiratory rate (t=13.64) were found significant (p'lt;0.05) after suctioning with normal saline. Repeated measures of analysis of variance F test suggest that there was significant difference in respiratory rate (F=10.98) and oxygen saturation (F=62.16) among patients was significant at level p'lt;0.05. Chi-square test concluded that level of consciousness was found significant with level of heart rate and age was significant with systolic blood pressure at p-value 'lt;0.05. The study findings revealed that saline instillation should not be used as a routine clinical practice as it increases the heart rate, respiratory rate and systolic blood pressure also there was no change in oxygen saturation.