Duration Of Intubation Research Articles

Acute kidney injury in hypoplastic left heart syndrome patients following the comprehensive stage two palliation.

An alternative surgical approach for hypoplastic left heart syndrome is the Hybrid pathway, which delays the risk of acute kidney injury outside of the newborn period. We sought to determine the incidence, and associated morbidity, of acute kidney injury after the comprehensive stage 2 and the cumulative incidence after the first two operations in the Hybrid pathway. A single centre, retrospective study was conducted of hypoplastic left heart patients completing the second-stage palliation in the Hybrid pathway from 2009 to 2018. Acute kidney injury was defined utilising Kidney Diseases Improving Global Outcomes criteria. Perioperative and post-operative characteristics were analysed. Sixty-one patients were included in the study cohort. The incidence of acute kidney injury was 63.9%, with 36.1% developing severe injury. Cumulatively after the Hybrid Stage 1 and comprehensive stage 2 procedures, 69% developed acute kidney injury with 36% developing severe injury. The presence of post-operative acute kidney injury was not associated with an increase in 30-day mortality (acute kidney injury 7.7% versus none 9.1%; p = > 0.9). There was a significantly longer median duration of intubation among those with acute kidney injury (acute kidney injury 32 (8, 155) hours vs. no injury 9 (0, 94) hours; p = 0.018). Acute kidney injury after the comprehensive stage two procedure is common and accounts for most of the kidney injury in the first two operations of the Hybrid pathway. No difference in mortality was detected between those with acute kidney injury and those without, although there may be an increase in morbidity.

Cardiovascular responses to laryngoscopy and tracheal intubation with GlideScope or Macintosh laryngoscope in elderly patients undergoing gynecologic surgery: A randomize clinical trial

Introduction: The purpose of this study was to compare the GlideScope and Macintosh laryngoscopes for cardiovascular response to laryngoscopy and endotracheal intubation in elderly patients undergoing gynecological procedures. Methods: In this clinical trial, endotracheal intubation was performed using a GlideScope (study group; n=35) and Macintosh laryngoscope (control group; n=35). Hemodynamic parameters were recorded, before induction of anesthesia (baseline), 30 and 15 seconds after starting the laryngoscopy, and every minute up to 5 minutes after intubation. Intubation time and complications of laryngoscopy and intubation were compared between two study groups. Results: Systolic blood pressure (SBP) in 1 (P=0.002), 2 (P=0.003) and 3 (P=0.003) minutes were significantly lower in the study group than that of the control group. The duration of laryngoscopy and intubation was not statistically different between two study groups. The frequency of hypertension after endotracheal intubation in the study group (20%) was significantly lower than that of patients in the control group (45.7%) (P=0.02). There was no significant difference in terms of postoperative complications related to laryngoscopy and intubation (hoarseness and sore throat) between two study groups (P>0.05). Conclusion: This study showed that the use of GlideScope better attenuated cardiovascular responses to laryngoscopy and intubation compared to Macintosh laryngoscope in elderly patients undergoing gynecologic surgery. Also, the frequency of hypertension following laryngoscopy and endotracheal intubation was lower with GlideScope compared to Macintosh laryngoscope. Durations of laryngoscopy, intubation and postoperative complications related to airway management (hoarseness and sore throat) were similar.

Dysphagia After Prolonged Intubation in SARS-CoV-19 Patients: A Single Institution Retrospective Review.

To determine the impact of various factors on swallowing in SARS-CoV-19 patients after prolonged intubation. Methods: A retrospective chart review of SARS-CoV-19 patients intubated between February 2020 and March 2021 was performed.Independent variables, including duration and factors of intubation, and patient demographic characteristics were analyzed.Formal swallow studies were performed for patients who failed a screening swallow evaluation. Results: Seventy-three individuals of 308 patients reviewed had a dysphagia score of ≤5. A total of 49% of patients' dysphagia resolved prior to discharge, with a median of eight days between extubation and the last evaluation. The median duration of intubation was 11 days. Increasing age, congestive heart failure, cerebrovascular disease, and hypertension were associated with dysphagia at the first and/or last evaluation. Hispanic ethnicity was associated with a decreased risk of dysphagia (all p<0.05). Conclusions: Although various patient factors including age and congestive heart failure were associated with the development of dysphagia after prolonged intubation, the length of intubation was not.

Assessment of early paediatric airway sequelae after using cuffed or uncuffed endotracheal tubes with ultrasound and flexible endoscopy

ABSTRACT Background Cuffed tracheal tubes (CTT) emerge to prevent air leakage despite that most anaesthesiologists prefer the uncuffed tracheal tubes (UTT) in the paediatrics. Using recent tools for evaluation of endotracheal intubation sequelae may help to prevent airway injury and determine the appropriate type and size of endotracheal tube (ETT). Purpose The study aimed to detect the early airway changes after using CTT or UTT in paediatrics. Also, to find out the correlation between the endoscopic and ultrasonographic findings in detection of post intubation sequelae in paediatrics. Methods A prospective, randomized study was performed over 80 children aged from two to five years, scheduled for abdominal surgeries under the effect of general anaesthesia. Patients were assigned into two equal groups: Group C: CTT and Group U: UTT. Results There was less statistically significant ETT exchange in the group C (p = 0.020). No significant difference could be found as regard to the change in the subglottic diameter, the incidence of stridor, laryngospasm and croup, and the occurrence of airway injuries. There was a positive correlation between the change in the subglottic diameter and the prevalence of airway injuries (P = 0.014). The duration of the endotracheal intubation could not influence the incidence of neither the stridor nor the airway injuries in both groups. Conclusion There were no difference between the use of CTT or UTT in the paediatrics in terms of early airway changes. However, the rate of tube exchange is significantly lower when using CTT. A positive correlation is found between the endoscopic and ultrasound findings in the detection of post intubation sequelae in paediatrics. Short-term endotracheal intubation neither affects the incidence nor the severity of airway injuries. Using the external diameter of the endotracheal tube instead of the inner diameter is crucial for proper sizing in paediatrics.

Anaesthesiologic and intensive care particularities in cervical surgery

Abstract BACKGROUND. Endotracheal intubation is frequently used to maintain airways proper functioning during elective surgical operations, in intensive care and in emergency rooms. The pathology of the oropharyngeal and laryngeal area or that of the cervical area induces, in most cases, changes in the airways, especially in the sense of their narrowing or deviation. The presence of tumors on the oro-pharyngo-laryngeal axis, some bleeding easily spontaneously or upon touch, can make the anaesthetic procedure difficult. MATERIAL AND METHODS. We conducted a prospective, observational study on 50 patients with cervical pathology who required general anaesthesia during 2019-2021. The criteria and parameters analysed for predicting difficult intubation were the duration of orotracheal or nasotracheal intubation, difficult face mask ventilation, Cormack-Lehane and Mallampati scores, anthropometric determinations of various cervical landmarks, including the thyromental distance, the distance between the arytenoid cartilages and the distance from the plane of the arytenoid cartilages to the skin, both of the latter determined ultrasonographically. RESULTS. The following statistically significant differences emerge from the study: the duration of orotracheal intubation (p&lt;0.001), the difficulty of face mask ventilation (p&lt;0.001), the intercondylar distance (p=0.042), the intermastoid distance (p=0.023), the Cormack-Lehane score (p=0.013), the Mallampati score (p=0.004), the distance between the arytenoid cartilages (p=0.007), the distance between the plane of the arytenoid cartilages and the skin (p&lt;0.001). All were increased in patients with tumoral pathology. CONCLUSION. The study demonstrates the variation of new criteria and parameters that can be analysed for the prediction of a difficult airway, identifies the efficiency of using ultrasound whenever possible in the preanesthetic evaluation of the airway, and quantifies the risk of difficulty in airway management based on anthropometric data, particularly through the occurrence of asymmetry at the cervical or facial level.

Implications of COVID-19 in Airway and Swallowing Function.

The acute treatment and complications of the novel COVID-19 virus have been well studied, but the implications of this novel virus for swallowing function continue to be investigated. The goal of this study is to retrospectively assess airway and swallowing outcomes for those patients who requiredintensive care unit(ICU)-level care for COVID-19 infection. Comparison of swallowing outcomes through diet change in COVID-19 patients in the Ochsner-Louisiana State University (LSU) Hospital ICU. Ochsner-LSU Hospital (Shreveport, Louisiana). A retrospective chart review was performed from March 2020 to May 2022 to identify patients with a primary diagnosis of COVID-19. Variables analyzed include age, gender, length of intubation, length of ventilation, airway interventions, use of extracorporeal membrane oxygenation, and diet prior to, during, and after hospitalization for COVID-19 infection. Two hundred and seven patients fit the inclusion criteria. There was a significant difference in discharge diet between those patients who were intubated and those who were not (P = .007). Thirty percent of patients were discharged on a different diet than their baseline with patients on a nonregular diet significantly more likely to discharge to a facility (P = .043). Negative vaccine status was associated with prolonged ICU stay, prolonged duration of intubation, and prolonged duration of ventilation. COVID-19 continues to present novel challenges with new implications and outcomes being discovered in the third year of the pandemic. Further research is necessary to determine the most effective treatment approaches with respect to optimized speech and swallow outcomes.

The effect of prolonged intubation on ventilator associated pneumonia: endotracheal tube cuff is really steril or not?

Aims: Endotracheal tube (ETT) design, size, cuff material, cuff pressure, and intubation duration are critical in preventing nosocomial pneumonia. We aimed to evaluate the possible infection focus potential of ETT cuff and pilot balloon, particularly in prolonged intubated patients. Methods: A total number of 66 patients who underwent orotracheal intubation and received conventional mechanical ventilation more than 48 hours in the intensive care unit (ICU), were included in this prospective cohort study. Results:The mean duration of intubation was 10.36±4.82 days. Bacteriologically confirmed positive tracheal aspirate culture was 18.2% (n=12). The most frequent positive culture was detected inside of ETT lumen with a percentage of 83.3% (n=55) and followed by cuff (27.3%, n=18), pilot balloon (13.6%, n=9), respectively. It was documented that rates of lung infections were significantly increased after 14 days (p = 0.017) and rates of cuff positive cultures were significantly increased after 10 and 14 days of incubation (p= 0.001, p=0.004). The same type of bacteriological strains was identified from both pilot balloon (n=9) and ETT cuff (n=9), simultaneously. In the remaining 9-cuff positive patients pilot balloons were sterile and ETT lumens were positive culture with the same strains as identified from the cuff. There was a statistically significant positive correlation between the intubation duration and the number of infected ETT parts (p&lt;0.001). Conclusion: ETT cuff was demonstrated to be a potential infection focus in the present study. In addition, it was observed that ETT cuff colonization increased in proportion to the intubation duration. We suggest changing ETT at appropriate time intervals in order to reduce ventilator-associated pneumonia in intubated patients.

Dysphagia Prevalence and Outcomes Associated with the Evolution of COVID-19 and Its Variants in Critically Ill Patients

Data collected during the 2020–21 COVID-19 alpha wave indicated dysphagia prevalence rates up to 93%. Whilst many patients recovered during hospital admission, some experienced persistent dysphagia with protracted recovery. To explore (1) prevalence, (2) treatment, and (3) recovery patterns and outcomes for swallowing, in the ICU patient with Delta and subsequent variants of COVID-19. Prospective observational study. Patients admitted to 26 Intensive Care Units (ICUs) over 12 months, diagnosed with COVID-19, treated for survival and seen by Speech–Language Pathology (SLP) for clinical swallowing assessment were included. Demographic, medical, SLP treatment, and swallowing outcome data were collected. 235 participants (63% male, median age = 58 years) were recruited. Median mechanical ventilation was 16 days, and ICU and hospital length of stay (LOS) were 20 and 42 days, respectively. ICU-Acquired Weakness (54%) and delirium (49%) were frequently observed. Prevalence of dysphagia was 94% with the majority (45%) exhibiting profound dysphagia (Functional Oral Intake Scale = 1) at initial assessment. Median duration to initiate oral feeding was 19 days (IQR = 11-44 days) from ICU admission, and 24% received dysphagia rehabilitation. Dysphagia recovery by hospital discharge was observed in 71% (median duration = 30 days [IQR = 17-56 days]). Positive linear associations were identified between duration of intubation, mechanical ventilation, hospital and ICU LOS, and duration to SLP assessment (p = 0.000), dysphagia severity (p = 0.000), commencing oral intake (p = 0.000), dysphagia recovery (p < 0.01), and enteral feeding (p = 0.000). Whilst older participants had more severe dysphagia (p = 0.028), younger participants took longer to commence oral feeding (p = 0.047). Dysphagia remains highly prevalent in ICU COVID-19 patients. Whilst invasive ventilation duration is associated with swallowing outcomes, more evidence on dysphagia pathophysiology is required to guide rehabilitation.

Non-channeled Video Laryngoscopy as an Alternative to Conventional Laryngoscopy for Intubating Adult Patients in the Intensive Care Unit.

Background Endotracheal intubation in the intensive care unit (ICU) is often a risky procedure due to the emergency situation, unstable condition of the patient, and technical problems such as inadequate positioning. Several new techniques, such as video laryngoscopy, have been developed recently to improve the success rate of first-pass intubations and reduce complications. We conducted this study to compare a non-channeled reusable video laryngoscope BPL VL-02 (manufactured by BPL Medical Technologies, Bangalore, India) with a conventional laryngoscope for intubation of adult patients in the ICU. Methodology A total of 72 ICU patients were randomly allocated to be intubated with either conventional direct laryngoscopy via Macintosh blade (group A) or video laryngoscopy with BPL VL-02 (group B). All patients were intubated by the primary investigator and the assistant noted the following parameters: the total number of intubation attempts, total duration of intubation, assistance or alternative technique required, Cormack Lehane grading, and any complications. Results There was no significant difference in the Cormack Lehane grading, number of attempts, or complications between the two groups. On comparing the assistance required during intubation in patients, it was observed that four (11.11%) patients in group A and seven (19.44%) patients in group B needed backward, upward, and rightward pressure on the larynx assistance during intubation. In five (13.89%) patients in group B, Stylet was required during intubation. The difference was statisticallysignificant (p = 0.0308). The video laryngoscopy group (group B) had a longer mean duration of intubation (64.36 ± 6.28 seconds) compared to group A (45.72 ± 11.45 seconds), and the difference was statistically significant (p < 0.0001). Conclusions Non-channeled video laryngoscope (BPL VL-02) is not a suitable alternative to conventional direct laryngoscopy with a Macintosh blade in terms of successful first-pass intubation, total duration of intubation, and assistance required.

Inhalation phage therapy as a new approach to preventing secondary bacterial pneumonia in patients with moderate to severe COVID-19: A double-blind clinical trial study.

Inhalation phage therapy is proposed as a replacement approach for antibiotics in the treatment of pulmonary bacterial infections. This study investigates phage therapy on bacterial pneumonia in patients with moderate to severe COVID-19 via the inhalation route. In this double-blind clinical trial, 60 patients with positive COVID-19 hospitalized in three central Mazandaran hospitals were chosen and randomly divided into two intervention and control groups. Standard country protocol drugs plus 10mL of phage suspension every 12h with a mesh nebulizer was prescribed for 7 days in the intervention group. The two groups were compared in terms of O2Sat, survival rate, severe secondary pulmonary bacterial infection and duration of hospitalization. Comparing the results between the intervention and control group, in terms of the trend of O2Sat change, negative sputum culture, no fever, no dyspnea, duration of hospitalization, duration of intubation and under ventilation, showed that the difference between these two groups was statistically different (P value<0.05). In conclusion, inhalation phage therapy may have a potential effect on secondary infection and in the outcome of COVID-19 patients. However, more clinical trials with control confounding factors are needed to further support this concept.

SP27. Mandibular Distraction in Patients with Pierre Robin Sequence: A Multi-surgeon Experience

PURPOSE: Mandibular distraction osteogenesis (MDO) is rapidly becoming a standard of care for management of patients with severe Pierre Robin Sequence. The tongue is brought forward to alleviate the airway obstruction. This study will look at an institutional, multi-surgeon experience with MDO over ten years. METHODS: This study was conducted as a retrospective chart review including all patients who underwent MDO at the authors’ institution from 2012 to 2022. Demographics, preoperative and postoperative respiratory and feeding status, and distraction data were collected. Primary outcomes were achievement of full oral feeds, avoidance of a gastrostomy tube (GT), avoidance of a tracheostomy, discharge from hospital on room air and complications. A significance value of 0.05 was utilized. RESULTS: Twenty-eight patients met inclusion criteria. Three craniofacial surgeons performed all interventions. The average age at MDO was 135 days, mean activation phase was 13.6 days, mean distraction length was 14.9 mm and mean consolidation phase was 64.2 days. MDO showed a significant improvement in apnea-hypopnea index (AHI) (p < 0.001) and %O2 Nadir (p < 0.001) on postoperative polysomnography. Syndromic patients were associated with discharge with a GT and negatively associated with avoidance of tracheostomy. Patients with preoperatively diagnosed tracheomalacia and subglottic stenosis were negatively associated with avoidance of a tracheostomy. Preoperative diagnosis of gastroesophageal reflux disease (GERD) was negatively associated with extubation immediately to room air (RA) following index procedure. A shorter duration of intubation following index procedure was associated with discharge on RA and a longer duration of intubation was associated with unilateral pan-facial nerve palsy. A longer activation phase was associated with discharge with a GT and a shorter activation phase was associated with discharge on full oral feeds. The ability to discharge on RA was associated with a shorter latency phase, shorter activation phase, and decreased distance of distraction. Repeat MDO was associated with postoperative infection requiring operative management. CONCLUSIONS: The goal of MDO is to achieve full oral feeds with no respiratory support. Several interesting findings are described in this study. When assessing patients preoperatively it is important to note the higher rate of failure to avoid a tracheostomy in patients with a syndrome and those with tracheomalacia and subglottic stenosis noted on airway evaluation. Syndromic patients were also noted to be more likely to be discharged with a GT. Several different latency periods were used in this study, and it appears that not only is a short latency period safe, but that it may be correlated with successful discharge on RA. This should be tempered with the finding that a decreased time spent intubated following surgery, decreased distance distracted and time spent in activation was also associated with discharge on RA, which may be a function of the severity of micrognathia in these patients. Of note, patients that spent a longer period intubated following surgery experienced a higher rate of facial nerve palsy. The reason for this correlation is unclear but may represent more severe cases that resulted in more forced retraction during surgery.

Impact of COVID-19-adapted guidelines using different airway management strategies on resuscitation quality in out-of-hospital-cardiac-arrest – a randomised manikin study

BackgroundAlthough airway management for paramedics has moved away from endotracheal intubation towards extraglottic airway devices in recent years, in the context of COVID-19, endotracheal intubation has seen a revival. Endotracheal intubation has been recommended again under the assumption that it provides better protection against aerosol liberation and infection risk for care providers than extraglottic airway devices accepting an increase in no-flow time and possibly worsen patient outcomes.MethodsIn this manikin study paramedics performed advanced cardiac life support with non-shockable (Non-VF) and shockable rhythms (VF) in four settings: ERC guidelines 2021 (control), COVID-19-guidelines using videolaryngoscopic intubation (COVID-19-intubation), laryngeal mask (COVID-19-Laryngeal-Mask) or a modified laryngeal mask modified with a shower cap (COVID-19-showercap) to reduce aerosol liberation simulated by a fog machine. Primary endpoint was no-flow-time, secondary endpoints included data on airway management as well as the participants‘ subjective assessment of aerosol release using a Likert-scale (0 = no release–10 = maximum release) were collected and statistically compared. Continuous Data was presented as mean ± standard deviation. Interval-scaled Data were presented as median and Q1 and Q3.ResultsA total of 120 resuscitation scenarios were completed. Compared to control (Non-VF:11 ± 3 s, VF:12 ± 3 s) application of COVID-19-adapted guidelines lead to prolonged no-flow times in all groups (COVID-19-Intubation: Non-VF:17 ± 11 s, VF:19 ± 5 s;p ≤ 0.001; COVID-19-laryngeal-mask: VF:15 ± 5 s,p ≤ 0.01; COVID-19-showercap: VF:15 ± 3 s,p ≤ 0.01). Compared to COVID-19-Intubation, the use of the laryngeal mask and its modification with a showercap both led to a reduction of no-flow-time(COVID-19-laryngeal-mask: Non-VF:p = 0.002;VF:p ≤ 0.001; COVID-19-Showercap: Non-VF:p ≤ 0.001;VF:p = 0.002) due to a reduced duration of intubation (COVID-19-Intubation: Non-VF:40 ± 19 s;VF:33 ± 17 s; both p ≤ 0.01 vs. control, COVID-19-Laryngeal-Mask (Non-VF:15 ± 7 s;VF:13 ± 5 s;p > 0.05) and COVID-19-Shower-cap (Non-VF:15 ± 5 s;VF:17 ± 5 s;p > 0.05). The participants rated aerosol liberation lowest in COVID-19-intubation (median:0;Q1:0,Q3:2;p < 0.001vs.COVID-19-laryngeal-mask and COVID-19-showercap) compared to COVID-19-shower-cap (median:3;Q1:1,Q3:3 p < 0.001vs.COVID-19-laryngeal-mask) or COVID-19-laryngeal-mask (median:9;Q1:6,Q3:8).ConclusionsCOVID-19-adapted guidelines using videolaryngoscopic intubation lead to a prolongation of no-flow time. The use of a modified laryngeal mask with a shower cap seems to be a suitable compromise combining minimal impact on no-flowtime and reduced aerosol exposure for the involved providers.

Nasolacrimal intubation in transcanalicular endoscopic dacryoplasty: a long-term follow-up study

Nowadays, transcanalicular endoscopic dacryoplasty represents the majority of lacrimal duct surgery procedures performed in adults in specialised centers. However, there are still hardly any data available regarding the intra- and postoperative care, particularly regarding the duration of silicone tube intubation (STI). Our aim was to evaluate the relation between tube duration and recurrence of symptoms in patients who underwent transcanalicular microdrill dacryoplasty (MDP) in a long-term setting. Medical records of 576 adult patients after MDP were retrospectively reviewed. A total of 256 eyes of 191 patients could be included. The median follow-up time was 7.83 [7.08; 9.25] years. In 57.0% of the cases there was still full resolution of symptoms at the time of the survey. The median duration of the STI was 6 [3.00; 6:00] months. When distinguishing between a tube duration < 3 months and ≥ 3 months there was a significant difference in the long-term success rate (< 3 months: 38%; ≥ 3 months: 61%; p = 0.011). In conclusion, an early removal of the STI (< 3 months) after transcanalicular MDP seems to be associated with a higher incidence of recurrence of symptoms. This should be considered in the intra- and postoperative care of patients following this minimally invasive first-step procedure.

Mitral Valve Replacement in Infants and Children: Experience Using a 15-mm Mechanical Valve

BackgroundReports using a 15-mm mechanical valve for mitral valve replacement (MMVR) in children are limited. We review our center's operative and postoperative experience with this valve. MethodsWe performed a single-center retrospective chart review identifying patients having undergone MMVRs between 2009 and 2022. We analyzed short- and long-term outcomes using descriptive statistics. ResultsFifteen patients underwent 16 MMVRs with no operative deaths. The median age and weight at the time of operation was 6.2 months (interquartile range [IQR] 4.4-13.7), and 5.16 kg (IQR 4.5-6.9), respectively. Ten implants (66%) were placed in the supraannular position. Median postoperative duration of intubation was 1.5 days (IQR 1.0-3.75), cardiac intensive care unit length of stay was 6 days (IQR 3-13.5), and overall hospital length of stay was 17.0 days (IQR 12-48.5). Three patients (20%) experienced major adverse events postoperatively. Four of 13 patients discharged home (31%) required readmission within 30 days for subtherapeutic/supratherapeutic international normalized ratio values. There were no surgical mortalities and 4 late mortalities (27%). Six patients underwent subsequent MMVR at a median time to second MMVR of 6.8 (IQR 3.6-8.9) years. There are 6 patients with the original 15-mm MVR at a median time of 4.7 years since placement. ConclusionsWe present the largest single-center cohort of patients having undergone 15-mm MMVR. Our experience is distinguished by a lower rate of major adverse events than previously reported, durability of the device, and a rapid postoperative recovery time. Appropriate and consistent anticoagulation is a notable challenge in this age group.

Clinical Characteristics and Outcomes of Vaccinated VS Non-Vaccinated Critically Ill COVID-19 Patients: Retrospective Observation Study.

We aim to identify the clinical characteristics and outcome of vaccine breakthrough infection in critically ill COVID-19 patients and to compare the clinical course of disease between vaccinated and non-vaccinated patients. A retrospective review of all adult patients aged ≥18 years admitted to the ICU in King Fahd Hospital of the University in Saudi Arabia with positive COVID-19 RT-PCR test between the period of January 1st to August 31st, 2021, were included. The recruited patients were grouped in to "vaccinated and non-vaccinated group" based on their immunization status. The demographic data, co-morbidities, modality of oxygen support, ICU length of stay (ICU LOS) and mortality were collected and analyzed. A total of 167 patients were included. Seventy-two patients (43%) were vaccinated. Cardiovascular diseases were higher among the vaccinated group (33.3% vs 12.6%, p value <0.001). Requirements of Non-invasive ventilation was significantly lower in vaccinated group compared to non-vaccinated group (73.6% vs 91.6%, p value <0.011). The rates of intubation were similar between both groups. The total intubation days was longer in non-vaccinated patients compared to vaccinated patients and the median duration of intubation was 8 days vs 2 days, respectively (p value 0.027). In subgroup analysis, the P/F ratio was significantly higher in patients who received two doses of vaccine compared to single dose (p value <0.002). In critically ill COVID-19 patients, the vaccinated group has significantly less need for Non-invasive ventilation, fewer intubation days and less hypoxia compared to non-vaccinated patients. We recommend more policies and public education nationwide and worldwide to encourage vaccination and raise awareness of the general population.

Defining Successful Intubation on the First Attempt Using Both Laryngoscope and Endotracheal Tube Insertions: A Secondary Analysis of Clinical Trial Data

Successful intubation on the first attempt has historically been defined as successful placement of an endotracheal tube (ETT) using a single laryngoscope insertion. More recent studies have defined successful placement of an ETT using a single laryngoscope insertion followed by a single ETT insertion. We sought to estimate the prevalence of first-attempt success using these 2 definitions and estimate their associations with the duration of intubation and serious complications. We performed a secondary analysis of data from 2 multicenter randomized trials of critically ill adults being intubated in the emergency department or ICU. We calculated the percent difference in successful intubations on the first attempt, median difference in the duration of intubation, and percent difference in the development of serious complications by definition. The study population included 1,863 patients. Successful intubation on the first attempt decreased by 4.9% (95% confidence interval 2.5% to 7.3%) when defined as 1 laryngoscope insertion followed by 1 ETT insertion (81.2%) compared with when defined as only 1 laryngoscope insertion (86.0%). When successful intubation with 1 laryngoscope and 1 ETT insertion was compared with 1 laryngoscope and multiple ETT insertions, the median duration of intubation decreased by 35.0 seconds (95% confidence interval 8.9 to 61.1 seconds). Defining successful intubation on the first attempt as placement of an ETT in the trachea using 1 laryngoscope and 1 ETT insertion identifies attempts with the shortest apneic time.

Comparison of the Intubation Success Rate in Video Laryngoscopy versus Direct Laryngoscopy in Patients with Philadelphia Collar: A Randomized Clinical Trial

Background: Video laryngoscopy (VL) and direct laryngoscopy (DL) are two approaches to provide secure airway for patients with compromised airways. This study aims to compare the intubation success rate in video laryngoscopy versus direct laryngoscopy in patients with Philadelphia collars.&#x0D; Methods: 172 patients with cervical collars who have undergone general anesthesia were enrolled. After induction of anesthesia for all patients, an oral airway was used to facilitate the ventilation. A VL approach in Group A and DL approach in Group B were used. In order to evaluate the effectiveness of each method, we considered related parameters, including intubation time, the number of intubation attempts, Cormack-Lehane (CL) score, orodental injuries, heart rate, and blood pressure 3 minutes after intubation, oxygen saturation, neck circumference, and BMI.&#x0D; Results: The ratio of first-attempt intubations was not different among the two groups (P = 1.00). The mean [SD] time for intubation was shorter with DL vs VL (p&lt;0.0001). There were almost equal rates of CL grades 1 and 2 (67.5% and 29%) using the VL than with the. The mean [SD] mean arterial pressure in VL vs DL was 86.17 mmHg vs 90.88 mmHg (p = 0.086).&#x0D; Conclusion: According to our results, there was no significant difference in complications and hemodynamic changes after intubation in both groups, but the intubation duration was significant shorter in DL group.

Evaluation of Ambu-Aura-i laryngeal mask as a conduit for endotracheal intubation. A comparison with Air-Q intubating laryngeal airway in adult surgical patients

ABSTRACT Background Supraglottic airway devices (SGA) are used as primary devices or conduits for endotracheal intubation with normal or difficult airway. The purpose of this study was to assess how the Ambu-Aura-i laryngeal mask would act as a conduit for endotracheal intubation compared to the Air-Q Intubating Laryngeal airway in adult patients in operating room. Methods Fifty-four adult patients scheduled for elective procedures under general anaesthesia were divided into air-Q and Aura-i groups. The ease and time of insertion, the number of insertion attempts, the airway leak pressure, the duration of fiberoptic endotracheal intubation, the grade of the fibre-optic laryngoscopic view, and the time to remove the device were noted. Results Comparing the Aura-i group to the Air-Q group, the Aura-i group had a considerably shorter insertion time and a longer time to remove the device (28.1 ± 3.5 vs 32.7 ± 6.9 sec P-value = 00.4 and 40.7 ± 5.1 vs 32.0 ± 5.4 sec, P-value = 0.001; respectively). Both devices were comparable regarding the number of insertion attempts and the time to insert an endotracheal tube. Compared to the Air-Q group, the Aura-i group’s airway leak pressure was considerably greater (25.9 ± 3.9 vs 23.4 ± 4 CmH2O, respectively, P-value = 0.03). Both groups had comparable fibre-optic laryngoscopic view grades. Conclusion The Ambu-Aura-i laryngeal mask and the Air-Q intubating laryngeal airway are efficient conduits for fibre-optic endotracheal intubation in adults with Ambu-Aura-i Laryngeal mask exhibiting advantages in terms of device insertion time and use during mechanical ventilation.

Erratum: Endotracheal Intubation Using a Flexible Intubation Endoscope As a Standardized Model for Safe Airway Management in Swine.

Erratum: Endotracheal Intubation Using a Flexible Intubation Endoscope As a Standardized Model for Safe Airway Management in Swine.

Evaluation of Anaesthetic Indices and Physiological Variables Following Total Intravenous Anaesthesia with Acepromazine-Butorphanol-Propofol Combination in Dogs

The study determined the anaesthetic and physiological effects of Acepromazine-Butorphanol-Propofol (ABP-combination) and propofol alone (PRO alone) in dogs. Ten clinically healthy dogs were randomly assigned to two groups to evaluate the anaesthetic and physiological effects following ABP-combination and PRO-alone anaesthesia administered intravenously (iv). Acepromazine at 0.02mg/kg and Butorphanol at 0.05mg/kg iv were used to premedicate the dogs and Propofol at 4mg/kg for induction five minutes after premedication in ABP-combination group while Propofol alone at 6mg/kg for total intravenous anaesthesia (TIVA) induction without premedication. Onset of anaesthesia, duration of anaesthesia time to standing, onset and duration of analgesia and duration of intubation were measured, whereas temperature, heart rate and respiratory rates were measured before induction of anaesthesia and at five minutes interval during anaesthesia. All the anaesthetic indices were significantly (p&lt;0.05) different between groups while onset and duration of analgesia was recorded in ABP group only. Significantly (p&lt;0.05) longer duration of anaesthesia was produced by ABP-combination compared with PRO-alone. Time to standing were significantly different (p&lt;0.05) between the two treatments. The onset and duration of analgesia was 5.0±2.0 and 33.6±3.2 min. following ABP-combination but no analgesia recorded with PRO-alone. There was significant decrease (p&lt;0.05) in rectal temperature and respiratory rate from the baseline in ABP-combination group but not significant in PRO-alone group. There was significant (p&lt;0.05) difference in heart rates between groups. ABP-combination TIVA provided longer duration of anaesthesia and analgesia with minimal effects on vital parameters. The dogs recovered from the anaesthesia uneventfully. The ABP-combination can be evaluated for clinical procedures in dog.