Emergency Endotracheal Intubation Research Articles

Design and implementation of community consultation for research conducted under exception from informed consent regulations for the PreVent and the PreVent 2 trials: Changes over time and during the COVID-19 pandemic.

Emergency clinical research has played an important role in improving outcomes for acutely ill patients. This is due in part to regulatory measures that allow Exception From Informed Consent (EFIC) trials. The Food and Drug Administration (FDA) requires sponsor-investigators to engage in community consultation and public disclosure activities prior to initiating an Exception From Informed Consent trial. Various approaches to community consultation and public disclosure have been described and adapted to local contexts and Institutional Review Board (IRB) interpretations. The COVID-19 pandemic has precluded the ability to engage local communities through direct, in-person public venues, requiring research teams to find alternative ways to inform communities about emergency research. The PreVent and PreVent 2 studies were two Exception From Informed Consent trials of emergency endotracheal intubation, conducted in one geographic location for the PreVent Study and in two geographic locations for the PreVent 2 Study. During the period of the two studies, there was a substantial shift in the methodological approach spanning across the periods before and after the pandemic from telephone, to in-person, to virtual settings. During the 10 years of implementation of Exception From Informed Consent activities for the two PreVent trials, there was overall favorable public support for the concept of Exception From Informed Consent trials and for the importance of emergency clinical research. Community concerns were few and also did not differ much by method of contact. Attendance was higher with the implementation of virtual technology to reach members of the community, and overall feedback was more positive compared with telephone contacts or in-person events. However, the proportion of survey responses received after completion of the remote, live event was substantially lower, with a greater proportion of respondents having higher education levels. This suggests less active engagement after completion of the synchronous activity and potentially higher selection bias among respondents. Importantly, we found that engagement with local community leaders was a key component to develop appropriate plans to connect with the public. The PreVent experience illustrated operational advantages and disadvantages to community consultation conducted primarily by telephone, in-person events, or online activities. Approaches to enhance community acceptance included partnering with community leaders to optimize the communication strategies and trust building with the involvement of Institutional Review Board representatives during community meetings. Researchers might need to pivot from in-person planning to virtual techniques while maintaining the ability to engage with the public with two-way communication approaches. Due to less active engagement, and potential for selection bias in the responders, further research is needed to address the costs and benefits of virtual community consultation and public disclosure activities compared to in-person events.

Association of glucagon-like peptide receptor 1 agonist therapy with the presence of gastric contents in fasting patients undergoing endoscopy under anesthesia care: a historical cohort study.

We aimed to estimate the association of glucagon-like peptide 1 (GLP-1) receptor agonist therapy with the incidence of endoscopically visible gastric contents after preprocedural fasting. We reviewed the records of esophagogastroduodenoscopy (EGD) performed at our institution between 2019 and 2023 and determined the presence of residual gastric contents from the procedure notes and saved images. We compared patients taking GLP-1 agonists at the time of the procedure (GLP group, 90 procedures) with patients who started GLP-1 agonist therapy within 1,000 days after undergoing EGD (control, 102 procedures). We excluded emergent procedures without fasting, combined EGD/colonoscopy procedures, and patients with known gastroparesis or previous gastric surgery. We estimated the association between GLP-1 agonist therapy and residual gastric contents with a confounder-adjusted generalized linear mixed effect model. Compared with controls, the GLP cohort had a higher age, American Society of Anesthesiologists' Physical Status, and incidence of nausea and diabetes mellitus. Body mass index and fasting duration were comparable between groups. Visible gastric content was documented in 17 procedures in the GLP group (19%) and in five procedures in the control group (5%), with an associated confounder adjusted odds ratio of 5.8 (95% confidence interval, 1.7 to 19.3; P = 0.004). There were five instances of emergent endotracheal intubation in the GLP group vs one case in control and one case of pulmonary aspiration vs none in control. In fasting patients, GLP-1 agonist therapy was associated with an increased incidence of residual gastric contents, potentially posing an additional risk of periprocedural pulmonary aspiration.

Understanding Team Dynamics and Culture of Safety using Video Reflexive Ethnography during Real-Time Emergent Intubation.

Endotracheal intubation is the third most common bedside procedure in U.S. hospitals. In over 40% of intubations preventable complications attributable to human factors occur. A better understanding of team dynamics during intubation may improve patient safety. To explore team dynamics and safety-related actions during emergent endotracheal intubations in the emergency department (ED) and intensive care unit (ICU), and to engage members of the care team in reflection for process improvement through a novel video-based team debriefing technique. Video-reflexive ethnography involves in-situ video-recording and reflexive discussions with practitioners to scrutinize behaviors and to identify opportunities for improvement. In this study, real-time intubations were recorded in the ED and ICU at Mayo Clinic Rochester and facilitated video-reflexive sessions were conducted with the multidisciplinary procedural teams. Themes about team dynamics and safety-related action were identified inductively from transcriptions of recorded sessions. Between December 2022 and January 2023, eight video-reflexive sessions were conducted with a total of 78 participants. Multidisciplinary members included nurses (n=23), respiratory therapists (n=16), pharmacists (n=7), advanced practitioners (n=5), and physicians (n=26). Video-reflexive discussions identified major safety gaps and proposed several solutions related to the use of a multidisciplinary intubation checklist, standardized communication and team positioning, developing a culture of safety, and routinely debriefing after the procedure. The findings of this study may inform the development of a team supervision model for emergent endotracheal intubations. This approach could integrate key components such as a multidisciplinary intubation checklist, standardized communication and team positioning, a culture of safety, and debriefing as part of the procedure itself.

Video laryngoscopy versus direct laryngoscopy in achieving successful emergency endotracheal intubations: a systematic review and meta-analysis of randomized controlled trials

BackgroundIntubating a patient in an emergent setting presents significant challenges compared to planned intubation in an operating room. This study aims to compare video laryngoscopy versus direct laryngoscopy in achieving successful endotracheal intubation on the first attempt in emergency intubations, irrespective of the clinical setting.MethodsWe systematically searched PubMed, Scopus, Web of Science, and the Cochrane Central Register of Controlled Trials from inception until 27 February 2023. We included only randomized controlled trials that included patients who had undergone emergent endotracheal intubation for any indication, regardless of the clinical setting. We used the Cochrane risk-of-bias assessment tool 2 (ROB2) to assess the included studies. We used the mean difference (MD) and risk ratio (RR), with the corresponding 95% confidence interval (CI), to pool the continuous and dichotomous variables, respectively.ResultsFourteen studies were included with a total of 2470 patients. The overall analysis favored video laryngoscopy over direct laryngoscopy in first-attempt success rate (RR = 1.09, 95% CI [1.02, 1.18], P = 0.02), first-attempt intubation time (MD = − 6.92, 95% CI [− 12.86, − 0.99], P = 0.02), intubation difficulty score (MD = − 0.62, 95% CI [− 0.86, − 0.37], P < 0.001), peri-intubation percentage of glottis opening (MD = 24.91, 95% CI [11.18, 38.64], P < 0.001), upper airway injuries (RR = 0.15, 95% CI [0.04, 0.56], P = 0.005), and esophageal intubation (RR = 0.37, 95% CI [0.15, 0.94], P = 0.04). However, no difference between the two groups was found regarding the overall intubation success rate (P > 0.05).ConclusionIn emergency intubations, video laryngoscopy is preferred to direct laryngoscopy in achieving successful intubation on the first attempt and was associated with a lower incidence of complications.

Various injury patterns due to combustion (typical but unfamiliar to physicians and easy to miss) in Korea: a case report

Patients transported from fire sites may exhibit various injury patterns. Major trauma, skin burn, inhalation burn, and carbon monoxide poisoning are typical injuries. However, most physicians may be unfamiliar that cyanide poisoning can frequently occur due to combustion. Cyanide poisoning is highly significant owing to high mortality and the existence of antidotes. I present a 35-year-old man who was transported from a burning building and suffered severe metabolic acidosis despite no major bleeding as well as mild carbon monoxide poisoning. I suspected cyanide poisoning and administered the antidote; subsequently, the patient showed improvement. The next day, sudden airway obstruction developed, and emergency endotracheal intubation was performed. The inhalation damage was detected only in the lower airway tract and not in the upper airway. Physicians should be aware of cyanide poisoning and inhalation burn to avoid missing treatment opportunities.

28 Improving First Pass Success Rate in Emergency Endotracheal Intubation – Quality Improvement Study

28 Improving First Pass Success Rate in Emergency Endotracheal Intubation – Quality Improvement Study

Outcome of Emergency Endotracheal Intubation in Critically Ill Adults in General ward, Critical Care Unit and Triage: A Comparative Study

Background &amp; Aims: Emergency endotracheal intubation is a life-saving procedure in any setting. We compared the outcomes of emergency endotracheal intubation calls for Anesthesiologists in General ward, Critical care unit and Triage in a single medical centre. Settings and Design: Prospective, Cross sectional study. Methods and Material: We evaluated all patients admitted to the Ward, Critical care unit and Triage between October 2021 to November 2022. A total of 186 patients, &gt;18 years of age, who required emergency endotracheal intubation were included in this study. Primary outcome was to estimate the proportion of difficult &amp; failed endotracheal in tubation. Secondary outcome was to assess the incidence of complications, survival and neurological outcome. Results: General ward had the highest proportion of difficult intubations (67.74%), followed by Triage (62.9%), and CCU (61.29%). General ward had 4.83% failed intubation followed by Triage 1.61%. The incidence of hypoxemia (33.87%) and hemodynamic collapse (12.9%) was higher in General ward as compared to CCU (12.9% &amp; 9.68%) and Triage (24.19% &amp;11.2%), (P=0.02 &amp; 0.04 respectively). There was a trend of higher survival rate in CCU (67.74%) as compared to General ward (25.61%) &amp; Triage (51.61%). Among these locations, CCU had the highest rate of neurologically intact (53.23%) survival to hospital discharge as compared to General ward (16.13%) &amp; Triage (30.63%). Conclusions: We concluded that the proportion of difficult and failed intubation, was highest in General ward followed by Triage and CCU. Incidence of complications was least in CCU followed by Triage and General ward.

Surgical Management and Outcomes of Pediatric Congenital Head and Neck Teratomas: A Scoping Review.

To perform a scoping review to characterize postoperative outcomes of pediatric patients (ages 0-18) with a history of congenital head and neck teratomas. PubMed, EMBASE, Web of Science, Cochrane, Clinicaltrails.gov. A search of multiple databases was performed. Studies were included if they detailed the surgical management and outcomes of pediatric patients with a history of congenital head and neck teratomas. One hundred and eight studies totaling 137 patients were identified. The median gestational age at birth was 37 weeks. Respiratory distress, prompting emergent endotracheal intubation or tracheostomy, was present in most patients (58%). The ex utero intrapartum treatment (EXIT) procedure was utilized for 21 (15%) patients. The teratomas were resected after a median duration of 4 days from birth. The most common postsurgical complications were vocal cord paralysis (3%), hemorrhage (2%), and tracheomalacia (2%). Death occurred perioperatively in 2 patients (2%). Twenty-six patients (19%) required additional surgery, and 5 patients (4%) needed adjuvant chemotherapy. Patients were monitored for a median duration of 24 months with a recurrence rate of 6%. Four recurrent cases (50%) had intracranial extension, and 88% of the recurrent cases were mature teratomas at initial histopathological diagnosis. Most patients with congenital head and neck teratomas require emergent airway management perinatally. Excisional and surgical complications are rare, and most patients are cured of their disease with a single operation. Recurrent teratomas tend to have an intracranial extension and are likely to be of mature pathology at the time of initial diagnosis.

Prognostic Analysis of 558 Emergency Tracheal Intubation Patients

Objective: To observe and analyze the prognosis and factors of hospitalized patients with emergency tracheal intubation. Methods: From January 2015 to December 2018, the hospitalized patients undergone emergency endotracheal intubation in Union Hospital Affiliated to Fujian Medical University were retrospectively analyzed. The primary goal was in-hospital mortality 30 days after intubation; the secondary observation indicators were intubation causes, causes of death, intubation operation site (surgical ward or medical ward) and time (daytime or off-hours), ICU admission, etc. The differences of the above indexes and the risk factors of mortality were analyzed. Results: 558 patients with emergency endotracheal intubation were included in the study. The hospital mortality rate was 66.8%, showing a downward trend year by year; the most common causes of intubation were respiratory system diseases, cardiovascular system and nervous system diseases. The proportion of patients receiving emergency intubation in medical ward was significantly higher than that in surgical ward, and the mortality was also significantly higher than that in surgical ward (<I>P</I><0.05); there was no significant difference in the intubation time between the dead patients and the surviving patients (<I>P</I>=0.36). The ICU occupancy rate of patients who died in hospital was significantly lower than that of patients who survived (<I>P</I>=0.00). Of the survival patients, the rate of cardiopulmonary cerebral resuscitation after intubation decreased significantly (<I>P</I>=0.04). In the death patients after intubation, the mean arterial pressure and venous oxygen saturation before intubation were significantly lower than those in the survival patients (<I>P</I>=0.00), and the shock index was significantly higher than that in the survival patients (<I>P</I>=0.00). Conclusion: The prognosis of patients with emergency endotracheal intubation is poor; The in-hospital mortality is as high as 66.8%; Intubation in surgical ward and ICU occupancy after intubation both are the risk factors to reduce the in-hospital mortality.

Pilot Study Examining Bed Angles and Heights During Ramped Position Intubation in the Emergency Department.

Ramped positioning during emergent endotracheal intubation has been associated with fewer peri-intubation complications, including a decrease in difficult intubations, esophageal intubations, pulmonary aspiration, and hypoxemia. However, the optimal bed angle and height for ramped position intubation have not been determined. Our objective was to examine the effect bed angle and height in the ramped position may have on laryngeal views during emergent intubation in the emergency department (ED). We performed a secondary analysis of prospectively collected quality improvement data on intubations from our ED. All adult medical intubations performed with ramped positioning in the ED over a 24-month study period (September 1, 2020, through August 30, 2022) were eligible. We compared laryngeal views using the percentage of glottic opening (POGO) score between ramp angles (≥30° and <30° from horizontal) and bed heights (relative to the intubator, including xiphoid or above, umbilicus or below, and between xiphoid and umbilicus). Of the 251 patients intubated during the study period, 201 were intubated in the supine position and 50 in the ramped position. Data forms were completed for 25 patients intubated using ramped position in the ED during the study period. The median ramp angle was 30° (interquartile range (IQR) 25, 40) with 16 (64%) subjects intubated at ≥30° and 9 (36%) subjects at <30°. The median POGO scores for bed angles ≥30° and <30° were 95% (IQR 79, 100) and 90% (IQR 75, 100), respectively. Bed heights varied, with four (16%) intubated at the xiphoid or above height, one (4%) at the umbilicus or below, and 20 (80%) between the xiphoid and umbilicus. The median POGO scores at each position were 95% (IQR 76, 100), 0% (IQR 0, 0), and 95% (IQR 79, 100), respectively. ED clinicians use a variety of bed angles and heights when intubating in the ramped position. More robust investigations are necessary to determine the optimal bed angle and height for ramped position intubation in the ED.

Emergency endotracheal intubation in critically ill patients with COVID-19: management and clinical characteristics

PurposesSARS-CoV-2 have become widespread worldwide since the outbreak. Respiratory function deteriorates rapidly in critically ill patients infected with SARS-CoV-2. Endotracheal intubation is an indispensable therapeutic measure during the development of the disease. This study was intended to describe the experience of endotracheal intubation from front-line anesthesiologists and clinical prognosis of patients infected with Coronavirus disease-19 (COVID-19).MethodsFourteen critical patients infected with COVID-19 who underwent endotracheal intubation were included in this study. We collate and analyze the blood gas results before and after tracheal intubation of patients and clinical prognostic indicators such as length of stay and. mortality. The experience of anesthesiologists who intubated patients has also been recorded in detail.ResultsPatients had a mean time of 10.6 days from initial symptoms to endotracheal intubation. Most intubated patients had one or more underlying conditions: hypertension (8, 57.14%), diabetes (5, 35.71%), and cardiovascular and cerebrovascular diseases (2, 14.29%). The oxygenation index increased significantly after intubation compared with before intubation (148.80 ± 42.25 vs 284.43 ± 60.17 p < 0.001). 85.72% of patients required extra-corporeal membrane oxygenation (ECMO) due to inability to maintain oxygen saturation with standard therapeutic measures. Two patients underwent lung transplantation because their lungs were essentially nonfunctional, and they recovered well after surgery. As of this writing, all patients were discharged after satisfactory recovery.ConclusionsReasonable selection of intubation timing is particularly important. It is crucial to increase the patient's oxygen supply and reduce oxygen consumption as much as possible during endotracheal intubation. In addition, the personal protective measures of medical personnel participating in treatment should be scientific and standardized.Graphical

No: 4649 Video vs direct laryngoscopy for emergency endotracheal intubation in full personal protective equipment: a randomized, crossover, simulation trial

No: 4649 Video vs direct laryngoscopy for emergency endotracheal intubation in full personal protective equipment: a randomized, crossover, simulation trial

Association Between Shock Index and Post-Emergency Intubation Hypotension in Patients Who Called the Rapid Response Team at Dr. Cipto Mangunkusumo Hospital

Introduction: Hypotension is an acute complication following Emergency Endotracheal Intubation (ETI) in populations who called the Rapid Response Team (RRT). Thus, a fast and simple tool is needed to identify the risk of Post-emergency Intubation Hypotension (PIH). Shock Index (SI) pre-intubation is one of the potential factors to predict PIH. Objective: To measure the association between shock index with post-emergency intubation hypotension after calling for the RRT. Materials and Methods: This research is a cohort retrospective study that analyzed 171 patients aged ≥18 years who have called RRT and underwent an emergency ETI. The cut-off point for SI was determined using the ROC curve to predict PIH. The modification effect was evaluated using stratification analysis. Data were analyzed using cox regression to determine the likelihood of SI in the cause of hypotension. Result: A total of 92 patients (53.8%) underwent post-emergency intubation hypotension. The SI cut-off point of 0.9 had a sensitivity of 82.6% and a specificity of 67.1% for predicting PIH (Area Under Curve (AUC) 0.81; 95% CI 0.754–0.882, p &lt;0.05). The increased risk of PIH associated with high SI score was an aRR of 1.9; 95% CI 1.03–3.57, a p-value of 0.040 among those with sepsis, and an aRR of 7.9, 95% CI 2.36–26.38, a p-value of 0.001 among those without sepsis. Conclusion: This study showed that a high SI score was associated with PIH after being controlled with other PIH risk variables. The risk of PIH associated with SI score modestly increased (2-fold increase) in those with sepsis and significantly increased (8-fold increase) in those without sepsis.

Dexmedetomidine as Conduit for Non-Invasive Ventilation (NIV) Compliance in COVID-19 and Chronic Obstructive Pulmonary Disease (COPD) Patients in Intensive Care Unit (ICU) Setting: Case Series.

Non-compliance to the non-invasive ventilation (NIV) mask in a distressed hypoxemic patient is not an unusual finding, especially in desaturated coronavirus disease(COVID-19)or chronic obstructive pulmonary disease(COPD)patients with respiratory distresswho require ventilatory support to improve oxygenation. Failure to achieve success with the non-invasive ventilatory support with the tight-fitting mask led to emergent endotracheal intubation. This was inview to avert consequences such as severe hypoxemia and subsequent cardiac arrest. Sedation is an important component of ICU management for noninvasive mechanical ventilation to improve NIV compliance/tolerance.Including the various sedatives used, such as fentanyl, propofol, or midazolam, the most suitable agentto be used asa primary/solesedative still remains unclear.Dexmedetomidineprovidinganalgosedationwithout significant respiratory depression facilitates better tolerance of NIV mask application. This case series is a retrospective analysis of patients in whom dexmedetomidine bolus followed by infusion was observed to facilitate compliance to NIV with the tight-fitting mask.Herein, a case summary of six patients with acute respiratory distresswho weredyspnoic, agitated havesevere hypoxemia were put on NIV with dexmedetomidine infusion is being reported. They were extremely uncooperative as their RASS score (Richmond Agitation-Sedation score) was + 1 to +3, not allowing the application of the NIV mask. Due to their poor compliance with to use of the NIV mask,proper ventilation could not be achieved. Dexmedetomidine infusion (0.3 to0.4mcg/kg/hr) was used after a bolus dose (0.2-0.3 mcg/kg).The RASS Score of our patients was +2 or +3 before this intervention which became -1 or -2 after including dexmedetomidine in the treatment protocol.The low dose dexmedetomidine bolus and infusion thereafter showed to improvethepatient'sacceptance of the device. Oxygen therapy with this was shown to improve patient oxygenation by allowing the acceptance of the tight-fitting NIV face mask.In conclusion, this case series serves as evidence of the use of dexmedetomidine as an effectivetherapy to calm the agitated desaturatedpatient, thereby facilitating non-invasive ventilation in COVID-19 and COPD patients and promoting better oxygenation. This may, in turn, avoid endotracheal intubation for invasive ventilation and the associated complications.

Emergency airway management with the gum elastic bougie outside of the operating room: a narrative review

The ongoing coronavirus 2019 (COVID-19) pandemic has increased the need for healthcare professionals to perform emergency endotracheal intubation (ETI) in patients with COVID-19-related respiratory failure outside of the operating room. Difficult airways and severe airway-related adverse events occur much more frequently in such settings due to limited time and resources as well as the patient’s reduced physiological reserve. The gum elastic bougie (GEB) intubation tube is an inexpensive, simple, and readily transportable aid to intubation, but its effectiveness in emergency airway management has not been comprehensively evaluated in recent years. Here, we performed a literature review and have updated the available evidence on the utility of GEB in emergency airway management. After a systematic MEDLINE search, we identified 36 relevant reports that compared GEB with alternative airway management approaches in a variety of real-world and simulated settings. In most studies, GEB increased the first-pass ETI success rate and decreased the force applied on the tongue and incisors during laryngoscopy. GEB also increased the speed, safety, and reliability of emergency cricothyrotomy. Conflicting results were obtained in studies examining GEB use for ETI during cardiopulmonary resuscitation, and other special circumstances such as selective lung ventilation, the presence of vomitus, and the use of personal protective equipment. These results suggest that GEB use could be expanded beyond difficult airways and rescue after failed ETI attempts, but further studies will be necessary to determine the utility of GEB under special conditions. Because fatal airway-related adverse events can in part be attributed to limited accessibility of proper airway management equipment, devices such as GEB may increase successful outcomes, especially under the overwhelmingly challenging conditions imposed by the COVID-19 pandemic.

Mask R-CNN based multiclass segmentation model for endotracheal intubation using video laryngoscope.

Endotracheal intubation (ETI) is critical to secure the airway in emergent situations. Although artificial intelligence algorithms are frequently used to analyze medical images, their application to evaluating intraoral structures based on images captured during emergent ETI remains limited. The aim of this study is to develop an artificial intelligence model for segmenting structures in the oral cavity using video laryngoscope (VL) images. From 54 VL videos, clinicians manually labeled images that include motion blur, foggy vision, blood, mucus, and vomitus. Anatomical structures of interest included the tongue, epiglottis, vocal cord, and corniculate cartilage. EfficientNet-B5 with DeepLabv3+, EffecientNet-B5 with U-Net, and Configured Mask R-Convolution Neural Network (CNN) were used; EffecientNet-B5 was pretrained on ImageNet. Dice similarity coefficient (DSC) was used to measure the segmentation performance of the model. Accuracy, recall, specificity, and F1 score were used to evaluate the model's performance in targeting the structure from the value of the intersection over union between the ground truth and prediction mask. The DSC of tongue, epiglottis, vocal cord, and corniculate cartilage obtained from the EfficientNet-B5 with DeepLabv3+, EfficientNet-B5 with U-Net, and Configured Mask R-CNN model were 0.3351/0.7675/0.766/0.6539, 0.0/0.7581/0.7395/0.6906, and 0.1167/0.7677/0.7207/0.57, respectively. Furthermore, the processing speeds (frames per second) of the three models stood at 3, 24, and 32, respectively. The algorithm developed in this study can assist medical providers performing ETI in emergent situations.

Uncommon anatomical variation of an epiglottis encountered during emergent endotracheal intubation.

Uncommon anatomical variation of an epiglottis encountered during emergent endotracheal intubation.

Tracheostomy decannulation rates in Japan: a retrospective cohort study using a claims database

Despite the exponential increase in the use of tracheostomy worldwide, rates of tracheostomy decannulation are unknown. We conducted a retrospective cohort study to investigate tracheostomy decannulation rates among adult patients over a two-year period and explored factors associated with prolonged tracheostomy. A health insurance claims database including 3,758,210 people in Japan was used. The primary outcome was time to decannulation. Assessed patient and hospital factors included age, sex, emergency endotracheal intubation, disease, and hospital size. A total of 917 patients underwent tracheostomy, and 752 met the eligibility criteria. Decannulation rates were 40.8% (95% confidence interval 36.8–44.9) at 3 months, 63.9% (58.4–69.0) at 12 months, and 65.0% (59.2–70.3) at 24 months. Hazard ratios of patient and hospital factors for tracheostomy decannulation were 0.44 for age (65–74 years) (95% confidence interval 0.28–0.68), 0.81 (0.63–1.05) for female sex, and 0.59 (0.45–0.76) for emergency endotracheal intubation. Cerebrovascular disease, head injuries, and cardiac arrest had lower hazard ratios compared to other diseases. Decannulation rates among adult patients in Japan increased rapidly up to 3 months after tracheostomy, reaching a plateau after 12 months. Older age, female sex, emergency endotracheal intubation, cerebrovascular disease, head injuries, and cardiac arrest were associated with prolonged tracheostomy.

Asma casi fatal como manifestación clínica en paciente diabética debut: Reporte de caso

Near-fatal asthma (NFA) is defined as the most severe form of asthma characterized by a refractory asthma attack with an arterial carbon dioxide tension (PaCO2) greater than 45 mmHg and altered consciousness, requiring mechanical ventilation. We reported the case of 40-year-old female patient, obese and asthmatic with irregular treatment who presented dyspnea accompanied by severe oppressive chest pain and loss of consciousness, with generalized cyanosis and severe shortness of breath, for which she underwent emergency endotracheal intubation and mechanical ventilation. Laboratory tests show decompensated respiratory acidosis, glycemia of 258 mg / dl and HbA1C of 7.94%; her diagnosing diabetes mellitus. Asthmatic patients with type 2 diabetes mellitus who have irregular treatment for both diseases are at increased risk of manifesting near-fatal asthma.

T-CELL LYMPHOMA CAUSING CENTRAL AIRWAY OBSTRUCTION TREATED WITH TRACHEOBRONCHIAL SELF-EXPANDING METALLIC STENT

T-CELL LYMPHOMA CAUSING CENTRAL AIRWAY OBSTRUCTION TREATED WITH TRACHEOBRONCHIAL SELF-EXPANDING METALLIC STENT