Endotracheal Intubation Time Research Articles

Comparison of two different positions of an anaesthesiologist for ease of endotracheal intubation in adult patients: A randomised control trial

Background and aimsMaintaining the airway with a cuffed endotracheal tube (ETT) in the trachea remains one of the most essential anaesthesia skills. Many parameters were described to assess the difficulty of intubation in the preoperative period, but none allow the prediction of all difficult intubations. The correct posture of the anaesthesiologist is also an important factor for successful endotracheal intubation. The aim of this study was. This study aimed to compare the impact of two different positions of an anaesthesiologist (sitting vs. standing) at the time of endotracheal intubation. MethodsOne hundred ten American Society of Anaesthesiologists (ASA) Physical Status I/II patients, aged between 17 to 65 years, Mallampati grade I/II, mouth opening 39–70 mm, thyromental distance (TMD) 6–6.5 cm, and sternomental distance (SMD) >13 cm, scheduled for elective laparoscopic cholecystectomy, were recruited. Patients were divided into two groups; Group I consisted of patients who underwent endotracheal intubation by an anaesthesiologist in a sitting posture, while Group II encompassed patients who underwent endotracheal intubation by anaesthesiologists in a standing posture. Assessment parameters include ease of intubation (IDS score), intubation time, intubation success rate, number of attempts, grade of laryngoscopy (Cormack Lehane score, POGO score), and complications like tooth and soft tissue damage. ResultsThe ease of intubation was higher in group I, 1(0–1), than in group II, 1(1−2) (p = 0.02), and there was a significant difference between the two groups. The Cormack Lehane grade (CL) was I/IIa/IIb/III in 19/23/13/0 in group I and I/IIa/IIb/III in 13/21/18/3 in group II. The first-attempt intubation success rate for groups I and II was 94.54 % and 92.72 % respectively. ConclusionThe sitting posture of an anaesthesiologist at the time of laryngoscopy provides a better intubating condition when compared with the standing posture. RegistrationClinical Trial Registry - India (CTRI) CTRI/2023/03/050371.

Evaluation of IntuBrite® laryngoscope for endotracheal intubation performed by paramedics in out-of-hospital cardiac arrest with particular insight on patients with obesity – A randomised control study

BackgroundAirway management next to the high-quality chest compressions and early defibrillation is one of the most important procedures performed by paramedics during cardiopulmonary resuscitation (CPR) in out-of-hospital cardiac arrest (OHCA). The aim of the presented study was to assess the time and effectiveness of endotracheal intubation performed by a paramedics during OHCA with the use of a classic Macintosh laryngoscope (MCL) and an IntuBrite laryngoscope (IBL). MethodsA total of 60 adult patients were qualified for the study. The tested laryngoscopes were evaluated in terms of the effectiveness and time of procedure, the degree of difficulty of intubation attempts and individual patient factors, with particular emphasis on obesity, which may negatively affect the intubation performance in pre-hospital care. ResultsThe overall number of successful intubations with the IBL was 30 (100 %), and with a MCL 20 (66,67 %). Efficiency of first intubation attempt (FIA) using, the IBL was 86,67 % (n = 26/30) while for the MCL it was 66,67 % (n = 20/30). During second attempt, 100 % of patients were intubated with the IBL and none with the MCL. The median time to first intubation (IT) was 18,12 s for the IBL and 19,86 s for the MCL. Non-obese patients were more effectively intubated than those with obesity (94,4 % vs 66,67 %, p = 0.01). ConclusionsFIA success of patients with OHCA using the IBL was significantly higher than the MCL (p = 0.0008), for both in the first and in the total number of intubation attempts. There were no statistically significant differences in the time of intubation between individual laryngoscopes. Non-obese patients were significantly more effectively intubated during CPR than obese patients (p = 0.01).

Comparing Alba 3D printed video laryngoscope vs. video laryngoscope C-MAC® vs. direct macintosh laryngoscope operated by medical students: A randomized, crossover, manikin study

Endotracheal intubation is the gold standard for airway management. Direct laryngoscopy is a difficult procedure with a high failure rate. A 3D printed video laryngoscope can be used as a more affordable replacement for a laryngoscope. The aim of this study was to evaluate the success rate and time of endotracheal intubation in manikins using the Alba 3D printed video laryngoscope, the C-MAC video laryngoscope and the Macintosh operated by medical students. This study was conducted using a cross sectional randomised study method involving 36 medical students. This study found that the mean endotracheal intubation time using Alba 3D Print was significantly shorter than using Macintosh, but not better than C-MAC (VL3D-25 vs LDM-50.5 vs VLC-21.5 s) with a p-value of <0.001. The success rate of endotracheal intubation using Alba 3D moulds was significantly better than using Macintosh, but not statistically significant when compared to C-MAC (VL3D-91.7% vs LDM-97.2% vs VLC-75%) with p-value <0.05). This study concluded that the use of Alba 3D prints has a better success rate and time compared to Macinctosh and can be an affordable alternative to commercial video laryngoscopes such as C-MAC for educational purposes.

Investigation of the effect of types of two different air filtered full-face masks used in chemical, biological, radiological, nuclear (CBRN) events on endotracheal intubation time: A randomized controlled study

IntroductionHealthcare personnel may have to intervene with the injured using personal protective equipment depending on the environmental conditions.In injuries occurring in chemical, biological, radiological and nuclear (CBRN) events, healthcare personnel may have to intervene in the injured using personal protective equipment.The equipment used may lead to limitations, especially in cases requiring advanced airway intervention such as intubation. In this study, the effects of personal protective equipment on the intubation times of healthcare personnel were investigated. MethodThis research was planned as a randomized prospective study, and the intubation procedure was performed on a simulation manikin. The intubation times were evaluated among three separate groups, 21 paramedic personnel in each. One group worked without masks, one used front filter masks, and the last worked with side filter masks. ResultsThe time spent for intubation by wearing a full-face mask with a side air filter and the intubation times performed without a mask were significantly different (p = 0.011). However, the intubation times of the groups using front and side air-filtered full-face masks were similar (p = 0.279). ConclusionsHealth personnel should use a full-face mask with a front air filter as personal protective equipment during the interventions for the injured who need endotracheal intubation.

Comparative study of total thoracoscopic mitral valve surgery and traditional open mitral valve surgery :propensity score matching study

Background: Conventional median open mitral valve replacement surgery usually requires a 20-30cm size incision to ensure adequate visual exposure. So, while we complete the valve replacement, it also brings about a series of problems. The appearance of TV thoracoscope changes the exposure of the surgical field. Because the microscopic field is enlarged, it not only makes the surgical vision clearer, but also greatly shortens the incision, reduces bleeding, and conceals the incision, minimizing the trauma and shortening the postoperative recovery time, which is in line with the concept of modern health. Aim: All technological innovation is controversial in the early stage, and it is such debate that can promote the progress and development of technology.This study was conducted in the context of this debate to summarize the experience of Total thoracoscopic mitral valve surgery in our center.Total thoracoscopic mitral valve replacement surgery and traditional median incision mitral valve replacement surgery were compared by the propensity score matching method.Evaluate its safety and merits. Methods: From January 2018 to December 2020, a total of 139 patients in the thoracoscopic group were eligible in the cardiothoracic surgery department of our hospital, and 1066 cases of traditional median sternotomy mitral valve replacement. After propensity score matching, 125 patients were selected in the thoracoscopic group, among 1066 patients with median incision MVR, 1:1 matched to 125, as the control group in the thoracoscopic group. Results: The results showed that the mean operative time in the thoracoscopic MVR group was significantly longer than that in the control group (185.73 ± 43.04 vs. 164.58 ± 40.28, p=0.0016). Similarly, both the mean CPB time and aortic block time were significantly longer than those in the control group (108.37±30.57min vs. 79.18±17.65min, p &lt;0.0001; 66.59±29.63min vs. 45.09±19.68min, p &lt;0.0001. Moreover, the proportion of patients with CPB greater than 120min and aortic block greater than 90min was significantly higher than the control group (24.1% vs. 3.2%, p &lt;0.0001,14.4% vs. 2.4%, p=0.0237). In addition, there was no significant difference in the mean ICU observation time between the two groups (49.35±34.51h vs. 48.72±25.89h, p=0. 8792). Differently, the mean endotracheal intubation time was significantly lower in the thoracoscopic MVR group compared to the control group (18.52±6.07h vs. 25.45±14.18h, p=0.0032). Similarly, the length of stay in the thoracoscopic group was 9.13 ± 4.58 days, which was significantly lower than 11.12 ± 5.76 days in the control group (p=0.0004). There was no significant difference in the postoperative hemoglobin concentration or platelet count between the two groups of MVR patients. Mean intraoperative bleeding volume in the thoracoscopic MVR group was significantly less than that in the control group (158.37±100.91ml vs.250.74 ± 81.34, P &lt;0.0001). Similarly, the mean postoperative discharge in the thoracoscopic MVR group was significantly than in the control group (428.39±361.38ml vs. 514.07 ± 347.92ml, p=0.0383). For patients with postoperative blood products, there were 37 (29.6%) in the thoracoscopic group and 33 (26.4%) in the control group. There was no significant difference between the two groups. Similarly, there was no significant difference in the mean total hospital costs between the two groups. Conclusion: This study shows that it has feasibility and safety for total thoracoscopic mitral valve replacement for mitral valve lesions, which can reduce the time and stay of the hospital compared with conventional direct surgery, and obtain good minimally invasive and cosmetic effect, and lay a theoretical and clinical foundation for the application of thoracoscopic technology in cardiac surgery, which has important scientific significance.

Excessive Use of Benzodiazepines Is a Risk Factor for Endotracheal Intubation in Children Who Present to Emergency With Prehospital Status Epilepticus.

There is lack of evidence-based information on the use and timing of endotracheal intubation (ETI) in children with prehospital status epilepticus (SE). The aim of this study was to investigate ETI use, timing, risk factors, and outcomes in children presenting to a single-center children's emergency (CE) with prehospital SE, over a 5-year period. A total of 118 events involving children presenting to CE with ongoing prehospital SE were included, and 39% (46/118) of the events required ETI. The most common indication for ETI was respiratory depression. The median time to intubation after arrival at CE was 20.0 minutes (1-155 minutes). Risk factors associated with ETI use include the administration of more than 2 benzodiazepines (26.1% vs 4.2%, P < 0.001) and the use of second- or third-line antiepileptic therapy ( P < 0.001). The use of more than 2 doses of benzodiazepines was found in 12.7% (15/118) of the patients. In patients who received excessive benzodiazepines, 87% (13/15) of them required intubation. Excessive use of benzodiazepine was found to be a main risk factor for ETI in patients with prehospital SE. Avoidance of the excessive use of benzodiazepines and adhering to clinical management guidelines may reduce the risk for ETI in the CE. The best approach to airway management in children with prehospital SE is lacking and urgently needed.

Meta-Analysis of Open-Heart Surgery Pain Relief Using Transversus Thoracic Plane Blocks

Background. Severe postoperative pain is commonly reported following open-heart surgery, necessitating the implementation of effective pain management strategies to facilitate patient recovery. The benefits of the transverse thoracic muscle plane (TTMP) block for open-heart surgery remain unclear. Therefore, a meta-analysis was conducted to systematically evaluate the effect of TTMP on postoperative analgesia and recovery in patients undergoing open-heart surgery. Methods. A computer search was performed in PubMed, Cochrane, Embase, CNKI, and Wangfang databases. The primary outcome was 24-hour postoperative opioid consumption, and the secondary outcomes were 12- and 24-hour postoperative resting and motor pain scores, time of first analgesia demand, extubation time, length of stay in the intensive care unit (ICU), time of first feces, incidence of nausea and vomiting, and length of hospitalization. Results. Thirteen randomized controlled trials (RCTs) involving a total of 766 patients were included in this meta-analysis. Compared with the control group, the TTMP group showed a significant reduction in opioid consumption within 24 h postoperatively (mean difference = −41.88 mg; 95% confidence interval: −51.99, −31.77; p&lt;0.001; and I2 = 98%). However, the 12- and 24-hour postoperative resting and moment VAS pain scores were significantly lower in the TTMP group. In addition, the TTMP group had a longer time of first analgesic demand; shorter endotracheal intubation time, ICU stay duration, time of first feces, and length of hospital stay; and a lower incidence of nausea and vomiting. Conclusions. Perioperative TTMP block can reduce the use of opioids in patients undergoing open-heart surgery for 24 h postoperatively, decrease the early postoperative pain scores, prolong the time of first analgesic demand, shorten the time of extubation and the length of ICU stay and hospitalization, and reduce the incidence of nausea and vomiting, which are all conducive to the recovery of patients. Registration. This trial is registered with PROSPERO database (CRD42022312435).

Comparison of preoxygenation with a high-flow nasal cannula and a simple face mask before intubation in Korean patients with head and neck cancer.

Although preoxygenation is an essential procedure for safe endotracheal intubation, in some cases securing sufficient time for tracheal intubation may not be possible. Patients with head and neck cancer might have a difficult airway and need a longer time for endotracheal intubation. We hypothesized that the extended apneic period with preoxygenation via a high-flow nasal cannula (HFNC) is beneficial to patients who undergo head and neck surgery compared with preoxygenation with a simple mask. The study was conducted as a single-center, single-blinded, prospective, randomized controlled trial. Patients were divided into groups based on one of the two preoxygenation. HFNC group or simple facemask (mask group). Preoxygenation was performed for 5 minutes with each method, and endotracheal intubation for all patients was performed using a video laryngoscope. Oxygen partial pressures of the arterial blood were compared at the predefined time points. For the primary outcome, the mean arterial oxygen partial pressure (PaO2 ) immediately after intubation was 454.2 mm Hg (95% confidence interval [CI], 416.9-491.5 mm Hg) in the HFNC group and 370.7 mm Hg (95% CI, 333.7-407.4 mm Hg) in the mask group (P=0.002). The peak PaO2 at 5 minutes after preoxygenation was not statistically different between the groups (P=0.355). Preoxygenation with a HFNC extending to the apneic period before endotracheal intubation may be beneficial in patients with head and neck cancer.

A randomized crossover comparison of the bébé VieScope and direct laryngoscope for pediatric airway management by nurses in medical simulation settings

ABSTRACT Background Airway management in life-threatening emergencies is essential for children, and endotracheal intubation is the gold standard. It protects against regurgitation and enables mechanical ventilation. New types of airway management equipment are being developed and implemented to meet the needs of medical personnel. Research design and methods This prospective, randomized, cross-over simulation trial evaluated the success of endotracheal intubation in three scenarios: normal airway (scenario-A), tongue edema (scenario-B), and continuous chest compression (scenario-C), using the bébé Vie Scope™ laryngoscope (VieScope) and the Macintosh blade laryngoscope (MAC) as a comparative tool performed by nurses with limited tracheal intubation experience. Results The results of the study showed that in scenario-A, there were no significant differences in the first attempt success rate or endotracheal intubation time between VieScope and MAC. However, VieScope was associated with better visualization of the glottis. In scenarios B and C, VieScope was significantly more effective than MAC in terms of first-pass success rate, time to intubate, Cormack-Lehane grade, POGO score, and ease of endotracheal intubation. Conclusions Bébé VieScope may be useful for endotracheal intubation in pediatric patients, particularly in cases of tongue edema and ongoing chest compression, providing a higher first-pass success rate than conventional laryngoscopes.

The optimal time for endotracheal intubation in subjects with coronavirus disease 2019 pneumonia: A retrospective observational study.

The optimal timing of intubation has been debated among healthcare professionals, current studies do not show any differences between early and late intubation. most studies failed to show any significant difference in clinical outcomes between early or late intubation. The study was conducted as a retrospective review of subjects with confirmed coronavirus disease 2019 admitted to the Dubai Hospital intensive care unit (ICU). Study variables included time to intubation, duration of supplemental oxygen requirement >15 L/min, and cumulative duration of tachypnea and tachycardia while on the aforementioned oxygen requirement on this oxygen usage level. Each time duration was assessed for correlation with clinical variables including mortality and length of stay in ICU and hospital. Subjects who require endotracheal intubation within 4 h after the start of oxygen >15 L/min have lower survival (P = 0.03). Subjects who have tachypnea on the aforementioned oxygen requirement for 6-19.5 h (P = 0.01) before they require intubation have better survival. No duration of tachycardia has any significant effect on survival. Only the duration of invasive mechanical ventilation (MV) correlated with the hospital length of stay. Subjects who require endotracheal intubation within 4 h after the start of oxygen >15 L/min have lower survival. The optimal time for intubation is after tachypnea of 6 h but before 19.5 h. No duration of tachycardia has any significant effect on survival. Only the duration of invasive MV correlated with the hospital length of stay.

Arterial partial pressure of oxygen and procalcitonin combined with ROX index predict the timing of tracheal intubation in patients with acute severe pancreatitis

To investigate the efficacy of arterial partial pressure of oxygen (PaO2), procalcitonin (PCT) combined with ROX index in predicting the timing of tracheal intubation in patients with acute severe pancreatitis (SAP). A case-control study was conducted. A total of 148 patients with SAP admitted to Hunan Provincial People's Hospital from January 2019 to December 2022 were selected as the research objects. According to whether endotracheal intubation was used after admission during hospitalization, the patients were divided into the intubation group (102 cases) and non-intubation group (46 cases). Gender, age, white blood cell count (WBC), lymphocyte count (LYM), platelet count (PLT), C-reactive protein (CRP), hemoglobin (Hb), PCT, PaO2, arterial partial pressure of carbon dioxide (PaCO2), arterial bicarbonate ion (HCO3-) 1 day after admission, arterial lactic acid (Lac), lactate dehydrogenase (LDH), heart rate (HR), respiratory rate (RR), pulse oxygen saturation (SpO2), oxygenation index (PaO2/FiO2), blood pressure, worst ROX index (ROX index = SpO2/FiO2/RR) within 30 minutes of admission and 30 minutes before intubation of the two groups were measured. Multivariate Logistic regression was used to analyze the independent risk factors for the timing of endotracheal intubation in patients with SAP. The receiver operator characteristic curve (ROC curve) was used to determine the optimal predictive cut-off value for endotracheal intubation. There were no significant differences in age, gender, WBC, LYM, CRP, Hb, LDH, HR and blood pressure at admission between the two groups. The PLT, Lac, PCT and RR in the intubation group were significantly higher than those in the un-intubation group, and HCO3-, PaO2, SpO2, PaO2/FiO2, the worst ROX index within 30 minutes after admission and 30 minutes before intubation were significantly lower than those in the non-intubation group (all P < 0.05). Logistic regression analysis showed that the worst ROX index within 30 minutes before intubation was the largest negative influencing factor for the timing of tracheal intubation in SAP patients [odds ratio (OR) = 0.723, 95% confidence interval (95%CI) was 0.568-0.896, P = 0.000], followed by PaO2 (OR = 0.872, 95%CI was 0.677-1.105, P < 0.001). PCT was the positive influencing factor (OR = 1.605, 95%CI was 1.240-2.089, P < 0.001). ROC curve analysis showed that the area under the ROC curve (AUC) of PaO2, PCT, the worst ROX index within 30 minutes before intubation and the combination to evaluate the tracheal intubation time of patients with SAP were 0.715, 0.702, 0.722 and 0.808, the sensitivity was 78.1%, 75.0%, 81.5% and 89.3%, the specificity was 66.7%, 59.0%, 73.2% and 86.4%, and the best cut-off value was 60.23 mmHg (1 mmHg ≈ 0.133 kPa), 2.72 μg/L, 4.85, and 0.58, respectively. The AUC of the combination of PaO2, PCT and the worst ROX index within 30 minutes before intubation predicted the timing of tracheal intubation in patients with SAP was significantly greater than using each index alone (all P < 0.01). The worst ROX index within 30 minutes before intubation combined with PaO2 and PCT is helpful for clinicians to make a decision for tracheal intubation in patients with SAP.

A pilot, prospective trial of IntuBrite® versus Macintosh direct laryngoscopy for paramedic endotracheal intubation in out of hospital cardiac arrest

BackgroundIntubation in the case of out-of-hospital cardiac arrest (OHCA) is one of the most difficult procedures for Emergency Medical Services (EMS). The use of a laryngoscope with a dual light source is an interesting alternative to classic laryngoscopes. However, there are as yet no prospective data concerning the use of double light direct laryngoscopy (DL) by paramedics in traditional ground ambulance agencies in OHCA.MethodsWe performed a non-blinded trial in a single EMS in Poland within ambulances crews, comparing time and first pass success (FPS) for endotracheal intubation (ETI) in DL using the IntuBrite® (INT) and Macintosh laryngoscope (MCL) during cardiopulmonary resuscitation (CPR). We collected both patient and provider demographic information along with intubation details. The time and success rates were compared using an intention-to-treat analysis.ResultsOver a period of 40 months, a total of 86 intubations were performed using 42 INT and 44 MCL based on an intention-to-treat analysis. The FPS time of the ETI attempt (13.49 vs. 15.55 s) using an INT which was shorter than MCL was used (p < 0.05). First attempt success (34/42, 80.9% vs. 29/44, 64.4%) was comparable for INT and MCL with no statistical significance.ConclusionsWe found a statistically significant difference in intubation attempt time when the INT laryngoscope was used. Intubation first attempt success rates with INT and MCL were comparable with no statistical significance during CPR performed by paramedics.Trial RegistrationTrial was registered in Clinical Trials: NCT05607836 (10/28/2022)

Effect of reverse Trendelenburg position and positive pressure ventilation on safe non-hypoxic apnea period in obese, a randomized-control trial

PurposeThere is an elevated incidence of hypoxemia during the airway management of the morbidly obese. We aimed to assess whether optimizing body position and ventilation during pre-oxygenation allow a longer safe non-hypoxic apnea period (SNHAP).MethodsFifty morbidly obese patients were recruited and randomized for this study. Patients were positioned and preoxygenated for three minutes in the ramp position associated with spontaneous breathing without additional CPAP or PEEP (RP/ZEEP group) or in the reverse Trendelenburg position associated with pressure support ventilation mode with pressure support of 8 cmH2O and an additional 10 cmH2O of PEEP while breathing spontaneously (RT/PPV group) according to randomization.ResultsThe SNHAP was significantly longer in the RT/PPV group (258.2 (55.1) vs. 216.7 (42.3) seconds, p = 0.005). The RT/PPV group was also associated to a shorter time to obtain a fractional end-tidal oxygen concentration (FEtO2) of 0.90 (85.1(47.8) vs 145.3(40.8) seconds, p < 0.0001), a higher proportion of patients that reached the satisfactory FEtO2 of 0.90 (21/24, 88% vs. 13/24, 54%, p = 0.024), a higher FEtO2 during preoxygenation (0.91(0.05) vs. 0.89(0.01), p = 0.003) and a faster return to 97% oxygen saturation after ventilation resumption (69.8 (24.2) vs. 91.4 (39.2) seconds, p = 0.038).ConclusionIn the morbidly obese population, RT/PPV, compared to RP/ZEEP, lengthens the SNHAP, decreases the time to obtain optimal preoxygenation conditions, and allows a faster resuming of secure oxygen saturation. The former combination allows a more significant margin of time for endotracheal intubation and minimizes the risk of hypoxemia in this highly vulnerable population.Trial registrationNCT02590406, 29/10/2015.

Comparison of onset of neuromuscular blockade with electromyographic and acceleromyographic monitoring: a prospective clinical trial

BackgroundReliable devices that quantitatively monitor the level of neuromuscular blockade after neuromuscular blocking agents’ administration are crucial. Electromyography and acceleromyography are two monitoring modalities commonly used in clinical practice. The primary outcome of this study is to compare the onset of neuromuscular blockade, defined as a Train-Of-Four Count (TOFC) equal to 0, as measured by an electromyography-based device (TetraGraph) and an acceleromyography-based device (TOFscan). The secondary outcome was to compare intubating conditions when one of these two devices reached a TOFC equal to 0. MethodsOne hundred adult patients scheduled for elective surgery requiring neuromuscular blockade were enrolled. Prior to induction of anesthesia, TetraGraph electrodes were placed over the forearm of patients’ dominant/non-dominant hand based on randomization and TOFscan electrodes placed on the contralateral forearm. Intraoperative neuromuscular blocking agent dose was standardized to 0.5 mg.kg−1 of rocuronium. After baseline values were obtained, objective measurements were recorded every 20 seconds and intubation was performed using video laryngoscopy once either device displayed a TOFC = 0. The anesthesia provider was then surveyed about intubating conditions. ResultsBaseline TetraGraph train-of-four ratios were higher than those obtained with TOFscan (Median: 1.02 [0.88, 1.20] vs. 1.00 [0.64, 1.01], respectively, p < 0.001). The time to reach a TOFC = 0 was significantly longer when measured with TetraGraph compared to TOFscan (Median: 160 [40, 900] vs. 120 [60, 300] seconds, respectively, p < 0.001). There was no significant difference in intubating conditions when either device was used to determine the timing of endotracheal intubation. ConclusionsThe onset of neuromuscular blockade was longer when measured with TetraGraph than TOFscan, and a train-of-four count of zero in either device was a useful indicator for adequate intubating conditions. Clinical trial number and registryURL NCT05120999, https://clinicaltrials.gov/ct2/show/NCT05120999.

Effect of other venous access on cardiopulmonary resuscitation quality: A prospective, randomized, controlled trial

ABSTRACT This randomized controlled study aimed to prospectively evaluate the application effects of other venous access in patients undergoing cardiopulmonary resuscitation. A total of 212 patients who underwent respiratory and cardiac arrest were randomly divided into peripheral intravenous (IV) access group (IV group, n = 69), femoral vein catheterization group (FVC group, n = 72), and internal jugular vein catheterization group (IJVC group, n = 71). The puncture time, first administration time, pressure interruption time caused by the establishment of fluid pathway, endotracheal intubation time, complications, ROSC time, and ETCO2 were recorded. The time of establishing venous access was: IV<FVC<IJVC. The once puncture success rate of the FVC group was markedly higher than that in IV and IJVC groups (P < 0.01). There was no significant difference in ROSC time between the FVC, IV, and the IJVC group (P = 0.23). The ROSC time in the FVC group was higher than in the IV and IJVC groups (P < 0.01). The success rate of ROSC in the FVC group and IJVC group were better than that in the IV group (PVC>IJVC>IV, P = 0.04). There was no significant difference in EtCO2 between the FVC, IV group, and IJVC group (PVC>IJVC>IV, P = 0.17). Due to catheterization, the time of suspending chest compression in the FVC group was significantly lower than in the IJVC group (5s vs. 12s). The time of establishing an artificial airway in the IV (38s) and FVC (35s) group were significantly longer than that in IJVC (52s) group. Central venous catheterization is more effective than peripheral venous catheterization in cardiopulmonary resuscitation. Moreover, femoral vein access was more effective than internal jugular vein access.

Effect of preoperative pulmonary hemodynamic and cardiopulmonary bypass on lung function in children with congenital heart disease

In children with congenital heart disease (CHD), pulmonary blood flow (Qp) contributes to alterations of pulmonary mechanics and gas exchange, while cardiopulmonary bypass (CPB) induces lung edema. We aimed to determine the effect of hemodynamics on lung function and lung epithelial lining fluid (ELF) biomarkers in biventricular CHD children undergoing CPB. CHD children were classified as high Qp (n = 43) and low Qp (n = 17), according to preoperative cardiac morphology and arterial oxygen saturation. We measured ELF surfactant protein B (SP-B) and myeloperoxidase activity (MPO) as indexes of lung inflammation and ELF albumin as index of alveolar capillary leak in tracheal aspirate (TA) samples collected before surgery and in 6 hourly intervals within 24 h after surgery. At the same time points, we recorded dynamic compliance and oxygenation index (OI). The same biomarkers were measured in TA samples collected from 16 infants with no cardiorespiratory diseases at the time of endotracheal intubation for elective surgery. Preoperative ELF biomarkers in CHD children were significantly increased than those found in controls. In the high Qp, ELF MPO and SP-B peaked 6 h after surgery and tended to decrease afterward, while they tended to increase within the first 24 h in the low Qp. ELF albumin peaked 6 h after surgery and decreased afterwards in both CHD groups. Dynamic compliance/kg and OI significantly improved after surgery only in the High Qp. Conclusion: In CHD children, lung mechanics, OI, and ELF biomarkers were significantly affected by CPB, according to the preoperative pulmonary hemodynamics.What is Known:• Congenital heart disease children, before cardiopulmonary run, exhibit changes in respiratory mechanics, gas exchange, and lung inflammatory biomarkers that are related to the preoperative pulmonary hemodynamics.• Cardiopulmonary bypass induces alteration of lung function and epithelial lining fluid biomarkers according to preoperative hemodynamics.What is New:• Our findings can help to identify children with congenital heart disease at high risk of postoperative lung injury who may benefit of tailored intensive care strategies, such as non-invasive ventilation techniques, fluid management, and anti-inflammatory drugs that can improve cardiopulmonary interaction in the perioperative period.

Intubation characteristics using modified USB videolaryngoscope: A prospective, randomised study.

Videolaryngoscopes with varying characteristics with regard to angulation of blades and video configurations are now available. However, the contribution of each of these in improving ease of intubation is quite different. We evaluated the role of video camera in the performance of laryngoscopy by using the universal serial bus (USB) videolaryngoscope in patients with predicted difficult airway. Sixty patients in the age group of 25 to 65 years having Mallampati grade III or IV were randomly allocated to two groups. All patients were American Society of Anesthesiologists physical status grade I or II and planned for elective surgical procedure under general anesthesia. USB videolaryngoscope or Macintosh laryngoscope was used for intubation as per group allotted. Comparison of time of endotracheal intubation was our primary outcome measure and it was calculated from the time the laryngoscope tip passes the incisors to the initial appearance of capnography wave. Rate of successful intubation, number of attempts needed for successful tube placement, optimisation manoeuvres used, changes in haemodynamic parameters and airway injuries were evaluated as secondary outcomes. Time for intubation was shorter in the Macintosh group than the USB group (P = 0.024). The incidence of successful intubation was similar in both groups (P = 0.079). USB group required lesser number of attempts for tube placement (P = 0.047). The incidence of airway injuries was similar in both the groups. USB videolaryngoscope reduces the number of attempts required for successful endotracheal intubation compared to Macintosh laryngoscope though it increases the time for intubation in patients with predicted difficult airway.

Elective Tracheostomy During Covid-19 Pandemic- A Tertiary Care Centre Experience.

: The aim of our study was to present an experience of elective tracheostomy in COVID-19 patients at our institute. The present prospective study was conducted, after approval by Institutional Ethics Committee, in the Department of ENT, SMGS Hospital, GMC Jammu from May 2020 to March 2021 over 60 patients having need for prolonged mechanical ventilation and having tested positive for COVID-19 with nasopharyngeal swab on rtPCR assay testing. Detailed information regarding following aspects was gathered :Age, Gender, Comorbidities (Diabetes, Cardiovascular disease, Pulmonary disease, Malignancy), time of endotracheal intubation to tracheostomy, time to wean sedation after tracheostomy, time to wean mechanical ventilation after tracheostomy, surgical complications, mortality, any health care worker in operating team getting infected by SARS-CoV-2. All 60 patients underwent Elective Open Tracheostomy Bed-side in the ICU section of our institute. The mean age of presentation was 55.9 ± 2.34 years, with male preponderance. The most common indication for tracheostomy was ARDS (Acute Respiratory Distress Syndrome) (56.6%). Out of 60 patients, co-morbidities were present in 44 patients (73.3%). The mean time between endotracheal intubation and tracheostomy was 12.2 ± 4.9 days. The mean time to wean mechanical ventilation after tracheostomy was 10.4 ± 2.31 days. The mean time to wean sedation was 2.2 ± 0.83 days. There were no deaths during the procedure. Out of 60 patients, 5 patients (8.3%) died due to complications of COVID-19. Our study provides important clinical data (such as timing of tracheostomy, pre-operative evaluation of patients, recommendations during procedure, outcomes of tracheostomy and postoperative care) on this threatening issue of tracheostomy in COVID-19 patients and might be of immense help to various Otorhinolaryngologists who are dealing with the same situation.

Comparison of AirTraq® laryngoscope with smartphone camera adapter vs Macintosh laryngoscope for endotracheal intubation performed by operators without clinical experience – a randomised, control manikin study

Aim: Difficult or failed tracheal intubation is a well-known cause of morbidity and mortality associated with anesthesia and emergency medicine. The aim of the presented study was to evaluate the laryngoscopes AirTraq, AirTraq with phone camera adapter and Macintosh in simulated conditions when used by people without clinical experience. Material and methods: A total of 32 students of medical direction were qualified for the study. The tested laryngoscopes were evaluated in terms of the effectiveness and time of endotracheal intubation procedure. In each scenario, participants had up to three attempts to intubate with each laryngoscope. The AirTraq was previously unknown to the study participants. In total, 288 endotracheal intubation attempts were evaluated. Results: The overall number of successful intubations with the AirTraq was 96 (100%), for the AirTraq with smartphone adapter 96 (100%) and with the Macintosh classic laryngoscope 88 (91%). The median time of endotracheal intubation was 28,3 seconds for the Macintosh laryngoscope, 16,4 seconds for AirTraq and 17,6 second for the AirTraq with smartphone adapter. Intubation performed with the AirTraq was shorter by 11.9 seconds in comparison with Macintosh laryngoscope and intubation performed with the use of camera-guided AirTraq was shorter by 10,7 seconds in comparison with Macintosh. Conclusions: The study shows that AirTraq and AirTraq with smartphone adapter are the most useful devices, combining high efficiency with a statistically significant reduction in time between successive attempts compared with Macintosh classic laryngoscope.

PERCUTANEOUS DILATATIONAL TRACHEOSTOMY IN COVID-19 PATIENTS IN THE COVID HOSPITAL INTENSIVE CARE UNIT: THE UNIVERSITY CLINICAL CENTER OF VOJVODINA EXPERIENCE.

Patients with acute respiratory distress syndrome due to COVID-19 require intensive care unit (ICU) admission with consecutive endotracheal intubation and invasive mechanical ventilation. In patients with long-term mechanical ventilation, percutaneous dilatational tracheostomy (PDT) may be considered. This retrospective analysis includes clinical data on patients treated at the ICUs of the COVID Hospital of the Clinical Center of Vojvodina in the period from September 3, 2021 to May 1, 2022, and underwent PDT. Patients were predominantly male (n=48; 65.8%). Weaning from mechanical ventilation was achieved in 31 (42.5%) and decannulation in 25 (34.2%) patients. The mean time from polymerase chain reaction SARS CoV-2 positivity until PDT was 15.59±6.85 days. The mean time of endotracheal intubation before the PDT procedure was 7.37±4.89 days. The mean weaning time from mechanical ventilation was 10.45±7.92 days. Twenty-five (34.2%) patients were decannulated at the mean time of 19.60±11.81 days. The complications were tracheostomy related bleeding (2 patients), pneumothorax (4 patients), subcutaneous emphysema (1 patient) and cricoid cartilage injury (1 patient). PDT is a simple, safe, and effective procedure performed in COVID-19 patients in the ICU.