Endotracheal Tube In Patients Research Articles

Comparison between ultrasonography and capnography for ascertaining placement of endotracheal tube in patients undergoing general anesthesia – A prospective observational study

Background: Confirmation of the position of the endotracheal tube (ETT) is an essential step for verification of intubation. Failure to diagnose esophageal intubation may lead to fatal consequences. Capnography is the gold standard for confirmation of ETT position, but it is practically impossible to be performed in all situations. Ultrasonography (USG) or “visual stethoscope” can be used as an effective alternative for all intubators in all situations. Aims and Objectives: The study was conducted to evaluate the ultrasonography (USG) technique with respect to its efficacy to detect the proper endotracheal position of ETT compared to end-tidal capnography among patients undergoing general anesthesia; to compare the time taken by the USG technique with that of capnography for detection of proper placement of ETT; to assess the feasibility of USG to detect accidental esophageal intubation. Materials and Methods: This prospective comparative cross-sectional observational study was conducted on 68 patients. Both capnography and upper airway USG were performed immediately after intubation to confirm the ETT placement. Sensitivity, specificity, and positive and negative predictive values of upper airway USG were determined against capnography as the reference method. The time required to determine ETT placement by the two methods was found out and compared. Agreement between the methods was assessed with kappa statistics. Results: USG detected all three cases of esophageal intubation but could not detect two patients with correct tracheal intubation. Upper airway USG had a sensitivity of 96.92% (95% confidence interval [CI]: 93.54–100%), specificity of 100%, positive predictive value of 100%, and negative predictive value of 60% (95% CI: 50.4–69.6%). The Kappa value was found to be 0.735, indicating a good agreement between upper airway USG and capnography for confirmation of ETT placement. Time taken for confirmation of ETT by capnography was 21.68±2.63 s versus 11.44±1.38 s for upper airway USG (P<0.001). USG demonstrated bilateral lung sliding in 60 (88.2%) patients, unilateral lung sliding in 3 (4.4%) patients, and lung sliding was absent in 5 (7.4%) patients. Conclusion: Real-time upper airway USG is an alternative method of confirmation of ETT that is not only sensitive and accurate but is faster than the current gold standard method, capnography.

The Biofilm Inhibition Properties of Glucosamine Gold Nanoparticles in Combination with Meropenem against Pseudomonas aeruginosa on the Endotracheal Tube: A Model of Biofilm-Related Ventilator-Associated Pneumonia.

Biofilm-related infections play a significant role in the development and persistence of ventilator-associated pneumonia. Pseudomonas aeruginosa (P. aeruginosa) frequently causes biofilm-related infections associated with ventilator tubing. Glucosamine gold nanoparticles (AuNPs) may exhibit antibiofilm properties; however, more studies, including combinatorial therapy with antibiotics, are needed to explore their potential applications in clinical settings. This study aims to investigate the biofilm inhibition properties of glucosamine AuNPs in combination with meropenem against P. aeruginosa ATCC 9027 on the endotracheal tube. A biofilm inhibition assay of glucosamine AuNPs at 0.02 mg/mL, both singly and in combination with meropenem at 1 mg/mL, was carried out against P. aeruginosa ATCC 9027 on an endotracheal tube using the tissue culture plate method. Scanning electron microscopy was performed for visualization. Glucosamine AuNPs at 0.02 mg/mL combined with meropenem at 1 mg/mL showed greater biofilm inhibition (72%) on the endotracheal tube than glucosamine nanoparticles at 0.02 mg/mL alone (26%) (p = 0.001). The scanning electron microscopic visualization revealed that the untreated P. aeruginosa biofilm was denser than the glucosamine nanoparticles-treated biofilm, whether combined with meropenem or using glucosamine nanoparticles alone. The combination of glucosamine AuNPs and meropenem may have the synergistic effect of inhibiting biofilm production of P. aeruginosa on the endotracheal tubes of patients with mechanical ventilation. Conducting additional experiments to explore the impact of combining glucosamine-coated gold nanoparticles (AuNPs) with meropenem on the inhibition of biofilm production by clinical P. aeruginosa isolates would be beneficial.

Atracurium for Rapid Sequence Induction; A dose determining Randomized Control Trial at a Tertiary Care Hospital.

Introduction: Expert airway management is one of the essential anesthetic skills. Rapid Sequence induction is a technique of providing rapid securement of airway with endotracheal tube in patients who are at risk of aspiration. Objective: To find out the efficacy of 3-4 ED95 dose of Atracurium in providing optimal intubating conditions for Rapid Sequence Induction. Methodology: Single-blind randomized control trial was carried out Department of Anesthesia and Critical Care Medicine, Pakistan Institute of Medical Sciences (PIMS), Islamabad. 118 patients were included and divided into two groups by help of computer-generated random numbers. All the patients were pre-medicated with 8 mg of IV Dexamethasone. Group A patients received 1 mg/kg while group B patients received 0.75 mg/kg of Atracurium. Intubating conditions were assessed on the basis of number of coughing episodes along with degree of vocal cord movement or paralysis. Results: Patients who received 0.75 mg/kg of Atracurium had statistically significant better intubating conditions as compared to those receiving 1 mg/kg of Atracurium (p value < 0.05). Coughing episodes were more common among patients receiving higher dose of Atracurium while degree of vocal cord paralysis was similar in both groups. Furthermore 75% of histamine related adverse effects such as erythema and bronchospasm were observed in higher dose group. The difference was statistically significant with a p value of <0.05. Conclusion: Atracurium at a dose of 0.75 mg/kg along with pre-medication with 8 mg of IV Dexamethasone provided better and safer intubating conditions for rapid sequence induction.

Comparison of Baska mask and I-gel with endotracheal tube in laparoscopic cholecystectomy: A randomized controlled study

Background: Supraglottic airway devices are frequently used instead of endotracheal intubation in laparoscopic surgeries. Two such devices, I-gel (IG) and Baska mask (BM), have been compared with respect to their sealing properties and leak fraction (LF) in comparison to the endotracheal tube. Aims and Objectives: The aim of the present study is to compare the performance of IG and BM with endotracheal tube in patients undergoing laparoscopic cholecystectomy under general anesthesia. Materials and Methods: In this randomized trial, 84 patients scheduled for laparoscopic cholecystectomy under general anesthesia were randomized to group (endotracheal tube [ETT], n=28), group BM (BM, n=28), or group IG (IG, n=28). All the patients received standard general anesthesia and the airway was maintained with either of three devices. The primary outcomes were the difference in the LF and airway sealing pressure (ASP) at different time points before and after pneumoperitoneum. Secondary outcomes were insertion-time, number of insertion attempts, and gastric insufflations. Heart rate and blood pressure were recorded. Complications such as sore throat, coughing, laryngospasm, blood staining of the device, and aspiration were noted. Results: P-values of LF of the three groups at time points T- after insertion (Ti), T-after pneumoperitoneum (Tp), and T- after peritoneal deflation (Tr) were 0.000 each and P-values of ASP at those time points were 0.000 each, respectively. Insertion time was significantly less for IG than ET (P<0.001). Heart rate and blood pressure showed P-values at Ti and Tp (P=0.004 and 0.000). Conclusion: It was concluded that IG or BM can maintain an airway with adequate seal and were not associated with any incidence of aspiration or laryngospasm. IG placement was found to be easier whereas the ease of ventilation was noted with BM.

A Comparison between Baska Mask and Endotracheal Tube in Patients Undergoing Gynecological Laparoscopic Surgery

A Comparison between Baska Mask and Endotracheal Tube in Patients Undergoing Gynecological Laparoscopic Surgery

Description of the colonizing mycobiota of endotracheal tubes from patients admitted to two intensive care units in Bogotá, Colombia

Introduction. Medical device colonization by pathogenic microorganisms is a risk factor for increasing infections associated with health care and, consequently, the morbidity and mortality of intubated patients. In Colombia, fungal colonization of endotracheal tubes has not been described, and this information could lead to new therapeutic options for the benefit of patients. Objective. To describe the colonizing fungi of the endotracheal tubes from patients in the intensive care unit, along with its antifungal sensitivity profile. Materials and methods. We conducted a descriptive, observational study in two health centers for 12 months. Endotracheal tubes were collected from patients in intensive care units. Samples were processed for culture, fungi identification, and antifungal sensitivity profile assessment. Results. A total of 121 endotracheal tubes, obtained from 113 patients, were analyzed: 41.32 % of the tubes were colonized by Candida albicans (64.62%), C. non‑albicans (30.77%), Cryptococcus spp. (3.08%) or molds (1.54%). All fungi evaluated showed a high sensitivity to antifungals, with a mean of 91%. Conclusion. Fungal colonization was found in the endotracheal tubes of patients under invasive mechanical ventilation. The antifungal sensitivity profile in these patients was favorable. A clinical study is required to find possible correlations between the colonizing microorganisms and infectivity.

The role of microbial biofilms in the development of respiratory system complications in patients with COVID-19: A literature review

One of the complications of COVID-19 is the development of acute respiratory failure, which may require artificial ventilation using an endotracheal tube to correct hypoxaemia. However, the establishment of biofilms during intubation of patients can pose a risk of microbial growth that can cause severe complications. Therefore, the research on the microbial composition of biofilms that causes such diseases becomes an urgent issue. The purpose of the research was to analyse and summarise the data from current studies on the role of microbial biofilms and their impact on the development of respiratory system complications in patients with COVID-19. After reviewing the literature, it was determined that Staphylococcus epidermidis, Enterococcus faecalis, Pseudomonas aeruginosa and Candida albicans accounted for the majority of biofilms isolated from endotracheal tubes in patients with COVID-19. The level of antimicrobial resistance among the isolated strains was almost 70%. The examination of samples from endotracheal tubes identified representatives of the lung microbiome, Prevotella spp. and some species of Streptococcus, Veillonella. However, in the research on the microbial composition of biofilms isolated from endotracheal tubes, pathogenic representatives dominated, such as Pseudomonas spp., Staphylococcus spp., Streptococcus spp., Stenotrophomonas spp., Enterobacterales, Haemophilus spp. and Actinomyces spp. Changes in the composition of the lung microbiome in patients with COVID-19 can lead to the development of severe complications accompanied by the establishment of biofilms. Microorganisms in biofilms can be a reservoir for secondary pulmonary infections, which affects the duration of mechanical ventilation and the admission of patients with COVID-19 to intensive care units. The development and implementation of effective measures for the prevention and treatment of biofilm-related infections is an important task for modern medical practice

Engineered live bacteria suppress Pseudomonas aeruginosa infection in mouse lung and dissolve endotracheal-tube biofilms.

Engineered live bacteria could provide a new modality for treating lung infections, a major cause of mortality worldwide. In the present study, we engineered a genome-reduced human lung bacterium, Mycoplasma pneumoniae, to treat ventilator-associated pneumonia, a disease with high hospital mortality when associated with Pseudomonas aeruginosa biofilms. After validating the biosafety of an attenuated M. pneumoniae chassis in mice, we introduced four transgenes into the chromosome by transposition to implement bactericidal and biofilm degradation activities. We show that this engineered strain has high efficacy against an acute P. aeruginosa lung infection in a mouse model. In addition, we demonstrated that the engineered strain could dissolve biofilms formed in endotracheal tubes of patients with ventilator-associated pneumonia and be combined with antibiotics targeting the peptidoglycan layer to increase efficacy against Gram-positive and Gram-negative bacteria. We expect our M. pneumoniae-engineered strain to be able to treat biofilm-associated infections in the respiratory tract.

An Innovative Method of Securing the Endotracheal Tube in Patients with Facial Hair Undergoing Neurosurgical Procedures.

An Innovative Method of Securing the Endotracheal Tube in Patients with Facial Hair Undergoing Neurosurgical Procedures.

Efficacy of Noble Metal–alloy Endotracheal Tubes in Ventilator-associated Pneumonia Prevention: a Randomized Clinical Trial

Background:Endotracheal tube (ETT) is an important risk factor for the development of Ventilator-associated pneumonia (VAP), as it acts as a reservoir for infectious microorganisms and bypasses the host’s defenses. One of the preventive measures for VAP is endotracheal tube composition. It has been reported that biofilm formation is reduced by using ETTs coated with pure silver or silver compounds. However, noble metal-alloy ETTs have not been adequately studied.Aims:To evaluate the efficacy of noble metal alloy ETT (coated Bactiguard Infection Protection ETTs) in preventing VAP compared to standard non-coated ETTs in patients requiring ≥ 48 hours of mechanical ventilation and presenting for coma due to drug intoxication.Study Design:Randomized controlled study.Methods:Participants were randomized using sealed envelopes with a concealed 1:1 allocation to either the intervention group or the control group. The intervention group used a noble metal–alloy ETT, while the control group received standard ETT. The primary outcomes were the incidence of VAP (per ventilated patients) and the duration of mechanical ventilation.Results:Initially, a total of 188 patients were assessed for eligibility, and the final allocation group consisted of 180 patients, who were subsequently randomized into the intervention group (n = 97) and control group (n = 83). The incidence of VAP in the intervention and control groups was 27.83% and 43.16% (P = 0.03), and the VAP ratio per 1000 ventilation days was 51.26/1000 and 83.38/1000 (P = 0.01), respectively. The mean durations of mechanical ventilation were 3.2 ± 0.78 in the intervention group and 5.03 ± 1.88 in the control group (P = 0.22). There was no statistically significant difference between groups in terms of mortality and duration of hospital stay.Conclusion:Noble metal-alloy ETT reduces the incidence of VAP, ventilation days, and ICU stay for patients in mechanical ventilation.

Apneic Technique in Laryngotracheal Surgery.

BackgroundApneic oxygenation can be applied to select laryngotracheal procedures to improve operative visualization and avoid potential complications associated with intubation and jet ventilation. Aims/objectivesThe authors sought to determine if apneic oxygenation using a high-flow nasal cannula could be used as a safe alternative airway management strategy for the duration of select laryngotracheal procedures.MethodsSingle institution, multi-site retrospective review of 38 adult (>18 years old) patients undergoing apneic oxygenation in the setting of various laryngotracheal procedures from January 2017 through January 2018. Humidified oxygen was delivered via a high-flow nasal cannula. The data was collected and analyzed using SAS version 9.4 (SAS Institute, Cary, NC).ResultsTwenty-four women and 14 men, mean age 60.0 years (SD 16.1; 36-89) and 70.1 years (SD 7.2; 56-81), respectively, underwent a mean total apneic time of 23.9 minutes (13-40). A statistically significant correlation existed between apneic time and minimum oxygen saturation (Pearson correlation coefficient 0.38; p=0.018). Twenty-one patients resumed spontaneous ventilation without the need for jet ventilation, mask ventilation, or placement of a definitive airway during the procedure. Conclusions and significanceApneic oxygenation allows for extended periods of operating without the need for the placement of an endotracheal tube in patients undergoing general anesthesia for select laryngotracheal procedures.

Comparison of LMA Protector vs. endotracheal tube in patients undergoing laparoscopic surgery: arandomised controlled trial.

Recent advances in airway management have led to supraglottic airway devices (SAD) being increasingly often chosen instead of tracheal intubation for laparoscopic surgery. However, there are ongoing arguments regarding the use of SAD due to worries about the risks of insufficient ventilation and pulmonary aspiration. The LMA Protector is a second generation SAD which was put into use recently. This prospective randomised trial investigated whether the LMA Protector was comparable to the tracheal tube regarding respiratory parameters, perioperative complications and haemodynamic parameters in patients undergoing laparoscopic surgery. A total of 154 adult patients were randomised to two groups: Group 1 (tracheal intubation) and Group 2 (LMA Protector). Achieving adequate depth of anaesthesia, the patients were either intubated or the LMA Protector was placed. The initial baseline measurements were recorded including tidal volume, peak inspiratory pressure (PIP), oropharyngeal leak pressure (OLP) and haemodynamic parameters. These measurements were repeated and recorded again following pneumoperitoneum and recovery from anaesthesia. At the mean age of 52.22 ± 13.90 years 77 patients were intubated and in 77 patients the LMA Protector was applied. Following insertion of the airway device and pneumoperitoneum, the heart rate was higher in the intubation group. In the LMA Protector group OLP measures were found to be statistically similar. The mean Brimacombe fibreoptic visualisation score was 2.12 ± 0.58 and the rate of requirement of optimisation was 15% in the LMA Protector group. With high OLP, better haemodynamic parameters and low laryngeal view scores, we concluded that the LMA Protector can be used safely in patients undergoing laparoscopic surgery.

LMA PROSEAL: AN ALTERNATIVE TO ENDOTRACHEAL IN- TUBATION IN OPEN APPENDECTOMY OPERATION.' IN THE DEPARTMENT OF ANESTHESIOLOGY, MEDICAL COLLEGE, KOLKATA

INTRODUCTION One of the important responsibilities of an Anaesthesiologist is to maintain a patent airway during any surgical procedure. Since the early days of Anaesthesia, various efforts have been made to dispel the problem of airway maintenance. AIMS AND OBJECTIVES The study entitled “LMAProSeal: An alternative to endotracheal intubation in open appendicectomy operation” was conducted with the aims to compare the efcacy of LMA ProSeal and Endotracheal Tube in patients undergoing Open Appendectomy under General Anaesthesia. MATERIALAND METHODS Study Area: This study was conducted in Medical College, Kolkata (West Bengal), under the department of Anaesthesiology in General Surgery Operation Theatre (C. B. Top OT/ Green OTComplex), after clearance from the Hospital ethical committee, during the period from 1st may 2013 to 31st January 2014. Awritten informed consent was taken from all patients included in the study. StudyPopulation:Patients postedforopenAppendicectomyoperationwithBMIbetween18.50–24.99kg/m2andbodyweightbetween30—60kg. Sample Size: 100 RESULTS AND OBSERVATIONS The effects were observed by monitoring heart rate, blood pressure and SPO2 preoperatively (as baseline), after intubation or placement of LMAProSeal at 1 min, 3 mins, 5mins and every 5 mins thereafter till the reading at removal of the device. For both the groups baseline ETCO2 was taken from connection of ETCO2 cable following placement of airway devices. SUMMARY AND CONCLUSION The study revealed that both the airway devices (ET tube and LMA ProSeal) were successful in operative procedure (open appendicectomy) in all the patients without any signicant complication. In experienced hands and following a strict protocol of insertion, the LMA ProSeal can prove to be an efcient and safe alternative to endotracheal tube for airway management of elective patients undergoing laparotomy procedure like open appendicectomy.

Comparison of hemodynamic and Ventilator parameters with i-gel vs endotracheal tube in patients for laparoscopic cholecystectomy

Comparison of hemodynamic and Ventilator parameters with i-gel vs endotracheal tube in patients for laparoscopic cholecystectomy

Efficacy of Baska mask as an alternative airway device to endotracheal tube in patients undergoing laparoscopic surgeries under controlled ventilation.

Background and Aims:Newer supraglottic devices with an additional gastric channel offer greater protection from aspiration and avoidance of laryngoscopy for their insertion would result in attenuated hemodynamic responses.The primary objective was to assess hemodynamic responses to insertion of Baska mask as compared to tracheal intubation. The time and attempts taken to secure airway and evidence of regurgitation and pulmonary aspiration of gastric contents were also assessed.Material and Methods:This prospective, randomized study was conducted in 80 patients undergoing laparoscopic cholecystectomy. All patients received standardized anaesthesia protocol. Baska mask was used to secure airway in Group B, while tracheal intubation was done in group T. Methylene blue was injected through Ryle's tube into stomach in both groups. At end of surgery, fibreoptic bronchoscopy was performed to detect bluish staining of trachea and/or main bronchi as evidence of aspiration of gastric contents and bluish staining in oropharynx as evidence of regurgitation. Chi-square test and Independent sample t-test were applied.Results:The time taken to secure airway was significantly longer in Group B as compared to Group T (45.3 ± 12.6 vs. 24.3 ± 9.1 sec) Percentage of patients who had oropharyngeal blue stain was comparable in both groups. No patient in both groups had tracheal blue stain. Group T had significantly higher HR and MAP after intubation till 10 min later.Conclusion:Baska mask insertion was associated with attenuated hemodynamic responses, though more time and attempts were required for securing the airway. It could be considered as an alternative to tracheal intubation during laparoscopic surgeries.

Comparison of oxygenation and ventilation parameters between proseal laryngeal mask airway and endotracheal tube in patients undergoing laparoscopic surgeries: a prospective observational study

Introduction: Use of endotracheal tube (ETT) has many limitations. There is a need for an airway device with similar safety and good side effect profile. In this prospective observational study, the oxygenation and ventilation parameters between patients who were inserted Proseal laryngeal mask airway (PLMA) or ETT for laparoscopic surgeries were compared. Materials and Methods: After ethical committee approval, informed consent was obtained from sixty patients (thirty in each group) posted for elective laparoscopic surgery. Following induction of general anaesthesia and paralysis, PLMA or ETT was inserted and pressure control mode was used for ventilation. The following parameters were measured: a. Oxygen saturation and changes in FiO2 needed to ensure a target SpO2> 95%, EtCO2 and changes in respiratory rate and inspiratory pressure needed to ensure a target EtCO2 between 35-45 mmHg. b. Insertion characteristics of airway device and gastric tube, hemodynamic responses, incidence of complications. Statistical Analysis: Chi-square test was used to analyze qualitative data. Independent t test was used to assess quantitative variables. Repeated measures ANOVA was used to compare the outcome measures over time adjusted for duration of surgery and anaesthesia. P values Results: Both groups were comparable with respect to age, gender and weight. Oxygenation and ventilation parameters achieved with both ETT and PLMA were comparable and satisfactory. Haemodynamic parameters increased significantly in ETT group compared to PLMA group during airway insertion and removal. Also, postoperative sore throat was comparatively less in the PLMA group. Conclusion: Hence we conclude that PLMA may be considered as an alternative to ETT in airway management of patients undergoing laparoscopic surgeries with comparable oxygenation and ventilation parameters and improved side effect profile. Keywords: Endotracheal tube, Proseal laryngeal mask airway, Laryngoscopy, Pneumoperitoneum.

Effect of Perioperative Subglottic Secretion Drainage on Ventilator-Associated Pneumonia After Cardiac Surgery: A Retrospective, Before-and-After Study

Although postoperative subglottic secretion drainage prevents ventilator-associated pneumonia (VAP) after cardiac surgery, its role during the perioperative period is unclear. For the present study, the effect of subglottic secretion drainage during and after cardiac surgery on postoperative VAP was investigated. Retrospective, single-center, before-and-after study. Perioperative care of cardiac surgical patients in a tertiary university hospital. Adult patients who underwent cardiac surgery from January 2013-December 2018. Conventional and subglottic suctioning endotracheal tubes were used in the control and intervention groups before and after a change in institutional policy, respectively. In the intervention group, subglottic secretion drainage was performed continuously during surgery and intermittently after surgery. The risk of postoperative VAP, identified by the National Healthcare Safety Network surveillance definition algorithm, was compared by weighted logistic regression. Logistic regression analyses, with propensity score matching and inverse probability weighting, also were performed. A total of 2,576 patients were analyzed (control [n = 2108]; intervention [n = 468]). Postoperative VAP occurred less frequently in the intervention group (1/468 [0.2%]) compared with the control group (30/2,108 [1.4%]). In the multivariate weighted logistic regression analysis, the risk of VAP after cardiac surgery was significantly lower in the intervention group than in the control group (odds ratio 0.29; 95% confidence interval 0.14-0.58). Similar results were obtained in multivariate analyses after propensity score matching (odds ratio 0.04; 95% confidence interval 0.01-0.14) and inverse probability weighting (odds ratio 0.16; 95% confidence interval 0.05-0.42). Routine perioperative subglottic secretion drainage using subglottic suctioning endotracheal tubes in patients undergoing cardiac surgery was associated with a reduction in the risk of VAP after surgery.

Molecular characterization of methicillin-resistant Staphylococcus aureus clinical strains from the endotracheal tubes of patients with nosocomial pneumonia

BackgroundAmong all cases of nosocomial pneumonia, Staphylococcus aureus is the second most prevalent pathogen (17.8%). In Europe, 29.9% of the isolates are oxacillin-resistant. The changing epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) nosocomial infections and the decreasing susceptibility to first-line antibiotics leave clinicians with few therapeutic options. The objective of our study was to determine the antimicrobial susceptibility, the associated molecular mechanisms of resistance and the epidemiological relatedness of MRSA strains isolated from the endotracheal tubes (ETT) of intubated critically ill patients in the intensive care unit (ICU) with nosocomial pneumonia caused by Staphylococcus aureus.MethodsThe antimicrobial susceptibility to vancomycin, linezolid, ciprofloxacin, clindamycin, erythromycin, chloramphenicol, fusidic acid, gentamicin, quinupristin-dalfopristin, rifampicin, sulfamethoxazole/trimethoprim, and tetracycline were measured. Resistance mechanisms were then analyzed by polymerase chain reaction and sequencing. Molecular epidemiology was carried out by multi-locus sequence typing.ResultsS. aureus isolates were resistant to ciprofloxacin, erythromycin, gentamicin, tetracycline, clindamycin, and fusidic acid. The most frequent mutations in quinolone-resistant S. aureus strains were S84L in the gyrA gene, V511A in the gyrB gene, S144P in the grlA gene, and K401R/E in the grlB gene. Strains resistant to erythromycin carried the ermC, ermA, and msrA genes; the same ermC and ermA genes were detected in strains resistant to clindamycin. The aac(6′)-aph(2″) gene was related to gentamicin resistance, while resistance to tetracycline was related to tetK (efflux pump). The fusB gene was detected in the strain resistant to fusidic acid. The most frequent sequence types were ST22, ST8, and ST217, which were distributed in four clonal complexes (CC5, CC22, CC45, and CC59).ConclusionsHigh levels of resistance to second-line antimicrobials threatens the treatment of nosocomial respiratory infections due to methicillin-resistant S. aureus with decreased susceptibility to linezolid and vancomycin. The wide genotypic diversity found reinforces the central role of ICU infection control in preventing nosocomial transmission.

Malposition of the endotracheal tube in patient with facial trauma

Malposition of the endotracheal tube in patient with facial trauma

Fibreoptic Orotracheal Intubation of Obese Patients Using Parker Flex-Tip vs. Standard Endotracheal Tube.

Advancement of the endotracheal tube through a fibreoptic scope can sometimes prove to be challenging in obese patients. The Parker Flex-Tip endotracheal tube was developed with a curved and tapered distal tip to facilitate easier placement in the trachea. This study examined the use of the Parker Flex-Tip tube as compared to standard endotracheal tubes in patients with a body mass index of 30 or greater. Sixty patients undergoing surgery requiring general anaesthesia were randomised into two groups. Using the fibreoptic scope, one group was intubated with the Parker Flex-Tip tube and the other group with a standard polyvinyl Portex tube. The time for intubation and the number of attempts required to place the endotracheal tube were measured and recorded. Using the Mann-Whitney U rank sum test, the median time needed for intubation with the two types of endotracheal tubes did not show a significant difference. The chi-square analyses were conducted for the number of attempts needed to place the endotracheal tubes, which also did not demonstrate any significant difference. Parker Flex-Tip endotracheal tube was not superior to the standard endotracheal tubes for fibreoptic intubation in obese patients.