Endotracheal Tube Suction Research Articles

Peyton’s Four- steps Approach Influence on Critical Nursing Students' Performance, Self-efficacy and Satisfaction Regarding Endotracheal Tube Suctioning.

Peyton’s Four- steps Approach Influence on Critical Nursing Students' Performance, Self-efficacy and Satisfaction Regarding Endotracheal Tube Suctioning.

Performance of a hybrid capture-based target enrichment next-generation sequencing for the identification of respiratory pathogens and resistance-associated genes in patients with severe pneumonia.

Severe pneumonia remains the leading infectious cause of death worldwide. The time-consuming nature and suboptimal sensitivity of sputum cultures hamper prompt pathogen detection for tailored treatments. Advanced techniques such as polymerase chain reaction (PCR) and next-generation sequencing (NGS) offer rapid genetic pathogen detection and identification of antimicrobial resistance (AMR) genes. However, the performance of hybrid capture-based target enrichment NGS, e.g., Respiratory Pathogen ID/AMR Enrichment Panel (RPIP), for pathogen detection in patients with severe pneumonia remains uncertain. A prospective study involving adults with severe pneumonia was conducted. Respiratory samples from the lower respiratory tract were collected via bronchoalveolar lavage, bronchial washing, or endotracheal tube suction. The performance of RPIP in pathogen and AMR-associated gene detection was compared to that of conventional culture methods and the multiplex PCR-based FilmArray Pneumonia Panel (FilmArray-PN). A total of 83 subjects were enrolled. The most prevalent pathogens detected by RPIP were Rothia mucilaginosa, Stenotrophomonas maltophilia, Pseudomonas aeruginosa; herpes simplex virus-1, cytomegalovirus, and Epstein-Barr virus, and Pneumocystis jirovecii. Overall, the positive and negative agreement rates for bacterial detection were 63.6% and 97.5% between RPIP and culture methods, respectively, and 55.8% and 99.4% between FilmArray-PN and culture methods, respectively. Compared to FilmArray-PN, RPIP exhibited significantly better detection rates for bacteria (P = 0.029), viruses (P < 0.001), and fungi (P < 0.001) and identified additional blaOXA, blaCMY as extended-spectrum β-lactamase genes and blaOXA, blaSHV as carbapenemase genes. In conclusion, RPIP can sensitively profile respiratory pathogens and is a promising tool for detecting multiple microorganisms and AMR-associated genes in patients with severe pneumonia.IMPORTANCESensitive pathogen detection is pivotal for timely treatment by tailoring adequate antimicrobial agents. Unlike conventional phenotypic approach, novel measures using molecular interrogation appear promising. This study aimed to elucidate the efficacy of a hybrid capture-based target enrichment next-generation sequencing technique (Respiratory Pathogen ID/AMR Enrichment Panel, RPIP) as exemplified in a cohort with severe pneumonia. Pathogen landscape in the population was illustrated by these three methodologies. As compared with multiplex polymerase chain reaction-based FilmArray Pneumonia Panel and conventional culture, RPIP demonstrated significantly improved sensitivity in identifying bacteria, viruses, and fungi. The RPIP also exhibited better performance in identifying different pathogens in patients co-infected with multiple microorganisms. Additionally, the genotypes contributing to antimicrobial resistance were determined by RPIP. The study facilitated the implementation of molecular diagnosis by presenting real-world data, whereas future studies are mandated to generalize such an approach toward different clinical settings.

Pharmacokinetics and Safety of Endotracheal Lidocainefor Endotracheal Intubation in Critically Ill Children.

Critically ill pediatric patients are endotracheally intubated in pediatric intensive care units for a variety of illnesses and indications. Management of an endotracheal tube (ETT) requires suctioning to remove patient secretions and prevent occlusion, but this practice can be associated with adverse events, such as hemodynamic deterioration or increases in intracranial pressure. Instillation of lidocaine into the ETT before suctioning may be beneficial in preventing these events. The purpose of this phase I, fixed-dose, open-label pharmacokinetic and safety study, conducted in endotracheally intubated and mechanically ventilated infants and children requiring ETT suctioning, was to determine the serum concentrations and safety of lidocaine after ETT administration. A total of 21 infants and children meeting inclusion criteria received a single dose of ETT lidocaine per institutional protocol. Blood samples were obtained pre-dose and at 5, 10, 30, and 120 minutes after administration for serum concentration analysis. Lidocaine dosing was driven by weight and age, with infants and children aged > 38 weeks' estimated gestational age and <3 years receiving 0.5 mg/kg/dose (maximum: 20 mg/dose) and children aged 3-18 years receiving 1mg/kg/dose (maximum: 100 mg/dose). No subjects aged <3 years had detectable serum lidocaine concentrations. Four subjects in the group aged ≥ 3 years had detectable serum lidocaine concentrations at 5, 10, and/or 30 minutes, but no serum concentrations were within the toxic range. No adverse effects, such as cough, bronchospasm, seizure activity, or clinically significant depression of cardiac or respiratory function, were noted in any subjects. Pharmacokinetic sampling showed that only 4 of 21 subjects had detectable serum lidocaine concentrations and none were within the toxic range. The safety of ETT administration of lidocaine in endotracheally intubated infants and children requiring ETT suctioning was demonstratedat the doses used in this study. The study was conducted at Norton Children's Hospital. The research team confirmed that this study was not registered with clinicaltrials.gov.

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

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

Development and Safety Trial of the OstreaVent2™ Prototype for Mechanically Ventilated Adult Patients.

With the surge of COVID-19 infections, there were concerns about shortage of mechanical ventilator in several countries including the Philippines. To transform a locally made, low-cost, neonatal ventilator into a volume- and pressure-controlled, adult ventilator and to determine its safe use among ventilated, adult patients at the Philippine General Hospital. The modification of the neonatal ventilator (OstreaVent1) to the adult OstreaVent2 was based on the critical need for adult ventilators, in volume or pressure mode, in the Philippines due to the COVID-19 pandemic. The adult ventilator settings were calibrated and tested for two days to check for consistency and tolerance and then submitted to a third party for certification. Once certified, a safety trial of 10 stable adult patients on mechanical ventilator was conducted. The patients were placed on the OstreaVent2 for four hours while ventilator parameters, patient's vital signs, and arterial blood gases were monitored at baseline, during, and after placement on the OstreaVent2. A post-study chest radiograph was also done to rule out pulmonary complications, particularly atelectasis and pneumothorax. The prototype OstreaVent2 received an FDA Certification for Medical Listing after passing its third-party certification. Ten patients (60% male) recruited in the study had a mean age of 39.1 ± 11.6 years. Half of the patients had a diagnosis of non-COVID-19 pneumonia. During the 4-hour study period, the patients while on the OstreaVent2, had stable ventilator settings and most of the variabilities were within the acceptable tolerances. Vital signs were stable and arterial blood gases were within normal limits. One patient developed alar flaring which was relieved by endotracheal tube suctioning. No patient was withdrawn from the study. One patient who was already transferred out of the ICU subsequently deteriorated and died three days after transfer to the stepdown unit from a non-ventilator related cause. The new OstreaVent2 is safe to use among adults who need ventilator support. Variabilities in the ventilator's performance were within acceptable tolerances. Clinical and blood gas measurements of the patients were stable while on the ventilator.

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

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

Risk of Bacterial Exposure to the Anesthesiologist's Face During Intubation and Extubation.

Anesthesiologists are exposed to the risk of infection from various secretions or droplets from the respiratory tract of patients. We aimed to determine bacterial exposure to anesthesiologists' faces during endotracheal intubation and extubation. Six resident anesthesiologists performed 66 intubation and 66 extubation procedures in patients undergoing elective otorhinolaryngology surgeries. Sampling was performed by swabbing the face shields twice in an overlapping slalom pattern, before and after each procedure. Samples for pre-intubation and pre-extubation were collected immediately after wearing the face shield at the time of anesthesia induction and at the end of the surgery, respectively. Post-intubation samples were collected after the injection of anesthetic drugs, positive pressure mask ventilation, endotracheal intubation, and confirmation of intubation success. Post-extubation samples were collected after endotracheal tube suction, oral suction, extubation, and confirmation of spontaneous breathing and stable vital signs. All swabs were cultured for 48 h, and bacterial growth was confirmed by colony forming unit (CFU) count. There was no bacterial growth in either pre- or post-intubation bacterial cultures. In contrast, while there was no bacterial growth in pre-extubation samples, 15.2% of post-extubation samples were CFU+ (0/66 [0%] vs 10/66 [15.2%], p=0.001). All the CFU+ samples belonged to 47 patients with post-extubation coughing, and the CFU count was correlated with the number of coughing episodes during the process of extubation (P < 0.01, correlation coefficient= 0.403). The current study shows the actual chance of bacterial exposure to the anesthesiologist's face during the patient awakening process after general anesthesia. Given the correlation between the CFU count and the number of coughing episodes, we recommend anesthesiologists to use appropriate facial protection equipment during this procedure.

The Effects of Tracheal Suction with N-acetylcysteine on Incidence of Ventilator-associated Pneumonia

Background: Correct endotracheal tube suction is one of the effective methods to prevent ventilator-associated infection. Many studies have reported that normal saline and N-acetylcysteine (NAC) in the trachea lead the translocation of bacteria to lower levels and increase the risk of pneumonia. Objectives: The present study sought to examine the effect of tracheal suction with NAC on the incidence of ventilator-associated pneumonia (VAP). Methods: This single-blind randomized clinical trial study was conducted on 60 patients admitted to the intensive care unit (ICU) of the Khatam Al-Anbia Hospital in Zahedan, Iran, in 2020. The patients were selected using the convenience sampling method and assigned into two intervention and control groups by permutation block randomization. Before the intervention, the patients were evaluated using the Modified Clinical Pulmonary Infection Score (MCPIS), and the patients with scores &lt; 5 on this scale were included in the study. Suctioning tracheal secretions in the intervention group was performed by pouring 2 cc of NAC into the tracheal tube during suction. The same suction procedure was performed for the patients in the control group by pouring 2 cc of normal saline into the tracheal tube in a standard way. The intervention was conducted for five days. After the intervention, the MCPIS scale was administered once more for the two groups. The collected data were analyzed using the independent samples t-test and chi-square test with SPSS software (version 25). Results: The independent samples t-test showed no significant difference between the intervention and control groups regarding the incidence of pneumonia (P = 0.31). Conclusions: Despite the effect of NAC on the incidence rate of pneumonia in patients under mechanical ventilation, there was no significant difference between NAC and normal saline in reducing the incidence of pneumonia. However, since NAC leads to no specific complication in patients, it can be safely used in the suction of tracheal lobule secretions in patients under ventilators. In this regard, further studies should examine the use of NAC for suctioning during tracheal tube obstruction by secretions.

Effectiveness of STP on Knowledge of Nursing Officers Regarding Endotracheal Tube Suctioning Working on Intensive Care Units of SKIMS Soura Srinagar, J&amp;K

Introduction: Endotracheal tubes have been used early in previous times and have evolved continuously to their present form. Franz Kuhn made significant contributions in the early 1900s. He was the first to stress the importance of the endotracheal tube as a route for removing pulmonary secretions from the bronchotracheal tree. The objectives of the study were to assess the pre and post-test knowledge of nursing officers regarding endotracheal tube suctioning. To find the association of pre-test knowledge scores of nursing officers regarding Endotracheal tube suctioning with their selected demographic variables (age in years, gender, professional qualification, place of posting, years of working experience, attended any in-service educational /training programme regarding endotracheal tube suctioning). Methodology Pre-experimental one-group pre-test post-test design was used to assess the effectiveness of a structured teaching program on the knowledge of 50 nursing officers regarding endotracheal tube suctioning working in ICUs of SKIMS Soura, Srinagar through purposive sampling technique. The tool used was Self structured questionnaire. Results The mean post-test knowledge score of the study subjects (42.84±4.419) was significantly higher than that of the mean pre-test knowledge score (31.52±6.309) at a 0.05 level of significance. There was a significant association between the pre-test knowledge score of study subjects with demographic variables like Age (P=0.004), professional qualification (P=0.000) and years of working experience (P=0.023) at 0.05 level of significance. Conclusion The nursing officers had average knowledge and practice regarding endotracheal tube suctioning. The structured teaching program was found to be effective in improving the knowledge and practice scores of study subjects, hence there was a need to educate them regarding endotracheal tube suctioning.

Closed versus open endotracheal tube suction in mechanically ventilated neonates: a randomized controlled trial

In a unit with a low incidence of VAP, the effect of the endotracheal suction method alone did not impact the occurrence of VAP in the study population. CTRI/2020/03/023679; Date: 17.02.2020. • Better physiological stability of the closed-suctioning method on short-term measures including noticeably fewer episodes of hypoxia, a smaller drop in TcPO2 levels, and less variability in heart rate and bradycardia episodes. • In a unit with a low incidence of VAP in the neonates, randomized control trial studying the effect of the endotracheal suction method alone did not impact the occurrence of VAP amongst the study population.

Effect of Competency Based Training Program on Nurses' Performance Regarding Endotracheal Tube Suction for Neonates on Mechanical Ventilator

Background: Clinical nursing competence is the capacity to apply care by integrating information, skills, attitude, beliefs, and experience. It reflects the nursing professional's feelings, ideas, and judgement. Aim: the study aimed to evaluate the effect of Competency Based Training Program on Nurses' Performance Regarding Endotracheal Tube Suction for Neonates on Mechanical Ventilator. Method: A quasi-experimental design was used to conduct the study at Neonatal Intensive Care Units (NICUs) and Surgical Neonatal Intensive Care Unit "SNICU" of Benha Specialized Pediatric Hospital. The study included 70 nurses who working in the previously mentioned setting. Tools: Researchers used five tools as; a structured interviewing questionnaire, an observational checklist, nurses' attitude questionnaire, Nurse Competence Scale, and nurses' opinion questionnaire. Results: Less than three quarters of studied nurses had good knowledge and the most of them had competent practice post competency-based training program. Also, the majority of nurses had positive attitude post competency-based training program and there was highly statistically significant difference in nurses' competence score pre and post competency-based training program. Conclusion: The implementation of the competency-based training program improved nurses' performance regarding endotracheal tube suction for neonates on mechanically ventilated. Recommendation: Develop periodic educational and training courses for nurses working at the neonatal intensive care units regarding care of endotracheal tube suction for neonates on mechanical ventilator. Further research should be done with large sample is recommended to ensure generalization of the results.

The Effect of Suction Endotracheal Tube on Oxygen Saturation of Respiratory Failure Patients

Respiratory failure can be characterized by a decrease in oxygen saturation. Oxygen saturation is the percentage of hemoglobin about oxygen in the arteries. Normal oxygen saturation is in the range of 95% - 100%. The cause of respiratory failure can occur due to pulmonary disorders such as pneumonia, sepsis, heart failure, or neurological disorders. Airway obstruction is a condition in which a person is unable to expel secretions effectively, this condition can lead to respiratory failure. Suction aims to free the airway, reduce the buildup of secretions, and prevent lung infections. This literature review is to determine the effect of endotracheal tube suction on the oxygen saturation of patients with respiratory failure. Search from scientific publications or research journals related to the effect of endotracheal tube suction on the oxygen saturation of patients with respiratory failure. Each scientific publication or research journal has been selected based on inclusion criteria. The results of the nine articles or journals analyzed showed that there was an effect of endotracheal tube suction on the oxygen saturation of patients with respiratory failure as indicated by the p-value &lt;0.05. There is an effect of endotracheal tube suction on the oxygen saturation of patients with respiratory failure.

Polymyxin flushes for endotracheal tube suction catheters in extremely low birth-weight infants: Any benefit in preventing ventilator-associated events?

We report that receipt of polymyxin B endotracheal tube suction catheter flushes did not reduce the incidence of pediatric ventilator-associated events (PedVAE) in infants weighing <1,000 g in this retrospective study. Incidence of PedVAE in our group of extremely low birth-weight infants was 6 per 1,000 ventilator days.

Question: Peripheral arterial pressure wave in the presence of ventricular asystole.

A 65-year-old man with no significant past medical history presented to the Emergency Department with respiratory failure. Investigations determined that this was secondary to COVID-19 pneumonia. He required intubation, mechanical ventilation, and was admitted to the intensive care unit. His admission was complicated with bacteraemia and ventilator-associated pneumonia, requiring treatment with intravenous antimicrobials and vasopressors. The Cardiology service was consulted on Day 22 of his admission for new recurrent episodes of sudden bradycardia and transient asystole, which occurred after position changes or endotracheal tube suctioning. Interrogation of telemetry recordings showed repeated episodes of sudden bradycardia and transient asystole of up to 12 s. These changes were in keeping with a vagal response pattern,1,2 with sudden prolongation of P-P and R-R intervals (Panel A) followed by complete atrioventricular block with no ventricular activation (Panel B) that spontaneously resolved after several seconds (Panel C). The review of concomitant radial arterial line tracing and O2 saturation reading revealed pressure waves and O2 saturation waves as shown in panels D, E, and F. Continuous telemetry is shown in Video 1.

Knowledge and Competence Towards Critical Care Concepts Among Final Year Medical Students and Interns: A Cross-Sectional Study.

PurposeCritical care knowledge constitutes an essential component in medicine. Unfortunately, ICU knowledge acquisition is limited in many medical schools. This study is intended to measure the knowledge background, gaps, and the confidence toward critical care concepts among final year medical students and interns at Umm Al-Qura University, Saudi Arabia.MethodsThis was a cross-sectional study using a self-administered online questionnaire completed by final-year medical students and interns during January and February 2022. We collected data on demographics, academic year, critical care knowledge, competency, and satisfaction.ResultsTwo-hundred-twenty-one (221) responses were analyzed. The male gender was 54.3%. A small proportion (15.8%) identified the lowest acceptable oxygen saturation in a normal person. Around three-quarters of the participants did not feel competent about nasal airway suctioning and endotracheal tube suctioning (65.6% and 75.6%, respectively). Only 7.2% of the responder correctly identified the three most useful physiological observations pertinent to quick SOFA criteria. Regarding the training adequacy for identifying critically ill patients, 59.3% answered that they are inadequately trained. Regarding the satisfaction level of exposure to critical care, 54% of the sample responded that they need further improvement.ConclusionUndergraduate students and interns have limited knowledge and confidence in critical care medicine. Thus, we highly recommend an early institution of a dedicated critical care training module in the medical school curriculum.

Future Trends in the Treatment of MRSA in Pakistan

&#x0D; Background: The Methicillin resistant Staphylococcus aureus (MRSA) is accountable for community and hospital acquired infections. Due to over and misuse of antibiotics, MRSA isolates are becoming multidrug resistant even with linezolid and vancomycin. The objective of this study was to determine recent antimicrobial profile of MRSA, isolated from different clinical samples and current treatment options for MRSA, other than vancomycin and Linezolid.&#x0D; Methodology: This cross-sectional study was conducted at Foundation university medical college from Jan 2019 to Dec 2020. Total 918 samples of blood, pus swab, throat swab, tracheal swab, wound swab, endotracheal tube (ETT) tips, Catheter tips, axillary swab and suction tips received by using aseptic techniques, for culture and sensitivity in different hospitals of Rawalpindi and Islamabad, were taken. Isolated pathogens were identified using standard protocols and susceptibility testing was done by Kirby-Bauer disc diffusion method.&#x0D; Results: Out of 918 samples, MRSA was isolated in 96 (10.4%) samples and most frequently observed in 27% (n=26) blood samples. The mean age of enrolled patients was 52.02 (SD±16.1) years, the infection was largely seen in age group 46-55(24%) and in 57% (n=52) male population. MRSA showed higher resistance to levofloxacin 78.1% (n=75), ciprofloxacin 75% (n=72), erythromycin 70.8% (n=68) and gentamycin 62.5% (n=60). The susceptibility of older drug chloramphenicol and Trimethoprim-sulfamethoxazole was found 61% &amp; 49% respectively. MRSA isolates were highly susceptible to vancomycin (96.8%), linezolid (89.5%) and teicoplanin (70.85%). Alarmingly, 2.1% (n=2) MRSA isolates showed resistance to vancomycin.&#x0D; Conclusion:Vancomycin resistant MRSA is a matter of great concern, because of unawareness among health administrative departments and public, self-medication, lack of surveillance system and non-availability of antibiotic policy. &#x0D; Keywords: Antibiotics, MRSA, Vancomycin, Chloramphenicol&#x0D;

Optic Nerve Sheath Viscoelastic Properties: Re-Examination of Biomechanical Behavior and Clinical Implications.

Meta-analyses show a variable relationship between optic nerve sheath diameter (ONSD) and the presence of raised intracranial pressure (ICP). Because optic nerve sheath (ONS) tissue can be deformed, it is possible that ONSD reflects not only the current ICP but also prior deforming biomechanical exposures. In this post hoc analysis of two published data sets, we characterize ONS Young's modulus (E, mechanical stress per unit of strain) and calculate threshold pressure for plastic deformation. The authors of two previously published articles contributed primary data for these unique post hoc analyses. Human cadaveric ex vivo measurements of ONSD (n = 10) and luminal distending pressure (range 5 to 65mm Hg) were used to calculate E and the threshold pressure for plastic deformation. Clinical in vivo measurements of ONSD and ICP during endotracheal tube suction from patients with traumatic brain injury (n = 15) were used to validate the ex vivo cadaveric findings. Ex vivo ONS estimate of E was 140 ± 1.3mm Hg (mean ± standard error), with evidence of plastic deformation occurring with distending pressure at 45mm Hg. Similar E (71 ± 10mm Hg) was estimated in vivo with an average ICP of 34 ± 2mm Hg. Ex vivo, ONS plastic deformation occurs at levels of pressure commonly seen in patients with raised ICP, leading to distortion of the ICP-ONSD relationship. This evidence of plastic deformation may illustrate why meta-analyses fail to identify a single threshold in ONSD associated with the presence of raised ICP. Future studies characterizing time-dependent viscous characteristics of the ONS will help determine the time course of ONS tissue biomechanical behavior.

Inter-Professional-Compassionate pain management during endotracheal suctioning: a valuable lesson from a Chinese surgical intensive care unit

Abstract Objective To compare the effects of a pain management program and routine suctioning methods on the level of pain presence and agitation in Chinese adults admitted to the intensive care unit. To disseminate the results from the implementation of the evidence-informed pain management interventions for reducing pain presence and agitation during endotracheal tube suctioning (ETS) and translate the key finding to clinical nursing practice. Methods A quasi-experimental study of a two-group post-test design was conducted in adults admitted after surgery to a surgical intensive care unit (SICU) of the Second Affiliated Hospital of Kunming Medical University, Yunnan, China in 2018. Fifty-two adults who met the study eligibility were included after consent, 26 in each group. Patients in the control group received usual care while patients in the intervention group received interventions to reduce agitation and pain-related ETS. The impacts of the intervention on the level of pain presence and agitation were measured at 5 measuring time points using the Chinese versions of Critical-Care Pain Observation Tool (CPOT) and Richmond Agitation Sedation Scale (RASS). Results The level of pain presence in the intervention group statistically significantly decreased during, immediately after, and 5 min after suctioning. The level of agitation in the intervention group significantly decreased during and immediately after suctioning. Conclusions The findings provide support for the positive pain-relieving effects of the evidence-informed pain-related ETS management interventions when compared with the usual ETS practice. The study interventions were sufficiently effective and safe to maintain patent airway clean and patent as standardized suctioning and helps pain relief. So, evidence-based pain-related ETS management intervention is worthy of recommending to utilize in SICU patients as well as other patients who required suctioning. It is worth noting that integrating pre-emptive analgesia prescription and administration with non-pharmacological intervention plays a critical role in achieving pain relief.

Assessment of a standardized EEG reactivity protocol after cardiac arrest

ObjectiveReactivity assessment during EEG might provide important prognostic information in post-anoxic coma. It is still unclear how best to perform reactivity testing and how it might be affected by hypothermia. Our primary aim was to determine and compare the effectiveness, inter-rater reliability and prognostic value of different types of stimulus for EEG reactivity testing, using a standardized stimulation protocol and standardized definitions. Our secondary aims were to assess the effect of hypothermia on these measures, and to determine the prognostic value of a simplified sequence with the three most efficient stimuli. MethodsProspective single-center cohort of post-anoxic comatose patients admitted to the intensive care unit of an academic medical center between January 1, 2016 and December 31, 2018 and receiving continuous EEG monitoring (CEEG). Reactivity was assessed using standardized definitions and standardized sequence of stimuli: auditory (mild noise and loud noise), tactile (shaking), nociceptive (nostril tickling, trapezius muscle squeezing, endotracheal tube suctioning), and visual (passive eye opening). Gwet’s AC1 and percent agreement (PA) were used to measure inter-rater agreement (IRA). Ability to predict favorable neurological outcome (defined as a Cerebral Performance Category of 1 to 2: no disability to moderate disability) was measured with sensitivity (Se), specificity (Sp), accuracy, and odds ratio [OR]. These were calculated for each stimulus type and at the level of the entire sequence comprising all the stimuli. ResultsOne-hundred and fifteen patients were included and 242 EEG epochs were analyzed. Loud noise, shaking and trapezius muscle squeezing most frequently elicited EEG reactivity (42%, 38% and 38%, respectively) but were all inferior to the entire sequence, which elicited reactivity in 58% cases. The IRA for reactivity to individual stimuli varied from moderate to good (AC1:58–69%; PA:56–68%) and was the highest for loud noise (AC1:69%; PA:68%), trapezius muscle squeezing (AC1:67%; PA:65%) and passive eye opening (AC1:68%; PA:64%). Mild (odds ratio [OR]:11.0; Se:70% and Sp:86%) and loud noises (OR:27.0; Se:73% and Sp:75%), and trapezius muscle squeezing (OR:15.3; Se:76% and Sp:83%) during hypothermia had the best predictive value for favorable neurological outcome, although each was inferior to the whole sequence (OR:60.2; Se:91% and Sp:73%). A simplified sequence of loud noise, shaking and trapezius muscle squeezing had the same performance for predicting neurological outcome as the entire sequence. Hypothermia did not significantly affect the effectiveness of stimulation, but IRA was slightly better during hypothermia, for all stimuli. Similarly, the predictive value was higher during hypothermia than during normothermia. ConclusionsDespite a standardized stimulation protocol and standardized definitions, the IRA of EEG reactivity testing in post-anoxic comatose patients was only good at best (AC1 < 70%), and its predictive value for neurological outcome remained imperfect, in particular with Sp values < 90%. While no single stimulus appeared superior to others, a full sequence using all stimuli or a simplified sequence comprising loud noise, shaking and trapezius muscle squeezing had the best combination of IRA and predictive value. SignificanceThis study stresses the necessity to use multiple stimulus types to improve the predictive value of reactivity testing in post-anoxic coma and confirms that it is not affected by hypothermia.

Airway gas temperature within endotracheal tube can be monitored using rapid response thermometer

Inappropriate preparation of respiratory gases is associated with serious complications during mechanical ventilation. To develop a temperature monitoring system of respiratory gases within the endotracheal tube, four newborn piglets were studied using an ultra-rapid-response thermometer attached to the closed endotracheal tube suction system. Respiratory gas temperatures were monitored at the mouth-corner level of the endotracheal tube using three thermocouples (Tairway, inserted into the endotracheal tube via the closed suction system; Ttube_centre and Ttube_wall, embedded within the endotracheal tube 0.5 mm and 1.6 mm from the tube wall, respectively). Univariate analysis showed that inspiratory Ttube_centre and inspiratory Ttube_wall were positively correlated with inspiratory Tairway (both p < 0.001). Multivariate analysis showed the dependence of inspiratory Tairway on inspiratory Ttube_centre and Ttube_wall and deflation of endotracheal tube cuff (p < 0.001, p = 0.001 and p = 0.046, respectively). Inspiratory gas temperature within the endotracheal tube can be monitored using a thermometer attached to the closed endotracheal tube suction system. Our system, with further validation, might help optimise respiratory gas humidification during mechanical ventilation.