Extubation In Group Research Articles

OR Extubation of Liver Transplant (LT) Patients is Associated with Significantly Less Blood Transfusion During Surgery, Acute Renal Failure and Bacterial Infection, and Shorter Hospital and ICU Stay

A retrospective analysis of our data was performed to determine the rate of OR extubation after liver LT. The records of 194 patients who underwent LT from January 2005 to December 2017 were reviewed retrospectively. We excluded 81 patients due to retransplantation (15), combined liver and kidney transplantation (17), liver emergency (20), Living donor LT (16) or patients with perioperative mortality within 7 days after surgery (13). Finally, we compared the main immediate postoperative complications in the extubation group (n = 36) versus the group with delayed extubation (n = 77) in the same period. The rate of OR extubation (group A) vs ICU extubated patients (group B) increased significantly from 4.3% during our first transplant era (years 2005-2012, n=46) to 50.7% during the second era (2013-2017, n=67). Both groups were similar in age, sex, body mass index and cause of liver failure. Average MELD score was significantly lower for group A (18.5 vs. 24.1, p=0.013). Group A vs group B patients respectively had significantly less need for blood transfusion in average (1.8 vs 5.2 packed red blood cells, p<0.001), lower bacterial infection rate (20.8% vs 45.5%, p=0.035), shorter average ICU stay (4.3 vs 9.7 days p=0,005), shorter average total hospitalization (10.9 vs 17.1 days, p=0.04) and lower acute renal failure rate (40% vs 68,8%, p=0.04). A subanalysis was performed for patients with a MELD score ≤ 20. Group A patients (n=25) had a significantly shorter average ICU stay (3.6 days vs. 12 days, p=0.009), shorter total average hospital stay (11.3 days vs. 22 days, p=0.04) and a significantly lower rate of bacterial infection (24% vs. 54.8%, p=0.02). There was less need for transfusion of red blood cell concentrate in average for group A (1.5 vs. 4.3 units, p<0.001).

Bilateral Erector Spinae Plane Block for Acute Post-Surgical Pain in Adult Cardiac Surgical Patients: A Randomized Controlled Trial

To examine the analgesic efficacy of bilateral erector spinae plane (ESP) block compared with conventional treatment for pain after cardiac surgery in adult patients. A prospective, randomized, controlled, single-blinded study. Single-center tertiary teaching hospital. One hundred and six adult patients undergoing elective cardiac surgery with cardiopulmonary bypass. Patients were randomized into 2 groups. Patients in group 1 (ESP block group, n = 53) received ultrasound-guided bilateral ESP block with 3mg/kg of 0.375% ropivacaine before anesthesia induction at the T6 transverse process level. Patients in group 2 (paracetamol and tramadol group, n = 53) received paracetamol (1 gm every 6 hours) and tramadol (50mg every 8 hours) intravenously in the postoperative period. The primary study outcome was to evaluate pain at rest using an 11-point numeric rating scale (NRS). Mann-Whitney U test was used for comparing NRS scores. The postoperative pain level after extubation and duration of analgesia during which NRS was <4 of 10 was compared between the groups. The median pain score at rest after extubation in group 1 was 0 of 10 until hour 6, 3 of 10 at hour 8, and 4 of 10 at hours 10 and 12 postextubation. These were significantly less in comparison with group 2 (p = 0.0001). Patients in group 1 had a significantly higher mean duration of analgesia (8.98 ± 0.14 hours), during which NRS was < 4 of 10, compared with group 2 (4.60 ± 0.12 hours) (p = 0.0001). ESP block safely provided significantly better pain relief at rest for longer duration as compared to intravenous paracetamol and tramadol.

Use of electronic critical care flow sheet data to predict unplanned extubation in ICUs

This study utilized critical care flow sheet data to develop prediction models for unplanned extubation. A total of 5180 patients with 5412 cases of endotracheal tube extubation treated in a tertiary care teaching hospital were evaluated. A total of 60 extubation cases were classified as unplanned, and 5352 as planned. Features documented in the critical care flow sheet for the 24 h prior to extubation were grouped into those with recording frequencies ≤3 and >3. The nearest values to the extubation were identified for all features. For features recorded >3 times, the maximum, minimum, mean, and recording frequencies were calculated. Univariate analyses were performed to select features for inclusion in multivariate analyses. Three multivariate logistic regression models were compared. Model 1 contained only the nearest value, Model 2 added a recording frequency, and Model 3 replaced the nearest value with the maximum, minimum, or mean that had the highest effect size for each feature recorded >3 times.Univariate analyses showed that 18 features differed significantly between the unplanned extubation and control groups. These included vital signs (e.g., pulse and respiration rates, body temperature), ventilator parameters (e.g., minute volume, peak pressure), and consciousness indicators (e.g., Glasgow coma scale score, Richmond agitation sedation scale score, motor power). On all three multivariate analyses, the Glasgow coma scale score, pulse rate, and peak pressure were statistically significant. The frequency of patient positioning (Model 2) and the minimum respiration rate (Model 3) were also significant. Area under the curve, sensitivity, and positive and negative predictive values improved slightly from Model 1 to Model 2 and from Model 2 to Model 3.This study found that minute volume, peak pressure, and motor power are significant risk factors for unplanned extubation that have not been previously reported. Recording frequency, which reflects how often nursing activities were provided, was also a useful predictor. The indicators identified in this study may help to predict and prevent unplanned extubation in clinical settings.

Early extubation is associated with improved early outcome after extracardiac total cavopulmonary connection independently of duration of cardiopulmonary bypass

Strict patient selection, short cardiopulmonary bypass (CPB) time and short mechanical ventilation are well-recognized aspects of optimizing the postoperative course after total cavopulmonary connection. In this study, we evaluated the influence of our early postoperative extubation strategy in our population of Fontan patients over the past 2 decades. Early postoperative course was evaluated retrospectively in 211 consecutive patients, who were selected for total cavopulmonary connection in our institution between 1995 and 2015. We analysed postoperative haemodynamic parameters and early outcome after surgery (mortality and length of hospital stay) according to preoperative patient characteristics, duration of CPB and duration of mechanical ventilation. To investigate the influence of mechanical ventilation, the cohort was subdivided into a 'fast-track' extubation group (≤6 h ventilation, n = 59) and a prolonged ventilation group (>6 h ventilation, n = 152). In the entire cohort, duration of CPB did not correlate with duration of mechanical ventilation (P = 0.1), and it did not differ between both groups (P = 0.3). Patients in the fast-track group showed significantly better haemodynamics with higher mean arterial pressure and lower mean pulmonary artery pressure at 6, 24 and 48 h postoperatively when compared with the prolonged ventilation group (P = 0.02-0.001). In multivariable analysis, longer mechanical ventilation, but not duration of CPB, was independently associated with length of hospital stay. Early weaning from mechanical ventilation correlates with improved early Fontan haemodynamics, whereas early outcome is unrelated to duration of CPB. This indicates that early extubation may represent a principal strategy for improving early results after total cavopulmonary connection.

Dexmedetomidine infusion as an analgesic adjuvant during laparoscopic \u0441holecystectomy: a randomized controlled study

BackgroundDexmedetomidine (DEX) has sedative, sympatholytic and analgesic effects and might be beneficial if used as an adjuvant to: improve analgesia; modulate haemodynamic responses to intubation and pneumoperitoneum and; reduce the number of opioid-associated adverse events. The aim of this study was to evaluate the efficacy and safety of DEX infusion during elective laparoscopic cholecystectomy (LC).MethodsA randomized, single-centre, parallel-group, placebo-controlled study was carried out between May 2016 and June 2017. Adult patients (18–79 years) with American Society of Anesthesiology (ASA) physical status I–II were randomly assigned to 0.5 μg/kg/h DEX infusion from induction of anaesthesia to extubation (Group D; n = 30) or normal saline infusion (Group C; n = 30). The primary efficacy outcomes were postoperative morphine consumption. Secondary efficacy outcomes included: time to first use of rescue analgesia; postoperative morphine consumption; intraoperative fentanyl consumption; time from end of surgery to extubation; lengths of intensive care unit (ICU) and general ward stay; degree of postoperative pain 3, 6, 12 and 24 h after surgery; incidence of persistent post-surgical pain.ResultsDEX infusion was associated with a decrease in postoperative morphine consumption (p = 0.001), lower incidence of severe postoperative pain (odds ratio [OR] 9, 95% confidence interval [CI] 1.1–77, p = 0.04) and significantly longer time to first use of rescue analgesia (p = 0.001). Group D also had significantly lower fentanyl consumption both intraoperatively (p = 0.001) and in the time from end of surgery to extubation (p = 0.001) plus decreased incidence of persistent post-surgical pain (OR 14.5, 95% CI 1.7–122, p = 0.005). The incidence of postoperative nausea and vomiting was lower in Group D than Group C (OR 5, 95% CI 1.1–26, p = 0.005). Median pain intensity did not differ between the groups 3, 6, 12 or 24 h after surgery and there were no inter-group differences in the lengths of ICU stay or overall hospital stay between groups. The incidence of hypertension was significantly higher in Group C (OR 13.8, 95% CI 4–48, p < 0.0001); there were no inter-group differences in incidences of hypotension and bradycardia.ConclusionsIntraoperative DEX infusion is safe and effective for improving analgesia during and after elective LC. DEX appears to significantly reduce the number of patients with severe postoperative pain, postoperative morphine consumption and prolong time to first use of rescue analgesia.Trial registrationClinicalTrials.gov: Retrospectively registered on July 7, 2017, NCT03211871.

Effect of recruitment maneuver on early postoperative lung ventilation in patients undergoing laparoscopic cholecystectomy: evaluation using electrical impedance tomography

Objective To evaluate the effect of recruitment maneuver on early postoperative lung ventilation in patients undergoing laparoscopic cholecystectomy using electrical impedance tomography (EIT). Methods Thirty American Society of Anesthesiologists physical status Ⅰor Ⅱ patients of both sexes, aged 30-60 yr, with body mass index of 18-28 kg/m2, scheduled for elective laparoscopic cholecystectomy, were divided into 2 groups (n=15 each) using a random number table: control group (group C) and recruitment maneuver group (group R). Recruitment maneuver was performed with a pressure of 30 mmHg, lasting for 30 s, starting from 5 min after establishment of pneumoperitoneum and from the end of pneumoperitoneum in group R. EIT was carried out before anesthesia induction (baseline) and after extubation, and the percentages of area in center of ventilation (CoV), dependent silent spaces (DSS) and non-dependent silent spaces (NSS) were recorded. Results There was no significant difference in the percentages of area in CoV, DSS or NSS between the two groups (P>0.05). Compared with the baseline before induction, the percentage of area in CoV was significantly decreased, and the percentages of area in DSS and NSS were increased after extubation in group C, and the percentages of DSS and NSS were increased (P 0.05). Conclusion Recruitment maneuver can alleviate decrease in early postoperative regional lung ventilation, and it does not improve atelectasis and hypoventilation in patients undergoing laparoscopic cholecystectomy. Key words: Laparoscopy; Pulmonary ventilation; Positive-pressure respiration; Tomography

Systematic evaluation of risk factors of unplanned extubation associated with peripherally inserted central catheters among cancer patients

Objective To assess the risk factors of unplanned extubation associated with peripherally inserted central catheters(PICC) among cancer patients, and to provide theoretical basis for unplanned extubation associated with PICC among cancer patients. Methods We searched the related papers from the Cochrane Library, PubMed, EMbase, CINAHL, CBM, WanFang Data, CNKI and VIP.The data were extracted according to the inclusion and exclusion criteria by two reviewers, the quality of included studies was also evaluated.Meta-analysis was conducted using RevMan 5.3 or only descriptive analysis was conducted instead. Results Six studies were included in the study.The sample size was 3 463 with 233 cases in unplanned extubation group and 3 230 cases in control group.The incidence rate of unplanned extubation associated with PICC was 6.7%.Meta-analysis showed that the relevant factors were thrombosis and drug. Conclusions The risk factors of unplanned extubation with PICC among cancer patients are thrombosis and drug(high concentration nutrition). Key words: Neoplasms; Peripherally Inserted Central Catheter; Unplanned extubation; Risk factor

Comparison on the efficacy of different extubation time after artificial nasolacrimal duct implantation

Objective To compare the efficacy of different extubation time after implantation of artificial nasolacrimal duct. Methods A prospective randomized single-blind comparision clinic experiment.The data of 42 eyes of 40 cases with nasolacrimal duct obstruction were collected and they were treated with lacrimal duct probing combined with reverse implantation of artificial nasolacrimal duct. All patients after surgery were randomly divided into two groups: the time of extubation in group A was 3 months after operation, and 6 months in group B after operation.The follow-up time was 12 months.The success rate of surgery and complications were observed and analyzed. Results The total effective rate was 83.33%, and in group A and group B were 85.71%and 80.95% respectively. The difference was not significant between the two groups. The incidence of complications in group A and B were 38.10% and 85.71% respectively.The difference was statistically significant between the two groups(P=0.001). Conclusion Artificial nasolacrimal duct implantation is a safe and effective method for lacrimal duct obstructive diseases. The efficacy of 6 months and 3 months extubation were similar, but wear the tube is kept for a long time may bring more complications. Key words: Nasolacrimal duct, artificial; Extubation time; Nasolacrimal duct obstruction

Extubation in the operating room after pediatric liver transplant: A retrospective cohort study.

Early extubation immediately following liver transplantation is increasingly common in adult practice. Some pediatric institutions have begun to adopt this strategy. Careful patient selection is essential in minimizing risk. This retrospective cohort study evaluated infants and children who underwent liver transplantation between July 2011 and December 2014. Our primary objective was to determine early extubation rate. Secondary objectives were to identify clinical factors associated with successful early extubation compared with delayed extubation and to examine significant postoperative complications, intensive care unit length of stay, and hospital length of stay. The early extubation rate was 57.8% (37/64, confidence interval [CI] 44.8%-70.1%) over this 3.5-year period, increasing from 42% in 2012 to 58% by the end of 2014. The patients in the early extubation group were more likely to be older than the delayed extubation group (mean [SD], 7 [5.3] years vs 3.5 [5.5] years, difference between the mean [95% CI], 3.5 [0.8, 6.2] years); were to have come from home on the day of surgery (78.4% vs 25.9%); and were less likely to be listed as United Network for Organ Sharing status 1A (2.7% vs 25.9%). The early extubation group received less packed red blood cell volume (mean [SD], 9 [13.2] mL/kg vs 40.6 [48.5] mL/kg, difference between the mean [95% CI], 31.6 [95% CI 14.9, 48.3] mL/kg) and fresh-frozen plasma (mean 2.7 [SD 9.5] vs 13.3 [SD15.1], difference between the mean [95% CI], 10.5 [4.4,16.7] mL/kg). None of the patients in the early extubation group required reintubation in the first 24hours following transplant and none experienced hepatic artery thrombosis. The early extubation group had a shorter average postoperative PICU stay (mean 3.8 [SD 2.1] days vs 17.6 [SD 31.3] days, difference between the mean [95% CI], 9.5 [4.3, 14.7] days) and a shorter postoperative hospital stay overall (mean 10.7 [SD 4.3] days vs 29.7 [SD 43.1] days, difference between the mean [95% CI], 19.1 [8.6, 29.6] days). More than half of our pediatric liver transplant patients were successfully extubated in the operating room immediately following surgery. We believe early extubation to be safe when employed in selected subpopulations of pediatric patients undergoing liver transplantation.

Effect of dexmedetomidine on emergence agitation after general anesthesia in children undergoing odontotherapy in day-surgery operating room

To study the effectiveness of dexmedetomidine used for general anesthesia maintenance in children undergoing odontotherapy in day-surgery operating room in reducing the incidence of emergence agitation (EA). Eighty children undergoing odontotherapy and under general anesthesia in day-surgery operating room were randomized into two groups, group A (n=40) and group B (n=40). Each patient in group A was administered with a bolus dose of dexmedetomidine (1.0 μg·kg⁻¹, saline diluted to 10 mL) pump-infused after intubation and a maintenance dose of 0.1-0.4 mL·(kg·h)⁻¹ followed-up until 45 min before the end of operation. Each patient in group B was administered with a bolus dose of normal saline 10 mL pump-infused after intubation and maintenance dose of 0.1-0.4 mL·(kg·h)⁻¹ followed-up until 45 min before the end of operation. Gender, age, weight, physical status according to the American Society of Anesthesiologists, perioperative heart rate (HR), mean arterial pressure (MAP), pulse oxygen saturation (SpO₂), sufentanil dosage, duration of surgery, time of extubation, time of regaining consciousness, and time to reach modified Aldrete's score≥12 were recorded. Behavior in postanesthesia care unit was rated on the four-point agitation scale. Compared with group B, decreases were observed in HR and MAP at the beginning of operation, in 10 and 30 min, 1 and 2 h after the beginning of operation, and after extubation of group A (P<0.05). Sufentanil dosage and incidence of EA during recovery of group A were also lower than those of group B (P<0.05). Time to regain consciousness and time to reach modified Aldrete's score≥12 of group A were longer than those of group B (P<0.05). No statistical difference was observed between other indexes of the two groups. As an anesthetic used for general anesthesia maintenance in children undergoing odontotherapy in day-surgery operating room, dexmedetomidine results in low incidence of EA during recovery and more stable vital signs.

English

Objectives: To identify the risk factors of delayed extubation after cardiac surgery.Study Design: Observational study. Setting: Cardiac surgery in CPE Institute of Cardiology.Period: 2 months from November-2016 to March-2017. Methods: Eighty-one (81) patients whounderwent cardiac surgery. In ICU we recorded extubation time of all patients. Patients withextubation time &lt;6 hours after labelled as early extubation group and those with extubationtime &gt;6 hours were labelled as delayed extubation group. We recorded their preoperative riskfactors and operative variables of surgery to identify the risk factors that leads to late extubationafter cardiac surgery (CS). Results: Prevalence of diabetes was significantly high in patientswith delayed extubation. There were 42.3% diabetic patients with delayed extubation and only12.7% diabetic patients with early extubation (p-value 0.003). Total pump time, cross clamptime and type of operation were similar between the groups. Cardiovascular instability wasthe most common cause of delayed extubation that occurred in 9 patients, reduced level ofconsciousness in 9 patients, post-op bleeding in 6 patients, while hypoxemia and increasedrespiratory rate occurred in 1, 1 patient respectively. Conclusion: Diabetes Mellitus is anindependent risk factor of delayed extubation after cardiac surgery. Cardiovascular instability,reduced level of consciousness and post-operative bleeding after surgery are the main factorsthat leads to delayed extubation after CS.

CARDAIC SURGERY;

Objectives: To identify the risk factors of delayed extubation after cardiac surgery.Study Design: Observational study. Setting: Cardiac surgery in CPE Institute of Cardiology.Period: 2 months from November-2016 to March-2017. Methods: Eighty-one (81) patients whounderwent cardiac surgery. In ICU we recorded extubation time of all patients. Patients withextubation time &lt;6 hours after labelled as early extubation group and those with extubationtime &gt;6 hours were labelled as delayed extubation group. We recorded their preoperative riskfactors and operative variables of surgery to identify the risk factors that leads to late extubationafter cardiac surgery (CS). Results: Prevalence of diabetes was significantly high in patientswith delayed extubation. There were 42.3% diabetic patients with delayed extubation and only12.7% diabetic patients with early extubation (p-value 0.003). Total pump time, cross clamptime and type of operation were similar between the groups. Cardiovascular instability wasthe most common cause of delayed extubation that occurred in 9 patients, reduced level ofconsciousness in 9 patients, post-op bleeding in 6 patients, while hypoxemia and increasedrespiratory rate occurred in 1, 1 patient respectively. Conclusion: Diabetes Mellitus is anindependent risk factor of delayed extubation after cardiac surgery. Cardiovascular instability,reduced level of consciousness and post-operative bleeding after surgery are the main factorsthat leads to delayed extubation after CS.

Correction to: Terminal weaning or immediate extubation for withdrawing mechanical ventilation in critically ill patients (the ARREVE observational study).

Correction to: Intensive Care Med (2017) DOI 10.1007/s00134-017-4891-0.

Intraoperative variables associated with extubation time in patients undergoing open heart surgery

Decreasing mechanical ventilation and early extubation in patients has many clinical benefits. Hence, an awareness of some variables, associated with extubation time can help nurses to plan convenient care aimed at making a safe and early extubation. The purpose of this study was to investigate whether any intraoperative variables had a significant effect on extubation time following open heart surgery. The research was conducted on 60 open heart surgery patients who met inclusion criteria between April 2014 and November 2014 in a cardiac and vasculer surgery clinic of university hospital in Istanbul, Turkey. The data were collected by using a “Questionnaire Form” which includes some intraoperative variables (type of surgery, the number of grafts, the duration of time of the cardiopulmonary bypass, aortic crossclamping, total operation time, and the extubation time). The data was analyzed by descriptive and analytical methods. Type of the surgery procedure was 40 (66%) patients were CABG, 10 (16,6%) were valvuler surgery, 6 (10%) were ASD/VSD primer repair and 4 (3,3%) were Bentall procedure. Extubation was achieved for 60 patients in a mean time of 8.33±1.99 h. 18,3% (11) of the patients were extubated in ≤6 h and 81,7% (49) of them were extubated in &gt;6 h after surgery, classifying them into the early and delayed extubation groups, respectively. On statistical analysis, the duration of the cardiopulmonary bypass (CPB) and aortic cross-clamping were found to have a significant effect on the extubation time.This study revealed that the duration of the cardiopulmonary bypass and aortic cross-clamping might play a role in the extubation time. Therefore, it is recommended that nurses consider this in their assessment of extubation as a shorter cardiopulmonary bypass time and aortic cross-clamping time might lead to earlier extubation. Keywords: Open heart surgery; extubation; intraoperative variables.

Evaluation of diaphragmatic function in mechanically ventilated children: An ultrasound study.

BackgroundThe recovery of diaphragmatic function is vital for successful extubation from mechanical ventilation. Recent studies have detected diaphragm atrophy in ventilated adults by using ultrasound, but no similar report has been conducted in children. In the current study, we hypothesized that mechanically ventilated children may also develop diaphragm atrophy and diaphragmatic dysfunction.Materials and methodsChildren who were admitted to the pediatric intensive care unit and were newly intubated for mechanical ventilation were enrolled into this prospective case–control study. Diaphragm ultrasound assessments were performed daily to evaluate diaphragmatic function in the enrolled children until their discharge from the pediatric intensive care unit. Diaphragm thickness and the diaphragmatic thickening fraction (DTF) were measured through these assessments.ResultsA total of 31 patients were enrolled, and overall, 1389 ultrasound assessments were performed. Immediately after intubation, the initial diaphragm thickness and DTF were measured to be 1.94 ± 0.44 mm and 25.85% ± 3.29%, respectively. In the first 24 hours of mechanical ventilation, diaphragm thickness and the DTF decreased substantially and decreased gradually thereafter. After extubation, the DTF was significantly different between the successful and failed extubation groups (P < 0.001), and a DTF value of <17% was associated with extubation failure.ConclusionsDiaphragm ultrasound is a noninvasive method for measuring diaphragmatic function in mechanically ventilated children. In this study, significant diaphragm atrophy and a decreased DTF were observed within 24 hours of mechanical ventilation. The recovery of diaphragm thickness and the DTF may be a potential predictor of successful extubation from mechanical ventilation.

Establishing failure predictors for the planned extubation of overweight and obese patients.

We investigated failure predictors for the planned extubation of overweight (body mass index [BMI] = 25.0–29.9) and obese (BMI ≥ 30) patients. All patients admitted to the adult intensive care unit (ICU) of a tertiary hospital in Taiwan were identified. They had all undergone endotracheal intubation for > 48 h and were candidates for extubation. During the study, 595 patients (overweight = 458 [77%]); obese = 137 [23%]) with planned extubation after weaning were included in the analysis; extubation failed in 34 patients (5.7%). Their mean BMI was 28.5 ± 3.8. Only BMI and age were significantly different between overweight and obese patients. The mortality rate for ICU patients was 0.8%, and 2.9% for inpatients during days 1–28; the overall in-hospital mortality rate was 8.4%. Failed Extubation group patients were significantly older, had more end-stage renal disease (ESRD), more cardiovascular system-related respiratory failure, higher maximal inspiratory pressure (MIP), lower maximal expiratory pressure (MEP), higher blood urea nitrogen, and higher ICU- and 28-day mortality rates than did the Successful Extubation group. Multivariate logistic regression showed that cardiovascular-related respiratory failure (odds ratio [OR]: 2.60; 95% [confidence interval] CI: 1.16–5.80), ESRD (OR: 14.00; 95% CI: 6.25–31.35), and MIP levels (OR: 0.94; 95% CI: 0.90–0.97) were associated with extubation failure. We conclude that the extubation failure risk in overweight and obese patients was associated with cardiovascular system-related respiratory failure, ESRD, and low MIP levels.

Effects of mistral-air inflatable blanket on neonatal blood coagulation function after surgery for general anesthesia

Objective To evaluate the value of mistral-air inflatable blanket in neonatal temperature , postoperative complications, and the influence of the blood coagulation function after surgery undergoing general anesthesia. Methods A total of 60 newborns with laparotomy operation undergoing general anesthesia were randomly divided into two groups, the control group and the observation group, 30 persons each group.The newborns were given mistral-air inflatable blanket in the observation group, and conventional methods in the control group, two groups were transferred to Postanesthesia Care Unit by incubator at 37℃.The introperative nasopharyngeal temprature, HR, MAP and SpO2 were recorded before induction(T0), 30 minutes during operation(T1), extubated instantly(T2), 15 minutes during PACU(T3), 30 min during PACU(T4). The extubation time and the incidence of apnoea and hyoxemia were recorded after operation.PT, APTT, TT and Fib were tested before induction and extubated instantly. Results The temperature of intraoperative and postoperative period were higher in the observation group than the control group, the difference was significant(P 0.05). The observation group extubation time were less than the control group, the difference was significant(P 0.05). The PT, APTT, TT and Fib in the observation group were better than the control group, the difference between the groups was significant(P<0.05). Conclusion Mistral-air inflatable blanket can effectively prevent the decrease of the body temperature during operation and PACU, reduce the exduction time and postoperative complications, and protect blood coagulation function. Key words: Mistral-Air inflatable blanket; Newborn; Temperature; Blood coagulation function

Case-control Study on Risk Factors of Unplanned Extubation Based on Patient Safety Model in Critically Ill Patients with Mechanical Ventilation

This study aimed to identify risk factors of unplanned extubation in intensive care unit (ICU) patients with mechanical ventilation using a patient safety model. This study was designed to be a case-control study. Data collection sheets, including 29 risk factors of unplanned extubation in mechanically ventilation patients were retrospectively collected based on a patient safety model over 3 years. From 41,207 mechanically ventilated patients, 230 patients were identified to have unplanned extubation during their ICU stay. Based on the characteristics of the cohort of 230 patients who had unplanned extubation, 460 case control comparison groups with planned extubation were selected by matching age, gender and diagnosis. Risk factors of unplanned extubation were categorized as people, technologies, tasks, environmental factors and organizational factors, by five components of the patient safety model. The results showed the risk factors of unplanned extubation as admission route [odds ratio (OR)=1.8], Glasgow Coma Scale-motor (OR=1.3), Acute Physiology and Chronic Health Evaluation score (OR=1.06), agitation (OR=9.0), delirium (OR=11.6), mode of mechanical ventilation (OR=3.0-4.1) and night shifts (OR=6.0). The significant differences were found between the unplanned and the planned extubation groups on the number of reintubation (4.3% vs. 79.6%, p<.001), ICU outcome at the time of discharge (χ2=50.7, p<.001), and length of stay in the ICU (27.0±33.0 vs. 43.8±43.5) after unplanned extubation. ICU nurses should be able to recognize the risk factors of unplanned extubation related with the components of the safety model so as to improve patient safety by minimizing the risk for unplanned extubation.

Comparison of I-gel versus Endotracheal Tube in Patients Undergoing Elective Cesarean Section: A Prospective Randomized Control Study.

Background and Aim:Physiological changes during pregnancy and the sympatho adrenalstimulation during larynoscopy and intubation leads to evaluation of safe devices to secure airway during cesarean section under general anesthesia. I-gel, recently emerging effective supra glottic device found safe during general anesthesia in cesarean section. Aim of the study is to compare the hemodynamic disturbances and airway related complications of I-gel and Endotracheal tube in patients undergoing cesarean section under general anesthesia.Material and Methods:Eighty ASA II pregnant patients posted for elective LSCS were randomly divided into two groups of 40 each (n = 40). According to the group they were inserted either I-gel (Group I) or ETT (Group E). Insertion time, ease of intubation, hemodynamics during insertion and Extubation, airway related complications like sore throat, blood on the device, dysphagia, regurgitation, nausea, vomiting, aspiration and laryngospasm were noted and compared. Statistical analysis was done by using unpaired t test, chi square test and fisher's test. P value of <0.05 was considered as significant.Results:The demographic parameters, ease of insertion, insertion times and adequacy of ventilation were comparable between the groups (P > 0.05). 8 out of 40 patients in Group E had difficult intubation (P < 0.01). More than 20% of rise in MAP and HR were found during intubation and Extubation in Group E (40 out of 40 patients) which was statistically significant when compared to Group I (P < 0.001). Post operative sore throat significantly high in Group E (30 out of 40) (P < 0.001) when compared to Group I (4 out of 40).Conclusion:Easier insertion with less hemodynamic disturbances and very low incidence of sore throat I-gel found to be safer device to secure the airway in patients undergoing LSCS under general anesthesia.

The Assessment of the Risk of Unplanned Extubation in an Adult Intensive Care Unit.

In order to plan and implement nursing intervention to reduce the incidence rate of unplanned extubation problem in the intensive care unit (ICU), it is necessary to determine the risk factors of unplanned extubation and the patients under risk. This study was undertaken with the aim of evaluating the risk of unplanned extubation of endotracheal tube in adult ICU. This was a case-control study. The population constituted patients hospitalized in the adult ICU during 1-year period in a university hospital. The sample from this population was composed of patients whose extubation was unplanned (30 patients) and the randomly selected patients (60 patients) who were intubated at the same time in the ICU for each patient whose extubation was unplanned. In data collection, the Richmond Agitation-Sedation Scale, Glasgow Coma Scale, Acute Physiology and Chronic Health Evaluation II were utilized. According to the findings, the variables such as sex, age, mechanical ventilation period, and Acute Physiology and Chronic Health Evaluation II and Glasgow Coma Scale scores did not have any effect on the unplanned extubation, but variables such as internal medicine diseases and Richmond Agitation-Sedation Scale did have an effect. It was also revealed that there was no extubation plan in most of the unplanned extubation group, the nurse was anticipating the unplanned extubation, the patient was intubated again, and a complication occurred. The patients who are provided inadequate sedation and analgesia and who have problems in their respiratory system are under risk of unplanned extubation. In order to prevent unplanned extubation, an adequate amount of sedation and private nursing care should be provided to patients in the ICU.