Intubation Research Articles

Risk of Acute Complications with Rocuronium versus Cisatracurium in Patients with Chronic Kidney Disease: A Propensity-Matched Study.

Neuromuscular blocking agents (NMBAs) play an integral role in modern anesthesia by facilitating endotracheal tube placement, assisting with mechanical ventilation, and creating optimal surgical conditions. However, NMBAs can have deleterious side effects. The purpose of this study was to retrospectively analyze acute complications of 2 pharmacodynamically similar but pharmacokinetically different NMBAs and their respective reversal agents. The global research network database, TriNetX, was used to evaluate deidentified patient information from 63 health care organizations. Cohort A was defined as patients aged 18 to 80 years who had chronic kidney disease (CKD) and were administered rocuronium with sugammadex. Cohort B was defined as patients aged 18 to 80 years who had CKD and were administered cisatracurium with neostigmine. Cohorts were propensity matched for age at event, ethnicity, race, sex, and relevant confounding pathologies. All outcomes besides mortality were analyzed from the same day to 1 week after administration of the indexed drug. Mortality was analyzed from the same day to thirty days after administration of the indexed drug. A total of 95,740 patients with CKD-administered rocuronium with sugammadex were matched with 10,708 patients with CKD-administered cisatracurium with neostigmine. Patients administered rocuronium with sugammadex had a significantly higher associated risk of respiratory failure (risk ratios [RR], 1.98, confidence interval [CI], 1.71-2.29, P < .0001), acute respiratory distress (RR, 2.70, CI, 1.31-5.58, P = .0052), hypertensive crisis (RR, 1.85, CI, 1.37-2.49, P < .0001), heart failure (RR, 1.14, CI, 1.06-1.23, P = .0004), pleural effusion (RR, 1.30, CI, 1.14-1.49, P < .0001), and 30-day mortality (RR, 1.31, CI, 1.10-1.56, P = .0021). From 2003 to 2023, patients who were administered rocuronium plus sugammadex were at a significantly higher risk for acute cardiovascular and pulmonary complications when compared to patients who were administered cisatracurium plus neostigmine.

The T-Type Calcium Channel CACNA1H is Required for Smooth Muscle Cytoskeletal Organization During Tracheal Tubulogenesis.

Abnormalities of tracheal smooth muscle (SM) formation are associated with several clinical disorders including tracheal stenosis and tracheomalacia. However, the cellular and molecular mechanisms underlying tracheal SM formation remain poorly understood. Here, it is shown that the T-type calcium channel CACNA1H is a novel regulator of tracheal SM formation and contraction. Cacna1h in an ethylnitrosourea forward genetic screen for regulators of respiratory disease using the mouse as a model is identified. Cacna1h mutants exhibit tracheal stenosis, disorganized SM and compromised tracheal contraction. CACNA1H is essential to maintain actin polymerization, which is required for tracheal SM organization and tube formation. This process appears to be partially mediated through activation of the actin regulator RhoA, as pharmacological increase of RhoA activity ameliorates the Cacna1h-mutant trachea phenotypes. Analysis of human tracheal tissues indicates that a decrease in CACNA1H protein levels is associated with congenital tracheostenosis. These results provide insight into the role for the T-type calcium channel in cytoskeletal organization and SM formation during tracheal tube formation and suggest novel targets for congenital tracheostenosis intervention.

Delivery room resuscitation and short-term outcomes in very preterm infants: a multicenter cross-sectional study in China.

To explore the risk factors of delivery room (DR) resuscitation and assess the association of DR resuscitation with neonatal outcomes in very preterm infants (VPIs). A multicenter retrospective cross-sectional study included VPIs with gestational age (GA) <32 weeks born between January, 2022 and June, 2023 and admitted to neonatal intensive care units of six tertiary hospitals in Shenzhen within 24 h after birth. They were divided into routine care group, positive-pressure ventilation (PPV) group, and endotracheal intubation (ETT) group based on the highest intensity of resuscitation received at birth. The association of antepartum and intrapartum risk factors and short-term outcomes with the intensity of DR resuscitation was evaluated. Of 683 infants included in this study, 170 (24.9%) received routine care, 260 (38.1%) received bag and mask ventilation or T-piece ventilation and 253 (37%) received ETT. Among the antepartum and intrapartum factors, exposure to antenatal steroids (ANS) decreased the likelihood of ETT. Increasing GA decreased the likelihood of receiving a higher level of DR resuscitation. Among the neonatal outcomes, increasing intensity of DR resuscitation was associated with a raise in the risk of Bronchopulmonary dysplasia. Higher levels of DR resuscitation were associated with the risk of early-onset sepsis. ETT was significantly associated with an increased risk of death. Among VPIs, low GA and no ANS use increased the risk of high-intensity DR resuscitation interventions; and those who receiving ETT were associated with an increased risk of adverse clinical outcomes.

Video laryngoscopy may improve the intubation outcomes in critically ill patients: a systematic review and meta-analysis of randomised controlled trials

BackgroundThe role of video laryngoscopy in critically ill patients requiring emergency tracheal intubation remains controversial. This systematic review and meta-analysis aimed to evaluate whether video laryngoscopy could improve the clinical...

Incidencia de retirada no programada de dispositivos invasivos en enfermos con COVID-19 en cuidados intensivos

IntroductionThe rate of unscheduled removal of invasive devices (ID) is an indicator of quality programmes in the critically ill. Our research group performed prevalence analyses since 2010 and another during the pandemic. The aim was to analyse the rates of use and non-planed removal of endotracheal tubes, catheters (central venous and arterial) and enteral catheters in the first wave of the COVID-19 pandemic comparing them with previous rates. MethodologyPrevalence study in a polyvalente ICU. After 4 prospective observational analyses (2010, 2011, 2018, 2019) a retrospective analysis was performed (8 March-8 May 2020). Variables: diagnosis, stay and reason for removal of ID (endotracheal tubes (ET), central venous catheters, arterial catheters and enteral catheters) and rate of reintubation after self-removal of ET. Variables analysed and described as accidental removal rates per 1000 device-days and rates of ID use. Results2026 patients were included (631 in 2010, 724 in 2011, 210 in 2018, 361 in 2019 and 100 in 2020). Significant differences, between all periods, in diagnoses (P<.001), ICU stay (P<.001) and mortality (P=.016) and, between 2020 and all other periods, in rates of use per 100 days-stay (P<.010) and per 100 admissions (P<.001) in all devices except arterial catheter. In 2020, there was an increase in ET obstruction (36.0%; rate 20.27 per 1000 intubation/days, P<.010), decrease in ET self-removals (2020 rate: 0.00 per 1000 intubation/days; P<.050) and enteral catheters (14.33 per 1000 catheter/days). Overall reintubation (all periods) after self-extubation: 12.5%. ConclusionsThe rate of devices self-removal in COVID-19 patients in the first wave of the pandemic was lower than that observed in the previous four periods. The high incidence rate of ET obstruction in these patients was significant and relevant.

Measuring the outward migration of the nasotracheal tube at vocal cords with head and neck extension: a novel approach using a flexible bronchoscope in patients undergoing head and neck oncosurgery.

Head and neck extension achieves optimal surgical exposure during head and neck oncosurgeries. However, it can lead to cephalad migration of the tracheal tube, causing complications. Preventing shallow intubation is essential, especially in patients with difficult airway. Using an innovative technique, we aimed to measure the proximal migration of the nasotracheal tube at the vocal cords on neck extension in patients with difficult airway. We enrolled 60 adult patients undergoing head and neck oncosurgeries with a mouth opening of less than 1.5 cm. After nasotracheal intubation using a flexible bronchoscope (FB), the FB was introduced into the adjacent nostril and maneuvered to reach the glottis. The FB was used to view and align the intubation depth mark (IDM) on the tracheal tube (TT) with the vocal cords in the neutral position. The outward migration of the TT at the vocal cords with a 30° to 40° neck extension was measured using the same maneuver. Also, the TT tip-to-carina distance was noted in both neutral and extension using FB. The mean proximal migration of the TT at the vocal cords during neck extension was 3±0.3 mm. The TT tip-to-carina distance increased by a mean of 20±7 mm with extension. The proximal migration contributed 15%, whereas elongation of the trachea contributed 85% to this increase. The major contributing factor for the increase in TT tip-to-carina distance on neck extension was tracheal elongation rather than outward migration of the TT at vocal cords.

Increased rate of anoxic brain damage with laryngeal tube compared to endotracheal intubation in patients with shockable out-of-hospital cardiac arrest – Experience from the HAnnover COoling REgistry (HACORE)

BackgroundSupraglottic airway devices such as the laryngeal tube (LT) are recommended in current guidelines for simplified airway management in patients during and immediately after out-of-hospital cardiac arrest (OHCA). Trials evaluating LTs included predominantly OHCA patients with non-shockable rhythms and low survival rates. Hence, LTs are widely used, but their impact on preventing hypoxic brain damage during resuscitation has not been evaluated yet. MethodsWe analysed 452 OHCA-patients with shockable-rhythms from the HAnnover COoling REgistry (HACORE) who had return of spontaneous circulation prior to transport. Of those, 405 patients received primary airway management by endotracheal intubation (ETI) and 47 by LT. Patients were afterwards treated according to the Hannover Cardiac Resuscitation Algorithm (HaCRA) applying a strict post-resuscitation management including therapeutic hypothermia and avoiding routine prognostication. ResultsWhile mortality in this group was moderate with both airway strategies (ETI 29 % vs LT 34 %, p = 0.487), the rate of anoxic brain damage was much higher in the LT compared to the ETI group (38 % vs 21 %, p = 0.011). Survivors in the ETI group were more likely to have good neurological outcome (cerebral performance category 1&2) compared to the LT group (35 % vs 17 %, p = 0.013). Pneumonia was more common in the LT vs ETI group (81 % vs 53 %, p < 0.001). ConclusionsWhile the original prehospital pragmatic trials comparing LT to ETI mostly included patients with non-shockable rhythm in settings with high mortality, our analysis is based on a real-world registry and focuses on successfully resuscitated patients, whose cause of arrest was most probably not due to hypoxia. In this cohort, use of LT was associated with a higher rate of anoxic brain damage and worse functional neurological outcome compared to use of ETI.

Association Between Neuromuscular Blocking Agents and Outcomes of Emergency Tracheal Intubation: A Secondary Analysis of Randomized Trials

To examine the association between the neuromuscular blocking agent received (succinylcholine versus rocuronium) and the incidences of successful intubation on the first attempt and severe complications during tracheal intubation of critically ill adults in an emergency department (ED) or ICU. We performed a secondary analysis of data from 2 multicenter randomized trials in critically ill adults undergoing tracheal intubation in an ED or ICU. Using a generalized linear mixed-effects model with prespecified baseline covariates, we examined the association between the neuromuscular blocking agent received (succinylcholine versus rocuronium) and the incidences of successful intubation on the first attempt (primary outcome) and severe complications during tracheal intubation (secondary outcome). Among the 2,440 patients in the trial data sets, 2,339 (95.9%) were included in the current analysis; 475 patients (20.3%) received succinylcholine and 1,864 patients (79.7%) received rocuronium. Successful intubation on the first attempt occurred in 375 patients (78.9%) who received succinylcholine and 1,510 patients (81.0%) who received rocuronium (an adjusted odds ratio of 0.87; 95% CI 0.65 to 1.15). Severe complications occurred in 67 patients (14.1%) who received succinylcholine and 456 patients (24.5%) who received rocuronium (adjusted odds ratio, 0.88; 95% CI 0.62 to 1.26). Among critically ill adults undergoing tracheal intubation, the incidences of successful intubation on the first attempt and severe complications were not significantly different between patients who received succinylcholine and patients who received rocuronium.

Airway management in microvascular reconstruction of the oral cavity: Is immediate extubation possible?

A tracheostomy is routinely performed following free tissue transfer (FTT) for oral cavity reconstruction; however, its avoidance whenever possible is advocated to enhance patient recovery and reduce hospital length of stay (LOS). This study aims to measure and compare clinically relevant outcomes for patients who have endotracheal intubation versus tracheostomy for FTT for oral cavity reconstruction. A retrospective cohort study was conducted to evaluate subjects undergoing FTT of the oral cavity for benign and malignant pathology at the University of Alabama at Birmingham from 2014 to 2021. Subjects with unresectable tumors or defects that were not primarily located in the oral cavity were excluded. The independent variable was perioperative airway management and was divided into 2 groups: 1) endotracheal intubation or 2) tracheostomy. The main outcome measure was defined as a postoperative airway-related complication and required escalation of care to an intensive care unit. LOS and surgical complications were also analyzed. The covariates were classified as demographic, medical, pathologic, and operative. Bivariate and multivariate statistical analyses were conducted to compare the outcomes between subjects who were immediately extubated and tracheotomized. Subject demographics and operative parameters were also analyzed. A total of 560 subjects met the inclusion criteria, with 122 subjects in the immediate extubation group and 438 subjects in the tracheostomy group. The mean age was 59.7±16.3years in the immediate extubation group and 59.3±13.8years in the tracheostomy group (P=.8). The proportion of males was 57.4% in the immediate extubation group and 60% in the tracheostomy group (P=.6). No postoperative airway-related complications occurred in the endotracheal intubation group. After controlling for confounding factors, tobacco use was associated with airway-related complications (odds ratio [OR]: 2.66; 95% confidence interval: 1.1-6.3; P=.03). LOS was shorter in the endotracheal intubation versus tracheostomy group (6.8 vs 9days, P<.01). In subjects who underwent FTT for oral cavity reconstruction, postoperative airway-related complications were associated with a tracheostomy and tobacco use status.

Comparative Study Of Standard Drug Dose Mixture Versus Fentanyl In Attenuating Stress Response During Laryngoscopy And Tracheal Intubation In Neurosurgery: A Prospective Observational Study

Background: Opioid-free anesthesia (OFA) is gaining prominence, particularly in neurosurgery, due to its potential to minimize opioid-related complications such as postoperative nausea and vomiting (PONV) and shivering. This Prospective observational study aims to compare the efficacy of a standard drug dose mixture comprising intravenous magnesium sulphate, lignocaine, paracetamol, and tramadol with fentanyl in attenuating the hemodynamic stress response during laryngoscopy and tracheal intubation. Methods: Sixty neurosurgical patients, aged 18 to 60 years, undergoing cervical or lumbar discectomies under general anesthesia in our institute were divided into two groups. One group received the standard drug dose mixture, and the other received fentanyl. Hemodynamic parameters, including pulse rate, blood pressure, oxygen saturation (SpO2), and electrocardiogram (ECG) changes, were recorded at baseline, during intubation, and at one- minute intervals for five minutes post-intubation. Results: Both groups demonstrated stable hemodynamics with no significant differences in pulse rate or blood pressure. No ECG abnormalities were observed, and SpO2 remained above 96% in all patients. Additionally, the standard drug dose mixture group showed a reduced incidence of PONV and shivering compared to the fentanyl group. Conclusion: The standard drug dose mixture provides a safe and effective alternative to fentanyl for attenuating the hemodynamic stress response during laryngoscopy and tracheal intubation, with fewer side effects. Further randomized controlled trials are recommended to confirm these findings and explore the benefits of opioid-free anesthesia in various surgical procedures.

Alkalized lidocaine in endotracheal tube cuff inflation in patients undergoing thyroidectomy surgery: a clinical trial.

The aim of the study was to compare the postoperative effects of endotracheal tube cuff inflation with alkalized lidocaine in patients undergoing thyroidectomy surgery. This is a randomized, double-blind clinical trial between August 2020 and August 2022 at the Hospital São Domingos, São Luís, Maranhão, Brazil. Patients over 18 years who underwent thyroidectomy of both sexes, American Society of Anesthesiologists (ASA) I or ASA II, were included. Patients with difficult orotracheal intubation, smoking, cuff rupture during orotracheal intubation, heart, lung, or neuropathies, previous surgery of the larynx or trachea, with risk of aspiration of gastric contents, or with the need to use a nasogastric tube were excluded. Patients were randomly selected and divided into the control group, whose cuff was filled with 0.9% saline solution, and the alkalinized lidocaine group, where the cuff was filled with 2% lidocaine and 8.4% sodium bicarbonate. The control group had higher systolic blood pressure [137 (94-183) mmHg] medians after extubation than the alkalinized lidocaine group [127 (82-189) mmHg] (p=0.03). The same was observed in heart rate values [control group: 86 (62-120); alkalinized lidocaine group: 80 (53-120)] (p=0.034). The alkalinized lidocaine group showed a significant increase in the ability to sustain phonation in the 24 h postoperatively, from 82.0 to 98.0% (p=0.031). There was no protective effect of the use of alkalinized lidocaine on the sensation of swallowing and complaints after thyroidectomy surgery. There was a significant improvement in hemodynamic response in the intervention group after extubation.

Neuropsychiatric symptoms of patients two years after experiencing severe COVID-19: A mixed observational study

BackgroundThe impact of SARS-CoV-2 infection (COVID-19) on mental health has not been extensively studied in the medium and long term. This study assessed how clinical, biological, and social factors affect mental health in patients who recovered from severe COVID-19. The evaluation was done 90 days after hospital discharge and followed up at 12 and 24 months. MethodsA retrospective-prospective cohort mixed observational study was conducted on patients over 18 years of age who required hospitalization in Internal Medicine or ICU for severe COVID-19 pneumonia during 2020 and 2021. Demographic information, clinical variables, and data for the scales were obtained from electronic medical records and telephone interviews. For comparisons of the different variables in each clinical variable (insomnia, depression, anxiety), the Student's t-test for independent samples has been used (normal distribution); otherwise, the Mann–Whitney test will be used. All tests and intervals will be performed with a confidence level of 95. Fisher's exact or Pearson's Chi-square test has been used as appropriate for qualitative variables. Results201 patients were recruited. 37.3% presented insomnia, 22.4% anxiety, and 21.4% depressive symptoms. A direct association was established between female sex and depressive symptoms. Psychotropic history, fatigue, and C-reactive protein levels (CRP) were correlated with depression. Anosmia and ageusia, CRP, cognitive symptoms, and dyspnea predicted insomnia. Sex, orotracheal intubation (OTI), pain, fatigue, mental health history, and academic level were independent predictors of anxiety. High percentages of depressive, anxiety, and insomnia symptoms were detected in the second month after discharge and persisted at 12 and 24 months. The fatigue variable maintained a significant relationship with depressive symptoms at 2, 12 and 24 months. A possible limitation could be recall bias in retrospective data collection. ConclusionsThis is a novel study to follow up on mental health for two years in patients with severe COVID-19. Clinical, biological, and psychosocial variables could be predictors of depressive symptoms, anxiety, and insomnia. The psychiatric symptoms persisted throughout the 2-year follow-up. These findings are critical for the follow-up of these patients and open the possibility of further studies in the medium and long term.

Randomised control trial of bispectral index with propofol induction 2 mg/kg versus 1.5 mg/kg during endotracheal intubation in general anaesthesia

Randomised control trial of bispectral index with propofol induction 2 mg/kg versus 1.5 mg/kg during endotracheal intubation in general anaesthesia

A Rare Case of Uvulitis Following Endotracheal Intubation Using C- Mac Videolaryngoscope and How To Avoid It

Uvular injuries are uncommon after general anesthesia and can result from direct trauma to the posterior part of the soft palate or compression and restriction of blood flow to the uvula caused by the inadvertent placement of the airway or suction devices in the oral cavity. There have been cases of inflammation and ulceration occurring in the midline oropharyngeal structures such as the uvula after general anesthesia with a tube or laryngeal mask airway, even in the absence of direct trauma or infection, presumably due to compression ischemia. While sore throat following general anesthesia is a common symptom, it is important to evaluate any severe or persistent pain to exclude uvulitis. Here we present a case of uvulitis that developed after the insertion of a flexometallic endotracheal tube using the midline technique during C-Mac video laryngoscopy. We also emphasize the measures that can be implemented to prevent such a complication. The entrapment of the uvula during intubation often goes unnoticed due to limited oral space after insertion of the video laryngoscope blade, with the intubating anesthetist staying focused on the monitor. This complication following the use of a C-Mac video laryngoscope has not been previously documented.

Randomised control trial comparing hemodynamic response of propofol induction 2 mg/kg versus 1.5 mg/kg during endotracheal intubation in general anaesthesia

Randomised control trial comparing hemodynamic response of propofol induction 2 mg/kg versus 1.5 mg/kg during endotracheal intubation in general anaesthesia

Mortality rate analysis of patients on invasive mechanical ventilation in the intensive care unit on day 28.

Outcomes in patients receiving invasive mechanical ventilation (IMV) are currently unclear. The present study aimed to explore the prognostic factors of the mortality rate on day 28 in patients treated in the intensive care unit (ICU) and undergoing IMV. The IMV Mortality Prediction Score (IMPRES) of 129 patients in the ICU receiving IMV after emergency (or selective) endotracheal intubation from March 2018 to August 2020 was calculated. The patients were divided into survival (n=73) and death groups (n=56) on day 28. The predictive factors of independent and combined mortality rates were determined using a receiver operating characteristic (ROC) curve and the area under the ROC curve (AUC). The AUC of the IMPRES for predicting patient death on day 28 was 0.785 (95% confidence interval (CI): 0.704-0.864, P<0.01). When the IMPRES cut-off was 4.50, the Youden index was at its maximum (0.487) with a sensitivity of 85.7% and a specificity of 63.0%. The AUC of the ventilator use time (days) at 12.5 days cut-off was 0.653 (95% CI: 0.56-0.746, P<0.01), the Youden index was 0.235 with a sensitivity of 52.1% and a specificity of 71.4%. The AUC of the IMPRES combined with the duration of ventilator use was 0.856 (95% CI: 0.789-0.922, P<0.001), the Youden index was 0.635 with a sensitivity of 84.9% and a specificity of 78.6%. The IMPRES was observed to be the main factor influencing the mortality rate of patients receiving IMV at the ICU on day 28, and the IMPRES combined with the duration of ventilator use had a significant predictive value for the 28-day mortality rates of these patients.

Clinical application of submandibular endotracheal intubation in craniomaxillofacial fracture

ObjectiveTo explore the clinical application of submandibular endotracheal intubation in craniomaxillofacial fractures. MethodsThe submandibular endotracheal intubation was used to treat 10 patients with cranio-maxillofacial fractures and contraindications to nasal intubation.Ventilator monitoring data including SPO2(oxygen saturation of blood), Freq,VT,MV,PEEP, PLAT and PEAK were monitored before and after the operation of submandibular endotracheal intubation. The technique of submandibular intubation was assessed intraoperatively and in the postoperative period. The outcomes and complications are presented. ResultsThe study included 10 patients aged between 18 and 63 years(6 males and 4 females). All patients had mandibular fractures, with 6 midface fractures (60 %), 5 nasal bone fractures (50 %), 6 zygomatic bone fractures (60 %). The procedure time ranged from 6 to 10 min (mean, 7.9 min). NO delayed extubation was performed in 10 cases. The technique has proved to be straightforward and satisfactory. A postoperative superficial infection occurred in 1 patients, whereas hypertrophic scars occurred in another 1 patients. ConclusionSubmandibular endotracheal intubation is a safe procedure for intraoperative airway control in maxillofacial trauma patients who present contraindication to nasotracheal intubation.

Ramped versus sniffing position for Ambu® AuraGainTM insertion in patients with obesity: a randomized controlled study.

The ramped position facilitates mask ventilation and endotracheal intubation in patients with obesity. This study aimed to determine whether the ramped position improves supraglottic airway (SGA) insertion in patients with obesity. In this prospective, randomized, single-center trial, 48 obese patients undergoing elective surgery were randomized into either ramped or sniffing position groups. The Ambu® AuraGainTM (Ambu A/S), a second-generation SGA, was used. The primary outcome was the time required for the AuraGain insertion. Secondary outcomes included ease and number of insertion attempts, oropharyngeal leak pressure (OLP), and complications. The number needed to treat (NNT) was calculated to ensure ease of insertion. The time required for the AuraGain insertion was significantly shorter in the ramped group than in the sniffing group (13.0 [11.0, 16.0] vs. 24.0 [21.0, 28.0], P < 0.001). The insertion was easier in the ramped group than in the sniffing group (23/24 vs. 13/24, NNT = 2.4 [95% CI, 1.6, 5.0], P = 0.003). The first-attempt success rate was higher in the ramped group than in the sniffing group, although the difference was not statistically significant (22/24 vs. 18/24, P = 0.319). The OLP and postoperative complication rates were not significantly different between the groups. The ramped position reduced the time required for the AuraGain insertion in obese patients while providing comparable airway sealing without increasing adverse events. Therefore, a ramped position may be a more suitable option for SGA insertion in this population.

Magnitude, associated factors of difficult airway, and predictive value of airway examinations among maxillofacial surgery patients at public hospitals in Southern Ethiopia: a multicentre cross-sectional study

Background: “Difficult airway” is the clinical situation in which a conventionally trained anesthesiologist experiences difficulty with mask ventilation, laryngoscopy, and difficulty with tracheal intubation, or both. Associated factors and predictive value difficult airways, maxillofacial surgery study setup is under studied. Objective: To determine the magnitude and associated factors of difficult airways and predictive value of airway examinations among adult patients who underwent maxillofacial surgery at public hospitals in Southern Ethiopia 2022. Methods and materials: An institutional-based multicenter cross-sectional study was conducted among 250 maxillofacial patients from March to 30 June 2022 at selected hospitals. The data were entered into Epi_Data software version 4.3 and analyzed by STATA software version 14. All variables that were statistically significant in bivariate analysis, at the P less than 0.25, were included in the multivariate logistic regression analysis. The predictive value or the effectiveness of airway examinations in predicting difficult airways was analyzed by receiver operating curve. Results: In the current study, the magnitude of difficult airways was 21.2% (95% CI = 16.3–26.1%) and the magnitude of difficult intubation, difficult laryngoscopy, and difficult mask ventilation was 6.4% (95% CI 3.3–9.4%), 9.6% (95% CI 6.1–13%), and 13.6% (95% CI (9.1–16.8%), respectively. History of head and neck surgery adjusted odds ratio (AOR)=6.3, 95% CI (2.85–14.34), cervical collar AOR=4.9, 95% CI (1.96–12.49), and cervical spine injury AOR=2.4, 95% CI (1.07–5.38) were independently and significantly associated with difficulty of airway. Modified Mallampati class and sternomental distance were identified as good preoperative tests to predict difficult laryngoscopy, intubation, and mask ventilation. Conclusion and recommendation: The magnitude of difficult airways was maxillofacial surgery. Among various airway assessment tests, no single test was perfectly accurate. Anaesthesia professionals are recommended to use a combination of preoperative airway assessments.

Risk Factors Analysis and Prediction Model Establishment for Carbapenem-Resistant Enterobacteriaceae Colonization: A Retrospective Cohort Study.

The objective of this study was to identify the risk factors associated with Carbapenem-resistant Enterobacteriaceae (CRE) colonization in intensive care unit (ICU) patients and to develop a predictive risk model for CRE colonization. In this study, 121 ICU patients from Fujian Provincial Hospital were enrolled between January 2021 and July 2022. Based on bacterial culture results from rectal and throat swabs, patients were categorized into two groups: CRE-colonized (n = 18) and non-CRE-colonized (n = 103). To address class imbalance, Synthetic Minority Over-sampling Technique (SMOTE) was applied. Statistical analyses including T-tests, Chi-square tests, and Mann-Whitney U-tests were employed to compare differences between the groups. Feature selection was performed using Lasso regression and Random Forest algorithms. A Logistic regression model was then developed to predict CRE colonization risk, and the results were presented in a nomogram. After applying SMOTE, the dataset included 198 CRE-colonized patients and 180 non-CRE-colonized patients, ensuring balanced groups. The two groups were comparable in most clinical characteristics except for diabetes, previous emergency department admission, and abdominal infection. Eight independent risk factors for CRE colonization were identified through Random Forest, Lasso regression, and Logistic regression, including Acute Physiology and Chronic Health Evaluation (APACHE) II score > 16, length of hospital stay > 31 days, female gender, previous carbapenem antibiotic exposure, skin infection, multi-site infection, immunosuppressant exposure, and tracheal intubation. The risk prediction model for CRE colonization demonstrated high accuracy (87.83%), recall rate (89.9%), precision (85.6%), and an AUC value of 0.877. Patients were categorized into low-risk (0-90 points), medium-risk (91-160 points), and high-risk (161-381 points) groups, with corresponding CRE colonization rates of 1.82%, 7.14%, and 58.33%, respectively. This study identified independent risk factors for CRE colonization and developed a predictive model for assessing the risk of CRE colonization.