Orotracheal Tube Research Articles

Stenting of the trachea with cicatricial stenosis, immediate and long-term results

The aim of study Evaluation of the results of stenting in the treatment of cicatricial stenosis of the trachea. Materials and methods During the period from 1995 to 2023, 154 patients with cicatricial stenosis of the trachea were treated (men - 109 (70.77%), women - 45 (29.22%). The age of the patients ranged from 15 to 83 years. Patients of working age (from 20 to 50 years old) were 102 (66, 23%). The causes of stenosis were: tracheostomy and / or prolonged mechanical lung ventilation through a tracheostomy tube (106-68.83%), mechanical ventilation through the orotracheal tube (38-24.67%), in 6 (3.89%) after circular resection of the trachea, in 3 (1.94%) recurrence of stenosis after tracheolaryngoplasty, in 1 (0.64%) after radiation therapy for primary tracheal cancer in the area of tumor stenosis. Results. In 69 (44.80%) patients, tracheal stenting was performed. Indications for stenting: the impossibility of performing circular resection of the trachea due to the severity of the condition (64-92.75%), preoperative preparation (2-2.89%), cicatricial narrowing of the tracheal anastomosis after circular resection of the trachea (2-2.89%), stenosis of the trachea after long-term treatment of staged treatment (tracheolaryngoplasty with the introduction of a T-shaped tube) (1-1.44%). In 67 patients silicone stents of the Dumont type were inserted, in 2 - stents made of an endotracheal tube and fixed to the neck tissues with a non-absorbable ligature. Complications in the postoperative period occurred in 22 (31,88%) patients. There were no lethal outcomes. It was possible to form a lumen sufficient for breathing in 46 (66.66%) patients. Conclusions. Tracheal stenting in patients with cicatricial tracheal stenosis is a safe and highly effective method that can be used both independently and for preoperative preparation. Restenosis that occurs after the stent removing can be corrected by stent reinsertion by circular resection of the trachea performing, if the patient’s condition allows it.

Noninvasive respiratory support in the perioperative setting: a narrative review.

The application of preoperative noninvasive respiratory support (NRS) has been expanding with increasing recognition of its potential role in this setting as a physiological optimization for patients with a high risk of developing atelectasis and postoperative pulmonary complications (PPC). The increased availability of high-performance anesthesia ventilator machines providing an easy way for NRS support in patients with reduced lung function should not be under-evaluated. This support can reduce hypoxia, restore lung volumes and theoretically reduce atelectasis formation after general anesthesia. Therapeutic purposes should also be considered in the perioperative setting, such as preoperative NRS to optimize treatment of patients' pre-existing diseases, e.g., sleep-disordered breathing. Finally, the recent guidelines for airway management suggest preoperative NRS application before anesthesia induction in difficult airway management to prolong the time needed to secure the airway with an orotracheal tube. This narrative review aims to revise all these aspects and to provide some practical notes to maximize the efficacy of perioperative noninvasive respiratory support.

Advanced Orotracheal Tube Fixation Techniques in Severe Burn Patients: Innovations from a Chilean Hospital

Since its foundation, the Hospital Emergency Public Assistance in Santiago, Chile, has been the national reference center for managing severe burn patients. In 2007, more than 6,000 hospital admissions for burns were registered in Chile due to the severity of the clinical condition. These patients must be treated in intensive care units. Therefore, the use of orotracheal tubes is essential for its management. The correct stabilization of these devices avoids complications or airway risks. In the Major Burn Unit, cotton cloth restraints and transpore-type adhesives are used on the user's face, but in patients with facial territory compromise, these cause tissue damage; due to this, the Dental Unit has innovative techniques of orotracheal tube fixation, using stainless steel and plastic wire ties, which have allowed to reduce the risks of extubation and accidental displacement of the tube, improving its stability. This work describes the technique used in orotracheal tube fixation in two patients with severe burns, performed by the Dental Unit of the Hospital Emergency Public Assistance, Dr. Alejandro del Río, Chile.

Height best predicts the optimal insertion length of orotracheal tubes in children

IntroductionAccurate formulae to predict the optimal insertion length of endotracheal tubes (ETT) are necessary for safe care and have been based on height, weight, age, and ETT size. We believe height best reflects the somatic growth of the trachea. Our goal is to compare a formula generated using height for optimal initial insertion length of ETT to previously published formulae based on height, weight, age, and ETT size.MethodsWe retrospectively reviewed chest radiographs over a two-year period where the head was assured in midline and midposition. We excluded children with conditions altering tracheal dimensions or stature, and scoliosis. We chose 2 cm above the carina to be the optimal insertion length of the ETT which was then correlated to height. We created linear regression equations and Bland-Altman plots.ResultsTwo hundred three orotracheally intubated children were included. The optimal ETT insertion length using the formula Height (cm)/8 + 3.4 had a high association with linear regression and Bland-Altman plots had the narrowest 95% limits of agreement as compared to previously published formulae.ConclusionsWe found optimal insertion length = Height (cm)/8 + 3.4 is more accurate as compared to commonly used formulae that are based on weight, age, or ETT size. This formula places the ETT 2 cm above the carina which should be safe until a chest radiograph is obtained. We find that the use of formulae that divide the height by 10 overestimates the depth of insertion in younger, smaller children and underestimates the depth of insertion in older children.

Association between multidrug-resistant bacteria and outcomes in intensive care unit patients: a non-interventional study.

In intensive care units (ICUs), infections by multidrug-resistant (MDR) microorganisms should be monitored to prevent healthcare-associated infections (HAIs). From 2018 to 2020, we investigated all medical records of patients admitted to the ICU of a public university hospital. All patients colonized/infected by MDR microorganisms and submitted to active surveillance cultures (ASCs) were included. Male patients prevailed, and 9.5% were positive for MDR bacteria. In-hospital deaths were statistically significant (p < 0.05) for older patients, patients with orotracheal tube use during previous and current hospitalization, and patients with high blood pressure, cardiac and pulmonary diseases, and chronic kidney disease. Carbapenem resistant Enterobacteriaceae was the most frequently resistance profile, followed by extended-spectrum beta-lactamase. The diagnosis or evolution of HAIs was statistically significant (p < 0.0001) for patients treated with meropenem and vancomycin, and in-hospital deaths occurred in 29.5% of patients using polypeptides while the use of macrolides reduced the odds for mortality. The BRADEN Scale demonstrated that 50% of the patients were at high risk of dying. Patients hospitalized in the ICU, colonized or infected by MDR bacteria, using invasive medical devices, and with underlying medical conditions presented increased mortality rates. The prescription of meropenem and vancomycin should be carefully monitored once patients using these antimicrobials already have or develop an HAI.

An Innovative Prone-Position Head Support for Spine Surgery: An Alternative Aimed at Mitigating Risks while Maintaining Good Exposure and Facilitating Effective Anesthesiological Interventions - A Technical Note

This article aims to describe the development of a head support for prone spinal surgery, which allows the patient's head to be positioned in neutral alignment with the body and enables monitoring of the position of the eyes, mouth, nose, and orotracheal tube, thus avoiding damage due to poor positioning during surgery. A literature review was conducted focusing on complications resulting from head positioning in different supports to develop an option that would reduce the risks of injury. It was developed a support that protects the patient's head and allows easy visualization of the face during surgery, with sufficient space for the anesthesia team to manage the orotracheal tube if necessary. Since its creation, no serious complications have been observed in the use of this support.

Intubação de sequência rápida em emergências pediátricas: uma revisão integrativa

Objectives: To identify up-to-date information that contributes to increasing the progress of rapid sequence intubation (RSI) in pediatric emergencies. Methods: This is an integrative literature review that used the keywords “Rapid Sequence Induction and Intubation”, “Intubation, Intratracheal” and “Pediatric Emergency Medicine” in the Scielo, PubMed and Virtual Health Library databases, using, after applying the inclusion and exclusion criteria, the content analysis for discussion. Results: We found 9 articles that were later discussed. Conclusions: Many health professionals do not correctly indicate medications during and after RSI in pediatric emergencies, and educational interventions aimed at correcting this failure are beneficial. An accurate epidemiological profile of RSI in pediatric emergencies cannot yet be established. The best way to collect data in studies involving RSI is through video recording. Interventions aimed at reducing the time spent during orotracheal tube insertion may more effectively reduce the total apnea time during RSI. The use of apneic oxygenation and fractional expired oxygen (FeO2) analysis may have some benefits in RSI.

EXPERIENCE REPORTE

This article aims to report the personal experience of the crew of the Mobile Intensive Care Unit – ICU, of a private company, in the center-west region of the state of Minas Gerais. The method used is the report of experiences lived in the last 15 months. It was noticed that the body mass index - BMI, was often not prioritized during removal requests in patients using an orotracheal tube in obese patients, as the majority of ventilators available on the market do not ventilate morbidly obese patients, generating a risk of barotrauma in bag-mask-valve ventilation. This generated in the institution a new protocol for assistance and reception by the attendant when it comes to intubated patients. As it is an Intensive Care Unit (mobile ICU) environment, it requires numerous prevention, stabilization and health promotion actions for the individual to be transported. This is a highly vulnerable vehicle for patients in transit and for the car’s crew. The article leads to reflection on the topic, providing the opportunity to have a broader view when it comes to transporting an obese patient. Despite being very specific and qualified assistance, the importance of disseminating information could awaken the community in general, as any human being could one day need this care and this type of transport. Among the ways to prevent transport complications, the measures taken include improving communication from the team leaving the support base until receiving the patient in the specialized bed with the best support.

Oropharyngolaryngeal manifestations in severe toxic epidermal necrolysis: a single-center's retrospective case series.

Toxic epidermal necrolysis is a rare and life-threatening mucocutaneous disease. Although mucosal ear, nose, and throat (ENT) involvement is common, little is known about the characteristics, treatment modalities, and outcomes of these lesions. The aim of this study was to evaluate ENT mucosal lesions in severe toxic epidermal necrolysis patients and analyze their characteristics, treatment modalities, and outcomes, as well as proposing a management algorithm to prevent long-term debilitating sequalae of these lesions. This is a retrospective review of toxic epidermal necrolysis cases treated at the tertiary burns unit of the Lausanne University Hospital CHUV, Switzerland, between 2006 and 2019. Out of 19 patients with severe toxic epidermal necrolysis, 17 (89%) underwent a complete ENT examination at admission and 14 (82%) had ENT mucosal involvement. Five (26.3%) patients died during the stay in the intensive care unit. Of the 16 patients who received maximal care, 13 (81%) required orotracheal intubation for a median time of 16 (IQR: 14) days. Out of the 14 patients who survived, four (29%) had long-term ENT complications consisting of synechiaes necessitating subsequent endoscopic procedures. Those four patients all required mechanical ventilation with an orotracheal tube and suffered from hypopharyngeal synechiaes as well as oral and endonasal synechiaes in individual cases. This study suggests a high prevalence of ENT synechiaes in patients with severe toxic epidermal necrolysis and requiring orotracheal intubation. Periodic ENT examination could prevent mature synechiae formation in these patients. We propose an algorithm to prevent long-term sequalae in ENT mucosal involvement.

Concomitant Intubation with Minimal Cuffed Tube and Rigid Bronchoscopy for Severe Tracheo-Carinal Obstruction.

Our aim was to report on the use of an innovative technique for airway management utilizing a small diameter, short-cuffed, long orotracheal tube for assisting operative rigid bronchoscopy in critical airway obstruction. We retrospectively reviewed the clinical data of 36 patients with life-threatening critical airway stenosis submitted for rigid bronchoscopy between January 2008 and July 2021. The supporting ventilatory tube, part of the Translaryngeal Tracheostomy KIT (Fantoni method), was utilized in tandem with the rigid bronchoscope during endoscopic airway reopening. Indications for collateral intubation were either tumors of the trachea with near-total airway obstruction (13), or tumors of the main carina with total obstruction of one main bronchus and possible contralateral involvement (23). Preliminary dilation was necessary before tube placement in only 2/13 patients with tracheal-obstructing tumors (15.4%). No postoperative complications were reported. There was one case of an intraoperative cuff tear, with no further technical problems. In our experience, this innovative method proved to be safe, allowing for continuous airway control. It enabled anesthesia inhalation, use of neuromuscular blockage and reliable end-tidal CO2 monitoring, along with protection of the distal airway from blood flooding. The shorter time of the procedure was due to the lack of need for pauses to ventilate the patient.

Determination of the minimum alveolar concentration of sevoflurane in Holstein steers

ObjectiveTo determine the minimum alveolar concentration (MAC) of sevoflurane in Holstein steers using electric stimulation. Study designProspective experimental study. AnimalsA total of 15 Holstein steers aged 7.3 ± 1.2 months and weighing 121 ± 25 kg. MethodsAnimals were anesthetized with sevoflurane at 8% in oxygen at 5 L minute–1 via facemask and were intubated with an orotracheal tube of a compatible size. After 15 minutes of stabilization of the initial expired concentration of sevoflurane (Fe′Sevo) at 2.6%, electrical stimulation on the thoracic limb was initiated with a sequence of 2 × 10 ms followed by 2 × 3 second electrical currents of 50 V and 50 Hz, 5 seconds apart. Following each stimulus with a negative response, the Fe′Sevo was decreased by 0.2% and a 15 minute interval was awaited before the next stimulus. The procedure was repeated until the first Fe′Sevo value with a positive motor response was obtained. The Fe′Sevo was then increased by 0.1%, followed by a new stimulus, until a negative response was obtained. The value of MAC was calculated as the arithmetic mean between the lowest Fe′Sevo associated with a negative motor response and the highest Fe′Sevo associated with a positive response. ResultsThe mean MAC for the 15 steers was 2.0 ± 0.3%, which corresponds to 2.1 ± 0.3% at sea level. ConclusionsBased on the proposed methodology, the MAC of sevoflurane for healthy Holstein steers is 2.1 ± 0.3% at sea level. Clinical relevanceThis Fe′Sevo value can be used to guide depth of anesthesia in steers weighing approximately 120 kg in clinical practice.

Usos del videolaringoscopio C-MAC en una Unidad de Cuidados Intensivos. Estudio prospectivo, observacional

ObjectiveTo describe the main uses of the C-MAC video laryngoscope (VL) in an Intensive Care Unit (ICU) during a period of 29 months. Material and methodsProspective, observational study during a period of 29 months. All patients admitted to our ICU where the VL C-MAC was used were included. Indications, efficacy, and complications were recorded. ResultsThe VL C-MAC has been used 297 times in 250 patients. The mean age of the patients was 68 ± 13 years. The most frequent use of the VL C-MAC was orotracheal intubation (IOT), in 103 (34.7%) cases. 86.4% of the patients were intubated at the first attempt. Intubation with the VL C-MAC accounted for 60.6% (103/170) of all IOTs performed during the study period. The VL C-MAC was used in 76 (25.6%) cases to review the pharynx-larynx area, and in 68 (22.9%) cases to facilitate the introduction of the transesophageal echocardiography (TEE) probe. Other uses were facilitating percutaneous tracheostomy placement (10.1%), nasogastric tube placement (3%), orotracheal tube exchange (3.4%) and Sengstaken balloon placement (0.3%). ConclusionsThe IOT, the review of the pharynx-larynx area and the introduction of the TEE probe were the most frequent uses of the VL C-MAC in our ICU. The use of VL C-MAC in an ICU is broader than tracheal intubation and can facilitate the management of critical patients.

IgG4-infiltrate in post-intubation tracheal stenosis: a call to interventional pulmonologist and thoracic surgeons.

Since December 2019, Sars-CoV2 infection has become a pandemic health emergency. The most severe manifestation of COVID-19 is acute respiratory distress syndrome requiring intensive care unit admission and mechanical ventilation. The most serious, although rare, complication of prolonged MV is post-intubation tracheal stenosis. We hypothesized that, in addition to recognized risk factors in COVID-19 patients, additional factors may promote airways injury. We analyzed data from 13 patients with PITS referred to our Thoracic Surgery Department from 2020 to 2022 divided in two groups: 8 ex-COVID-19 patients (in MV for ARDS during Sars-Cov2 positivity) and 5 non-COVID-19 patients (in MV for other reasons). Computer-tomography and bronchoscopy were performed to confirm diagnosis of PITS. Surgical treatment including tracheal resection and end-to-end anastomosis was performed in all patients. Tracheal samples were histologically analyzed to define the existence of any difference between the two groups. The presence of total immunoglobulin G (IgG) and immunoglobulin G4 (IgG4) were tested. IgG infiltrate was present in both groups. IgG4-infiltrate was significantly represented in the tracheal sample of ex-COVID-19 patients and absent in the non-COVID-19 cohort of patients. It is suggested that COVID-19 patients have almost double the risk of developing tracheal injuries. This work supports the idea of a major predisposition for such injuries in COVID-19 patients due to a possible immune-mediated mechanism leading to aberrant and fibrotic wound healing following a trigger insult (in this case MV with oro-tracheal tube). In the near future an increasing incidence of PITS is expected. Interventional pulmonologist and thoracic surgeons might be called to deal with this possibility. Clarification of the physiopathology of PITS is needed to prevent excessive tracheal scarring following prolonged endotracheal intubation and recurrence after endoscopic and/or surgical treatment. Careful prevention, early detection and effective management of this life-threatening condition are warranted.

Effect of the duration of prone position in ARDS patients during the SARS-CoV-2 pandemic

ObjectiveTo describe the characteristics of patients with acute respiratory distress syndrome (ARDS) due to bilateral COVID-19 pneumonia on invasive mechanical ventilation (IMV), and to analyze the effect of prone position >24 h (prolonged) (PPP) compared to prone decubitus <24 h (PP). DesignA retrospective observational descriptive study was carried out, with uni- and bivariate analyses. SettingDepartment of Intensive Care Medicine. Hospital General Universitario de Elche (Elche, Alicante, Spain). ParticipantsPatients with SARS-CoV-2 pneumonia (2020−2021) on IMV due to moderate-severe ARDS, ventilated in prone position (PP). InterventionsIMV. PP maneuvers. Main variables of interestSociodemographic characteristics, analgo-sedation, neuromuscular blockade (NMB), PD duration, ICU stay and mortality, days of IMV, non-infectious complications, healthcare associated infections. ResultsFifty-one patients required PP, and of these, 31 (69.78%) required PPP. No differences were observed in terms of patient characteristics (gender, age, comorbidities, initial severity, antiviral and antiinflammatory treatment received). Patients on PPP had poorer tolerance to supine ventilation (61.29% vs 89.47%, p = 0.031), longer hospital stay (41 vs 30 days, p = 0.023), more days of IMV (32 vs 20 days, p = 0.032), longer duration of NMB (10.5 vs 3 days, p = 0.0002), as well as a higher percentage of episodes of orotracheal tube obstruction (48.39% vs 15%, p = 0.014). ConclusionsPPP was associated with greater resource use and complications in patients with moderate-severe ARDS due to COVID-19.

Efecto de la duración del decúbito prono en pacientes con SDRA durante la pandemia por SARS-CoV-2

ObjectiveTo describe the characteristics of patients with acute respiratory distress syndrome due to bilateral COVID-19 pneumonia on invasive mechanical ventilation (IMV) and analyze the effect of prolonged prone decubitus>24h (PPD) compared to prone decubitus<24h (PD). DesignRetrospective observational descriptive study. Uni and bivariate analysis. SettingDepartment of Intensive Care Medicine. General University Hospital of Elche. ParticipantsPatients with SARS-CoV-2 pneumonia (2020–2021) in VMI for moderate-severe acute respiratory distress syndrome, ventilated in PD. InterventionsIMV. PD maneuvers. Main variables of interestSociodemographic; analgo-sedation; neuromuscular blockade; PD (duration), ICU stay and mortality, days of IMV; non-infectious complications; health care-associated infections. ResultsFifty-one patients required PD and of these 31 (69.78%) required PPD. No differences were found in patient characteristics (sex, age, comorbidities, initial severity, antiviral and anti-inflammatory treatment received). Patients on PPD had lower tolerance to supine ventilation (61.29 vs. 89.47%, p=0.031), longer hospital stay (41 vs. 30 days, p=0.023), more days of IMV (32 vs. 20 days, p=0.032), longer duration of neuromuscular blockade (10.5 vs. 3 days, p=0.0002), as well as a higher percentage of episodes of orotracheal tube obstruction (48.39 vs. 15%, p=0.014). ConclusionsPPD was associated with higher resource use and complications in patients with moderate-severe acute respiratory distress syndrome by COVID-19.

Transesophageal Echocardiographic Assessment in Patients with Severe Respiratory Distress due to COVID-19 in the Prone Position: A Feasibility Study.

Our aim was to assess the feasibility, safety, and utility of implementing transesophageal echocardiographic screening in patients with coronavirus disease-2019 (COVID-19)-related acute respiratory distress syndrome (ARDS), receiving mechanical ventilation (MV) and in prone position (PP). Prospective observational study performed in an intensive care unit; patients 18 years, with ARDS, invasive MV, in PP were included. A total of 87 patients were included. There was no need to change ventilator settings, hemodynamic support, or any difficulties with the insertion of the ultrasonographic probe. Mean duration of transesophageal echocardiography (TEE) was 20 minutes. No displacement of the orotracheal tube, vomiting, or gastrointestinal bleeding was observed. Frequent complication was displacement of the nasogastric tube in 41 (47%) patients. Severe right ventricular (RV) dysfunction was detected in 21 (24%) patients and acute cor pulmonale was diagnosed in 36 (41%) patients. Our results show the importance of assessing RV function during the course of severe respiratory distress and the value of TEE for hemodynamic assessment in PP. Sosa FA, Wehit J, Merlo P, Matarrese A, Tort B, Roberti JE, et al. Transesophageal Echocardiographic Assessment in Patients with Severe Respiratory Distress due to COVID-19 in the Prone Position: A Feasibility Study. Indian J Crit Care Med 2023;27(2):132-134.

Comparison Of Chula Formula With Standard 21/23 Rule For Estimation Of Orotracheal Tube Depth In Intubated Adult Patients: A Sindh Institute Of Urology And Transplantation Experience.

The proper estimation of depth of the orotracheal tube (OTT) in intubated patients is difficult. Several methods have been developed for proper estimation of the depth of OTT. The purpose of this study was to compare two commonly used formulae (21/23 rule and Chula formula) for proper estimation of depth of OTT in our Pakistani population. In this randomized interventional study, we included 74 adult patients. The study was conducted in the Intensive care unit of a tertiary care hospital in Karachi, Pakistan, from October 2021 to April 2022. Patients were intubated using either the 21/23 rule (OTT was fixed at 21 cm in females and 23 cm in males from the right incisor) or the Chula formula (OTT was fixed at the right incisor according to the height based formula, {(height in cm/10)+4}). The distance between the carina and the OTT tip was measured using the digital chest x-ray with a PACS software. A total of 74 patients were intubated in which 32 were intubated using 21/23 rule and 42 were intubated using the Chula formula. Four female patients in 21/23 rule group encountered unsafe distance between the carina and the tip of the OTT (i.e., <2 cm) while no such complications were reported in Chula formula group (p-value 0.031). Chula formula was safe method for OTT placement in our study. Further studies with larger sample size are needed to assess the safety and efficacy of Chula formula for Pakistani Population.

Prevention of Endotracheal Tube-Related Pressure Injury: A Systematic Review and Meta-analysis.

Hospital-acquired pressure injuries, including those related to airway devices, are a significant source of morbidity in critically ill patients. To determine the incidence of endotracheal tube-related pressure injuries in critically ill patients and to evaluate the effectiveness of interventions designed to prevent injury. MEDLINE, Embase, CINAHL, and the Cochrane Library were searched for studies of pediatric or adult patients in intensive care units that evaluated interventions to reduce endotracheal tube-related pressure injury. Reviewers extracted data on study and patient characteristics, incidence of pressure injury, type and duration of intervention, and outcomes. Risk of bias assessment followed the Cochrane Collaboration's criteria. Twelve studies (5 randomized clinical trials, 3 quasi-experimental, 4 observational) representing 9611 adult and 152 pediatric patients met eligibility criteria. The incidence of pressure injury was 4.2% for orotracheal tubes and 21.1% for nasotracheal tubes. Interventions included anchor devices, serial endotracheal tube assessment or repositioning, and barrier dressings for nasotracheal tubes. Meta-analysis revealed that endotracheal tube stabilization was the most effective individual intervention for preventing pressure injury. Nasal alar barrier dressings decreased the incidence of skin or mucosal injury in patients undergoing nasotracheal intubation, and data on effectiveness of serial assessment and repositioning were inconclusive. Airway device-related pressure injuries are common in critically ill patients, and patients with nasotracheal tubes are particularly susceptible to iatrogenic harm. Fastening devices and barrier dressings decrease the incidence of injury. Evidence regarding interventions is limited by lack of standardized assessments.

Atuação profissional no serviço hospitalar de fisioterapia diante das infecções por coronavírus

ABSTRACT During the COVID-19 pandemic, we observed an important growth of demands on healthcare providers. Delimited attributions for each position are important, aiming less burden and better care effectiveness. Physical therapists play a fundamental role in the care of patients with COVID-19 complications. This research analyzed physical therapist’s role and knowledge about COVID-19 during the pandemic in a public hospital. This is a mixed cross-sectional study, with a quantitative descriptive and qualitative exploratory method, carried out in a public hospital in Goiânia. The physical therapists filled out an anamnesis form and a questionnaire with pre-structured questions about the attributions of physical therapy in the hospital environment. The population was composed of 13 professionals. Most considered oxygen therapy implementation (100%), INVASIVE and non-invasive ventilation management (100%), participation in orotracheal intubation (92.3%), airway aspiration (100%), extubation (92.3%), measurement of the orotracheal tube cuff pressure (92.3%), and replacement the mechanical ventilator filter (92.3%) as physical therapy assignments. Most professionals (46.15%) considered that these patients’ mobilization must frequently be carried out. regarding COVID-19 AND their role in the pandemic. Confusion is still present regarding procedures related to the respiratory area in the hospital environment.

New Device for Submental Endotracheal Intubation: A Prospective Cohort Study

Silveira etal (2020) described a new device that aims to facilitate submental intubation. This study aimed to verify the clinical complications from using this new device for submental endotracheal compared to the conventional technique. Patients who underwent submental intubation with the orotracheal tube transposition device were compared to those who underwent the conventional technique in a prospective cohort study. The primary predictor variable was intubation technique: conventional versus device-assisted. The primary outcome was total complications (all complications trans and postoperative, were recorded). Secondary variables were 1) age, 2) sex, 3) etiology, 4) race/ethnicity, 5) fracture types, and 6) intubation procedure time. The data were analyzed using descriptive and inferential statistics. Differences were considered statistically significant at P<.05. Forty-two cases are described, including 24 cases with the device and 18 cases using the conventional technique. The mean age was 30.5±11.228years. The majority of patients were of male sex (88%), non-white (64%), and victims of motorcycle accidents (33%). The mean time to perform submental intubation was 9.9minutes (±2.1293). Nine complications were recorded, including 2 intraoperative (2 tube dislocations) and 7 postoperative (5 unesthetic scars, one localized hematoma, and one skin infection). The technique used did not affect the time to submental intubation (P=.610). There was no association between technique and occurrence of intraoperative (P=.679; RR=0.75; confidence interval [CI], 0.05-11.2), postoperative (P=.656; RR=1.000; CI, 0.255-3.922), or total complications (P=.602; RR=0.938; CI, 0.293-3.003). The new device proposed seems to be a good option with similar complication rates as compared to conventional submental intubation.