Rate Of Tracheal Intubation Research Articles

Airtraq(®) versus Macintosh laryngoscope: A comparative study in tracheal intubation.

Background:The curved laryngoscope blade described by Macintosh in 1943 remains the most widely used device to facilitate tracheal intubation. The Airtraq® (Prodol Meditec S.A, Vizcaya, Spain) is a new, single use, indirect laryngoscope introduced into clinical practice in 2005. It has wan exaggerated blade curvature with internal arrangement of optical lenses and a mechanism to prevent fogging of the distal lens. A high quality view of the glottis is provided without the need to align the oral, pharyngeal and tracheal axis. We evaluated Airtraq and Macintosh laryngoscopes for success rate of tracheal intubation, overall duration of successful intubation, optimization maneuvers, POGO (percentage of glottic opening) score, and ease of intubation.Materials and Methods:Patients were randomly allocated by computer-generated random table to one of the two groups, comprising 40 patients each, group I (Airtraq) and group II (Macintosh). After induction of general anesthesia, tracheal intubation was attempted with the Airtraq or the Macintosh laryngoscope as per group. Primary end points were overall success rate of tracheal intubation, overall duration of successful tracheal intubation, optimization maneuvers, POGO score and ease of intubation between the two groups.Results:We observed that Airtraq was better than the Macintosh laryngoscope as duration of successful intubation was shorter in Airtraq 18.15 seconds (±2.74) and in the Macintosh laryngoscope it was 32.72 seconds (±8.31) P < 0.001. POGO was also better in the Airtraq group 100% grade 1 versus 67.5% in the Macintosh group, P < 0.001. Ease of intubation was also better in the Airtraq group. It was easy in 97.5% versus 42.5% in the Macintosh group, P < 0.001.Conclusion:Both Airtraq and Macintosh laryngoscopes are equally effective in tracheal intubation in normal airways. Duration of successful tracheal intubation was shorter in the Airtraq group which was statistically significant.

In reply: efficacy of a new videolaryngoscope; what we should assess?

To the Editor: We thank Dr. Meng and colleagues for their constructive comments to our study [1]. Videolaryngoscopes have been shown to be useful in patients with and without difficult airways [2–5], but their efficacies may differ [2]. To assess the usefulness of each new device, we need to address three major factors: the device (efficacy), the patient (degree of difficult airway), and the performer (expertise). In addition to these major factors, as Meng and colleagues point out, we may need to assess the efficacy of supportive measures (such as pressure on the neck or use of a stylet). It would be ideal to assess all of these, but it is often impractical to standardize all factors (other than the device factor). We considered that because it would be difficult and may be unethical to standardize the patient factor in real patients, we chose to standardize the patient factor using a manikin with four different simulated difficult airways. Regarding the expertise of the performer, we stated the reasoning for choosing residents and their equal proficiency in our article [1]: It is known that the expertise of the anesthesiologist will affect the success rate of tracheal intubation. We considered that, for experienced anesthesiologists, they would be able to intubate the trachea using either a Macintosh laryngoscope or a fibreoptic bronchoscope, whereas for less experienced anesthesiologists (but with minimum skills), videolaryngoscopes may be regarded as the first choice when tracheal intubation using a Macintosh laryngoscope has failed. The participants had minimum skills with the Macintosh laryngoscopes, because in a manikin with normal airway, there were no significant differences in the success rate of tracheal intubation between the VLP-100, the AWS, and the Macintosh [1]. Meng and colleagues state that the difference in laryngoscopic views among three laryngoscopes was stated as a final endpoint of performance comparison, and comparing the views obtained with direct and video laryngoscopes is not an entirely appropriate comparison. We agree with their comments on the uncertainty regarding the use of the Cormack–Lehane score for assessing the efficacy of videolaryngoscopes, and this is why we did NOT use the view of the glottis as the primary endpoint. We clearly state that the main aim of our study was to compare success rates of tracheal intubation between the three laryngoscopes, and tracheal intubation was the primary endpoint [1]. As Meng and colleague imply, there are many factors that we did not study: for example, there is still insufficient evidence to judge whether tracheal intubation using a videolaryngoscope is less likely to traumatize the airway or to prolong apnea time [2]. We need to continue carrying out randomized controlled trials and reporting large case series, together with some tips for effective use, to establish the true role of each videolaryngoscope in patients with and without difficult airways.

Efficacy of Coopdech videolaryngoscope: comparisons with a Macintosh laryngoscope and the Airway Scope in a manikin with difficult airways

We studied the efficacy of the Coopdech videolaryngoscope Portable VLP-100, by comparing it with a Macintosh laryngoscope, and another videolaryngoscope, the Airway Scope (AWS), in a manikin with four simulated difficult airways. In a randomized, crossover design, each of 50 residents inserted the three devices, in turn, and graded the view of the glottis at laryngoscopy. Time to see the glottis, time to intubate the trachea, and the success rate of tracheal intubation (within 120s) were recorded. In all situations, the AWS provided a significantly shorter time to see the glottis. In a manikin with tongue edema, the AWS was associated with a significantly higher success rate of intubation than the VLP-100 and the Macintosh laryngoscope (P<0.05). In a manikin with cervical spine rigidity or pharyngeal obstruction, the AWS and the VLP-100 provided significantly higher success rates of intubation than the Macintosh laryngoscope (P<0.05). In a manikin with laryngospasm, no one could intubate the trachea using any device. Our results indicate that, in patients with difficult airways, the videolaryngoscopes (VLP-100 and AWS) would provide higher success rates of tracheal intubation than the Macintosh laryngoscope, but the VLP-100 may be inferior to the AWS.

Comparison of the air-Q ILA™ and the LMA-Fastrach™ in airway management during general anaesthesia

AbstractOne hundred and sixty patients aged between 20–60 years with ASA physical status I-II, undergoing elective surgery under general anaesthesia, were enrolled into this prospective, randomised, double-blinded study to compare the success rate of tracheal intubation between the air-Q™ intubating laryngeal airway (ILA) and the laryngeal mask airway (LMA)-Fastrach™ (80 patients in each group). The degree of mouth opening, occurrence of coughing, laryngospasm, ease of insertion, adequacy of ventilation, and number of attempts were recorded during the insertion of the air-Q™ ILA and the LMA-Fastrach™. Tracheal intubation via the supraglottic airway devices was then performed, and cricoid manipulation, ease of insertion and number of attempts, were noted. Postoperatively, the degree to which patients had a sore throat using visual analogue scale (VAS), hoarseness of voice and blood on the air-Q™ ILA and the LMA-Fastrach™ were recorded. In terms of ease of insertion, there was no statistically significant d...

Evaluation of three adjusting manoeuvres and type of endotracheal tube in the success of air-Q™ aided tracheal intubation

Background: The present study observed whether the use of three different adjusting manoeuvres and use of an armoured tracheal tube would increase the success rate of tracheal intubation, aided by the air-Q™ intubating laryngeal airway (air-Q ™ ILA). Method: Fifty American Society of Anesthesiologists (ASA) I and II patients undergoing elective surgical procedures were randomly assigned to two groups. In the endotracheal tube (ETT) group, standard ETT was used, while in the armoured ETT (AETT) group, tracheal intubation was performed using AETT. After a uniform premedication, induction and relaxation technique, an appropriate sized air-Q ™ ILA with ETT in-situ, was placed. After good ventilation, a flexible fibrescope was passed down the ETT, and the percentage of glottic opening (POGO) was documented. Subsequently, three adjusting manoeuvres were applied in sequence. These included firstly, backward pressure over the larynx; secondly, head extension; and lastly, neck flexion. After noting the POGO score with each adjusting manoeuvre, the incidence of successful intubation was noted, with and without manoeuvres. Results: The best POGO score (84%) was observed with the application of backward pressure. Successful tracheal intubation was achieved in 56-60% of patients without the use of any manoeuvres, using either type of tracheal tube. For the rest, tracheal intubation was achieved using backward pressure, except in one patient from the ETT group. The incidence of successful tracheal intubation was nearly identical with either type of ETT. Conclusion: Successful tracheal intubation can be achieved in 96% of cases using adjusting manoeuvres. The nature of the tracheal tubes did not influence the success rate.

Randomized Clinical Trial of the i-gel™ and Magill Tracheal Tube or Single-Use ILMA™ and ILMA™ Tracheal Tube for Blind Intubation in Anaesthetized Patients With a Predicted Difficult Airway

Theiler, L.*†; Kleine-Brueggeney, M.*‡; Urwyler, N.*; Graf, T.*; Luyet, C.*; Greif, R.*Author Information

Videolaryngoscopes

Videolaryngoscopes

Orotracheal intubation of morbidly obese patients, comparison of GlideScope(®) video laryngoscope and the LMA CTrach™ with direct laryngoscopy.

Background:Morbidly obese patients are at increased risk of difficult mask ventilation and intubation as well as increased risk of hypoxemia during tracheal intubation. Recently, new video-assisted intubation devices have been developed. The GlideScope® videolaryngoscope and LMA CTrach™ (CT) allows continuous video-endoscopy of the tracheal intubation procedure.Objective:this study is to determine whether the GlideScope® videolaryngoscope (GVL) and the LMA CTrach™ (CT) provide the best airway management, measured primarily in intubation difficulty scale (IDS) scores, time and numbers of intubation attempts, and improvement in the intubation success rate of morbidly obese patients when compared with the direct Macintosh laryngoscope (DL).Materials and Methods:After Ethics’ Committee approval, 90 morbidly obese patients (BMI > 35 kg/m2) scheduled for general, gynecological, and bariatric surgery were included in this prospective study. Patients were randomly assigned in three groups: tracheal intubation using direct laryngoscopy (DL), GlideScope® videolaryngoscope (GVL) or the LMA CTrach™ (CT). Characteristics and consequences of airway management were evaluated. The primary outcome was the intubation difficulty scale score (IDS), Secondary outcomes were theintubation time, overall success rate, number of attempts, Cormack–Lehane grade, subjective difficulty of intubation, desaturation and upper airway morbidity.Results:Difficulty in facemask ventilation was similar in the three groups. IDS scores were significantly lower with GVL and CT than with DL. The mean TTI was 14 s faster in patients intubated with the GVL (86 s, IQR: 68-115) compared with DL (100 s, IQR; 80-150), and was 34 s faster when compared with CT (120 s, IQR; 95-180). The success rate of tracheal intubation was lower with the DL (80%) compared with the GVL (100%) or the CT (100%). Six cases of failed intubation occurred in group DL, four patients from the six patients were intubated successfully with GVL, and two patients were intubated with the CT. Both the GVL and the CTimproved the Cormack and Lehane view obtained at laryngoscopy, compared with the DL. Significantly high percent of patients in DL (43%) and CT (27%) required optimization maneuvers (external laryngeal pressure) compared with GVL (0%). In the CT group, 30% of the patients required laryngeal mask manipulation (for view optimization) compared with (0%) in GVL and CT groups.Conclusion:The GlideScope® videolaryngoscope and the LMA CTrach™ reduced the difficulty, improved laryngoscopic views and overall success rate of tracheal Intubationto a similar extent compared with the Macintosh laryngoscope in morbidly obese patients. The GVL improved intubation time for tracheal intubation compared with the CT and DL but no patient became hypoxic with CT because of prolonged intubation time.

The efficacy of mechanical ventilation with BiPAP for severe pneumonia

Objective To explore the efficacy of mechanical ventilation with BiPAP for severe pneumonia.Methods 60 patients with severe pneumonia who had been hospitalized during January 2008 to January 2009 were randomly divided into study group and control group.The control group received conventional therapy and the study group received mechanical ventilation with BiPAP in addition to conventional therapy.Results Levels of PaO2 and SpO2 were significantly higher in the study group than in control group after treatment ( P ＜ 0.05 ).Heart rate was markedly lower in the study group than in the control group ( P ＜ 0.05 ).PH level did not differ significantly between the two groups ( P ＞ 0.05 ).Length of hospital stay was shorter,and rate of tracheal intubation and death rate were significantly lower in the study group than in the control group ( P ＜ 0.05 ).No obvious adverse reactions were found in both groups.Conclusions Mechanical ventilation with BiPAP is more effective in the treatment of severe pneumonia.It has fewer adverse reactions and is worth popularizing. Key words: BiPAP; Mechanical ventilation; Severe pneumonia

Randomized clinical trial of the i-gel™ and Magill tracheal tube or single-use ILMA™ and ILMA™ tracheal tube for blind intubation in anaesthetized patients with a predicted difficult airway

The single-use supraglottic airway device i-gel™ has been described in several case reports as a conduit for intubation, but no prospective data about success rates of blind intubation are available. Therefore, we performed this prospective randomized controlled trial to compare the success rate of blind tracheal intubation with a Magill PVC tube through the i-gel™ with intubation using an sILMA™ PVC tube through the single-use intubating laryngeal mask airway (sILMA™). With ethics committee approval and written informed consent, 80 patients with predictors of a difficult airway were computer randomized to either supraglottic airway device (SAD). The corresponding tracheal tube (TT) was introduced through the SAD under fibreoptic visualization but without fibreoptic guidance. Primary outcome was blind intubation success rate. Times, airway leak pressure, fibreoptic view, and adverse events were recorded. To control for the influence of the TT, we compared data from 40 patients described in an accompanying study (sILMA™ with Magill TT and i-gel™ with sILMA™ TT). Blind intubation success rate through the sILMA™ (69%) was higher than with the i-gel™ (15%, P<0.001). Data from the other patient group excluded the TT type as the primary cause for the difference in success rate. Removal of SADs was without problems with no difference between the type of SAD. Blind tracheal intubation using the sILMA™ tube through the sILMA™ is much more successful than blind intubation with a Magill PVC tube through the i-gel™. Because of its low success rate, we would not recommend blind intubation through the i-gel™.

Difficult Tracheal Intubation of In-hospital Emergent Patients

Difficult Tracheal Intubation of In-hospital Emergent Patients

Induction of tracheal intubation without muscle relaxant by target controlled infusion of propofol combined with remifentanil in children

To observe the safety and feasibility of tracheal intubation by target-controlled infusion of propofol and remifentanil without muscle relaxant in children. Totally 100 4-10-year-old pediatric patients (ASA1) who had been scheduled for plastic surgery were equally divided into remifentanil group and control group through computer-generated randomized grouping. In all patients, five minutes after intravenous administration of atropine 0.01 mg/kg and midazolam 0.1 mg/kg, propofol was infused at the targeted effect-site concentration (Ce of 6 μg/ml. When the intended target Ce of propofol was reached, the remifentanil group began to be infused with remifentanil at a Ce of 5 ng/ml, and normal saline (0.1 ml/kg) was injected simultaneously. In the control group remifentanil was replaced by normal saline and rocuronium (0.8 mg/kg) was injected together with the normal saline. After the equilibration of plasma and the Ce of remifentanil were reached, tracheal intubation was attempted. The complications during the induction and tracheal intubation were recorded. The intubating conditions were assessed using a five-point scoring system based on ease of laryngoscopy, vocal cords position, coughing, jaw relaxation and limb movement. The success rate of tracheal intubation was in 90% in remifentanil group and 98% in the control group (P=0.122).CONCLUSION Target-controlled infusion of propofol and remifentanil at Ce of 6 μg/ml and 5 ng/ml is feasible for the induction and tracheal intubation without muscle relaxant in children.

Management of Unanticipated Difficult Airway in the Prehospital Emergency Setting

We were greatly interested in the recent article of Combes et al. 1that prospectively validated a prehospital difficult-intubation algorithm. In this clinical study, the tracheal intubation with direct laryngoscope proved impossible in 160 patients. However, of these 160 patients, 15 had a laryngeal view of the Cormack and Lehane (C&amp;L) class I or II, which is generally regarded as an easy laryngoscopy.2The ease of direct laryngoscopy is not synonymous with ease of tracheal intubation, but the laryngeal view obtained by direct laryngoscopy usually is an important determinant of successful intubation. We would like to know the detailed cause of failed intubation in these patients with an easy laryngoscopy. Moreover, the authors did not clearly describe whether their algorithm required for use of an endotracheal tube with a malleable stylet at the initial intubation attempt. In managing difficult intubation, mounting the endotracheal tube onto a stylet and angling the distal tip upward help to guide the tube tip toward the glottis and improve the success rate of tracheal intubation.3This measure is especially useful when a poor laryngeal view is obtained during direct laryngoscopy or when using a flexible endotracheal tube without a natural anterior curve. In general, when speed of tracheal intubation is important (as in a patient with a full stomach or chest compression), an endotracheal tube should always be equipped with a stylet.4In this difficult-intubation management algorithm, the authors recommended that if the tracheal intubation failed after either two attempts with a C&amp;L class less than IV or a single attempt with a C&amp;L class IV, along with optimal upper airway and head manipulations, the participants were requested to move to the next step of the algorithm, the gum elastic bougie (GEB). GEB-guided intubation was used as first choice and the intubating laryngeal mask airway (ILMA) as a backup. However, what usually determines the successful intubation with the GEB is part or complete visualization of the epiglottis with or without laryngeal structure. For an intubator who has no extensive experience in the GEB-guided intubation, if direct laryngoscopy can not expose any epiglottic structure as an objective mark (e.g. , C&amp;L class IV), blindly inserting the GEB into the trachea will be very difficult. In clinical practice, the GEB-guided intubation is really most suitable for patients with a C&amp;L class less than IV.5Thus, we consider that in their difficult-intubation management algorithm, the rescue step to use the GEB-guided intubation as first choice may be suitable only for the patients with a C&amp;L class less than IV. After a single intubation attempt failed in patients with a C&amp;L class IV, the rescue airway algorithm should move directly to the step that uses the ILMA to ventilate the patients and then to intubate the trachea, but not to the step that attempts reintubation with the GEB because it has high risks of failed intubation and increased airway trauma. For this situation, we completely agree with the editorial view of Drs. Isono and Ishikawa that maintenance of oxygenation is the final goal of airway management.6The authors did not clearly state the type of the ILMA used for this difficult-intubation management algorithm. When an ILMA is used as a rescue airway device in the prehospital setting, we recommend use of the ILMA CTrach™ (Laryngeal Mask Company Limited, San Diego, CA) with the integrated fiberoptic channels and a detachable liquid crystal display viewer, rather than the ILMA Fastrach™ (Laryngeal Mask Company Limited). It has been shown that compared with the ILMA Fastrach™, the ILMA CTrach™ can enable a higher first-attempt success rate of tracheal intubation because of the view of the glottis it provides, the way it optimizes placement of the device, and the ability to observe the process of tracheal intubation through the device.7In addition, data from the study of Nickel et al. 8suggest that the ILMA CTrach™ is a suitable device for emergency airway management in the prehospital setting because it provides ventilation and facilitates intubation with a very high success rate.*Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China. fruitxue@yahoo.com.cn

Utilisation de l’Airtraq ® par des praticiens inexpérimentés supervisés pour une série de patients adultes prévus difficiles à intuber

Introduction The Airtraq ® optical laryngoscope (Vygon, Écouen, France) is a new intubation device designed to provide a view of the glottis without alignment of the oral, pharyngeal and laryngeal axes. In recent literature, the efficiency of the Airtraq ® even in difficult intubation and its short learning curve were characterized. The goal of our study is to evaluate Airtraq™ efficiency when use by inexperienced physicians in anticipated difficult intubation adult patients. Methods The patients showing at least one of the four difficult intubation predictors (history of difficult intubation, thyromental distance less than 60 mm, mouth opening less than 35 mm and Mallampati class 3 or 4 were included. Before induction of anaesthesia, the inexperienced physicians participating the study received a short oral formation on the use of the Airtraq ®. For each intubation manoeuvres, the participant were supervised by an expert in Airtraq ® handling. The Cormack and Lehane grade of direct laryngoscopy view, the duration times to best glottis view and to intubate the trachea, the success or failure of tracheal intubation, the drop in arterial oxygen saturation of below 95%, the need for external manipulation, and the difficulties met by the operators were noted. Results Twenty patients were included over a month period. Thirteen had a history of difficult intubation, eight a thyromental distance less than 60 mm, nine a mouth opening less than 35 mm and 12 patients were classified as Mallampati IV. The success rate of tracheal intubation with the Airtraq ® laryngoscope was 80%. Times to best glottis view and to complete tracheal intubation were 28 and 47 s, respectively. Four tracheal intubation failures were encountered. The LMA Fastrach ® and the flexible fiberoscope were used respectively in one and three patients. Discussion In the majority of the cases, the insertion of the Airtraq ®, the visualization of the glottis and the subsequent intubation were easy and rapid, without arterial oxygen desaturation. However, the four tracheal intubation failures associated with prolonged tracheal intubation times in some patients highlight the fact that the Airtraq ® laryngoscope requires a clinical training process particularly in case of anticipated difficult airway management situations.

Efficacy of the Airway Scope on tracheal intubation in the lateral position: comparison with the Macintosh laryngoscope

The Airway Scope (AWS) may become a rescue airway device to secure the airway in the lateral position. We evaluated the efficacy of the AWS on tracheal intubation in patients in this position in comparison with the Macintosh laryngoscope. Seventy patients scheduled for surgery in the lateral position under general anaesthesia with tracheal intubation were randomised into two groups: intubation with the Macintosh laryngoscope and that with the AWS. After general anaesthesia and muscle relaxation, experienced anaesthetists performed laryngoscopy and intubation using either laryngoscope in the right or left lateral position. Laryngoscopic view, intubation time, intubation difficulty scale score and success rate of tracheal intubation (within 60 s) were recorded and compared between intubation with the Macintosh laryngoscope and that with the AWS. In the lateral position, the laryngoscopic view with the AWS was significantly better than that with the Macintosh laryngoscope (P < 0.01). Tracheal intubation was successful at the first attempt with the AWS in all patients and with the Macintosh laryngoscope in 85.3% of patients (P < 0.05). The median times to intubation with the AWS and with the Macintosh laryngoscope were 14 (interquartile range, 9-19) s and 29 (20-31) s, respectively (P < 0.01). Also, the AWS significantly reduced the intubation difficulty scale score compared with the Macintosh laryngoscope (P < 0.01). In the situation in which securing the airway in the lateral position is required, the AWS is more effective than the Macintosh laryngoscope.

A randomized Comparison of C-MAC Videolaryngscope Versus Macintosh Laryngoscope for Tracheal Intubation

Purpose: The present study compared the C-MAC videolaryngoscope (C-MAC) with Macintosh laryngoscope with regard to the laryngoscopic view, laryngoscopic time and time required to complete the tracheal intubation. We aimed to investigate any disadvantages that the C-MAC laryngoscope may have when used in routine clinical practice. Methods: Ninety patients undergoing elective surgery requiring general anaesthesia and tracheal intubation were randomly allocated to receive tracheal intubation using the C-MAC or the Macintosh laryngoscope. Following a standardised general anaesthetic, data were collected during laryngoscopy and endotracheal intubation. Results: The median laryngoscopic time (IQR) for the C-MAC and Macintosh laryngoscope respectively were 9.8 (4) and 8.1 (3.3) seconds (p = 0.037). The median total intubation time (IQR) for the C-MAC and Macintosh laryngoscope respectively were 29.2 (18.6) and 23.5 (9.4) seconds, (p = 0.011). There were no significant differences in the laryngoscopic view, additional airway manoeuvres and success rate of tracheal intubation between the two groups. Conclusion: Although the differences in the laryngoscopic time and intubation time were statistically significant, they did not achieve clinical significance. Therefore we conclude that the C-MAC videolaryngoscope may be used in routine clinical practice for tracheal intubation.

Characteristics of elderly Japanese patients with severe burns

In this study, we report the clinical characteristics of elderly Japanese patients with severe burns. We studied the clinical features of 76 adult patients with severe burns, 35 of whom (46.1%) were ≥65 years old. We evaluated the characteristics of patients with respect to each type of burn. In addition, we studied the rate of death and survival in the elderly and also between the elderly and non-elderly patients. The following parameters were either assessed or compared between the elderly and non-elderly: gender, average age, vital signs (Glasgow Coma Scale, systolic blood pressure, heart rate and respiratory rate) and PaO 2/FiO 2 (P/F) ratio at admission, cause of burn and a history of physical or psychiatric disease. Further, we investigated whether the burn was caused by attempting suicide and determined the percent total body surface area (%TBSA), second- and third-degree burn area, burn index (BI), prognostic burn index (PBI), presence of tracheal burns, presence of alcohol intoxication and overdose poisoning, presence of tracheal intubation, outcome and cause of death. The male:female ratio of the elderly patients was 17:18 (average age, 78.1 (8.2) years). Burns were mostly caused by flame (26/35), followed by scalding (8/35). Ten patients had attempted suicide. The %TBSA, second-degree burn area, third-degree burn area, BI and PBI, respectively were 46.6% (26.7%), 15.3% (19.0%), 35.6% (26.0%), 41.1 (25.2) and 119.2 (25.9). Of the 35 patients, 23 died. The notable characteristics of the elderly patients who died were flame as the cause of the burns: high %TBSA, BI and PBI, and a high rate of tracheal intubation. Elderly patients constituted approximately 45% of our study population. Most burns were caused by flames. The incidence of accidental bathtub-related burns was higher and that of suicide attempts was lower in the elderly patients, as compared with the non-elderly patients. Severe burns were fatal for elderly patients. Therefore, elderly Japanese people should be educated on how to prevent non-intentional burns.

Application of non-invasive ventilation in treating COPD patients with respiratory failure

Objective To evaluate the clinical value of early use of non-invasive ventilation in chronic obstructive pulmonary disease(COPD)patients with respiratory failure.Methods Totally 58 patients with COPD induced respiratory failure,admitted from January 2007 to June 2009,received BIPAP non-invasive ventilation treatment,and were retrospectively studied.The changes of respiration rate,heart rate,arterial blood gas before and after non-invasive ventilation application were compared.According to the application time of non-invasive ventilation,58 patients were divided into two groups:group Ⅰ(early application group,n=27)and group Ⅱ(non-early application group,n=31).The time to improve the symptoms,the application time of non-invasive ventilation,cure rate,tracheal intubation rate and mortality were compared between the two groups.Results Non-invasive ventilation was applied on 54 patierts effectively.Their respiratory rate,heart rate significantly decreased,PH,PaO_2 and SaO_2 significantly increased and PaCO_2 significantly decreased(P＜0.05).The tracheal intubation was performed in 4 patients.The time needed to improve the symptoms and the application time of non-invasive ventilation were significantly different between group Ⅰ and group Ⅱ(t=7.38,5.64,all P＜0.01).In group Ⅰ,all patients were cured,no tracheal intubation.In group Ⅱ,27 patients were cured,4 patients required tracheal intubation,and 2 died.Conclusion Non-invasive ventilation application is effective in the treatment of COPD patients with respiratory failure.Early application can increase the cure rate and reduce mortality. Key words: Pulmonary disease,chronic obstructive; Ventilators,mechanicai; Respiratory insufficiency

Non-invasive mechanic ventilation in treating acute respiratory failure

Non invasive ventilation (NIV) in acute respiratory failure (ARF) improve clinical parameters, arterial blood gases, decrease mortality and endo tracheal intubation (ETI) rate also outside the intensive care units (ICUs). Objective of this study is to verify applicability of NIV in a general non respiratory medical ward. We enrolled 68 consecutive patients (Pts) with Hypoxemic or Hyper capnic ARF: acute cardiogenic pulmonary edema (ACPE), exacerbation of chronic obstructive pulmonary disease (COPD), Pneu - monia, acute lung injury / acute respiratory distress syndrome (ALI/ARDS). NIV treatment was CPAP or PSV + PEEP. 12 Pts (18,5%) met primary endpoint (NIV failure): 11 Pts (17%) needed ETI (5ALI/ARDS p &lt; 0,0001, 6COPD 16,6%), 1 Patient (1,5%) died (Pneumonia). No Pts with ACPE failed (p = 0,0027). Secondary endpoints: significant improvement in Respiratory Rate (RR), Kelly Score, pH, PaCO2, PaO2 vs baseline. Median duration of treatment: 16:06 hours: COPD 18:54, ACPE 4:15. Mean length of hospitalisation: 8.66 days. No patients discontinued NIV, no side effects. Results are consistent with literature. Hypoxemic ARF related to ALI/ARDS and pneumonia show worst outcome: it is not advisable to manage these conditions with NIV outside the ICU. NIV for ARF due to COPD and ACPE is feasible, safe and effective in a general medical ward if selection of Pts, staff&rsquo;s training and monitoring are appropriate. This should encourage the diffusion of NIV in this specific setting. According to strong evidences in literature, NIV should be considered a first line and standard treatment in these clinical conditions irrespective of the setting.

Randomized controlled trial of the Pentax AWS®, Glidescope®, and Macintosh laryngoscopes in predicted difficult intubation

The purpose of this study was to determine the potential for the Pentax AWS and the Glidescope to reduce the difficulty of tracheal intubation in patients at increased risk for difficult tracheal intubation, in a randomized, controlled clinical trial. Seventy-five consenting patients presenting for surgery requiring tracheal intubation, and who were deemed to possess characteristics indicating an increased risk for difficult tracheal intubation, were randomly assigned to undergo intubation using a Macintosh, AWS, or Glidescope laryngoscope (n=25 patients per group). All patients were intubated by one of three anaesthetists experienced in the use of each laryngoscope. Both the Glidescope and the AWS significantly reduced the intubation difficulty score compared with the Macintosh. The rate of successful tracheal intubation was lower with the Macintosh (84%) compared with the Glidescope (96%) or the AWS (100%). There were no differences in the duration of tracheal intubation attempts between the devices. Both the Glidescope and the AWS significantly reduced the need for additional manoeuvres and improved the Cormack and Lehane view obtained at laryngoscopy, compared with the Macintosh. Tracheal intubation with the AWS but not the Glidescope reduced the degree of haemodynamic stimulation compared with the Macintosh laryngoscope. The AWS and the Glidescope laryngoscopes reduced the difficulty of tracheal intubation to a similar extent compared with the Macintosh laryngoscope, in patients at increased risk for difficult tracheal intubation.