Tracheal Intubation In Patients Research Articles

The performance of C-MAC videostylet versus D-Blade during tracheal intubation in patients with simulated cervical immobilization: A randomized comparative trial

ABSTRACT Background Concerning patients with suspected cervical spine (C-spine) fractures or other cervical pathologies, tracheal intubation must be done very carefully to avoid injury to the spinal cord. Methods Fifty-two patients within a range of 20–60 years old, and arranged for elective surgery, were indiscriminately allocated into two groups; Group S was intubated with the C MAC Videostylet (VS), whereas Group L was intubated by D blade Video Laryngoscope (VL) during cervical immobilization by Philadelphia collar. The first successful attempt duration, total number of intubation attempts, the total duration of the intubation, haemodynamic parameters, stress response of intubation, the degree of C-spine movement and complications were evaluated in both groups. Results Group L showed substantially shorter times for the first successful attempt (p-value <0.001) and the whole intubation procedure (p-value <0.001) compared to Group S. Group S had a significantly more total number of intubation attempts (p-value = 0.010). The haemodynamic parameters did not significantly differ throughout the measurements among groups. Regarding the blood cortisol measurements at different periods, there were statistically insignificant changes among the groups. Concerning the greatest alteration in C-spine angulation at the occiput-C1, C1-C2, and C2-C5 segments during laryngoscopy and intubation, there were statistically insignificant differences among groups. Conclusion The C MAC D-blade VL is superior to the VS in terms of the number and duration of intubation attempts during C-spine immobilization. Conversely, the VS showed comparable results to the D blade regarding C-spine motion and stress response.

Tracheal intubation in patients with Pierre Robin sequence: development, application, and clinical value based on a 3-dimensional printed simulator.

Background: The main clinical manifestations of patients with Pierre Robin sequence (PRS) include micrognathia, the glossoptosis and dyspnoea. The difficulty of tracheal intubation (TI) in such patients is increased. Objective: The purpose of the study was to evaluate the reliability and efficacy of the PRS simulator. Methods: A PRS simulator was developed by using 3-dimensional (3D) printing technology under computer-aided design. A total of 12 anaesthesiologists each trained 5 times for TI on the PRS Training Simulator-1 and recorded the simulation time. After the training, they were randomly divided into three groups with a total of 12 nontrained anaesthesiologists, and the simulation was completed on PRS Simulator-2, 3 and 4. The simulation time was recorded, and the performance was evaluated by three chief anaesthesiologists. Then, all 24 anaesthesiologists completed the questionnaire. Results: A PRS simulator developed by 3D printing was used to simulate the important aspects of TI. The average number of years worked was 6.3 ± 3.1years, and 66.7% were female. The time for the 12 anaesthesiologists to complete the training gradually decreased (p < 0.01). Compared with the trained anaesthesiologists, the simulation time of TI in the nontrained anaesthesiologists was much longer (all p < 0.01). In addition, the simulation performance of the trained anaesthesiologists was relatively better (all p < 0.01). Conclusion: The reliability and efficacy of the PRS simulator is herein preliminarily validated, and it has potential to become a teaching and training tool for anaesthesiologists.

Feasibility of ProVu™ Video Stylet for awake intubation of patients with severe obesity: A pilot observational study

BackgroundAirway management in the obese patient is known to be challenging as oxygenation may rapidly decrease after general anesthesia induction. Mask ventilation and tracheal intubation can be complicated due to obesity-related anatomical features. The reduced safe apnea time can put the patient at risk of severe and rapid desaturation. Recent guidelines recommend avoiding the suppression of spontaneous breathing in cases of predicted anatomically or physiologically difficult airway. Many different devices, such as video stylets and video laryngoscopes, have been proposed as alternatives to traditional gold standard flexible bronchoscope use for awake intubation. AimOur study reports the use of a new flexible ProVu™ Video Stylet (Flexicare Medical Ltd., Mountain Ash, UK) for awake intubations in 11 patients with severe obesity, who presented with at least one criterion for potentially difficult oxygenation (during ventilation and/or intubation attempts) after suppression of spontaneous breathing. MethodsIn total 11 consecutive patients with severe obesity and clinical indication for an awake tracheal intubation were enrolled over a 10-months period and intubated with the ProVu™ Video Stylet. ResultsAll 11 tracheal intubations were successfully performed. The procedures also highlighted potential limitations to consider while using the device in an awake intubation setting. ConclusionDespite the limitations of this small observational pilot study, our study showed that the ProVu™ Video Stylet may be a promising tool and a valid alternative for performing awake tracheal intubation in patients with severe obesity and predictors of difficult oxygenation. Future studies are needed to compare the performance of the ProVu™ Video Stylet with video laryngoscopy and flexible bronchoscopy, and to provide stronger evidence in favor or against the use of this new device. The possible availability of an alternative device, combined with the skill and confidence to use it, may provide the anesthesiologist an additional tool for managing awake intubation of at-risk airways, in accordance with recommendations from the most recent guidelines.

Comparison between high-flow nasal cannula and conventional oxygen therapy in COVID-19 patients: a systematic review and meta-analysis.

High-flow nasal cannula (HFNC) and conventional oxygen therapy (COT) are important respiratory support strategies for acute hypoxemic respiratory failure (AHRF) in coronavirus disease 2019 (COVID-19) patients. However, the results are conflicting for the risk of intubation with HFNC as compared to COT. We systematically synthesized the outcomes of HFNC relative to COT in COVID-19 patients with AHRF and evaluated these outcomes in relevant subpopulations. This study was designed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched PubMed, EMBASE, Web of Science, Scopus, ClinicalTrials.gov, medRxiv, BioRxiv, and the Cochrane Central Register of Controlled Trials for randomized controlled trials and observational studies that compared the efficacy of HFNC with COT in patients with COVID-19-related AHRF. Primary outcomes were intubation rate and mortality rate. Secondary outcomes were the ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2), respiratory rate, hospital length of stay, intensive care unit (ICU) length of stay, and days free from invasive mechanical ventilation. In total, 20 studies with 5732 patients were included. We found a decreased risk of requiring intubation in HFNC compared to COT [odds ratio (OR) = 0.61, 95% confidence interval (CI): 0.46-0.82, p = 0.0009, I2 = 75%]. Similarly, we found HFNC was associated with lower risk of intubation rate compared to COT in the subgroup of patients with baseline PaO2/FiO2 < 200 mmHg (OR = 0.69, 95% CI: 0.55-0.86, p = 0.0007, I2 = 45%), and who were in ICU settings at enrollment (OR = 0.57, 95% CI: 0.38-0.85, p = 0.005, I2 = 80%). HFNC was associated with an improvement of PaO2/FiO2 and respiratory rate compared to COT. The use of HFNC compared to COT did not reduce the mortality rate, days free from invasive mechanical ventilation, hospital length of stay, or ICU length of stay. Compared to COT, HFNC may decrease the need for tracheal intubation in patients with COVID-19-related AHRF, particularly among patients with baseline PaO2/FiO2 < 200 mmHg and those in ICU settings. This systematic review and meta-analysis protocol was prospectively registered with PROSPERO (no. CRD42022339072).

Pre-oxygenation with high-flow oxygen through the nasopharyngeal airway compared to facemask on carbon dioxide clearance in emergency adults: a prospective randomized non-blinded clinical trial.

Before tracheal intubation, it is essential to provide sufficient oxygen reserve for emergency patients with full stomachs. Recent studies have demonstrated that high-flow nasal oxygen (HFNO) effectively pre-oxygenates and prolongs apneic oxygenation during tracheal intubation. Despite its effectiveness, the use of HFNO remains controversial due to concerns regarding carbon dioxide clearance. The air leakage and unknown upper airway obstruction during HFNO therapy cause reduced oxygen flow above the vocal cords, possibly weaken the carbon dioxide clearance. Patients requiring emergency surgery who had fasted < 8h and not drunk < 2h were randomly assigned to the high-flow group, who received 100% oxygen at 30-60 L/min through nasopharyngeal airway (NPA), or the mask group, who received 100% oxygen at 8 L/min. PaO2 and PaCO2 were measured immediately before pre-oxygenation (T0), anesthesia induction (T1), tracheal intubation (T2), and mechanical ventilation (T3). The gastric antrum's cross-sectional area (CSA) was measured using ultrasound technology at T0, T1, and T3. Details of complications, including hypoxemia, reflux, nasopharyngeal bleeding, postoperative pulmonary infection, postoperative nausea and vomiting (PONV), and postoperative nasopharyngeal pain, were recorded. The primary outcomes were PaCO2 measured at T1, T2, and T3. The secondary outcomes included PaO2 at T1, T2, and T3, CSA at T1 and T3, and complications happened during this trial. Pre-oxygenation was administered by high-flow oxygen through NPA (n = 58) or facemask (n = 57) to 115 patients. The mean (SD) PaCO2 was 32.3 (6.7) mmHg in the high-flow group and 34.6 (5.2) mmHg in the mask group (P = 0.045) at T1, 45.0 (5.5) mmHg and 49.4 (4.6) mmHg (P < 0.001) at T2, and 47.9 (5.1) mmHg and 52.9 (4.6) mmHg (P < 0.001) at T3, respectively. The median ([IQR] [range]) PaO2 in the high-flow and mask groups was 404.5 (329.1-458.1 [159.8-552.9]) mmHg and 358.9 (274.0-413.3 [129.0-539.1]) mmHg (P = 0.007) at T1, 343.0 (251.6-428.7 [73.9-522.1]) mmHg and 258.3 (162.5-347.5 [56.0-481.0]) mmHg (P < 0.001) at T2, and 333.5 (229.9-411.4 [60.5-492.4]) mmHg and 149.8 (87.0-246.6 [51.2-447.5]) mmHg (P < 0.001) at T3, respectively. The CSA in the high-flow and mask groups was 371.9 (287.4-557.9 [129.0-991.2]) mm2 and 386.8 (292.0-537.3 [88.3-1651.7]) mm2 at T1 (P = 0.920) and 452.6 (343.7-618.4 [161.6-988.1]) mm2 and 385.6 (306.3-562.0 [105.5-922.9]) mm2 at T3 (P = 0.173), respectively. The number (proportion) of complications in the high-flow and mask groups is shown below: hypoxemia: 1 (1.7%) vs. 9 (15.8%, P = 0.019); reflux: 0 (0%) vs. 0 (0%); nasopharyngeal bleeding: 1 (1.7%) vs. 0 (0%, P = 1.000); pulmonary infection: 4 (6.9%) vs. 3 (5.3%, P = 1.000); PONV: 4 (6.9%) vs. 4 (7.0%, P = 1.000), and nasopharyngeal pain: 0 (0%) vs. 0 (0%). Compared to facemasks, pre-oxygenation with high-flow oxygen through NPA offers improved carbon dioxide clearance and enhanced oxygenation prior to tracheal intubation in patients undergoing emergency surgery, while the risk of gastric inflation had not been ruled out. This trial was registered prospectively at the Chinese Clinical Research Registry on 26/4/2022 (Registration number: ChiCTR2200059192).

Combined Styletubation with Videolaryngoscopy for Tracheal Intubation in Patients Undergoing Thyroidectomy with Intraoperative Neuromonitoring

The purpose of this case series report is to demonstrate the current state of the art regarding tracheal intubation of an evoked electromyography-endotracheal tube (EMG-ET tube) for continuous intraoperative recurrent laryngeal nerve monitoring (IONM) in patients undergoing thyroid surgery. Both direct laryngoscopy (DL) and videolaryngoscopy (VL) are popular for routine tracheal intubation of an EMG-ET tube. A new intubating technique (styletubation), using a video-assisted intubating stylet (VS), provides less traumatic and swift intubation. Styletubation combined with VL ensures the precise placement of the EMG-ET tube. This novel intubation technique improves the outcome of intubating an EMG-ET tube for IONM.

Evaluation of Ultrasound Guided Measurement of Tongue Thickness in Predicting Difficult Tracheal Intubation in Patients Undergoing Elective Surgery: A Cross Sectional Study

Background: Preoperative airway assessment is necessary to identify airway difficulties to the earliest, ensure adequate preparation to airway management before induction and to avoid airway related complications. Various Imaging techniques have been studied for prediction of the difficult airway. the ultrasound is a quick and simple technique. Aim of the study was to evaluate ultrasound guided measurement of tongue thickness in predicting difficult tracheal intubation in patients undergoing elective surgery.&#x0D; Methods: Sixty-one patients American Society of Anesthesiologist class I and II,18-65 years of age, either sex, were included. Tongue thickness was measured by ultrasound as the distance from the surface of tongue to the submental skin. Modified mallampatti score was also recorded.&#x0D; Results: Receiver operating characteristic (ROC) curve of tongue thickness showed an AUC of 0.879 for a cut off value of &gt;6 cm. This shows it has an excellent predictive value. Tongue thickness (&gt;6cm) was found to have 90.16% combined diagnostic accuracy with 75% sensitivity and 94.74% specificity for prediction of difficult intubation. No correlation between tongue thickness and modified mallampatti score. (Correlation coefficient was 0.013, p value 0.920).&#x0D; Conclusion: We conclude that ultrasound guided measurement of tongue thickness&gt; 6 cm can reliably predict difficult tracheal intubation in patients undergoing elective surgery.

[Arterial partial pressure of oxygen and procalcitonin combined with ROX index predict the timing of tracheal intubation in patients with acute severe pancreatitis].

To investigate the efficacy of arterial partial pressure of oxygen (PaO2), procalcitonin (PCT) combined with ROX index in predicting the timing of tracheal intubation in patients with acute severe pancreatitis (SAP). A case-control study was conducted. A total of 148 patients with SAP admitted to Hunan Provincial People's Hospital from January 2019 to December 2022 were selected as the research objects. According to whether endotracheal intubation was used after admission during hospitalization, the patients were divided into the intubation group (102 cases) and non-intubation group (46 cases). Gender, age, white blood cell count (WBC), lymphocyte count (LYM), platelet count (PLT), C-reactive protein (CRP), hemoglobin (Hb), PCT, PaO2, arterial partial pressure of carbon dioxide (PaCO2), arterial bicarbonate ion (HCO3-) 1 day after admission, arterial lactic acid (Lac), lactate dehydrogenase (LDH), heart rate (HR), respiratory rate (RR), pulse oxygen saturation (SpO2), oxygenation index (PaO2/FiO2), blood pressure, worst ROX index (ROX index = SpO2/FiO2/RR) within 30 minutes of admission and 30 minutes before intubation of the two groups were measured. Multivariate Logistic regression was used to analyze the independent risk factors for the timing of endotracheal intubation in patients with SAP. The receiver operator characteristic curve (ROC curve) was used to determine the optimal predictive cut-off value for endotracheal intubation. There were no significant differences in age, gender, WBC, LYM, CRP, Hb, LDH, HR and blood pressure at admission between the two groups. The PLT, Lac, PCT and RR in the intubation group were significantly higher than those in the un-intubation group, and HCO3-, PaO2, SpO2, PaO2/FiO2, the worst ROX index within 30 minutes after admission and 30 minutes before intubation were significantly lower than those in the non-intubation group (all P < 0.05). Logistic regression analysis showed that the worst ROX index within 30 minutes before intubation was the largest negative influencing factor for the timing of tracheal intubation in SAP patients [odds ratio (OR) = 0.723, 95% confidence interval (95%CI) was 0.568-0.896, P = 0.000], followed by PaO2 (OR = 0.872, 95%CI was 0.677-1.105, P < 0.001). PCT was the positive influencing factor (OR = 1.605, 95%CI was 1.240-2.089, P < 0.001). ROC curve analysis showed that the area under the ROC curve (AUC) of PaO2, PCT, the worst ROX index within 30 minutes before intubation and the combination to evaluate the tracheal intubation time of patients with SAP were 0.715, 0.702, 0.722 and 0.808, the sensitivity was 78.1%, 75.0%, 81.5% and 89.3%, the specificity was 66.7%, 59.0%, 73.2% and 86.4%, and the best cut-off value was 60.23 mmHg (1 mmHg ≈ 0.133 kPa), 2.72 μg/L, 4.85, and 0.58, respectively. The AUC of the combination of PaO2, PCT and the worst ROX index within 30 minutes before intubation predicted the timing of tracheal intubation in patients with SAP was significantly greater than using each index alone (all P < 0.01). The worst ROX index within 30 minutes before intubation combined with PaO2 and PCT is helpful for clinicians to make a decision for tracheal intubation in patients with SAP.

The Heister jaw opener: a novel solution for tracheal intubation in patients with temporomandibular joint ankylosis

The Heister jaw opener: a novel solution for tracheal intubation in patients with temporomandibular joint ankylosis

Preoperative lignocaine nebulisation for attenuation of the pressor response of laryngoscopy and tracheal intubation in patients with severe preeclampsia undergoing caesarean section delivery: A randomised double-blind controlled trial.

Following induction of general anaesthesia, direct laryngoscopy and endotracheal intubation usually cause tachycardia and hypertension due to increased sympathetic activity. This response is generally exaggerated in hypertensive patients. This study aimed to evaluate the effectiveness of preoperative lignocaine nebulisation in attenuating the pressor response to laryngoscopy and endotracheal intubation in patients with severe preeclampsia undergoing caesarean delivery. After ethical approval, we conducted this randomised, double-blind study, which included 110 patients with severe preeclampsia who underwent caesarean delivery under general anaesthesia. These patients were randomly allocated into two groups to receive either preoperative nebulisation of lignocaine 2% in a dose of 4.5 mg/kg (not exceeding 400 mg) in the lignocaine group or nebulisation of an equivalent volume of 0.9% NaCl in the saline group. The primary objective was the systolic blood pressure after tracheal intubation. The secondary objectives included heart rate, maternal serum cortisol and blood glucose levels, grade of cough during emergence, postoperative sore throat and hoarseness of voice, neonatal Apgar score and umbilical blood gas. The systolic blood pressure was significantly lower in the lignocaine group compared to the saline group at 1, 3 and 5 min after endotracheal intubation and after delivery of the foetus (P = 0.001, 0.003, 0.002 and 0.019, respectively). Similarly, the heart rate was significantly lower in the lignocaine group versus saline group at 1 and 3 min after endotracheal intubation (P = 0.041 and 0.042, respectively). Preoperative lignocaine nebulisation in a dose of 4.5 mg/kg effectively attenuated the pressor response to laryngoscopy and endotracheal intubation in patients with severe preeclampsia undergoing caesarean delivery.

Evaluation of oxygen saturation as an indicator for tracheal intubation in patients with COVID-19: a prospective cohort study

   Background. Since the beginning of COVID-19 pandemic, the importance of clinical criteria for tracheal intubation in critically ill patients with respiratory failure became more noteworthy, especially in resource limitations. The objective was to evaluate the importance of hemoglobin oxygen saturation as a criterion for tracheal intubation in patients with COVID-19.   Materials and methods. This is a multi-center, prospective, observational cohort study. We included 117 patients with COVID-19 who needed respiratory support between March to June 2021. Patients were intubated by the protocol of each institution participating in the study and the anesthesiologist’s clinical judgement. Signs of respiratory failure, methods of respiratory support and patient outcome were recorded.   Results. Among 117 studied cases, 100 patients had hemoglobin oxygen saturation of 60–90 % in whom 58 were intubated. During hospitalization, 56 intubated patients and 14 non-intubated patients died (96.6 % Vs. 33.3 %).   Conclusion. Arterial blood hemoglobin oxygen saturation of 60–90 could not be the correct key to unlock the problem of intubation decision in patients with COVID-19. Therefore, hemoglobin oxygen saturation should not be solely regarded as an indication for intubation in COVID-19. 

Comparison of Effects of Nalbuphine and Tramadol on Cardiovascular Response to Tracheal Intubation in Patients Undergoing Emergency Appendectomy

Objectives: To compare the effects of Nalbuphine with Tramadol on cardiovascular response (change in heart rate and blood pressure) to tracheal intubation in patients undergoing emergency appendectomy. Material and methods: This randomized controlled trial was conducted at the Department of Anaesthesiology, CMH Mardan from January 1, 2022, to June 30, 2022. A total of 100 patients who were undergoing emergency appendectomy under general anaesthesia, with ASA grade I, aged between 30-50 years, and weighing between 50-80 kg were selected. Patients were either male or female and had normal blood pressure. They were divided into two groups: the Nalbuphine group and the Tramadol group. The study focused on analyzing the cardiovascular response (changes in heart rate and blood pressure) to tracheal intubation in both groups. Results: Most of the patients in both Group A and Group B were females, with a female to male ratio of 3.54:1 and 2.57:1, respectively. The mean age of patients in Group A was 37.90±5.41, while in Group B it was 40.10±6.39. After laryngoscopy and tracheal intubation, patients in Group A had a significantly less increase in heart rate and blood pressure as compared to those in Group B. Conclusion: The Nalbuphine is better than Tramadol in attenuating the cardiovascular response to laryngoscopy and tracheal intubation. Keywords: Nalbuphine, Tramadol, Cardiovascular Response, Tracheal Intubation, Laryngoscopy, Heart Rate and Blood Pressure.

Head elevation during preoxygenation can delay desaturation time: A randomized-controlled trial

BackgroundPreoxygenation before anesthesia induction is an important part of airway management to reduce the risk of hypoxemia when the patient is apneic. The effectivity of preoxygenation is influenced by several things such as patient's head position. This study aimed to compare preoxygenation between various degrees of head elevation (20°, 30°, and 45°) and 0° or no elevation position towards desaturation time before tracheal intubation in patients undergoing general anesthesia. MethodThis was a single-blinded randomized clinical trial of 48 patients, assigned into four groups (0°, 20°, 30°, and 45° head elevation group). All subjects were preoxygenated for 3 min with 100% oxygen. Induction of anesthesia was started with fentanyl and propofol, followed by rocuronium after the patient lost consciousness. Time was recorded from the beginning of induction until the oxygen saturation decreased to 93% or a time limit of 5 min was reached. ResultThe desaturation time in 45° head elevation group was significantly the longest, followed by 30°, 20°, and 0° group (224,0 ± 49,4; 196,4 ± 41,7; 187,2 ± 29,8; and 166,1 ± 51,3 s, respectively; P < 0.05). ConclusionsPatients with 45° head elevation had significant longer mean desaturation time compared to 0° and 20° head elevation group. In patients undergoing general anesthesia, preoxygenation with head elevation slowed down the time for desaturation before tracheal intubation compared to the conventional position. Clinical trial registrationNCT05688722.

Emergency endotracheal intubation in critically ill patients with COVID-19: management and clinical characteristics

PurposesSARS-CoV-2 have become widespread worldwide since the outbreak. Respiratory function deteriorates rapidly in critically ill patients infected with SARS-CoV-2. Endotracheal intubation is an indispensable therapeutic measure during the development of the disease. This study was intended to describe the experience of endotracheal intubation from front-line anesthesiologists and clinical prognosis of patients infected with Coronavirus disease-19 (COVID-19).MethodsFourteen critical patients infected with COVID-19 who underwent endotracheal intubation were included in this study. We collate and analyze the blood gas results before and after tracheal intubation of patients and clinical prognostic indicators such as length of stay and. mortality. The experience of anesthesiologists who intubated patients has also been recorded in detail.ResultsPatients had a mean time of 10.6 days from initial symptoms to endotracheal intubation. Most intubated patients had one or more underlying conditions: hypertension (8, 57.14%), diabetes (5, 35.71%), and cardiovascular and cerebrovascular diseases (2, 14.29%). The oxygenation index increased significantly after intubation compared with before intubation (148.80 ± 42.25 vs 284.43 ± 60.17 p < 0.001). 85.72% of patients required extra-corporeal membrane oxygenation (ECMO) due to inability to maintain oxygen saturation with standard therapeutic measures. Two patients underwent lung transplantation because their lungs were essentially nonfunctional, and they recovered well after surgery. As of this writing, all patients were discharged after satisfactory recovery.ConclusionsReasonable selection of intubation timing is particularly important. It is crucial to increase the patient's oxygen supply and reduce oxygen consumption as much as possible during endotracheal intubation. In addition, the personal protective measures of medical personnel participating in treatment should be scientific and standardized.Graphical

Effectiveness of C-MAC video-stylet versus C-MAC D-blade video-laryngoscope for tracheal intubation in patients with predicted difficult airway: Randomized comparative study

ABSTRACT Background This prospective study was done on patients with suspected difficult airway to compare between C-MAC video-stylet (VS) and D-blade video-laryngoscope for tracheal intubation. Patients and methodology Randomization was done on 160 adult patients with anticipated difficulty in intubation for different causes to divide them into two equal groups (VS group and D group). Patients in each group were divided into five categories according to the cause of anticipated intubation difficulty. Duration of intubation, number of attempts, and success intubation rate were recorded. Hemodynamics parameters were measured before intubation as baseline, then after intubation at 1 and 5 min. Results In VS group, intubation time ranged between 23 and 166 s with mean of 53.2 ± 24.19 s and in D group it ranged between 30 and 279 s with mean of 65.5 ± 40.63 s (P-value 0.021). This shorter intubation time was not constant in different patient’s categories. The first attempt intubation was successfully done in 68 patients (85%) in VS group versus 61 patients (76.3%) in D group. Hemodynamically, HR and MABP showed significant increase in D group more than in VS group at 1 and 5 min after intubation (P-value = 0.001). Conclusion Both devices are helpful when there is a risk of difficult intubation. C-MAC VS is a better choice in cases of limited mouth opening and obesity, but in cases of limited cervical motility, the use of C-MAC D-blade is a better choice with a faster intubation time.

Controversies Concerning Emergency Tracheal Intubation in Patients with COVID-19

Should we still worry about coronavirus disease 2019 (COVID-19) in 2023? Mandatory restrictions of many activities due to COVID-19 have been largely relaxed across the country. We’ve dealt with COVID-19, haven’t we? However, concerning levels of COVID-19 infections have still been reported in many metropolitan areas. China’s Joint Prevention and Control Mechanism of the State Council reported that from December 8, 2022 to January 12, 2023, 59,938 hospital deaths related to COVID-19 occurred in healthcare facilities across the country, among whom 5503 were due to respiratory failure caused by COVID-19. Early and appropriate management with invasive mechanical ventilation is crucial in critically ill patients with COVID-19. Tracheal intubation still plays an important role in the successful treatment of these patients. We updated the pertinent information and new understanding on several controversial topics regarding emergency tracheal intubation in patients with COVID-19.

Effect of gabapentin on pressor response to laryngoscopy and tracheal intubation in patients undergoing elective cholecystectomy

Effect of gabapentin on pressor response to laryngoscopy and tracheal intubation in patients undergoing elective cholecystectomy

695: EVALUATING AIRWAY MANAGEMENT IN PATIENTS WITH TRISOMY 21 IN THE PEDIATRIC INTENSIVE CARE UNIT

Introduction: Children with Trisomy 21 (T21) are known to have anatomic and physiologic abnormalities that may complicate tracheal intubation. However, current tracheal intubation (TI) practice in critically ill children with T21 is not well described. We sought to describe TI practice in critically ill children with T21. We hypothesize the Adverse Airway Outcomes: AAOs (adverse TI associated events: TIAEs and/or peri-intubation hypoxemia: >20% decrease in SpO2) are higher in children with T21 as compared to those without T21. Methods: Multicenter airway management quality improvement database (NEAR4KIDS) was queried. In addition, we collected patient’s T21 status, cervical spine and cardiac conditions. The association between T21 status and occurrence of AAOs was evaluated using Chi2 and multivariable logistic regression adjusting for patient, provider, and practice covariates. Results: Of the 8401 TI encounters from 15 pediatric general/cardiac ICUs between 2014-2020, 274 (3.3%) were TIs in patients with T21. Among those with T21, 84% had congenital heart disease, and 4% had atlantoaxial instability with cervical spine protection used in 6%. Patients with T21 were smaller (median (IQR) weight 7.8 (4.5-14.7) kg vs 10.6 (5.2-25) kg, p< 0.001). Patients with T21 (vs without) were more commonly urgently intubated for oxygenation (46% vs 32%, p< 0.001) and ventilation failure (41% vs 35%, p=0.04) as opposed to elective procedural intubations. Patients with T21 had more difficult airway features (35% vs 25%, p=0.001), including upper airway obstruction (14% vs 8%, p=0.001). Patients with T21 were more likely to receive atropine (34% vs 26%, p=0.004) and less likely intubated with video laryngoscopy (30% vs 37%, p=0.023). AAOs occurred similarly between those with T21 vs without (26% vs. 24%, p=0.669); adverse TIAEs occurred less in T21 (9% vs 14%, p=0.02), but hypoxemia occurred more frequently (23% vs 18%, p=0.046). After adjusting for age, indication, provider, device, paralytic, and apneic oxygenation, T21 condition was not associated with increased AAOs (OR 0.91, 95% CI 0.69-1.21, p=0.53). Conclusions: T21 condition was not associated with higher adverse airway outcomes. Patients with T21 were intubated more frequently for respiratory failure and with atropine and less frequently with video laryngoscopy.

Effectiveness of non-invasive respiratory support strategies in patients with COVID-19: A systematic review and meta analysis.

BackgroundThe effectiveness of non-invasive respiratory strategies, namely CPAP and HFNO, in reducing the risk of mortality and tracheal intubation in patients with severe COVID-19 is not well established. A thorough literature search was conducted across 3 electronic databases (Medline, EMBASE and Cochrane Central) from inception through July 2022. Randomized controlled trials (RCTs) and observational studies assessing the impact of CPAP or HFNO on clinical outcomes in patients infected with COVID-19 were considered for inclusion. End-points included all-cause mortality and risk of tracheal intubation. Evaluations were reported as risk ratios (RRs) with 95% confidence intervals (CI) and analysis was performed using a random effects model. I2 index was used to assess heterogeneity. From the 1041 articles retrieved from initial search, 7 potentially relevant studies (n=2831 patients) were included in the final analysis. Compared to conventional oxygen therapy, non-invasive respiratory strategies reduced the risk of tracheal intubation (RR=0.84, [95% CI 0.72, 0.98]; p=0.02, I2=43%) and all-cause mortality (RR=0.83, [95% CI 0.71-0.97]; p=0.02, I2=0%) in patients infected with COVID-19 However, reduction in length of hospital stay was not significant between the non-invasive respiratory group and conventional oxygen therapy (MD=-0.60, [95% CI -2.17 - 0.98]; p=0.46, I2=26%). This meta-analysis supports the application of non-invasive respiratory strategy is feasible as it can delay the start of tracheal intubation and reduce mortality rates among patients infected with COVID-19.

Опыт выполнения респираторной поддержки у пострадавших с тяжелыми травмами в ходе проведения санитарно-авиационной эвакуации вертолетами легкого класса

The aim of the study was to determine the optimal types of respiratory support for acute respiratory failure in patients with severe trauma during medical evacuation by light-class helicopters. Materials and research methods. The materials of the study are the data on the performance of respiratory support in patients with various types of trauma and acute respiratory failure for 2016-2021, contained in the automated information-analytical system “Disaster Medicine of Moscow” of the State Budget Institution “Moscow Territorial Scientific and Practical Center for Disaster Medicine of the Moscow City Health Department”. When performing the study, historical, statistical and analytical methods were used. Study results and their analysis. The results of the analysis showed: – proportion of victims with various traumas received in the emergency situations in Moscow constitutes 31,9% of all sanitary losses in emergencies. Of them 12.9% were in an extremely severe and serious condition, including 1.1% who needed artificial lung ventilation and tracheal intubation; – severe acute respiratory distress requiring ventilation and tracheal intubation was caused in 49.7% of cases by polytrauma, in 38.4 cases — by isolated trauma, in 8.7 cases — by thermal trauma, and in 3.2% of cases — by combined trauma. The indications and peculiarities of artificial ventilation with tracheal intubation in patients with various traumas to be medically evacuated by a light-class ambulance helicopter have been determined.