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pediatric endotracheal tube

Rahul Pillai, Suresh Kumaran, L Jeyaseelan, Sajan P George, Raj Sahajanandan
Introduction: The search for an accurate and predictable method to estimate the endotracheal tube (ETT) size in pediatric population had led to derivation of many formulae. Of this, age-based formulae are the most commonly used. Studies have shown that minimal transverse diameter of subglottic airway (MTDSA) measurements using a high-frequency probe improves the success rate of predicting the airway diameter to about 90%. We did a prospective observational study using MTDSA as the criteria to select the size of ETT in children with congenital heart disease...
October 2018: Annals of Cardiac Anaesthesia
Chang-Hoon Koo, Sun Young Lee, Seung Hyun Chung, Jung-Hee Ryu
The purpose of this study was to compare the incidence of airway complications between extubation under deep anesthesia (deep extubation) and extubation when fully awake (awake extubation) in pediatric patients after general anesthesia. A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) statement standards. The review protocol was registered with the International Prospective Register of Systematic Reviews (registration number: CRD 42018090172)...
October 14, 2018: Journal of Clinical Medicine
Heather A Ballard, Olga S Leavitt, Anthony C Chin, Rashmi Kabre, Debra E Weese-Mayer, John Hajduk, Narasimhan Jagannathan
BACKGROUND: Congenital Central Hypoventilation Syndrome and Rapid-Onset Obesity with Hypothalamic dysfunction, Hypoventilation, and Autonomic Dysregulation are rare neurocristopathies characterized by autonomic dysregulation including bradyarrhythmias, abnormal temperature control, and most significantly, abnormal control of breathing leading to tracheostomy and ventilator dependence as life support. Surgical advancements have made phrenic nerve-diaphragm pacemakers available, to eliminate the tether to a mechanical ventilator for 12-15 hours each day...
September 24, 2018: Paediatric Anaesthesia
Liang Chen, Jun Zhang, Guoshi Pan, Xia Li, Tianwu Shi, Wensheng He
Background: Cuffed and uncuffed endotracheal tubes are commonly used for pediatric patients in surgery and emergency situations. It is still controversial which approach should be adopted. The purpose of the study was to compare the application of cuffed and uncuffed endotracheal tubes in pediatric patients. Methods: We searched PubMed, Web of Science and Cochrane Library for clinical trials, which compared the two applications in children. The study characteristics and clinical data were summarized by two independent reviewers...
2018: Open Medicine (Warsaw, Poland)
Nathaniel H Greene, Edmund H Jooste, Dylan P Thibault, Amelia S Wallace, Alice Wang, David F Vener, Roland A Matsouaka, Marshall L Jacobs, Jeffrey P Jacobs, Kevin D Hill, Warwick A Ames
BACKGROUND: In adults undergoing cardiopulmonary bypass surgery, oral intubation is typically preferred over nasal intubation due to reduced risk of sinusitis and infection. In children, nasal intubation is more common and sometimes preferred due to perceived benefits of less postoperative sedation and a lower risk for accidental extubation. This study sought to describe the practice of nasal intubation in the pediatric population undergoing cardiopulmonary bypass surgery and assess the risks/benefits of a nasal route against an oral one...
September 5, 2018: Anesthesia and Analgesia
Edward D Ferenczy, Michael J Stoner, Sandra P Spencer, Samantha W Gee, Daniel J Scherzer, Joseph D Tobias
OBJECTIVE: The objective of this study was to evaluate endotracheal tube cuff pressure after emergency intubation and identify variables associated with an elevated cuff pressure. METHODS: This was a prospective cohort study of intubated patients in the emergency department of Nationwide Children's Hospital. The primary study outcome, cuff pressure, was measured via manometer. Clinical details related to the intubation were collected and analyzed as secondary outcomes...
October 2018: International Journal of Pediatric Otorhinolaryngology
Kazuhiro Uda, Chitose Koyama-Wakai, Kensuke Shoji, Noriyasu Iwase, Daisuke Motooka, Shota Nakamura, Isao Miyairi
BACKGROUND: WU polyomavirus (WUPyV) is a relatively new virus associated with respiratory infections. However, its role is unclear in children with severe respiratory failure. OBJECTIVES: We aimed to evaluate the characteristics of severe respiratory failure associated with WUPyV infection in children. STUDY DESIGN: We retrospectively reviewed cases of respiratory tract infection at a tertiary children's hospital in Japan and performed real-time polymerase chain reaction (PCR) for WUPyV using residual extracted nucleic acid samples taken from respiratory tract samples of pediatric patients primarily with respiratory failure...
August 9, 2018: Journal of Clinical Virology: the Official Publication of the Pan American Society for Clinical Virology
Milton Halyson Benevides de Freitas, Luciana Cavalcanti Lima, Tania Cursino de Menezes Couceiro, Maria Célia Ferreira da Costa, Márcio Handerson Benevides de Freitas
BACKGROUND AND OBJECTIVES: Conjoined twins are monozygotic twins physically joined at some part of the body. This is a rare phenomenon, estimated between 1:50,000 to 1:200,000 births. The objective of this report is to present the anesthetic management and the perioperative challenges for a separation surgery. CASE REPORT: Thoraco-omphalopagus twins were diagnosed by ultrasound and were followed by the fetal medicine team of the service. After 11hours of cesarean, the pediatric surgical team chose to separate the twins...
August 7, 2018: Revista Brasileira de Anestesiologia
Megan M Gray, Rachel A Umoren, Spencer Harris, Thomas P Strandjord, Taylor Sawyer
OBJECTIVE: To examine the use and perceived safety of stylets for neonatal intubation in a cohort of providers in the United States. STUDY DESIGN: A cross-sectional survey was sent to members of the American Academy of Pediatrics Section on Neonatal-Perinatal Medicine. RESULT: A total of 640 responses were received. 57% reported using a stylet 'every time' or 'almost every time' they intubated. The preferred stylet bend was a smooth bend of <30 degrees...
October 2018: Journal of Perinatology: Official Journal of the California Perinatal Association
Teresa A Volsko, Yuriy Petrov, Neil L McNinch, Donald S Prough, Clark R Anderson, Michael T Bigham
BACKGROUND: Confirmation of endotracheal tube (ETT) tip position and timely identification and correction of malposition is an essential component of care for endotracheally intubated and mechanically ventilated children. We evaluated the ability of a prototype optoacoustic medical device to determine ETT tip position. We hypothesized that the precision of optoacoustic assessment of ETT tip position would be comparable to chest radiography. METHODS: We recruited children aged newborn to 16 y who were admitted to the pediatric ICU requiring tracheal intubation and undergoing a chest radiograph for clinical purposes...
July 31, 2018: Respiratory Care
Paulo Sergio Lucas da Silva, Nádia Lais Lobrigate, Marcelo Cunio Machado Fonseca
OBJECTIVES: Postextubation dysphagia is common and associated with worse outcomes in the PICU. Although there has been an increased participation of speech-language pathologists in its treatment, there is limited evidence to support speech-language pathologists as core PICU team member. We aimed to assess the impact of speech-language pathologists interventions on the treatment of postextubation dysphagia. DESIGN: A quasi-experimental prospective study. In the historical group (controls), patients received a standard care management for dysphagia whereas the intervention group was routinely treated by speech-language pathologists...
October 2018: Pediatric Critical Care Medicine
Hamiyet Kzl, Merdiye Şendir
AIM: This study is a quasi-experimental research that was conducted to evaluate the effects of bathing on vital signs and oxygen saturation in intubated children who are connected to mechanical ventilation. METHODS: The study sample consisted of children who are treated in the pediatric intensive care unit, University of Istanbul Cerrahpasa Faculty of Medicine Hospital. A total of 60 children who met the criteria of the sample group were included in the study. The children were given bed bathing with plain warm water of 32°C to 38°C on 3 different days...
September 2018: Dimensions of Critical Care Nursing: DCCN
Ana Lygia R de Carvalho, Roberto B Vital, Carlos C S de Lira, Igor B Magro, Patrícia T S Sato, Laís H N Lima, Leandro G Braz, Norma S P Módolo
There is an association between upper respiratory tract infection (URTI) and an increased incidence of perioperative respiratory adverse events (PRAEs), which is a major risk for morbidity during pediatric anesthesia. The aim of the present study was to compare the risk of PRAEs among different airway devices during anesthesia in children with a URTI. A systematic review according to the Cochrane Handbook and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted. Only randomized clinical trials evaluating anesthesia in children with a URTI and who were submitted to any of the airway devices were included...
October 2018: Anesthesia and Analgesia
Yukihide Koyama, Hiroyuki Oshika, Hiroko Nishioka, Naoko Kamoshida, Sousuke Tanaka, Gaku Inagawa, Tomio Andoh
BACKGROUND: The increase in endotracheal tube cuff pressure due to nitrous oxide diffusion is a well-known risk during general anesthesia using nitrous oxide. We hypothesized that lubricating endotracheal tube cuffs with K-Y™ Jelly might inhibit the increase in cuff pressure that occurs during exposure to nitrous oxide. METHODS: We used two types of endotracheal tube cuffs: one made from ultrathin polyurethane (PU) and another made from conventional polyvinyl chloride (PVC)...
July 28, 2018: BMC Anesthesiology
Teresa A Volsko, Neil L McNinch, Donald S Prough, Michael T Bigham
BACKGROUND: Adherence to guidelines for endotracheal tube (ETT) insertion depth may not be sufficient to prevent malposition or harm to the patient. To obtain an estimate of ETT malpositioning, we evaluated initial postintubation chest radiographs and hypothesized that many ETTs in multiple intubation settings would be malpositioned despite adherence to Pediatric Advanced Life Support and Neonatal Resuscitation Program guidelines. METHODS: In a random subset (randomization table) of 2,000 initial chest radiographs obtained from January 1, 2009, to May 5, 2012, we recorded height, weight, age, sex, ETT inner diameter, and cm marking at the lip from the electronic health record...
September 2018: Respiratory Care
Jörg Thomas, Markus Weiss, Vincenzo Cannizzaro, Christian Peter Both, Alexander Robert Schmidt
BACKGROUND: Over the last decade, cuffed endotracheal tubes are increasingly used in pediatric anesthesia and also in pediatric intensive care. However, the smaller inner diameter of cuffed endotracheal tubes and, implicitly, the increased endotracheal tube resistance is still a matter of debate. AIMS: This in vitro study investigated work of breathing and inspiratory airway pressures in cuffed and uncuffed endotracheal tubes and the impact of pressure support ventilation and automatic tube compensation...
September 2018: Paediatric Anaesthesia
Ji-Hye Kwon, Young Hee Shin, Nam-Su Gil, Hyean Yeo, Ji Seon Jeong
The narrowest portions of the pediatric larynx are the glottis and subglottic region. However, the pliable and paralyzed subglottic region, acting like a curtain, is no resistance when passing an endotracheal tube. Therefore, the 'functionally' portion of the pediatric upper airway, which may be the most vulnerable to damage during intubation, is the unyielding portion below the cricoid cartilage. We investigated the functionally-narrowest portion below the cricoid cartilage.Computed tomography (CT) was performed under deep sedation...
July 2018: Medicine (Baltimore)
Georg M Schmölzer, Charles Christoph C Roehr
BACKGROUND: The success rate of correct endotracheal tube (ETT) placement for junior medical staff is less than 50% and accidental oesophageal intubation is common. Rapid confirmation of correct tube placement is important because tube malposition is associated with serious adverse outcomes including hypoxaemia, death, pneumothorax and right upper lobe collapse.ETT position can be confirmed using chest radiography, but this is often delayed; hence, a number of rapid point-of-care methods to confirm correct tube placement have been developed...
July 5, 2018: Cochrane Database of Systematic Reviews
Matthew K Leroue, J Kirk Harris, Katherine M Burgess, Mark J Stevens, Joshua I Miller, Marci K Sontag, Yamila L Sierra, Brandie D Wagner, Peter M Mourani
Background: Ventilator-associated pneumonia (VAP) is a known complication of mechanically ventilated children in the pediatric intensive care unit (PICU). Endotracheal tube (ETT) biofilms are often implicated in the development of VAP by providing a conduit for pathogens to the lower respiratory tract. Methods: A prospective cohort study from April 2010-March 2011 of children 4 weeks to 18 years of age ventilated for greater than 72 hours to determine the microbiota of ETT biofilms and tracheal aspirates...
December 2017: Advances in Pediatric Research
Naomi-Liza Denning, Ibrahim Abd El-Shafy, John Hagen, Steven Stylianos, Jose M Prince, Aaron M Lipskar
BACKGROUND: The development of a gastrocutaneous fistula (GCF) after gastrostomy tube removal is a frequent complication that occurs 5%-45% of the time. Conservative therapy with chemical cauterization is frequently unsuccessful, and surgical GCF repair with open primary layered closure of the gastrotomy is often required. We describe an alternative approach of GCF closure that is an outpatient, less invasive procedure that allows patients to avoid the comorbidities of general endotracheal anesthesia and intraabdominal surgery...
September 2018: Journal of Surgical Research
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