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Difficult extubation

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https://www.readbyqxmd.com/read/29614554/-effect-of-foam-sclerotherapy-for-the-treatment-of-oropharyngeal-venous-malformation
#1
C Q Niu, H Jiang, S Y Zhou, G Shen, H B Li, J Zhang
Objective: To evaluate the safety and efficacy of foam sclerotherapy with polidocanol for the treatment of venous malformation in the oropharynx. Methods: The clinical data of 21 children with venous malformation in the oropharynx treated by foam sclerotherapy were retrospectively analyzed. There were 10 males and 11 females, ranging in age from 1 month to 13 years, with a median age of 2.3 years. MRI was performed in all children, and the diagnosis was further confirmed by radiography. After general anesthesia, the oropharynx was exposed by opening device...
March 7, 2018: Zhonghua Er Bi Yan Hou Tou Jing Wai Ke za Zhi, Chinese Journal of Otorhinolaryngology Head and Neck Surgery
https://www.readbyqxmd.com/read/29609909/-why-is-the-morbidly-obese-patient-at-high-risk-of-anesthetic-complications
#2
Audrey De Jong, Daniel Verzilli, Marie Geniez, Gérald Chanques, David Nocca, Samir Jaber
Obesity is often associated with obstructive sleep apnea (OSA), which increases the risk of intraoperative and postoperative complications. The role of preoperative screening of OSA is crucial, with adequate management based on continuous positive pressure before, during and after surgery. The obese patient is at risk of postoperative complications: difficult airway management, acute respiratory failure following extubation due to atelectasis and airway obstruction, added to morphine overdosing. Optimal management of difficult mask ventilation and intubation, protective ventilation, combined to the reduction of sedatives and analgesics and the sitting position as soon as possible with a postoperative monitoring should decrease the occurrence of complications...
March 30, 2018: La Presse Médicale
https://www.readbyqxmd.com/read/29605361/combined-nd-yag-laser-and-bleomycin-sclerotherapy-under-the-same-anesthesia-for-cervicofacial-venous-malformations-a-safe-and-effective-treatment-option
#3
Stacie Gregory, Patricia E Burrows, Herodotos Ellinas, Michael Stadler, Robert H Chun
INTRODUCTION: Extensive cervicofacial venous malformations (VM) pose significant challenges to a patient's quality of life (altered breathing, dysphagia, dysarthria). Treatment options include: 1) Surgical debulking; 2) Sclerotherapy; 3) laser therapy; or 4) Combined modalities. Recent studies have demonstrated the importance of multimodality and multidisciplinary management of these patients. However, no studies have described combined single anesthetic laser and sclerotherapy treatment...
May 2018: International Journal of Pediatric Otorhinolaryngology
https://www.readbyqxmd.com/read/29584447/inspiratory-muscle-rehabilitation-in-critically-ill-adults-a-systematic-review-and-meta-analysis
#4
Stefannie Vorona, Umberto Sabatini, Sulaiman Al-Maqbali, Michele Bertoni, Martin Dres, Bernie Bissett, Frank Van Haren, A Daniel Martin, Cristian Urrea, Debbie Brace, Matteo Parotto, Margaret S Herridge, Neill Kj Adhikari, Eddy Fan, Luana T Melo, W Darlene Reid, Laurent J Brochard, Niall D Ferguson, Ewan C Goligher
BACKGROUND: Respiratory muscle weakness is common in critically ill patients; the role of targeted inspiratory muscle training (IMT) in ICU rehabilitation strategies remains poorly defined. OBJECTIVES: The primary objective was to describe the range and tolerability of published methods for IMT. The secondary objectives were to determine whether IMT improves respiratory muscle strength and clinical outcomes in critically ill patients. DATA SOURCES: We conducted a systematic review to identify randomized and non-randomized studies of physical rehabilitation interventions intended to strengthen the respiratory muscles in critically ill adults...
March 27, 2018: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/29577233/an-assessment-of-the-tolerability-of-the-cook-staged-extubation-wire-in-patients-with-known-or-suspected-difficult-airways-extubated-in-intensive-care
#5
S McManus, L Jones, C Anstey, S Senthuran
The Cook staged extubation set (Cook Medical) has been developed to facilitate management of the difficult airway. A guidewire inserted before tracheal extubation provides access to the subglottic airway should re-intubation be required. This prospective cohort study examines patients' tolerance of the guidewire and its impact on clinical status around tracheal extubation in the intensive care unit. Vital signs, incidence of symptoms and patient tolerance of the wire were recorded. Twenty-three patients were enrolled and 17 (73%) tolerated the wire for 4 h...
March 25, 2018: Anaesthesia
https://www.readbyqxmd.com/read/29554711/-difficult-airway-management-in-thoracic-anaesthesia
#6
Sarah-Hélène Müller, Jérôme M Defosse, Mark U Gerbershagen, Torsten Loop
Difficult airway management in thoracic anesthesia has rarely been addressed in current guidelines. However, difficult airway management may be a challenge in thoracic anaesthesia: Achieving lung separation and collapse in combination of potentially distorted upper airway anatomy (difficult upper airway), the presence of subglottic pathologies (difficult lower airway) and the need for one-lung ventilation (difficult lung separation). This review will focus on identification of patients at risk, recommendations and algorithms for the airway management in the anticipated and unexpected difficult in-/extubation, and choice of devices for lung separation in this context...
March 2018: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
https://www.readbyqxmd.com/read/29519925/impact-of-sleep-alterations-on-weaning-duration-in-mechanically-ventilated-patients-a-prospective-study
#7
Arnaud W Thille, Faustine Reynaud, Damien Marie, Stéphanie Barrau, Ludivine Rousseau, Christophe Rault, Véronique Diaz, Jean-Claude Meurice, Rémi Coudroy, Jean-Pierre Frat, René Robert, Xavier Drouot
Sleep is markedly altered in intensive care unit (ICU) patients and may alter respiratory performance. Our objective was to assess the impact of sleep alterations on weaning duration. We conducted a prospective physiological study performed in a French teaching hospital. ICU-patients intubated at least 24 h and difficult-to-wean were included. Complete polysomnography was performed after the first spontaneous breathing trial failure. Presence of atypical sleep, duration of sleep stages particularly rapid eye movement (REM) sleep, and electroencephalogram (EEG) reactivity at eye opening were assessed by a neurologist...
March 8, 2018: European Respiratory Journal: Official Journal of the European Society for Clinical Respiratory Physiology
https://www.readbyqxmd.com/read/29491518/fast-tracking-in-adult-living-donor-liver-transplantation-a-case-series-of-15-patients
#8
Pooja Bhangui, Prashant Bhangui, Nikunj Gupta, Annu Sarin Jolly, Seema Bhalotra, Nishant Sharma, A S Soin, Vijay Vohra
Background and Aims: Fast tracking (FT) for more efficacious use of resources may be difficult after living donor liver transplantation (LDLT) due to a partial liver graft, complex vascular anastomoses and longer operating time. Our study was aimed at reporting our experience with FT (on table extubation) in LDLT recipients. A secondary objective of our study was to look at defining a subgroup of patients who could be prospectively planned for FT. Methods: We studied the demographics and outcomes of 15 LDLT recipients extubated immediately in the operating suite based on an uneventful intraoperative course, haemodynamic stability after graft reperfusion and improvement of metabolic parameters post-implantation and vascular anastomoses...
February 2018: Indian Journal of Anaesthesia
https://www.readbyqxmd.com/read/29430408/using-bronchoscopy-to-detect-acquired-tracheoesophageal-fistula-in-mechanically-ventilated-patients
#9
Michael S Green, Johann J Mathew, Lia J Michos, Parmis Green, Mansoor M Aman
Introduction: An acquired Tracheoesophageal fistula (TEF) is commonly caused by a malignancy or trauma, with pulmonary infection or aspiration being the presenting symptom. However, in the critical care setting the presentation can be subtle and may present with difficult ventilation. High endotracheal tube cuff pressures can lead to tracheal erosions and thus increasing the chances for developing a TEF. Prolonged intubation in the presence of other risk factors like poor general state of health, episodic hypotension, nasogastric tubes, and repeated intubations can increase the likelihood of developing an acquired TEF...
August 2017: Anesthesiology and Pain Medicine
https://www.readbyqxmd.com/read/29284880/securing-a-difficult-airway-tracheal-intubation-achieved-after-deliberate-placement-of-an-endotracheal-tube-in-esophagus-a-new-approach
#10
Vanilla Chopra, Nandita Mehta, Mohd Reidwan Dar
Enlarged thyroid gland with retrosternal extension has an increased incidence of difficult intubation, and it poses real airway challenge for the anesthesiologists. Here, we present a case of successful management of a difficult airway in a female patient of enlarged thyroid gland, planned for open reduction and internal fixation of the upper end of humerus. Endotracheal intubation was achieved after deliberate insertion of an endotracheal tube in esophagus. The patient was extubated over a ventilating bougie, with uneventful postoperative course...
October 2017: Anesthesia, Essays and Researches
https://www.readbyqxmd.com/read/29284851/comparison-of-i-gel-versus-endotracheal-tube-in-patients-undergoing-elective-cesarean-section-a-prospective-randomized-control-study
#11
Manohar Panneer, Saravana Babu, Prakash Murugaiyan
Background and Aim: Physiological changes during pregnancy and the sympatho adrenalstimulation during larynoscopy and intubation leads to evaluation of safe devices to secure airway during cesarean section under general anesthesia. I-gel, recently emerging effective supra glottic device found safe during general anesthesia in cesarean section. Aim of the study is to compare the hemodynamic disturbances and airway related complications of I-gel and Endotracheal tube in patients undergoing cesarean section under general anesthesia...
October 2017: Anesthesia, Essays and Researches
https://www.readbyqxmd.com/read/29279645/methadone-gastrobezoar-in-a-psychiatric-patient-presented-in-coma
#12
Alexandra Gavala, Despoina Manou, Vasiliki Psalida, Maria Nystatzaki, Christos Mavrogiannis, George Alevizopoulos, Pavlos Myrianthefs
A 43-year-old psychiatric patient was transferred in coma and hypercapnic respiratory failure at the emergency department. He was intubated for airway protection and transferred to the Intensive Care Unit (ICU). Abdominal X-ray revealed a radiopaque mass; a pharmacobezoar was suspected and confirmed by gastroscopy; one large in the stomach fundus and a smaller one in the pylorus. Gastric lavage through the gastroscope and administration of gastro-kinetic drugs and laxatives were able to dilute the bezoars. Tablets retrieved from the stomach identified as methadone and toxicological tests of the gastric fluid confirmed the presence of methadone as the only organic chemical compound...
November 2017: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/29262440/who-is-safe-to-extubate-in-the-neuroscience-intensive-care-unit
#13
Julian Bösel
Patients admitted to the neuroscience intensive care unit (NICU) may have respiratory compromise from either central or peripheral neurological pathology, and may hence require intubation and mechanical ventilation for very diverse reasons. Liberation from invasive ventilation, that is, extubation, at the earliest possible time is a widely accepted principle in intensive care. For this, classic extubation criteria have been established in the general critical care setting, mainly targeting pulmonary function and cooperativeness of the patient...
December 2017: Seminars in Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/29216230/a-comprehensive-scoring-system-in-correlation-with-perioperative-airway-management-for-neonatal-pierre-robin-sequence
#14
Ning Yin, Lei Fang, Xiaohua Shi, Hongqiang Huang, Li Zhang
PURPOSE: To evaluate a comprehensive scoring system which combines clinical manifestations of Pierre Robin Sequence (PRS) including severity of breathing difficulties, body weight and preoperative Cormack-Lehane grade, for its correlation with perioperative PRS airway management decision. DESIGN: Forty PRS children were retrospectively recruited after surgery. Specialists examined all subjects and scored for clinical manifestations (1´ - 4´), weight gain (1´- 4´), dyspnea scores (1´- 4´), and Cormack-Lehane grade (1´- 4´)...
2017: PloS One
https://www.readbyqxmd.com/read/29201634/innovative-chest-physiotherapy-techniques-the-metaneb-%C3%A2-system-in-the-intubated-child-with-extensive-burns
#15
Alexandra Ferguson, Sarah Wright
Introduction: The Metaneb® is a new generation Intrapulmonary Percussive Ventilation device utilised by the physiotherapist to assist airway clearance by providing calibrated oscillations during inspiration up to 3.8Hz. Predominantly used in the adult chronic respiratory patient, with anecdotal evidence in intubated patients, it was also proven to be safe in a paediatric lung model lab study. This case report outlines the first use of the Metaneb® with an intubated child in Australia...
2017: Respiratory Medicine Case Reports
https://www.readbyqxmd.com/read/29191205/different-effects-of-cardiac-and-diaphragm-function-assessed-by-ultrasound-on-extubation-outcomes-in-difficult-to-wean-patients-a-cohort-study
#16
Ling Luo, Yidan Li, Xiukai Chen, Bing Sun, Wenxiong Li, Wei Gu, Shuo Wang, Song Zhao, Yanwei Lv, Mulei Chen, Jingen Xia, Feng Sui, Xue Mei, Huanzhong Shi, Zhaohui Tong
BACKGROUND: Ultrasound is a convenient tool to evaluate cardiac and diaphragm function. The ratio (E/Ea) of mitral Doppler inflow velocity to annular tissue Doppler wave velocity by transthoracic echocardiography (TTE) and diaphragmatic excursion (DE) by diaphragm ultrasound have been confirmed in predicting extubation outcomes independently, however their different roles in the weaning process have not been determined until now. METHODS: We designed a cohort study to preform diaphragm ultrasound and TTE before and after the spontaneous breathing trial (SBT) in difficult-to-wean patients...
December 1, 2017: BMC Pulmonary Medicine
https://www.readbyqxmd.com/read/29151413/-effects-of-mechanical-ventilation-on-diaphragmatic-contractile-function-in-patients-with-aecopd
#17
Feifei Wang, Xiaoping Zhu, Changjing Zhang, Hui Zhu, Yu Feng, Yang Liu, Shaolin Ma
OBJECTIVE: To study diaphragmatic strength in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) during mechanical ventilation (MV), and to explore the predictive value of maximal transdiaphragm pressure (Pdi max) for successful extubation. METHODS: A prospective study was conducted. Twenty-one patients with AECOPD receiving MV admitted to intensive care unit (ICU) of Shanghai East Hospital of Tongji University of School Medicine from February 2015 to May 2017 were enrolled...
November 2017: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://www.readbyqxmd.com/read/29137579/assessment-of-the-reliability-of-intubation-and-ease-of-use-of-the-cook-staged-extubation-set-an-observational-study
#18
C Furyk, M L Walsh, I Kaliaperumal, S Bentley, C Hattingh
The Staged Extubation Set has recently been introduced by Cook Medical for the management of difficult airway patients who potentially require reintubation; however, its reliability for intubation and ease of use is not reported in the literature. The set contains a wire and reintubation catheter with a central lumen for the wire and oxygenation if required. Reintubation is by a two-stage Seldinger-like technique. After induction of general anaesthesia, 23 low-risk elective surgical patients had the Staged Extubation Wire from the Cook set inserted into their trachea under direct laryngoscopy...
November 2017: Anaesthesia and Intensive Care
https://www.readbyqxmd.com/read/29098448/incidence-of-airway-complications-in-patients-using-endotracheal-tubes-with-continuous-aspiration-of-subglottic-secretions
#19
Jordi Vallés, Susana Millán, Emili Díaz, Eva Castanyer, Xavier Gallardo, Ignacio Martín-Loeches, Marta Andreu, Mario Prenafeta, Paula Saludes, Jorge Lema, Montse Batlle, Néstor Bacelar, Antoni Artigas
BACKGROUND: Continuous aspiration of subglottic secretions is effective in preventing ventilator-associated pneumonia, but it involves a risk of mucosal damage. The main objective of our study was to determine the incidence of airway complications related to continuous aspiration of subglottic secretions. METHODS: In consecutive adult patients with continuous aspiration of subglottic secretions, we prospectively recorded clinical airway complications during the period after extubation...
November 2, 2017: Annals of Intensive Care
https://www.readbyqxmd.com/read/29090253/fiberoptic-bronchoscope-and-c-mac-video-laryngoscope-assisted-nasal-oral-tube-exchange-two-case-reports
#20
Sungmi Ji, Jaegyok Song, Seok Kon Kim, Moon-Young Kim, Sangyun Kim
In cases of multiple facial trauma and other specific cases, the anesthesiologist may be asked to convert an oral endotracheal tube to a nasal endotracheal tube or vice versa. Conventionally, the patient is simply extubated and the endotracheal tube is re-inserted along either the oral or nasal route. However, the task of airway management can become difficult due to surgical trauma or worsening of the airway condition. Fiberoptic bronchoscopy was considered a novel method of airway conversion but this method is not useful when there are secretions and bleeding in the airway, or if the anesthesiologist is inexperienced in using this device...
September 2017: Journal of dental anesthesia and pain medicine
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