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Wang J, Su Z, Oto J, Kacmarek RM, Jiang Y, Liu S. Endotracheal catheter equipped with functional cuff produces clinically relevant positive end expiratory pressure: a bench study. J Clin Monit Comput 2018; 33:419-429. [PMID: 30073444 DOI: 10.1007/s10877-018-0189-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 07/30/2018] [Indexed: 10/28/2022]
Abstract
Recently, we developed a novel endotracheal catheter with functional cuff (ECFC). Using such an ECFC and a regular ICU ventilator, we were able to generate clinically relevant tidal volume in a lung model and adult human sized animal. This ECFC allows co-axial ventilation without using a jet ventilator. The aim of this study was to determine if ECFC also could generate clinically relevant positive end expiratory pressure (PEEP). The experiment was conducted on a model lung and artificial trachea. Lung model respiratory mechanics were set to simulate those of an adult human being. The tip of the distal end of ECFC 14 or 19 Fr catheter was positioned in the artificial trachea 3 cm above the carina. The proximal end of ECFC was connected to an ordinary ICU ventilator. With 14 Fr catheter at respiratory rate 10 bpm, PEEP 0, 2.9, 8.2, 12.9 cmH2O was generated at preset PEEP 0, 5, 10, 15 cmH2O respectively and tidal volume was up to 393.4 ml. With 19 Fr catheter, PEEP was 0, 2.8, 7.6, 12.3 cmH2O, at preset PEEP 0, 5, 10, 15 cmH2O respectively and the tidal volume was up to 667.3 ml. With 14 Fr catheter at respiratory rate 20 bpm, PEEP was 0, 3.9, 9.6, 14.6 cmH2O at preset PEEP 0, 5, 10, 15 cmH2O respectively and tidal volume was up to 188.8 ml. With 19 Fr catheter, PEEP was 0, 3.6, 8.9, 13 cmH2O, at preset PEEP 0, 5, 10, 15 cmH2O respectively and tidal volume was up to 345.3 ml. ECFC enables clinicians to generate not only adequate tidal volume but also clinically relevant PEEP via co-axial ventilation using an ordinary ICU ventilator.
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Affiliation(s)
- Jingwen Wang
- Department of Reproductive Medicine, Gynecology and Obstetrics, The Affiliated Hospital of Jining Medical University, Jining, China.,Department of Anaesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, USA
| | - Zhenbo Su
- Department of Anaesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, USA.,Department of Anaesthesia, China-Japan Union Hospital of Jilin University, Jilin, China
| | - Jun Oto
- Department of Anaesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, USA.,The Emergency and Critical Care Medicine, Tokushima University Hospital, Tokushima, Japan
| | - Robert M Kacmarek
- Department of Anaesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, USA.,Respiratory Care Services, Massachusetts General Hospital, Boston, USA
| | - Yandong Jiang
- Department of Anaesthesiology, Vanderbilt University Medical Center, Nashville, USA
| | - Shujie Liu
- Department of Anaesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, USA. .,Department of Anaesthesiology, The First Affiliated Hospital of Harbin Medical University, No. 23 Youzheng Street, Harbin, China.
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Rivas E, Ubré M, Martínez-Pallí G, Valero R, Beltran J, López A, Balust J. [Fibreoptic clinical training in anaesthesia. Course design and results based on a self-assessment survey]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2012; 59:483-488. [PMID: 22921112 DOI: 10.1016/j.redar.2012.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Accepted: 06/06/2012] [Indexed: 06/01/2023]
Abstract
BACKGROUND AND OBJECTIVE Fibreoptic intubation is the technique of choice for resolving complications related to a difficult airway. Our aim was to determine whether a clinical-practice-based, individualized course provides sufficient training and confidence to allow anaesthetists to routinely practice fibreoptic intubation. METHODS Our hospital developed a clinical-practice-based, individualized course on fibreoptic intubation in general anaesthesia that provided practice in sedated spontaneously breathing patients and insertion through supraglottic devices. From 2005 to 2009, we e-mailed participants for response to an anonymous online self-assessment survey. We asked participants about the training outcomes and their overall degree of satisfaction. RESULTS Seventy-seven participants were sent the questionnaire six months after the course and 61% responded. All respondents considered themselves skilled in handling the bronchoscope at the end of the course and 97% used it in their routine practice in patients with difficult airways. CONCLUSIONS These results suggest a high success rate can be expected from individually tailored fibreoptic intubation courses that supplement theory and mannequin experience with clinical practice.
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Affiliation(s)
- E Rivas
- Servicio de Anestesiología, Reanimación y Terapia del Dolor, Hospital Clínic de Barcelona, Universitat de Barcelona, España.
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Popat M, Mitchell V, Dravid R, Patel A, Swampillai C, Higgs A. Difficult Airway Society Guidelines for the management of tracheal extubation. Anaesthesia 2012; 67:318-40. [PMID: 22321104 DOI: 10.1111/j.1365-2044.2012.07075.x] [Citation(s) in RCA: 295] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Tracheal extubation is a high-risk phase of anaesthesia. The majority of problems that occur during extubation and emergence are of a minor nature, but a small and significant number may result in injury or death. The need for a strategy incorporating extubation is mentioned in several international airway management guidelines, but the subject is not discussed in detail, and the emphasis has been on extubation of the patient with a difficult airway. The Difficult Airway Society has developed guidelines for the safe management of tracheal extubation in adult peri-operative practice. The guidelines discuss the problems arising during extubation and recovery and promote a strategic, stepwise approach to extubation. They emphasise the importance of planning and preparation, and include practical techniques for use in clinical practice and recommendations for post-extubation care.
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