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Wang J, Zhang Y, Chen X, Tao F, Sun B, Xie J, Chen J. Targeted delivery of inhalable drug particles in the tracheobronchial tree model of a pediatric patient with bronchopneumonia: A numerical study. Respir Physiol Neurobiol 2023; 311:104024. [PMID: 36731709 DOI: 10.1016/j.resp.2023.104024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/19/2023] [Accepted: 01/28/2023] [Indexed: 02/01/2023]
Abstract
Pneumonia is a common cause of hospitalization and death in children worldwide. Inhalation therapy is one of the methods treating pneumonia However, there are limited studies that distinguish between the physiology of children and adults, especially with respect to targeted drug delivery. A tracheobronchial (TB) tree model of an 11-year-old child with bronchopneumonia is selected as a testbed for in silico trials of targeted drug delivery. The airflow and particle transport are solved by the computational fluid dynamics method at an airflow rate of 15 LPM. The results indicate that the distribution of deposited particles shows aggregation on the particle release map. Point-source aerosol release (PSAR) method can significantly reduce the deposition efficiency (DE) of particles in the TB tree model. Specifically, the PSAR method can reduce the DE of large particles (i.e., 7.5 µm and 10 µm) by 7.57% and 9.61%, respectively. This enables rapid design of patient-specific treatment for different population age groups and different airway diseases.
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Affiliation(s)
- Jianwei Wang
- School of Energy and Mechanical Engineering, Nanjing Normal University, Nanjing, Jiangsu 210046, China
| | - Ya Zhang
- Department of Otolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710004, China
| | - Xiaole Chen
- School of Energy and Mechanical Engineering, Nanjing Normal University, Nanjing, Jiangsu 210046, China.
| | - Feng Tao
- Zhongda Hospital, Southeast University, Nanjing, Jiangsu 210009, China
| | - Baobin Sun
- Zhongda Hospital, Southeast University, Nanjing, Jiangsu 210009, China
| | - Jun Xie
- School of Energy and Mechanical Engineering, Nanjing Normal University, Nanjing, Jiangsu 210046, China
| | - Jingguo Chen
- Department of Otolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710004, China
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Propst EJ, Gorodensky JH, Wolter NE. Length of the Cricoid and Trachea in Children: Predicting Intubation Depth to Prevent Subglottic Stenosis. Laryngoscope 2021; 132 Suppl 2:S1-S10. [PMID: 33973659 DOI: 10.1002/lary.29616] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/20/2021] [Accepted: 05/01/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Define the length of the subglottis and trachea in children to predict a safe intubation depth. METHODS Patients <18 years undergoing rigid bronchoscopy from 2013 to 2020 were included. The carina and inferior borders of the cricoid and true vocal folds were marked on a bronchoscope and distances were measured. Patient age, weight, height, and chest height were recorded. Four styles of cuffed pediatric endotracheal tubes (ETT) were measured and potential positions of each cuff and tip were calculated within each trachea using five depth of intubation scenarios. Multivariate linear regression was performed to identify predictors of subglottic and tracheal length. RESULTS Measurements were obtained from 210 children (141 male, 69 female), mean (SD) age 3.21 (3.66) years. Patient height was the best predictor of subglottic length (R2 : 0.418): Lengthsg (mm) = 0.058 * height (cm) + 2.8, and tracheal length (R2 : 0.733): Lengtht (mm) = 0.485 * height (cm) + 21.3. None of the depth of intubation scenarios maintained a cuff-free subglottis for all ETT styles investigated. A formula for depth of intubation: Lengthdi (mm) = 0.06 * height (cm) + 8.8 found that no ETT cuffs would be in the subglottis and all tips would be above the carina. CONCLUSION Current strategies for determining appropriate depth of intubation pose a high risk of subglottic ETT cuff placement. Placing the inferior border of the vocal cords 0.06 * height (cm) + 8.8 from the superior border of the inflated ETT cuff may prevent subglottic cuff placement and endobronchial intubation. LEVEL OF EVIDENCE 4 Laryngoscope, 2021.
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Affiliation(s)
- Evan Jon Propst
- Department of Otolaryngology - Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Jonah Haskel Gorodensky
- Department of Otolaryngology - Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Nikolaus Ernst Wolter
- Department of Otolaryngology - Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Dave MH, Kemper M, Schmidt AR, Both CP, Weiss M. Pediatric airway dimensions-A summary and presentation of existing data. Paediatr Anaesth 2019; 29:782-789. [PMID: 31087466 DOI: 10.1111/pan.13665] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 05/05/2019] [Accepted: 05/12/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Age-related pediatric airway dimension reference values for cricoid, tracheal, and bronchial diameters as well as tracheal and bronchial lengths are essential for distinguishing normal from pathological airway findings and for manufacturing and selecting appropriately sized airway equipment. AIM The aim of this work was to summarize and present existing pediatric airway dimension data for the larynx, trachea, and main stem bronchi from fetus to adolescence. METHODS A systematic literature search was carried out using PubMed, Scopus, Embase, and Google Scholar. Publications containing original data on pediatric airway dimensions as mean or median in tabular form and spanning narrow age groups of 1 or 2 years were included in our study. Original data such as diameters, lengths, and cross-sectional areas of trachea, cricoid, left and right main bronchi in fetuses and children were collected and presented as figures. RESULTS Pediatric airway dimension data were gathered and compiled from 15 studies fulfilling the inclusion criteria. Data were obtained from different measurement methods such as autopsy, chest X-ray, computed tomography, magnetic resonance imaging, rigid and flexible bronchoscopy as well as ultrasound examinations. There was considerable variation among age-related data due to biologic heterogeneity, different presentation of data, different definitions, and various measurement techniques. CONCLUSION This investigation revealed heterogeneous data on pediatric airway dimensions, making it impossible to compile them into standard reference values for airway dimensions. New studies with structured and standardized measurements and data presentation in large populations of children are required to provide more valid pediatric airway dimension data.
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Affiliation(s)
- Mital H Dave
- Department of Anesthesia and Children's Research Center, University Children's Hospital, Zurich, Switzerland
| | - Michael Kemper
- Department of Anesthesia and Children's Research Center, University Children's Hospital, Zurich, Switzerland
| | - Alexander R Schmidt
- Department of Anesthesia and Children's Research Center, University Children's Hospital, Zurich, Switzerland
| | - Christian P Both
- Department of Anesthesia and Children's Research Center, University Children's Hospital, Zurich, Switzerland
| | - Markus Weiss
- Department of Anesthesia and Children's Research Center, University Children's Hospital, Zurich, Switzerland
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Naina P, Syed KA, Irodi A, John M, Varghese AM. Pediatric tracheal dimensions on computed tomography and its correlation with tracheostomy tube sizes. Laryngoscope 2019; 130:1316-1321. [PMID: 31228208 DOI: 10.1002/lary.28141] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 05/16/2019] [Accepted: 05/30/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Age-based formulas for selecting the appropriate size of tracheostomy tubes in children are based on data on tracheal dimensions. This study aims to measure the tracheal dimensions of Indian children by computerized tomography (CT) and to compare this with the dimensions of age-appropriate tracheostomy tubes. METHODS CT scans of children aged less than 16 years that were taken for indications other than respiratory distress were included. Tracheal diameters at the tracheostomy point and tracheal length from the tracheostomy point to the carina were calculated from the scans. These dimensions were correlated with age, weight, and height. The measurement on the CT scan was used to predict the appropriate size of tracheostomy tube, which was compared with the tracheostomy tube sizes. RESULTS Two hundred and fourteen CT scans of children aged below 16 years were included in the study. On multiple logistic regression analysis, tracheal diameter correlated well with age and weight (P = 0.04 and 0.001, respectively), whereas tracheal length correlated well with age and height of the child (P = 0.03 and 0 < 0.001, respectively). On comparison with dimensions of the tracheostomy tube, tracheal diameter correlated well, and the length was found to be longer than needed to prevent endobronchial intubation. The regression value was used to predict the size of an ideal tracheostomy tube. CONCLUSION Tracheal diameter of Indian children correlates well with the outer diameter of age-appropriate tracheostomy tubes, but the length of these tubes is longer than the ideal length. This would necessitate a change in the design of these tubes. LEVEL OF EVIDENCE 2b Laryngoscope, 130:1316-1321, 2020.
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Affiliation(s)
- P Naina
- Department of ENT, Christian Medical College, Vellore, India
| | | | - Aparna Irodi
- Department of Radiology, Christian Medical College, Vellore, India
| | - Mary John
- Department of ENT, Christian Medical College, Vellore, India
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Aeppli N, Lindauer B, Steurer MP, Weiss M, Dullenkopf A. Endotracheal tube cuff pressure changes during manual cuff pressure control manoeuvres: An in-vitro assessment. Acta Anaesthesiol Scand 2019; 63:55-60. [PMID: 30132783 DOI: 10.1111/aas.13249] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 07/07/2018] [Accepted: 07/31/2018] [Indexed: 01/27/2023]
Abstract
BACKGROUND Endotracheal tube (ETT) cuffs are designed to seal the lower airway for precise ventilation and to protect against ingress of pathogens from the pharyngeal space. Therefore, a minimal continuous cuff pressure must be maintained. Aim of this study was to analyse the course of cuff pressure in an in-vitro model during manual cuff pressure control manoeuvres. METHODS An artificial trachea was intubated with an appropriately sized ETT and cuff pressure set to 20 cm H2 O. Thirty-two experienced ICU nurses each performed six cuff pressure control manoeuvres (three times in two different ETTs) using a manual cuff pressure manometer. Course of cuff pressure from connecting the manometer to disconnecting it from the cuff pilot balloon was recorded using a pressure transducer. RESULTS There were 190 cuff pressure control manoeuvres suitable for analysis. In all control manoeuvres a cuff pressure below 20 cm H2 O was noted. In 20.0% of the control manoeuvres the cuff pressure dropped below 10 cm H2 O. Cuff pressure drops were mainly caused by initially connecting the manometer to the pilot balloon, less frequently by manipulating the pressure gauge of the manometer. Disconnecting the manometer after the control manoeuvre caused a cuff pressure drop in 78.1% of cases, contributing to a final cuff pressure below 20 cm H2 O in 31.3% of control manoeuvres. CONCLUSION Routine manual cuff pressure control manoeuvres in ETT cuffs result in considerable cuff pressure drops. This may have an impact on silent aspiration of pharyngeal contents passing along the cuff into the lower airway.
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Affiliation(s)
- Norbert Aeppli
- Department of Anaesthesiology and Intensive Care Medicine; Kantonsspital Frauenfeld; Frauenfeld Switzerland
| | - Bastian Lindauer
- Department of Anaesthesiology and Intensive Care Medicine; Kantonsspital Frauenfeld; Frauenfeld Switzerland
| | - Marc P. Steurer
- Department of Anesthesia and Perioperative Care; University of California; San Francisco California
| | - Markus Weiss
- Department of Anaesthesia and Children's Research Centre; University Children's Hospital; Zurich Switzerland
| | - Alexander Dullenkopf
- Department of Anaesthesiology and Intensive Care Medicine; Kantonsspital Frauenfeld; Frauenfeld Switzerland
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Dave MH, Schmid K, Weiss M. Airway dimensions from fetal life to adolescence-A literature overview. Pediatr Pulmonol 2018; 53:1140-1146. [PMID: 29806162 DOI: 10.1002/ppul.24046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 04/04/2018] [Indexed: 01/11/2023]
Abstract
BACKGROUND Data on airway dimensions in pediatric patients are important for proper selection of pediatric airway equipment such as endotracheal tubes, double-lumen tubes, bronchial blockers, or stents. The aim of the present work was to provide a synopsis of the available data on pediatric airway dimensions. METHODS A systematic literature search was carried out in the PubMed database, Scopus, Embase, Web of Science, Prisma, and Google Scholar and secondarily completed by a reference search. Based on inclusion and exclusion criteria, a final selection of 109 studies with data on pediatric airway dimensions published from 1923 to 2018 were further analyzed. RESULTS Six different airway measurement methods were identified. They included anatomical examinations, chest X-ray, computed tomography, magnetic resonance tomography, bronchoscopy, and ultrasound. Anatomical studies were more abundant compared to other methods. Data provided were very heterogeneously presented and powered. In addition, due to different study conditions, they are hardly comparable. Among all, anatomical and computer tomography studies are thought to provide the most reliable data. Ultrasound is an upcoming technique to estimate airway parameters of fetus and premature infants. There was, in general, a lack of comprehensive studies providing a complete range of airway dimensions in larger groups of patients from birth to adolescence. CONCLUSIONS This work revealed a large heterogeneity of studies providing data on pediatric airway dimensions, making it impossible to compare, or assemble them to normograms for clinical use. Comprehensive studies in large population of children are needed to provide full range nomograms on pediatric airway dimensions.
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Affiliation(s)
- Mital H Dave
- Department of Anesthesia and Children's Research Center, University Children's Hospital, Zürich, Switzerland
| | - Kathrin Schmid
- Department of Anesthesia and Children's Research Center, University Children's Hospital, Zürich, Switzerland
| | - Markus Weiss
- Department of Anesthesia and Children's Research Center, University Children's Hospital, Zürich, Switzerland
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Gupta B, Gupta L. Significance of the outer diameter of an endotracheal tube: a lesser-known parameter. Korean J Anesthesiol 2018; 72:72-73. [PMID: 29843505 PMCID: PMC6369347 DOI: 10.4097/kja.d.18.00056] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 05/08/2018] [Indexed: 11/11/2022] Open
Affiliation(s)
- Bhavna Gupta
- Department of Anesthesia, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Lalit Gupta
- Department of Anesthesia, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
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9
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Maconochie IK, Bingham R, Eich C, López-Herce J, Rodríguez-Núñez A, Rajka T, Van de Voorde P, Zideman DA, Biarent D, Monsieurs KG, Nolan JP. European Resuscitation Council Guidelines for Resuscitation 2015. Resuscitation 2015; 95:223-48. [DOI: 10.1016/j.resuscitation.2015.07.028] [Citation(s) in RCA: 217] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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10
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Abstract
This article reviews recent developments and core topics in the use and design of pediatric cuffed tracheal tubes. A concept for an appropriate pediatric cuffed tracheal tube is introduced. The main points in this concept are evidence-based tracheal tube size recommendation, continuous cuff pressure monitoring and a pediatric tracheal tube with an anatomically-based intubation depth mark and a short distally placed high-volume-low pressure cuff made from an ultra-thin polyurethane membrane with markedly improved tracheal sealing performance. The main points in proper handling of cuffed tracheal tubes in children are highlighted. Finally, an outlook on future developments in the design of pediatric cuffed tracheal tubes and an overview of tasks to be performed in evaluating them is given.
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Affiliation(s)
- Markus Weiss
- University Children's Hospital, Steinwiesstrasse 75, CH 8032 Zurich, Switzerland.
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Szpinda M, Daroszewski M, Szpinda A, Woźniak A, Mila-Kierzenkowska C, Flisiński P, Wiśniewski M. The normal growth of the tracheal wall in human foetuses. Arch Med Sci 2013; 9:922-9. [PMID: 24273580 PMCID: PMC3832814 DOI: 10.5114/aoms.2012.31411] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Revised: 11/24/2011] [Accepted: 12/16/2011] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Tracheal wall thickness is a substantial indicator in various pathological changes. The present study was performed to compile normative data and formulae for the tracheal wall thickness and volume at varying gestational age. MATERIAL AND METHODS Using anatomical dissection, digital image analysis and statistics a range of the wall thickness, proximal internal-to-external cross-sectional area ratio, and wall volume for the trachea in 73 spontaneously aborted human fetuses aged 14-25 weeks was examined. RESULTS No significant male-female differences were found. The values of tracheal wall thickness ranged from 0.36 ±0.01 mm for the 14-week group to 1.23 ±0.17 mm for the 25-week group of gestation, according to the linear function y = -0.823 + 0.083 × age ± 0.087. The tracheal lumen rate, expressed as the proximal internal-to-external cross-sectional area ratio, decreased from 42.61 ±1.11% to 26.78 ±4.95%, according to the function y = 62.239 - 1.487 × age ±3.119. The tracheal wall volume rose from 16.28 ±4.18 mm(3) in fetuses aged 14 weeks to 269.22 ±29.26 mm(3) in fetuses aged 25 weeks, according to the quintic function y = 0.000052 × age(4.894). CONCLUSIONS The tracheal wall parameters show no sexual dimorphism. The tracheal wall grows linearly in its length, and according to a quintic function in its volume. A relative decrease in the tracheal lumen at the expense of an increase in both the wall thickness and wall volume of the trachea is found during gestation.
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Affiliation(s)
- Michał Szpinda
- Department of Normal Anatomy, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
| | - Marcin Daroszewski
- Department of Normal Anatomy, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
| | - Anna Szpinda
- Department of Normal Anatomy, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
| | - Alina Woźniak
- Department of Medical Biology, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
| | - Celestyna Mila-Kierzenkowska
- Department of Medical Biology, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
| | - Piotr Flisiński
- Department of Normal Anatomy, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
| | - Marcin Wiśniewski
- Department of Normal Anatomy, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
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Biarent D, Bingham R, Eich C, López-Herce J, Maconochie I, Rodríguez-Núñez A, Rajka T, Zideman D. European Resuscitation Council Guidelines for Resuscitation 2010 Section 6. Paediatric life support. Resuscitation 2011; 81:1364-88. [PMID: 20956047 DOI: 10.1016/j.resuscitation.2010.08.012] [Citation(s) in RCA: 151] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Dominique Biarent
- Paediatric Intensive Care, Hôpital Universitaire des Enfants, 15 av JJ Crocq, Brussels, Belgium.
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Nolan JP, Soar J, Zideman DA, Biarent D, Bossaert LL, Deakin C, Koster RW, Wyllie J, Böttiger B. European Resuscitation Council Guidelines for Resuscitation 2010 Section 1. Executive summary. Resuscitation 2011; 81:1219-76. [PMID: 20956052 DOI: 10.1016/j.resuscitation.2010.08.021] [Citation(s) in RCA: 847] [Impact Index Per Article: 65.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Jerry P Nolan
- Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK
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de Caen AR, Kleinman ME, Chameides L, Atkins DL, Berg RA, Berg MD, Bhanji F, Biarent D, Bingham R, Coovadia AH, Hazinski MF, Hickey RW, Nadkarni VM, Reis AG, Rodriguez-Nunez A, Tibballs J, Zaritsky AL, Zideman D. Part 10: Paediatric basic and advanced life support: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Resuscitation 2011; 81 Suppl 1:e213-59. [PMID: 20956041 DOI: 10.1016/j.resuscitation.2010.08.028] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Allan R de Caen
- Stollery Children's Hospital, University of Alberta, Canada.
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Biarent D, Bingham R, Eich C, López-Herce J, Maconochie I, Rodrίguez-Núñez A, Rajka T, Zideman D. Lebensrettende Maßnahmen bei Kindern („paediatric life support“). Notf Rett Med 2010. [DOI: 10.1007/s10049-010-1372-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Kleinman ME, Chameides L, Schexnayder SM, Samson RA, Hazinski MF, Atkins DL, Berg MD, de Caen AR, Fink EL, Freid EB, Hickey RW, Marino BS, Nadkarni VM, Proctor LT, Qureshi FA, Sartorelli K, Topjian A, van der Jagt EW, Zaritsky AL. Part 14: Pediatric Advanced Life Support. Circulation 2010; 122:S876-908. [DOI: 10.1161/circulationaha.110.971101] [Citation(s) in RCA: 473] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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17
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Kleinman ME, de Caen AR, Chameides L, Atkins DL, Berg RA, Berg MD, Bhanji F, Biarent D, Bingham R, Coovadia AH, Hazinski MF, Hickey RW, Nadkarni VM, Reis AG, Rodriguez-Nunez A, Tibballs J, Zaritsky AL, Zideman D. Pediatric basic and advanced life support: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Pediatrics 2010; 126:e1261-318. [PMID: 20956433 PMCID: PMC3784274 DOI: 10.1542/peds.2010-2972a] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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18
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Kleinman ME, de Caen AR, Chameides L, Atkins DL, Berg RA, Berg MD, Bhanji F, Biarent D, Bingham R, Coovadia AH, Hazinski MF, Hickey RW, Nadkarni VM, Reis AG, Rodriguez-Nunez A, Tibballs J, Zaritsky AL, Zideman D. Part 10: Pediatric basic and advanced life support: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation 2010; 122:S466-515. [PMID: 20956258 PMCID: PMC3748977 DOI: 10.1161/circulationaha.110.971093] [Citation(s) in RCA: 143] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Note From the Writing Group: Throughout this article, the reader will notice combinations of superscripted letters and numbers (eg, “Family Presence During ResuscitationPeds-003”). These callouts are hyperlinked to evidence-based worksheets, which were used in the development of this article. An appendix of worksheets, applicable to this article, is located at the end of the text. The worksheets are available in PDF format and are open access.
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Comparison of the outer diameter of the ‘best-fit’ endotracheal tube with MRI-measured airway diameter at the cricoid level. Eur J Anaesthesiol 2009; 26:736-9. [DOI: 10.1097/eja.0b013e32832aaccd] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
Differences in the anatomy and physiology of the young child necessitate specialist equipment and anesthetic equipment is constantly evolving. We will review the factors influencing the design of pediatric tubes and highlight those areas of special interest. There have been pleas for more standardization of tube markings, as this would help with positioning of tubes, especially in small babies, and there are recent advances in this area. Anesthetists need to be aware that there are important differences between tubes so that they take this into account when choosing an appropriate tube. In addition, developments in the design of cuffed tubes are increasingly being used both for routine care and specialist surgery.
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Affiliation(s)
- Lisa Leong
- Department of Anaesthetics, Great Ormond Street Hospital for Children NHS Trust, London, UK.
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Abstract
Current endotracheal and tracheostomy tubes have high volume low pressure cuffs. These cuffs are ineffective at preventing the ongoing pulmonary aspiration of oropharyngeal and gastric contents. This ubiquitous complication of intubation is the most important cause of ventilator-associated pneumonia (VAP), the commonest and most devastating nosocomial infection in the Intensive Care Unit (ICU). Current tracheal tubes are made of relatively fixed curved PVC, and this produces forces on the airway tissues which is associated with laryngeal and tracheal injury. There is a need for the development of tracheal tube technologies to prevent aspiration injury and the reduce airway injury associated with mechanical ventilation of the critically ill. Given the costs associated with VAP there is currently a massive mismatch in what we spend on prevention.
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Affiliation(s)
- Sarah Yarham
- Specialist Registrar in Anaesthesia, Queen Elizabeth Hospital, Gayton Road, Kings Lynn, PE30 4ET, 01553 613457, UK
| | - Peter Young
- Consultant, Critical Care Unit, Queen Elizabeth Hospital, Gayton Road, Kings Lynn, PE30 4ET, 01553 613457, UK,
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Advances in Translaryngeal Tube Technology. Intensive Care Med 2007. [DOI: 10.1007/978-0-387-49518-7_30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Weiss M, Nicolai T. Einsatz von gecufften Endotrachealtuben bei Kindern in der Notfall- und Rettungsmedizin. Notf Rett Med 2006. [DOI: 10.1007/s10049-006-0805-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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