Articles: intubation.
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J Coll Physicians Surg Pak · Apr 2022
Case ReportsSubglottic Hemangioma: Now You See it, Now You Don't.
Subglottic hemangiomas may be missed on flexible laryngoscopy or even bronchoscopy requiring a contrast-enhanced computed tomography scan to clinch the diagnosis. We report an otherwise healthy three-month baby girl presenting with recurrent upper airway obstruction with a history of multiple admissions requiring intubation and artificial ventilation. An initial contrast-enhanced computed tomography scan was performed when the child was intubated, which showed no airway anomalies. ⋯ Following the surgical intervention, the child had persistent stridor and a repeat contrast-enhanced computed tomography scan clinched a diagnosis of a localised subglottic hemangioma at the age of 7 months. In the presence of an endotracheal tube, airway hemangiomas may be missed on bronchoscopy and contrast-enhanced computed tomography scan. Key Word: Subglottic stenosis, Congenital, Hemangiomas, Computed tomography.
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Anesthesia and analgesia · Apr 2022
Meta AnalysisAirway Ultrasound as Predictor of Difficult Direct Laryngoscopy: A Systematic Review and Meta-analysis.
Despite several clinical index tests that are currently applied for airway assessment, unpredicted difficult laryngoscopy may still represent a serious problem in anesthesia practice. The aim of this systematic review and meta-analysis was to evaluate whether preoperative airway ultrasound can predict difficult direct laryngoscopy in adult patients undergoing elective surgery under general anesthesia. ⋯ Our study demonstrates that airway ultrasound index tests are significantly different between patients with easy versus difficult direct laryngoscopy, and the DSE is the most studied index test in literature to predict difficult direct laryngoscopy. However, it is not currently possible to reach a definitive conclusion. Further studies are needed with better standardization of ultrasound assessment to limit all possible sources of heterogeneity.
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Review Meta Analysis
Effect of Prone Positioning on Clinical Outcomes of Non-Intubated Subjects with COVID-19: A Comparative Systematic Review and Meta-Analysis.
Awake prone positioning (APP) has been recently proposed as an adjunctive treatment for non-intubated coronavirus disease 2019 (COVID-19) patients requiring oxygen therapy to improve oxygenation and reduce the risk of intubation. However, the magnitude of the effect of APP on clinical outcomes in these patients remains uncertain. We performed a comparative systematic review and meta-analysis to evaluate the effectiveness of APP to improve the clinical outcomes in non-intubated subjects with COVID-19. ⋯ APP has the potential to reduce the in-hospital mortality rate in COVID-19 subjects with hypoxemia without a significant effect on the need for intubation or length of hospital stay. However, there was a significant decrease in the need for intubation on subgroup analysis of RCTs. More large-scale trials with a standardized protocol for prone positioning are needed to better evaluate its effectiveness in this select population.
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Curr Opin Anaesthesiol · Apr 2022
ReviewChallenges and outcomes in airway management outside the operating room.
Airway management outside the operating room poses unique challenges that every clinician should recognize. These include anatomic, physiologic, and logistic challenges, each of which can contribute to complications and lead to poor outcomes. Recognizing these challenges and highlighting known outcome data may better prepare the team, making this otherwise daunting procedure safer and potentially improving patient outcomes. ⋯ Emergency airway management outside the operating room remains a high-risk procedure, associated with poor outcomes. Pre-intubation hemodynamic optimization may mitigate some of the risks, and future research should focus on identification of best strategies for hemodynamic optimization prior to and during this procedure.
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Curr Opin Anaesthesiol · Apr 2022
ReviewExtubation of the potentially difficult airway in the intensive care unit.
Extubation in the intensive care unit (ICU) is associated with a failure rate requiring reintubation in 10-20% patients further associated with significant morbidity and mortality. This review serves to highlight recent advancements and guidance on approaching extubation for patients at risk for difficult or failed extubation (DFE). ⋯ Extubation in the ICU remains an elective decision and patients found to be at risk should be further optimized and planning undertaken prior to proceeding. Extubation for the at-risk patient should be operationalized utilizing easily reproducible strategies, with airway experts present to guide decision making and assist in reintubation if needed.