Articles: intubation.
-
Prehosp Disaster Med · Apr 1992
An analysis of invasive airway management in a suburban emergency medical services system.
Airway management is the most critical and potentially life-saving intervention performed by emergency medical service (EMS) providers. Invasive airway management often is required in non-cardiac-arrest patients who are combative or otherwise uncooperative. The success of prehospital invasive airway management in this patient population was evaluated. ⋯ Prehospital providers can intubate a high but improvable proportion of non-cardiac-arrested patients by both the orotracheal and nasotracheal routes. The use of pharmacologic adjuncts to facilitate the prehospital intubation of selected, non-cardiac-arrested patients is a promising adjunct that needs further evaluation.
-
Anesthesia and analgesia · Apr 1992
Comparative StudyQuantification of the jet function of a jet stylet.
The concept and use of a jet stylet as an additional safety measure during tracheal extubation of patients in whom subsequent ventilation and/or reintubation of the trachea may be difficult has recently been described. If jet ventilation through a jet stylet could provide for effective gas exchange, it would allow additional time to assess the need for reintubation of the trachea. We determined the tidal volumes (measured by integrating a pneumotachograph flow signal) that 50-psi jet ventilation, at an inspiratory to expiratory time ratio of 1:1 (unit of time = 1 s), could deliver through small, medium, and large Sheridan tube exchangers into an in vitro lung model that had lung compliances of 50 and 30 mL/cm H2O (six experimental permutations). ⋯ Decreased lung compliance caused decreased VT and end-expiratory volume for all six experimental conditions. The largest VT and minute ventilation (VE) generated were 1680 mL and 51.6 L/min (large tube exchanger, high lung compliance) and the lowest VT and VE were 440 mL and 13.2 L/min (small tube exchanger, low lung compliance), respectively. These findings validate the term "jet stylet" for all three tube exchangers as even the smallest tube exchanger, coupled with a low lung compliance, can provide a VE consistent with total ventilatory support for most clinical situations.
-
J. Cardiothorac. Vasc. Anesth. · Apr 1992
Comparative StudyBronchial cuff pressures of two tubes used in thoracic surgery.
The pressure/volume characteristics of the bronchial cuff of a polyvinylchloride (PVC) double-lumen endobronchial tube (DLT) was compared with the inflatable cuff of a bronchial blocker. At the volumes needed to seal a series of rigid model bronchi the PVC DLT bronchial cuff consistently generated significantly lower pressures than the bronchial blocker cuff.
-
Critical care medicine · Apr 1992
Site of pressure measurement during spontaneous breathing with continuous positive airway pressure: effect on calculating imposed work of breathing.
To describe the importance of measuring pressure at the tracheal end of the endotracheal tube during spontaneous breathing with continuous positive airway pressure in order to correctly assess: a) the changes in airway pressure and b) the work imposed by the breathing apparatus. ⋯ The results indicate that pressure should be measured as close to the patient's airway as possible, i.e., at the tracheal end of the endotracheal tube, rather than using the traditional approach of measuring pressure and assessing work at the inspiratory or expiratory limbs, or "Y" piece of the breathing tubing.