Articles: intubation.
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Intensive care medicine · Jan 1992
Randomized Controlled Trial Clinical TrialPrevention of nosocomial pneumonia in intubated patients: respective role of mechanical subglottic secretions drainage and stress ulcer prophylaxis.
Chronic microaspiration through a tracheal cuff is the main culprit in the penetration and colonization of the lower respiratory tract. A total of 145 patients intubated for more than 3 days were randomly assigned to a double nosocomial pneumonia (NP) prevention: 1--Prevention of aspiration by hourly subglottic secretion drainage (SSD) with a specific endotracheal tube (HI-LO Evac tube, Mallinckrodt); 2--Prevention of gastric colonization using either sucralfate or antacids. ⋯ Subglottic secretion drainage treatment was associated with: a) a twice lower incidence of NP (no-SSD: 29.1%, SSD: 13%); b) a prolonged time of onset of NP (no-SSD: 8.3 +/- 5 days, SSD: 16.2 +/- 11 days); c) a decrease in the colonization rate from admission to end-point day in tracheal aspirates (no-SSD: +21.3%, SSD: +6.6%) and in subglottic secretions (no-SSD: +33.4%, SSD: +2.1%). Sucralfate was not associated with a significantly lower incidence of NP (antacids: 23.6%, sucralfate: 17.8%), but with a lower increase in the colonization rate in subglottic and gastric aspirates, from admission to end-point day.
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A jet stylet is a small internal diameter (ID), semirigid hollow catheter that is inserted into an in situ tracheal tube prior to extubation of a patient who may be difficult to reintubate. After the tracheal tube is withdrawn over the jet stylet, the hollow catheter can be used for jet ventilation or as an intratracheal stylet for reintubation with a new tracheal tube. It was previously thought that after the new tracheal tube was inserted over the jet stylet, the stylet would have to be removed to allow connection of the new tube to the breathing circuit and confirmation of intratracheal placement of the tube. We describe a method for preserving the intratracheal location of the jet stylet while confirming intratracheal placement of the new tracheal tube.
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To determine how well Laser-Guard protects polyvinyl chloride (PVC) endotracheal tubes from the carbon dioxide (CO2) laser. ⋯ Laser-Guard protects the shafts of combustible PVC endotracheal tubes from direct, high-power, continuous CO2 laser radiation.
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Randomized Controlled Trial Clinical Trial
Effect of fentanyl on the circulatory responses to orotracheal fibreoptic intubation.
The effectiveness of fentanyl in attenuating the pressor and heart rate response to orotracheal fibreoptic intubation under general anaesthesia was assessed in 60 healthy patients undergoing elective surgery. Patients were randomly assigned to receive either fibreoptic intubation with or without fentanyl 6 micrograms.kg-1 or traditional Macintosh intubation with fentanyl 6 micrograms.kg-1. ⋯ The heart rate response to fibreoptic intubation was also significantly reduced in the patients who received fentanyl, but, in contrast, was still significantly greater than that in the Macintosh-fentanyl group. Fentanyl 6 micrograms.kg-1 appears to have a useful place in attenuating the cardiovascular effects of fibreoptic intubation under general anaesthesia.
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Critical care medicine · Jan 1992
Comparative StudyEsophageal electrodes allow precise assessment of cardiac output by bioimpedance.
To analyze the impact of the position of the thoracic external electrodes on the values of cardiac output measured by electrical bioimpedance and to compare the results obtained by bioimpedance with those values determined by thermodilution in critically ill patients. ⋯ a) The values of cardiac output derived from measurements obtained by bioimpedance using internal electrodes were comparable with those values derived from thermodilution. b) Values of cardiac output from bioimpedance studies with external electrodes were dependent on the position of the xiphoid electrodes.