Articles: intubation.
-
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.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Effect of verapamil on the cardiovascular responses to tracheal intubation.
We have studied the efficacy of verapamil in attenuating the cardiovascular responses to tracheal intubation in three groups of ASA grade I patients given verapamil 0.05 mg kg-1 or 0.1 mg kg-1 or saline 45 s before the start of laryngoscopy. Anaesthesia was induced with thiopentone 5 mg kg-1 i.v. and tracheal intubation was facilitated with vecuronium 0.2 mg kg-1. ⋯ In patients who received saline, there was a significant increase in mean arterial pressure and rate-pressure product associated with tracheal intubation. The increases were significantly less in verapamil-treated patients compared with those in the control group, although verapamil failed to prevent tachycardia caused by laryngoscopy and intubation.
-
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.
-
Acta Anaesthesiol Belg · Jan 1992
Randomized Controlled Trial Comparative Study Clinical TrialIntraocular pressure changes in response to endotracheal intubation facilitated by atracurium or succinylcholine with or without lidocaine.
Changes in intraocular pressure (IOP) and hemodynamics (SP, DP and HR) were measured in 105 patients ASA I and II randomly assigned into seven equal and comparable groups (A to G) during induction of anesthesia and endotracheal intubation facilitated either by succinylcholine or atracurium with or without lidocaine. IOP decreased significantly (p less than 0.01) after induction of anesthesia with thiopentone in all the groups. While atracurium with or without lidocaine did not affect IOP following complete suppression of train-of-four (groups A, B, and C), succinylcholine per se or in combination with lidocaine (groups F and G) significantly (p less than 0.01) increased IOP after induction with thiopentone but not exceeding the baseline IOP level. ⋯ However, atracurium when used in a rapid sequence intubation could not produce similar intubation conditions when compared with succinylcholine. Consequently, we cannot endorse atracurium as an alternative to succinylcholine for patients with penetrated eye injuries and full stomach requiring rapid sequence intubations. In this context, the role of IV lidocaine in mitigating or preventing the systemic and ocular reactions and especially the acute increase in IOP associated with endotracheal intubation should be emphasized.
-
Intensive care medicine · Jan 1992
Comparative StudyContinuous positive airway pressure by face mask or mechanical ventilation in patients with human immunodeficiency virus infection and severe Pneumocystis carinii pneumonia.
We reviewed the records of 44 patients with AIDS who had 45 episodes of severe Pneumocystis carinii pneumonia (PCP). While 9 patients required intubation and mechanical ventilation (MV) on admission, continuous positive airway pressure (CPAP) by face mask was the initial measure in 36 episodes. There were 25 patients managed with CPAP alone, 23 of whom survived. ⋯ The in-hospital mortality for severe PCP in this study was 33% overall, and reached 65% for mechanically ventilated patients. The 1-year survival was 43% (95% confidence interval, 28%-58%). These data confirm the improved prognosis for patients with AIDS and severe PCP, and suggest that mask CPAP may be an adequate mean of ventilatory support in this setting.