Articles: intubation.
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Intensive care medicine · Jan 1992
Inspiratory work imposed by continuous positive airway pressure (CPAP) machines: the effect of CPAP level and endotracheal tube size.
Inspiratory work imposed by Continuous Positive Airway Pressure (CPAP) machines has been a matter of concern. The imposed inspiratory work of CPAP machine circuits (Wcir) and the effect of the total breathing apparatus with endotracheal tube (ETT) and connector included in the circuit (Wapp), were measured in three continuous flow (CF) and various configurations of three demand flow (DF) CPAP machines. The performance was assessed at 0, 5, 10 and 15 cmH2O CPAP using a Michigan Instruments Test Lung Model 1600, internal compliance set at 50 ml/cmH2O, driven at square wave inspiratory flows (VI) of 20, 40 and 60 l/min at a tidal volume of 500 ml. ⋯ No consistent advantage of CF over DF machines was demonstrated. There was little advantage of high gas flows (greater than 5 l/min) in various DF circuits. Within an individual machine maximum negative pressures generated during inspiration correlated with both Wcir and Wapp.
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Case Reports
Severe localised pulmonary interstitial emphysema--decompression by selective bronchial intubation.
We report three infants (26-28 weeks gestational age) in whom selective bronchial intubation was associated with successful decompression of severe localised pulmonary interstitial emphysema, uniquely in two cases this involved intubation of the left main bronchus. Pulmonary interstitial emphysema did not recur despite maintenance of selective intubation for only 48 hours or less in all three cases.
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The applied anatomy of the cricothyroid and cricotracheal region of the neck and a retrograde method of tracheal intubation using the subcricoid region are described. This approach has several advantages, including absence of bleeding complications, as there are no major blood vessels on the cricotracheal membrane, and reduction in the possible development of subglottic oedema and stenosis.
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This study was undertaken to examine the effects of nicardipine on circulatory responses to laryngoscopy and tracheal intubation in normotensive (n = 39) and hypertensive (n = 36) patients. Laryngoscopy and tracheal intubation were performed after induction of anaesthesia with thiamylal, followed by administration of intravenous saline or nicardipine 20 or 30 micrograms.kg-1 and suxamethonium. Blood pressure and heart rate were recorded, and rate-pressure product was calculated. ⋯ The changes in heart rate after intubation were significantly greater in normotensive patients than in hypertensive patients when 20 or 30 micrograms.kg-1 of nicardipine was given (p less than 0.05 and p less than 0.01 respectively). Rate-pressure product increased significantly (p less than 0.01) after intubation in normotensive patients whether nicardipine was administered or not, but the increase was suppressed completely by nicardipine 20 or 30 micrograms.kg-1 in hypertensive patients. We conclude that nicardipine is effective in preventing the circulatory responses to laryngoscopy and tracheal intubation in hypertensive patients.