Articles: intubation.
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Plast. Reconstr. Surg. · Mar 1991
Letter Biography Historical ArticleAn historical note on endotracheal intubation.
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Comment Letter Comparative Study
Use of the laryngeal mask airway in primary care.
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Anesthesia and analgesia · Feb 1991
Comment Letter Case ReportsReuse of a disposable stylet with life-threatening complications.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Sinusitis in long-term intubated, intensive care patients: nasal versus oral intubation].
Discussion of paranasal sinusitis as a nosocomial infection in the mechanically ventilated intensive care (ICU) patient has recently been intensified. Some authors have emphasized nasotracheal intubation as a possible pathogenetic pathway. The aim of this study was to investigate the impact of nasotracheal or orotracheal intubation on the development of sinusitis in ICU patients. ⋯ We found that patients intubated orotracheally developed significantly less sinusitis than those intubated nasotracheally. Edema, local infection of the nasal mucosa, or mechanical obstruction of sinus drainage pathways by the tube are possible explanations. The fact that 63% of orally intubated patients had a pathologic maxillary sinus finding as well suggests that in addition to other reasons, an increased central venous pressure, positive pressure ventilation, and the supine position must be regarded as predisposing factors that increase the incidence of sinusitis. We conclude that the conditions of critically ill patients predispose to the development of sinusitis. Nasotracheal intubation is to be regarded as an additional risk, and therefore oral intubation should be preferred.
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We sought to determine the percent delivery by metered-dose inhaler (MDI) of a preparation of salbutamol (albuterol) to the distal end of either pediatric-size tracheal tubes or a narrow-gauge catheter. A bench model consisting of a swivel actuator; 3.0-6.0-mm ID tracheal tubes all 16 cm in length or a 19-G (standard wire gauge) catheter; mesh filters; and a continuous flow of dry air was used. Six actuations of salbutamol (100 micrograms each) were delivered during each experiment, and each experiment was repeated nine times. ⋯ The DE of salbutamol in tracheal tubes (less than or equal to 12.3%) increased dramatically (97%; P less than 0.001) when a 19-G catheter was used. We conclude that the DE of salbutamol by MDI through 3.0-6.0-mm ID tracheal tubes is low but may be dramatically increased by actuating the canister into a 19-G distally placed catheter. Because of the increased efficiency of delivery, caution must be exercised when using a distally placed catheter to deliver MDI aerosols to patients.