Articles: intubation.
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Critical care medicine · Dec 1990
Randomized Controlled Trial Clinical TrialIncidence of colonization, nosocomial pneumonia, and mortality in critically ill patients using a Trach Care closed-suction system versus an open-suction system: prospective, randomized study.
Eighty-four intubated, mechanically ventilated patients were prospectively evaluated for incidences of colonization and nosocomial pneumonias dependent on whether they received endotracheal suctioning by an "open" suction method vs. "closed" suction (Trach Care Closed Suction System) method. Results show that closed suctioning is associated with a significant (67% vs. 39% p less than .02) increase in colonization compared with open suctioning. ⋯ Survival analysis demonstrated that the probability of survival without developing nosocomial pneumonia was greater among closed-suctioning patients vs. open-suctioned patients (p less than .03). This study shows that suctioning performed via the Trach Care closed-suction system increases the incidence of colonization but not the incidence of nosocomial pneumonia, and may actually decrease mortality when compared with open-suction systems.
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Eight patients with a history of failed tracheal intubation during pregnancy were investigated by x-ray laryngoscopy after delivery. Partial elevation of the epiglottis with no view of glottic structures was found in five patients who were therefore considered to still present difficulty. ⋯ Relatively few abnormal anatomical indices were seen in these patients and this was in keeping with the level of difficulty encountered. An angular measure of jaw protrusion from a line joining the upper incisors and a point just above and anterior to the vocal cords, to the mid-point on the inner surface of the mandible was useful: the lower angle of this triangle was as important as the angle at the incisors.
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Anasth Intensivther Notfallmed · Dec 1990
[A modified Macintosh blade with an angulated tip for difficult intubations].
The depth of the proximal part of a normal Macintosh blade was carved more shallow and the tip of the blade was made adjustable in its angle by means of a joint controlled by a screw-lock fixation via a small wire parallel to the blade. Clinical experience with this modified blade in 33 patients is reported. In 10 of 13 patients with severely reduced mouth opening less than or equal to 25 mm and 19 of 20 patients with a mouth opening greater than 25 mm, visibility during laryngoscopy with the modified blade was improved, compared to the normal Macintosh blade. The carved proximal part of the blade improves its maneuverability in a small mouth avoiding undue pressure on the incisors, the adjustable tip increases the blade's pressure on the base of the tongue lifting the epiglottis.
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We have studied eight patients with a history of difficult tracheal intubation, using x-ray laryngoscopy and local anaesthesia, a curved Macintosh blade and a standard intubating position. The view obtained was better than recorded previously during general anaesthesia in two patients, and in a third the x-ray showed that positioning the blade tip beneath the epiglottis would have improved vision, suggesting that reproducibility of the assessment may not be consistent. The "ease of intubation" and "complementary" angles may be helpful in the assessment of such patients. ⋯ In the absence of muscle paralysis, removal of the blade caused immediate correction. However, during anaesthesia with neuromuscular block it is suggested that this not only occurs more readily but, may not correct when the blade is removed. Iatrogenic airway obstruction during moderately difficult tracheal intubation may be common and should be anticipated.