Articles: intubation.
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Although intubation of emergency patients in the field is a routine measure, endotracheal tube misplacement remains a serious problem. Using radiologic criteria, the frequency of undetected endobronchial intubation by physicians was determined retrospectively in 100 (78 traumatized) field-intubated adult patients (72 men and 28 women; age, 18 to 90 years; mean age, 39.1 years) consecutively admitted to the University Hospital of Tuebingen, Tuebingen, Federal Republic of Germany, between January 1987 and February 1988. Position of tube tip relative to carina was evaluated on anteroposterior chest radiographs made on admission. ⋯ While unilateral intubation is not immediately catastrophic, the resulting systemic hypoxemia and hypercapnia are aggravated by potential accompanying injury (eg, lung contusion, hematothorax, pneumothorax, shock, or cerebrocranial trauma), which can lead to secondary damage (eg, acute respiratory insufficiency, ischemic brain damage). Evaluation of the depth of tube insertion with the aid of common clinical techniques is particularly unreliable in the case of thoracic trauma, aspiration, or previously existing pulmonary disease. Suggested measures for prevention of endobronchial intubation are improved and intensified training of emergency staff to increase awareness of and prevent the catastrophic effects of endobronchial malposition of the tube tip, tube shortening before intubation, assessment of insertion depth by checking length scale on the tube, and avoidance of patient head and neck movement.
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Asymptomatic bacteraemia following balloon dilatation was assessed in 20 adults with oesophageal stricture. Asymptomatic bacteraemia occurred in 12 of 19 patients. The source of the bacteraemia appeared to be the patients' oropharyngeal flora. The bacteraemia was not of clinical importance in our patients, but might lead to endocarditis in predisposed individuals.
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The respiratory flow velocity of 74 infants under halothane-nitrous oxide-oxygen anesthesia was measured, and the statistical relationship between the age in months and the flow velocity was obtained with least square method. The flow resistance of endotracheal tubes (size of 2.5, 3.0, 3.5, 4.0, 4.5 and 5.0 mmI. ⋯ The mean flow resistance and respiratory work with each size of endotracheal tube were calculated by simulation technique using these data. These data coincided well with the data obtained by calculation based on in vitro experiments.
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Critical care medicine · Jul 1989
Comparative StudyAdditional work of breathing imposed by endotracheal tubes, breathing circuits, and intensive care ventilators.
A disadvantage of spontaneous breathing through an endotracheal tube (ETT) and connector attached to a breathing circuit and/or ventilator (breathing device) is an increase in the work of breathing. The work of breathing associated with ETT of 6 to 9-mm diameter and eight breathing devices was determined, using a lung simulator to mimic spontaneous inspiration at flow rates of 20 to 100 L/min and a tidal volume of 500 ml, at both zero end-expiratory pressure (ZEEP) and 10 cm H2O continuous positive airway pressure (CPAP). Work associated with the breathing devices alone (WCIR) ranged from -0.002 kg.m/L (Servo 900-C ventilator, 7-mm ETT, 20 L/min, ZEEP) to 0.1 kg.m/L (continuous flow circuit, 7-mm ETT, 100 L/min, CPAP), the latter representing 196% of the work of normal breathing. ⋯ This additional work imposed by the ETT varied considerably among devices. Spontaneous breathing through modern ventilators, circuits and ETT imposes a burden of increased work, most of which is associated with the presence of the ETT and connector. Whether this burden represents an impediment to the weaning patient, or has training value for the ultimate resumption of unassisted spontaneous ventilation, remains to be determined.