Articles: intubation.
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Critical care medicine · Mar 1988
Endotracheal tube occlusion associated with the use of heat and moisture exchangers in the intensive care unit.
A heat moisture exchanger (HME) with bacterial filtering capabilities was evaluated over an 8-month period in a total of 170 ICU patients. During this time there were 15 endotracheal tube (ETT) occlusions in 15 patients. Over the ensuing 4 months, cascade humidification was used for 81 patients and only one ETT occlusion occurred (p less than .01). ⋯ Most patients with ETT occlusion required minute volumes greater than 10 L and F10(2) greater than 0.4. We conclude that HMEs do not provide sufficient airway humidification for generalized ICU use. Their role outside of the operating room remains to be determined.
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Randomized Controlled Trial Clinical Trial
[Suppression of blood pressure increases during intubation: lidocaine or fentanyl?].
The hypertensive response to anesthetic induction with endotracheal intubation may be harmful in patients with cardiovascular disease, increased intracranial pressure, or anomalies of the cerebral vessels. Recommendations for attenuating the reflex hypertension and tachycardia elicited by upper airway irritation are therefore manifold. Besides minimizing the cardiovascular response, anesthesia induction for patients at risk must also satisfy the following requirements: it must be applicable regardless of patient collaboration, prevent impairment of cerebral blood flow, and avoid arousal of the patient; it should neither be time-consuming nor affect the duration or modality of the ensuing anesthesia. ⋯ The two equally simple induction procedures were compared to anesthesia induction with thiopental alone. In both patient groups no significant effect of lidocaine on the pressure response could be observed. Fentanyl lowered the pressure response slightly though significantly in brain-tumor patients only (p less than 0.05), but showed a significant pressure-lowering action persisting over the whole observation period in all patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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Comparative Study
An additional tactile test. Further developments in tactile tests to confirm laryngeal placement of tracheal tubes.
An additional clinical test to confirm laryngeal placement of tracheal tubes is described. Using the new test, placement was confirmed in all of 50 patients studied in whom difficulty would have been anticipated using previously described tactile tests (male patients with lower molar teeth). Two anaesthetists with small hands averaged 98% confirmations in two series each of 100 consecutive unselected intubations. ⋯ The three tactile tests are reviewed and analysed. In the authors' combined experience of 14 cases of difficult laryngoscopy the tests gave reliable confirmation in 12 patients. Familiarity with these tests is stressed to be important for their reliable implementation.