Articles: intubation.
-
This study determined which variables affected endotracheal tube "leak" pressures in 80 surgical patients, two weeks to 11 years of age, intubated with uncuffed tracheal tubes. We defined "leak" pressure as the inspiratory pressure needed to cause an audible escape of gas around the endotracheal tube. "Leak" pressure was measured after varying either head position, tracheal tube depth within the trachea, fresh gas flow rate, or degree of neuromuscular block. "Leak" pressure increased progressively from 16.9 +/- 1.3 cmH2O with complete patient paralysis to 30.6 +/- 1.4 cmH2O following 100 per cent recovery of neuromuscular function. ⋯ Thus, there may be marked variability in "leak" pressure, depending on head position and degree of neuromuscular blockade. Keeping the patient fully paralyzed with the head in a neutral position provides a reliable and consistent method for measuring "leak" pressures.
-
On the fifth postoperative day after pulmonary lobectomy, a 64-year-old man accidentally connected his nasal catheter (providing six liters of oxygen per minute) to his nasogastric tube. Tension pneumoperitoneum occurred with acute respiratory distress. ⋯ Our case illustrates another unusual cause of tension pneumoperitoneum. Emergency percutaneous decompression was effected with needle aspiration, followed by laparotomy for gastric repair covered by an omental flap.
-
Comparative Study
Comparison of the esophageal obturator airway and endotracheal intubation in prehospital ventilation during CPR.
The esophageal obturator airway (EOA), esophagogastric tubular airway (EGT) and endotracheal (ET) intubation are compared as they relate to blood gases during CPR. Although statistically better levels of gases are obtained with the endotracheal tube in patients who had an EOA inserted previously, no difference in survival is noted in a separate prospective and retrospective series of patients in whom the devices were used in the field. ⋯ It would appear that patients with a PO2 of less than 60 mm Hg do not tend to survive. The endotracheal tube remains the gold standard, although its universal use is impractical, while the EOA would appear to be an effective alternative and an important airway adjunct in the prehospital phase of CPR.
-
Comparative Study
Intracuff pressures in endotracheal and tracheostomy tubes. Related cuff physical characteristics.
This study compared intracuff pressure (ICP) during mechanical ventilation in a variety of currently used endotracheal (ET) and tracheostomy (trach) tube cuffs and related cuff physical characteristics. Tracheostomy tube physical characteristics were also measured. Variation was observed to exist between "just-seal" inspiratory and end-expiratory intracuff pressure during mechanical ventilation. ⋯ Thin, large-diameter, compliant cuffs generally "just seal" with relatively low ICPs. We recommend use of tracheal airways (endotracheal and tracheostomy) fitted with cuffs that seal in patients with low intracuff pressures. We also recommend nonrigid (soft) thermolabile tracheostomy tubes.