Articles: intubation.
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The main cause for the rise in cuff-pressure during anesthesia is the diffusion of nitrous oxide into the tube cuff. Gas-diffusion induced pressure changes in low pressure-high volume cuffs are registered continuously. Exposure of an air-filled cuff into an anaesthetic gas atmosphere in vitro shows, that there is an increase in cuff-pressure up to 150 mm Hg within 8 hours. ⋯ In intubated patients cuff-pressure increases even more. During anesthesia lasting 4--5 hours we recorded pressures up to 150 mm Hg, too. To prevent these high pressures we recommend the reducing of cuff-volume within defined times of anesthesia or, alternatively, the use of the anesthetic gas mixture as cuff inflating gas.
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Endotracheal intubation in emergency situations is a recognized function of respiratory therapists, as defined by the American Association for Respiratory Therapy in 1973. A training program based in the operating room, using one-on-one instruction, was the basis for a training program designed to meet JCAH standards for endotracheal intubation. To evaluate the success of our training and our system for attempting intubations, we recorded the results of 50 consecutive intubation attempts by our therapists. ⋯ While 39 patients were intubated within one minute, 11 required more than one minute. In five patients, physicians had attempted intubation prior to a therapist's arrival; those intubations took eleven times longer than those that were attempted by therapists only. The average time for intubations attempted solely by therapists was 54 seconds.
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We designed and implemented a program to train respiratory therapy personnel to perform emergency endotracheal intubation in a community hospital. During a one-year study period, 143 emergency intubations were attempted by physicians, nurse anesthetists, and respiratory therapy personnel. ⋯ Physicians and nurse anesthetists attempted 69 intubations, with 39 complications, for a complication rate of 57%. We conclude that trained respiratory care personnel can safely and effectively secure an airway via endotracheal intubation under emergency circumstances in our institution.