Articles: intubation.
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Critical care medicine · Aug 2011
Review Meta AnalysisSubglottic secretion drainage for the prevention of ventilator-associated pneumonia: a systematic review and meta-analysis.
Aspiration of secretions containing bacterial pathogens into the lower respiratory tract is the main cause of ventilator-associated pneumonia. Endotracheal tubes with subglottic secretion drainage can potentially reduce this and, therefore, the incidence of ventilator-associated pneumonia. New evidence on subglottic secretion drainage as a preventive measure for ventilator-associated pneumonia has been recently published and to consider the evidence in totality, we conducted an updated systematic review and meta-analysis. ⋯ In those at risk for ventilator-associated pneumonia, the use of endotracheal tubes with subglottic secretion drainage is effective for the prevention of ventilator-associated pneumonia and may be associated with reduced duration of mechanical ventilation and intensive care unit length of stay.
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Review Meta Analysis
[Endotracheal tubes in pediatric patients. Published formulas to estimate the optimal size].
Estimating the endotracheal tube size with the optimal internal diameter (ID) is of outstanding importance for airway management in pediatric patients. For many years different weight, height, and/or age-based formulas have been published. The aim of the present study was to identify and to compare published formulas to estimate optimal tube size in pediatric patients. ⋯ The identified formulas were comparatively simple to apply but were validated only for pediatric patients older than 1 year. Using tubes with a cuff can minimize the problem of optimal tube size. If a tube without a cuff is intended to be used other sizes should also be available.
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Int J Colorectal Dis · Apr 2011
Review Meta AnalysisThe role of nasogastric tube in decompression after elective colon and rectum surgery: a meta-analysis.
Nasogastric tubes (NGT) have been routinely used after abdominal procedures, largely due to the accepted tradition, especially in China. However, studies recently questioned the role of routine NGT intubation by stating that it was overused and many complications occurred from its use. ⋯ In conclusion, routine NGT decompression did no good to the time to return gastrointestinal function, but increased the morbidity of pharyngolaryngitis and respiratory infection significantly. Routine NGT was not recommended for patients after elective colon and rectum surgery.
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Cochrane Db Syst Rev · Jan 2011
Review Meta AnalysisTracheal suctioning without disconnection in intubated ventilated neonates.
Assisted mechanical ventilation is a necessity in the neonatal population for a variety of respiratory and surgical conditions. However, there are a number of potential hazards associated with this life saving intervention. New suctioning techniques have been introduced into clinical practice which aim to prevent or reduce these untoward effects. ⋯ There is some evidence to suggest suctioning without disconnection from the ventilator improves the short term outcomes; however the evidence is not strong enough to recommend this practice as the only method of endotracheal suctioning. Future research utilising larger trials needs to address the implications of the different techniques on ventilator associated pneumonia, pulmonary morbidities and neurodevelopment. Infants less than 28 weeks also need to be included in the trials.
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Review Meta Analysis
Sugammadex for reversal of neuromuscular block after rapid sequence intubation: a systematic review and economic assessment.
Sugammadex 16 mg kg⁻¹ can be used for the immediate reversal of neuromuscular block 3 min after administration of rocuronium and could be used in place of succinylcholine for emergency intubation. We have systematically reviewed the efficacy and cost-effectiveness and made an economic assessment of sugammadex for immediate reversal. The economic assessment investigated whether sugammadex appears cost-effective under various assumptions about the value of any reduction in recovery time with sugammadex, the likelihood of a 'can't intubate, can't ventilate' (CICV) event, the age of the patient, and the length of the procedure. ⋯ Because of the lack of evidence, the value of some parameters remains unknown, which makes it difficult to provide a definitive assessment of the cost-effectiveness of sugammadex in practice. The use of sugammadex in combination with high-dose rocuronium is efficacious. Further research is needed to clarify key parameters in the analysis and to allow a fuller economic assessment.