Articles: intubation.
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Multicenter Study Comparative Study
Bedside assessment of enteral tube placement: aligning practice with evidence.
Since the flexible Levin tube was introduced in 1921, enteral feeding has become ubiquitous. From the out-set, nurses have been responsible for confirming the correct placement of enteral feeding tubes prior to their use for alimentation or medication administration, but current nursing practice doesn't always reflect the best evidence. ⋯ The authors examine the research that's been conducted over the past 25 years and compare the accumulated evidence with current practice, as reflected in a convenience sample of 28 New England hospitals. In addition, they evaluate various methods for assessing enteral feeding tubes and make evidence-based practice recommendations.
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Randomized Controlled Trial Multicenter Study
Effectiveness of cricoid pressure in preventing gastric aspiration during rapid sequence intubation in the emergency department: study protocol for a randomised controlled trial.
Cricoid pressure is considered to be the gold standard means of preventing aspiration of gastric content during Rapid Sequence Intubation (RSI). Its effectiveness has only been demonstrated in cadaveric studies and case reports. No randomised controlled trials comparing the incidence of gastric aspiration following emergent RSI, with or without cricoid pressure, have been performed. If improperly applied, cricoid pressure increases risk to the patient. The clinical significance of aspiration in the emergency department is unknown. This randomised controlled trial aims to; 1. Compare the application of the 'ideal" amount of force (30 - 40 newtons) to standard, unmeasured cricoid pressure and 2. Determine the incidence of clinically defined aspiration syndromes following RSI using a fibrinogen degradation assay previously described. ⋯ The benefits and risks of cricoid pressure application will be scrutinised by comparison of the incidence of aspiration and difficult or failed intubations in each group. The role of cricoid pressure in RSI in the emergency department and the use of a pepsin detection as a predictor of clinical aspiration will be evaluated.
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Anesthesia and analgesia · Jan 2012
Multicenter StudyThe epidemiology of upper airway injury in patients undergoing major surgical procedures.
Airway injury is a potentially serious and costly adverse event of anesthesia care. The epidemiologic characteristics of airway injury have not been well documented. ⋯ The risk of airway injury for patients undergoing major surgical procedures is approximately 1 in 500. Patients with difficult airways as indicated by Mallampati classes III and IV are at significantly increased risk of sustaining airway injury during anesthesia for major surgical procedures.
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Randomized Controlled Trial Multicenter Study
The Flex-Tip™ tracheal tube does not reduce the incidence of postoperative sore throat: a randomized controlled trial.
Sore throat after tracheal intubation is common with an incidence of 30-70%. The Parker Flex-Tip™ endotracheal tube (ETT) is designed to reduce trauma during ETT placement. This randomized single-blinded trial was designed to assess whether using the Flex-Tip ETT would reduce the incidence of postoperative sore throat and/or vocal change. ⋯ In this study involving experienced clinicians, no significant difference was observed in the incidence of postoperative sore throat or vocal change between the Flex-Tip ETT and the standard Mallinckrodt Hi-Lo cuffed ETT. This trial was registered at www.clinicaltrials.gov , NCT01095861.
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Multicenter Study
Out-of-theatre tracheal intubation: prospective multicentre study of clinical practice and adverse events.
Tracheal intubation is commonly performed outside the operating theatre and is associated with higher risk than intubation in theatre. Recent guidelines and publications including the 4th National Audit Project of the Royal College of Anaesthetists have sought to improve the safety of out-of-theatre intubations. ⋯ Out-of-theatre intubation frequently occurs in the absence of essential safety equipment, despite the existing guidelines. The associated adverse event rate is high.