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BACKGROUND: The present study aims to determine the impact of different cuff diameters on the cuff pressure of endotracheal tubes (ETTs) when the trachea is adequately sealed. METHODS: In the present single-center clinical trial, adult patients who underwent cardiothoracic surgery were assigned to use ETTs from 2 brands (GME and GZW). The primary endpoint comprised of the following: cuff diameter, inner diameter of the ETT, manufacturer, and the number of subjects with tracheal leakage when the cuff pressure was 30 cm H2O. RESULTS: A total of 298 patients were assigned into 2 groups, based on the 2 distinct brands of ETTs: experimental group (nâ =â 122, GME brand) and control group (nâ =â 176, GZW brand). There were no significant differences in baseline characteristics. However, the cuff diameter was significantly smaller in the control group, when compared to the experimental group (Pâ =â .001), and the incidence of tracheal leakage was significantly higher in the control group (Pâ =â .001). Furthermore, the GME brand ETT had a significantly larger cuff diameter, when compared to the GZW brand ETT. CONCLUSION: The cuff size would mismatch the tracheal area in clinical practice. Therefore, chest computed tomography is recommended to routinely evaluate the tracheal cross-sectional area during anesthesia, in order to ensure the appropriate cuff size selection.
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Estado Terminal , Intubação Intratraqueal , Humanos , Intubação Intratraqueal/métodos , Intubação Intratraqueal/instrumentação , Intubação Intratraqueal/efeitos adversos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Traqueia , Desenho de Equipamento , AdultoRESUMO
AIM: The commonly recommended endotracheal tube cuff pressure is 20-30 cmH2O. However, some patients require a cuff pressure of >30 cmH2O to prevent air leakage. The study aims to determine the risk factors that contribute to the endotracheal tube cuff pressure of >30 cmH2O to prevent air leakage. DESIGN: A multi-centre prospective observational study. METHODS: Eligible patients undergoing mechanical ventilation in the intensive care unit of three hospitals between March 2020 and July 2022 were included. The endotracheal tube cuff pressure to prevent air leakage was determined using the minimal occlusive volume technique. The patient demographics and clinical information were collected. RESULTS: A total of 284 patients were included. Among these patients, 55 (19.37%) patients required a cuff pressure of >30 cmH2O to prevent air leakage. The multivariate logistic regression results revealed that the surgical operation (odds ratio [OR]: 8.485, 95% confidence interval [CI]: 1.066-67.525, p = 0.043) was inversely associated with the endotracheal tube cuff pressure of >30 cmH2O, while the oral intubation route (OR: 0.127, 95% CI: 0.022-0.750, p = 0.023) and cuff inner diameter minus tracheal area (OR: 0.949, 95% CI: 0.933-0.966, p < 0.001) were negatively associated with the endotracheal tube cuff pressure of >30 cmH2O. Therefore, a significant number of patients require an endotracheal tube cuff pressure of ï¼30 cmH2O to prevent air leakage. Several factors, including the surgical operation, intubation route, and difference between the cuff inner diameter and tracheal area at the T3 vertebra, should be considered when determining the appropriate cuff pressure during mechanical ventilation.
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Intubação Intratraqueal , Respiração Artificial , Humanos , Estudos Prospectivos , Masculino , Feminino , Respiração Artificial/efeitos adversos , Respiração Artificial/instrumentação , Intubação Intratraqueal/efeitos adversos , Intubação Intratraqueal/instrumentação , Pessoa de Meia-Idade , Fatores de Risco , Idoso , Pressão/efeitos adversos , Unidades de Terapia IntensivaRESUMO
Objectives: The cuff pressures > 30 cmH2O may create a seal in the trachea. The objective of this study was to identify risk factors associated with lack of tracheal sealing by an endotracheal cuff inflated to > 30 cmH2O in patients undergoing mechanical ventilation. Methods: This prospective cross-sectional study was conducted from 2019 to 2020 in the cardiothoracic intensive care unit and respiratory medical care unit of a Hospital in Nantong, China. Patients aged >16 years undergoing cardiothoracic surgery with mechanical ventilation using endotracheal intubation were included. Patient characteristics and ventilator parameters were analyzed. Cuff pressure was maintained with the minimum leak technique (MLT) and measured with a cuff pressure gauge. Cuff pressure was measured for 30 seconds when ventilation was accompanied by no leak, simultaneously detected by the ventilator or auscultation with a stethoscope. Result: Of 352 patients undergoing mechanical ventilation, 51 patients (14.5%) had a cuff pressure of >30 cmH2O. Multivariable analysis showed that cuff manufacturer (Guangzhou Weili) and nasal endotracheal intubation significantly increased the risk of an unsealed trachea. Peak inspiratory pressure, cuff diameter and male sex had a strong inverse association with an unsealed trachea. Conclusions: These findings suggest that an endotracheal cuff pressure of 20 to 30 cmH2O is adequate for most patients, but lack of a tracheal seal still occurs in a small number of people. An unsealed trachea is most likely because cuff and tracheal diameters do not match. Clinical Trial Registration: http://www.chictr.org.cn/index.aspx Unique identifier: ChiCTR-COC-15006459.
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We herein report a case in which the trachea could be completely sealed only when the cuff pressure reached 100 cmH2O. An excessive cross-sectional area of the trachea is a rare phenomenon, but we believe that our case will be helpful for clinicians who encounter similar situations.
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In this letter, we describe a method about disposable medical hydrogel recommended inside surgical masks to reduce the water vapor in the goggles. The introduction is as follows.Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 . Letter to the Editor.
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Rinoplastia , Vapor , Dispositivos de Proteção dos Olhos , Humanos , HidrogéisRESUMO
In this report, the development of physical vapor transport (PVT) methods for bulk aluminum nitride (AlN) crystal growth is reviewed. Three modified PVT methods with different features including selected growth at a conical zone, freestanding growth on a perforated sheet, and nucleation control with an inverse temperature gradient are discussed and compared in terms of the size and quality of the bulk AlN crystals they can produce as well as the process complexity. The PVT method with an inverse temperature gradient is able to significantly reduce the nucleation rate and realize the dominant growth of only one bulk AlN single crystal, and thus grow centimeter-sized bulk AlN single crystals. X-ray rocking curve (XRC) and Raman spectroscopy measurements showed a high crystalline quality of the prepared AlN crystals. The inverse temperature gradient provides an efficient and relatively low-cost method for the preparation of large-sized and high-quality AlN seed crystals used for seeded growth, devoted to the diameter enlargement and quality improvement of bulk AlN single crystals.
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Cristalização/métodos , Gases/química , Compostos de Alumínio/química , Tamanho da Partícula , Análise Espectral Raman , TemperaturaRESUMO
The aim of the study is to evaluate the safety and efficacy of simultaneous endoscopic submucosal dissection (ESD) for multiple early gastric cancers.A total of 70 solitary early gastric cancers from 70 patients and 20 multiple early gastric cancers from 10 patients were included in this retrospective study. The curative resection rate, en bloc resection rate, procedure-related complications, and local recurrence were compared between the 2 groups.There was no statistical difference in the rate of complete resection, en bloc resection, and curative resection between the 2 groups (Pâ>â.05). No significant difference was found with respect to the occurrence of postoperative bleeding (Pâ>â.05). Procedure time was significantly longer in the simultaneous group than that in the single group (87.6â±â25.1âmin vs 54.6â±â22.0âmin, Pâ=â.004). The overall incidence of synchronous early gastric cancer was 7.5%.Simultaneous ESD for multiple early gastric cancers is a safe and feasible choice in low-volume hospital. The entire stomach should be examined meticulously during and after ESD. Larger randomized studies are needed to validate our results.
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Ressecção Endoscópica de Mucosa/métodos , Hospitais com Baixo Volume de Atendimentos/estatística & dados numéricos , Neoplasias Gástricas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Neoplasias Gástricas/patologiaRESUMO
OBJECTIVES: The purpose of this study was to compare the effects of skin cleaning with 5% NaHCO3 to 75% alcohol on the removal of skin grease and pain of patients with central venous catheters (CVC). MATERIALS AND METHODS: This was a randomized, controlled, single-blinded and prospective study. From January-September 2015, 143 consecutive patients who met the inclusion and exclusion criteria and who underwent elective cardiovascular surgery with placement of a CVC were selected. Patients were randomly divided into 2 groups according to the disinfection preparation procedure: experimental group (n = 60), in which 5% NaHCO3 and distilled water solution at 40-45°C were used, and the control group (n = 66), in which 75% alcohol was used. Main outcome measures were verbal rating scale pain score, satisfaction and bacterial count after 2 minutes of iodine disinfection. RESULTS: The verbal rating scale pain scores were lower in the experimental group than in the control group (P < 0.001). In the control group, 4.5% of patients and 43% of nurses were satisfied with 75% alcohol cleaning before disinfection procedure, compared to 74% and 78%, respectively, in the experimental group. The bacterial count did not show any difference between these 2 groups after iodine disinfection (P = 0.455). CONCLUSIONS: Cleaning of the CVC before disinfection with 5% NaHCO3 and distilled water at 40-45°C alleviated pain and improved patient and nurse satisfaction compared with using 75% alcohol.
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Cateterismo Venoso Central , Desinfetantes , Bicarbonato de Sódio , Adulto , Idoso , Infecções Relacionadas a Cateter/prevenção & controle , Etanol , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Satisfação do Paciente , Método Simples-Cego , PeleRESUMO
OBJECTIVES: Compared with a dry environment with talcum powder, a wet, alkaline environment with NaHCO3 solution is better for hair removal, as it can soften and expand the hair, decrease the friction and shear forces on the skin, and make hair removal easier and more efficient. The purpose of this study was to compare the effects of a preoperative skin preparation of 5% NaHCO3 with that of talcum powder for softening hair in patients undergoing coronary artery bypass graft (CABG) surgery with the saphenous vein. METHODS: A prospective randomized, single-blinded, controlled study was established. Between March 2012 and June 2013, 120 patients who met the inclusion and exclusion criteria underwent elective CABG surgery with the saphenous vein in our hospital. The same doctor obtained the saphenous vein of each patient by a uniform method. CABG surgery was performed through an open or endoscopic technique, according to each patient's condition. Patients were divided into two groups of 60 patients each, according to whether the preoperative skin preparation procedure was performed with a 5% solution of NaHCO3 at 45-50°C (experimental group) or with talcum powder (control group). Main outcome measures were the incision inflammation rate, skin preparation time, presence of shaving-induced macroscopic haemorrhagic spots, verbal rating scale (VRS) pain score and satisfaction. RESULTS: Neither group had any evidence of incision inflammation. The average (mean ± standard deviation) skin preparation time of the experimental group was shorter than that of the control group (5.58 ± 1.52 vs 9.74 ± 1.23 min, P < 0.001). Three patients in the experimental group and 17 in the control group had shaving-induced macroscopic haemorrhagic spots after skin preparation (P = 0.001). The VRS pain scores were different between the two groups (P < 0.001). In the control group, 40% of patients and 37% of nurses were satisfied with the skin preparation procedure, compared with 95 and 90%, respectively, in the experimental group (both P < 0.001). CONCLUSIONS: Hair softening with a 5% NaHCO3 solution protected the skin integrity, alleviated pain and improved patient satisfaction to a greater extent than talcum powder. Nurses found the 5% NaHCO3 solution to be more convenient and less time-consuming to use.
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Ponte de Artéria Coronária/métodos , Remoção de Cabelo/efeitos adversos , Remoção de Cabelo/métodos , Cuidados Pré-Operatórios/métodos , Bicarbonato de Sódio/uso terapêutico , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória , Satisfação do Paciente , Estudos ProspectivosRESUMO
The aim of this study was to investigate the expression of Nrf2 and IGF-1 in benign, premalignant, and malignant gastric lesions, and to explore the role of Nrf2 and IGF-1 in gastric carcinoma carcinogenesis. Nrf2 and IGF-1 expression was detected in normal gastric mucosa, hyperplastic polyp, intraepithelial neoplasia, and adenocarcinoma by immunohistochemistry. There was no expression of Nrf2 and IGF-1 in normal gastric mucous membrane. With the elevation of Nrf2, IGF-1 expression, their co-expressions were highly elevated from benign proliferative lesions to malignant lesions. There were significant differences between hyperplastic polyps, intraepithelial neoplasias, and adenocarcinoma (hyperplastic polys vs. intraepithelial neoplasia: P=0.012; hyperplastic polyps vs. adenocarcinoma: P=0.023; and intraepithelial neoplasia vs. adenocarcinoma: P=0.027; hyperplastic polyps vs. adenocarcinoma: P=0.0000, respectively). Nrf2 expression and IGF-1 expression were correlated positively (r=0.337, P=0.037). The increased expression of Nrf2 and IGF-1 may be related to gastric carcinogenesis. Elevated Nrf2 and IGF-1 may play important roles in promoting tumor progression.
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Adenocarcinoma/química , Biomarcadores Tumorais/análise , Carcinoma in Situ/química , Mucosa Gástrica/química , Fator de Crescimento Insulin-Like I/análise , Fator 2 Relacionado a NF-E2/análise , Pólipos/química , Lesões Pré-Cancerosas/química , Neoplasias Gástricas/química , Adenocarcinoma/patologia , Carcinoma in Situ/patologia , Proliferação de Células , China , Progressão da Doença , Mucosa Gástrica/patologia , Humanos , Hiperplasia , Imuno-Histoquímica , Estadiamento de Neoplasias , Pólipos/patologia , Lesões Pré-Cancerosas/patologia , Neoplasias Gástricas/patologia , Regulação para CimaRESUMO
OBJECTIVE: To investigate the association of TGF beta1 and AT1R gene polymorphisms with hereditary susceptibility and clinical phenotype of HBV-induced liver cirrhosis. METHODS: Peripheral blood samples were collected from 102 patients with HBV-induced liver cirrhosis and 106 healthy blood donors. The polymorphisms of the promoter site -509C/T of TGF beta1 and 1166A/C of AT1R gene were determined by PCR-RFLP. RESULTS: The frequency of the homozygote CC of -509C/T of TGF beta1 gene in the group of liver cirrhosis was higher than that the control group (P<0.05); and the frequency rate of homozygote CC was higher in group C than in group A and group B of liver cirrhosis (P<0.05), but there was no significant difference in allele frequency among these group (P>0.05). There was no significant difference in genotypes and allele frequency of AT1R gene 1166A/C between the liver cirrhosis group and the control group (P>0.05). CONCLUSION: The polymorphism of the promoter site -509C/T of TGF beta1 gene is associated with hereditary susceptibility to liver cirrhosis and severity of HBV-induced liver cirrhosis; the polymorphism of AT1R gene 1166A/C is not associated with hereditary susceptibility to HBV-induced liver cirrhosis.