A comparison of methods used to secure pediatric endotracheal tubes using a live human dermal model.

BACKGROUND: Endotracheal intubation is a common lifesaving procedure. An in situ endotracheal tube (ETT) must be secured in position to avoid displacement and potentially life-threatening complications. Adhesive tapes form the most common intraoperative ETT stabilization methods. Limited published data are available to guide the clinical decision regarding ETT taping method. We performed an interventional study aiming to establish which of many commonly employed ETT tape/supplementary adhesive methods provides the most resistance to ETT distraction. METHODS: An experiment was undertaken to measure the force required to distract an ETT secured to a live dermal model with 24 different ETT securing methods comprising six types of tape alone and in combination with one of three supplementary adhesives. The primary measurement was the peak force (Newtons) required to distract a secured ETT 3 cm. RESULTS: A total of 1,164 measurements were made. The mean force required to distract the ETT ranged from 7.8 to 21.8 Newtons. The combination of Cloth Adhesive™ + Mastisol® had the greatest observed mean distraction force, as well as the greatest estimated lower and upper confidence limits. CONCLUSIONS: There are significant differences in force required to distract an ETT based on taping methods.

RéSUMé: CONTEXTE: L'intubation endotrachéale est une intervention critique courante. Le tube endotrachéal (TET) in situ doit être fixé en position adéquate pour éviter qu'il ne se déplace et provoque des complications potentiellement fatales. Les bandes adhésives sont la méthode de stabilisation peropératoire de TET la plus fréquemment utilisée. Il n'existe que peu de données publiées pour guider la décision clinique quant à la méthode de fixation du TET. Nous avons réalisé une étude interventionnelle visant à établir laquelle des nombreuses méthodes couramment employées de bandes adhésives ou de méthodes adhésives supplémentaires du TET procurait la meilleure protection contre un déplacement du TET. MéTHODE: Une expérience a été menée pour mesurer la force nécessaire à déplacer/déloger un TET fixée à un modèle de derme vivant avec 24 méthodes différentes de sécurisation du TET, comprenant six types de ruban adhésif seuls et en combinaison avec l'un de trois adhésifs supplémentaires. La mesure principale était la force maximale (en newton) nécessaire pour déplacer un TET sécurisée de 3 cm. RéSULTATS: Au total, 1164 mesures ont été effectuées. La force moyenne requise pour déplacer le TET allait de 7,8 à 21,8 newtons. La combinaison du ruban Cloth Adhesive™ + Mastisol® a entraîné la plus grande force de déplacement moyenne observée, ainsi que les plus grandes limites inférieure et supérieure estimées des intervalles de confiance. CONCLUSION: Il existe des différences significatives dans la force nécessaire pour déplacer un TET en fonction des méthodes de fixation utilisées.

A rapid and low-cost estimation of bacteria counts in solution using fluorescence spectroscopy.

The fluorescence spectrum of bacterially bound acridine orange (AO) was investigated to evaluate its use for the rapid enumeration of bacteria. Escherichia coli ATCC 25922 samples were stained with 2 × 10-2, 2 × 10-3 or 2 × 10-4% w/v AO, followed by 3, 2 or 0 washing cycles, respectively, and fluorescence spectra were recorded using a fibre-based spectroscopic system. Independent component analysis was used to analyse the spectral datasets for each staining method. Bacterial concentration order of magnitude classification models were calculated using independent component weights. The relationship between fluorescence intensity of bound AO and bacterial concentration was not linear. However, the spectral signals collected for AO stain concentration-bacterial concentration pairs were reproducible and unique enough to enable classification of samples. When above 105 CFU ml-1, it was possible to rapidly determine what the order of magnitude of bacterial concentration of a sample was using a combination of two of the sample preparation methods. A relatively inexpensive (around US$10 per test) rapid method (within 25 min of sampling) for enumeration of bacteria by order of magnitude will reduce the time and cost of microbiological tests requiring gross concentration information. Graphical Abstract Fluorescence spectra of bacterially bound acridine orange (AO) were used for the rapid enumeration of bacteria. Order of magnitude bacterial concentration classification models were calculated using independent components analysis of these fluorescence spectra. When above 105 CFU ml-1, it was possible to rapidly determine the order of magnitude of bacterial concentration of a sample using a combination of two sample preparation methods.

Superiority of non-opioid postoperative pain management after thyroid and parathyroid operations: A systematic review and meta-analysis.

BACKGROUND: This meta-analysis aimed to evaluate the body of evidence investigating the post-operative use of non-opioid analgesic drugs and techniques in endocrine neck surgeries. Adequate pain control is crucial for successful recovery after thyroid and parathyroid surgery. Effective postoperative pain control can shorten hospital stay, improve postoperative outcomes, decrease morbidity and improve the overall patient experience. Traditionally, opioids have been the mainstay of postoperative analgesia after thyroid and parathyroid surgeries. However, the use of opioids has been linked to an increased incidence of postoperative complications. METHODS: A comprehensive systematic literature review via Medline, Embase, Web of Science and Cochrane Central Register for Controlled Trials from inception until December 26th, 2020 was conducted, followed by meta-analysis. Abstract and full-text screening, data extraction and quality assessment were independently conducted by 2 investigators. Odds ratios (OR), mean differences (MD) and 95% confidence intervals were calculated using RevMan 5.3. RESULTS: Sixty-five randomized control trials were identified from 486 unique publications. Pooled MD and 95% confidence interval for pain scores were higher for the control group at 24 h postoperatively both at rest (-0.65 [-0.92, -0.37]) and with swallowing (-0.77 [-1.37, -0.16]). These differences were statistically significant. The pooled MD and confidence interval for postoperative analgesic requirements was lower in the intervention group (-1.38 [-1.86, -0.90]). The incidence of PONV had a pooled OR of 0.67 [0.48, 0.94]. CONCLUSION: Non-opioid analgesia was superior to the control group for pain control in patients undergoing thyroid and parathyroid operations with no significant difference in complications.