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Introducción. Las cardiopatías congénitas (CC) en Chile corresponden a la segunda causa de muerte en menores de 1 año, requiriendo cirugías paliativas y/o correctivas el 65% de estas. En el post operatorio frecuentemente se utiliza ventilación mecánica invasiva (VM) y succión endotraqueal (SET) para remover secreciones. Sin embargo, la kinesiología respiratoria (KTR) ha mostrado mejoras significativas en la distensibilidad toracopulmonar (Cest) y resistencia de vía aérea (Rva) en otros grupos de usuarios pediátricos y adultos en VM. Objetivo. Comparar los cambios en la Cest y Rva en usuarios pediátricos en VM post cirugía de cardiopatía congénita (CCC) sometidos a KTR versus SET exclusiva. Métodos. Revisión sistemática de estudios publicados en bases de datos PUBMED, PeDro, Scielo y Google Scholar que comparan el uso de KTR ó SET sobre los cambios en mecánica ventilatoria en usuarios pediátricos en VM post cirugía de cardiopatía congénita, limitados a inglés, español y portugués, excluyendo a sujetos con traqueostomía o con oxigenación por membrana extracorpórea. Se utilizó guía PRISMA para la selección de artículos. Se revisaron 397 artículos y se seleccionó 1 artículo extra de los artículos sugeridos. Se eliminó 1 artículo por duplicidad. Por títulos y resúmenes se seleccionaron 2 artículos, los cuales al leer el texto completo fueron retirados debido a que la población no correspondía a cardiópatas. Resultados. El final de artículos seleccionados fue de 0 artículos, debido a lo cual se removió el operador Booleano "NOT", y se removió la población de cardiopatías. De este modo quedaron 2 artículos seleccionados para la revisión cualitativa final donde se compara KTR versus SET, y KTR en kinesiólogos especialistas y no especialistas, mostrando ambos aumento en la Cest y disminución de la Rva a favor de la KTR, hasta los 30 minutos post intervención. Conclusiones. No se encontraron artículos que demuestren cambios en Cest y Rva con el uso de KTR + SET versus SET exclusiva, en usuarios pediátricos ventilados posterior a CCC. Con la remoción de filtros seleccionamos 2 artículos que demuestran aumento de Cest y disminución de Rva en sujetos pediátricos en VM, uno comparando con SET, y por grupos de especialistas y no especialistas en respiratorio. Se sugieren estudios primarios para evaluar los efectos de esta intervención en esta población.
Introduction. Congenital heart diseases (CHD) are the second general cause for children death under 1 year. In Chile, approximately 65% CHD need surgery, could was palliative or corrective. In the postoperative period, invasive mechanical ventilation (MV) is frequently used as a life support method, but it is associated with complications. Tracheal suction (SET) is regularly used to remove secretions; however, respiratory chest physiotherapy (KTR) has shown significant improvements in thoraco-pulmonary compliance and airway resistance in other groups of pediatrics and adult's users in MV. Objetive. to compare changes in thoraco-pulmonary compliance and airway resistance in pediatric subjects under mechanical ventilation after congenital heart disease surgery comparing chest physiotherapy and exclusive tracheal suction. Methods. systematic review of studies published in PUBMED, PeDro, Scielo and Google Scholar databases who compares KTR or SET use on changes in ventilatory mechanics in pediatric users under MV after congenital heart disease surgery, limited to English, Spanish and Portuguese languages, excluding user with tracheostomy or extracorporeal membrane of oxygenation. It was use the PRISMA guide to articles selection. A search was carried out, with a total of 397 articles reviewed (English: PubMed = 3, PeDro = 8, Scholar = 383; Spanish: Scholar = 3, Scielo = 0; and Portuguese: Scielo = 0). One extra article was selected from the suggested articles, and 1 article was eliminated due to duplication. By titles and abstracts, 2 articles were selected, but the population did not correspond to heart disease. Results. the final selected articles were 0 articles. By this reason, it were removed: Boolean operator "NOT", and congenital heart disease population. Thus, 2 articles were selected for the final qualitative review where it was compares KTR versus SET, and KTR by specialist and non-specialist. Both articles shown improvement in compliance and resistance until 30 minutes post intervention. The CC population was in a 40 to 60% range in both studies. Conclusions. it was no found articles that demonstrate changes in compliance and resistance in the airway with the use of KTR + SET versus exclusive SET in pediatric users after CCC connected to MV. After filter remotion, we found 2 studies shown improves in increase compliance and reduce resistance in pediatric user in MV, ones comparing with SET, and the other one comparing between specialists in respiratory pediatric physiotherapy and not specialists. It suggests to made primary clinical studies about this intervention in CC population.
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@#BACKGROUND: Ischemic stroke refers to a disorder in the blood supply to a local area of brain tissue for various reasons and is characterized by high morbidity, mortality, and disability. Early reperfusion of brain tissue at risk of injury is crucial for the treatment of acute ischemic stroke. The purpose of this study was to evaluate comfort levels in managing acute stroke patients with hypoxemia who required endotracheal intubation after multidisciplinary in situ simulation training and to shorten the door-to-image time. METHODS: This quality improvement project utilized a comprehensive multidisciplinary in situ simulation exercise. A total of 53 participants completed the two-day in situ simulation training. The main outcome was the self-reported comfort levels of participants in managing acute stroke patients with hypoxemia requiring endotracheal intubation before and after simulation training. A 5-point Likert scale was used to measure participant comfort. A paired-sample t-test was used to compare the mean self-reported comfort scores of participants, as well as the endotracheal intubation time and door-to-image time on the first and second days of in situ simulation training. The door-to-image time before and after the training was also recorded. RESULTS: The findings indicated that in situ simulation training could enhance participant comfort when managing acute stroke patients with hypoxemia who required endotracheal intubation and shorten door-to-image time. For the emergency management of hypoxemia or tracheal intubation, the mean post-training self-reported comfort score was significantly higher than the mean pre-training comfort score (hypoxemia: 4.53±0.64 vs. 3.62±0.69, t= -11.046, P<0.001; tracheal intubation: 3.98±0.72 vs. 3.43±0.72, t= -6.940, P<0.001). We also observed a decrease in the tracheal intubation and door-to-image time and a decreasing trend in the door-to-image time, which continued after the training. CONCLUSION: Our study demonstrates that the implementation of in situ simulation training in a clinical environment with a multidisciplinary approach may improve the ability and confidence of stroke team members, optimize the first-aid process, and effectively shorten the door-to-image time of stroke patients with emergency complications.
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Objectives: This pilot study aimed to identify and test a battery of time-efficient and cost-effective voice and swallowing screening tools for post-extubated patients in Chile. Methods: A panel of four experts selected and rated voice and swallowing screening tools. Seven measures were selected: smoothed cepstral peak prominence (CPPS) and maximum phonation time (MPT) for voice assessment, Volume-Viscosity Swallow Test (V-VST) for swallowing, voluntary and reflex peak cough flow for cough assessment, Eating Assessment Tool-10 (EAT-10), and Vocal Symptom Scale (VoiSS) for patient-reported outcomes. These tools were applied to four post-extubation patients within 48-72 hours post-hospital discharge, alongside the assessment of 17 matched controls. Results: Post-extubation patients showed significantly shorter MPT, lower CPPS values, increased V-VST dysphagia signs, reduced voluntary peak cough flow, and more pronounced symptoms on both the VoiSS and EAT-10 compared to controls. Limitations: The study had a modest sample size and relied solely on clinical screening tools. Value: This pilot study suggests a feasible and cost-effective approach to voice and swallowing screening for post-extubation patients, valuable in resource-constrained settings. Conclusion: While these accessible tools are not gold-standard assessments, they offer valuable insights and can guide future research. This study underscores the potential of selected tools in facilitating early detection of voice and swallowing disorders in post-extubation patients.
Objetivos: Este estudio piloto tuvo como objetivo identificar y probar una batería de herramientas de detección de problemas de voz y deglución que fueran eficientes en cuanto a tiempo y costo para pacientes chilenos postextubados. Métodos: Un panel de cuatro expertos seleccionó y evaluó herramientas de detección de voz y deglución. Se seleccionaron siete medidas: prominencia de pico cepstral suavizado (CPPS) y tiempo máximo de fonación (TMF) para la evaluación de la voz, prueba de volumen-viscosidad (V-VST) para la deglución, flujo máximo voluntario y reflejo de la tos para evaluar la tos, Eating Assessment Tool-10 (EAT-10) y la Escala de Sintomas Vocales (ESV) para los resultados informados por los pacientes. Estas herramientas se aplicaron a cuatro pacientes postextubados (48-72 horas), junto con la evaluación de 17 controles pareados. Resultados: Los pacientes postextubados mostraron un TMF y CPPS significativamente más bajos, aumento de los indicios de disfagia en la V-VST, reducción del flujo máximo de la tos y síntomas más pronunciados tanto en la ESV como en la EAT-10 en comparación con los controles. Limitaciones: El estudio tuvo un tamaño de muestra reducida y se basó únicamente en herramientas de detección clínica. Valor: Este estudio piloto sugiere un enfoque factible y rentable para la detección de problemas de voz y deglución en pacientes postextubados, valioso en entornos con recursos limitados. Conclusión: Aunque ese abordaje no sustituye a las evaluaciones de referencia, ofrece información valiosa y puede guiar futuras investigaciones que busquen facilitar la detección temprana de los trastornos de la voz-deglución en pacientes postextubados.
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Background and Aim: The appropriate size of endotracheal tube for children are traditionally selected based on their age, height and or weight by using formulas. The ultrasound guided measurement of subglottic laryngeal diameter can be used to appropriate selection of endotracheal tube. The endotracheal tube is selected based on the nearest external diameter corresponding to the measured subglottic region. The aim of the study is to compare the appropriateness of uncuffed endotracheal tube selection based on age based formula with that of ultrasound assessment of subglottic diameter in children. A prospective randomised parallel group study involving 60 children Materials and Methods: of age 2-6years undergoing elective surgeries under general anaesthesia were selected for study. They are divided into two groups as Group A – Endotracheal tube selection based on ultrasound assessment of diameter of subglottic region and Group B – Endotracheal tube selection based on age based formula which is (Age /3)+ 3.5mm ID. The noted parameters were internal diameter (ID) and external diameter (OD) of the predicted ETT by the two methods, ID and OD of the appropriate size ETT used and the ultrasound assessed subglottic diameter. The incidence of ETT size predicted by ultrasound assessment of Results: subglottic diameter was 83.33% while with age based formula it is 53.34%. The linear regression equation model in Group A showed R²= 0.694, P = 0.001 which was statistically signicant. While in Group B it was R²=0.258., p=0.001. There Conclusion: was a strong correlation between the outer diameter of clinically used uncuffed ETT and the subglottic diameter assessed with ultrasound examination in paediatric patients. Hence USG assessment of the subglottic diameter is a better tool in predicting the appropriate uncuffed ETT in paediatric patients undergoing elective surgeries under general anaesthesia than the age- based formula
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Resumen: A través de los siglos hemos descubierto la importancia de mantener permeable y segura la vía aérea. Desde Hipócrates en la antigua Grecia, hasta el siglo XX en oriente y occidente, se ha continuado con el desarrollo de herramientas que faciliten esta cotidiana tarea por lo que, con esta revisión sistemática, se establecieron como objetivos exponer el origen y los antecedentes del tubo endotraqueal, cánula orofaríngea y laringoscopio, así como discutir su utilidad en la práctica anestésica-quirúrgica, a través del tiempo hasta hoy en día.
Abstract: Over the centuries, we have discovered the importance of preserving a safe permeable airway. From Hippocrates in ancient Greece to the 20th century in the East and West, the development of multiple tools that enable this task continues through time, which is why with this systematic review we aim to uncover the origin and historical background of the endotracheal tube, the oropharyngeal cannula and the laryngoscope, discussing their effectiveness in the anesthetic-surgical practice over years to the present day.
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Se describe el caso clínico de un adulto joven de 30 años de edad, con antecedente de buena salud, quien fue asistido en el Servicio de Cirugía del Hospital Universitario Manuel Ascunce Domenech en Camagüey por presentar aumento de volumen en la región abdominal de dos meses de evolución, concomitante con astenia, anorexia, vómitos y pérdida de peso. En el examen físico resultaron notables el abdomen globuloso (bazo palpable) sin dolor, un hematoma periumbilical y múltiples adenopatías supraclaviculares; en tanto, en los estudios imagenológicos se evidenció la presencia de esplenomegalia. Se realizó esplenectomía con administración de anestesia general endotraqueal y en el estudio histopatológico de la muestra resecada se confirmó el diagnóstico de linfoma primario del bazo.
The case report of a 30-year-old young adult with a history of good health is described, who was assisted at the Surgery Service of Manuel Ascunce Domenech University Hospital in Camagüey due to volume increase in the abdominal region with a course of two months, concomitant with asthenia, anorexia, vomits and weight loss. Physical examination revealed a globular abdomen (palpable spleen) with no pain, a periumbilical hematoma, and multiple supraclavicular adenopathies; meanwhile, in the imaging studies splenomegaly was evidenced. Splenectomy was performed with administration of general endotracheal anesthesia and the histopathological study of the resected sample confirmed the diagnosis of primary spleenic lymphoma.
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Objective:To explore the comparative study of video laryngoscopy combined with bronchial blocker and video laryngoscopy combined with double-lumen tube in the teaching of endotracheal intubation in thoracic surgery in the standardized residency training of anesthesia.Methods:The trainees of the standardized residency training were randomly divided into control group and experimental group for clinical teaching, with 25 ones in each group. The experimental group was treated with visual laryngoscopy combined with bronchial blocker, while the control group was treated with visual laryngoscopy combined with double-lumen tube group. The intubation time, intubation success rate, positioning time, hemodynamic changes, and complication incidence during intubation, as well as student assessment results were recorded. GraphPad Prism 6.0 was used for t test and Chi-square test. Results:The time of endotracheal intubation [(95.3±10.1) vs. (137.5±13.5)] and positioning time [(100.8±11.7) vs. (155.4±15.3)] in the experimental group were both shorter than those of the control group ( P< 0.001), the hemodynamic changes in patients with immediate intubation were smaller ( P<0.001), the success rate of intubation was higher (92% vs. 68%) ( P<0.001), the complication incidence was lower ( P<0.001) and the students' performance was higher ( P<0.001). Conclusion:In the anesthesia teaching of thoracic surgery, bronchial blocker can reduce the time of endotracheal intubation, lower the hemodynamic changes during intubation, cut down the incidence of complications, improve the success rate of endotracheal intubation and enhance the confidence of students.
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@#Objective To compare the clinical efficacy between right visual double lumen tube (VDLT) intubation and right common double lumen tube (DLT) intubation in lung isolation technique. Methods A total of 57 patients undergoing thoracoscopic surgery with right DLT lung isolation technique in the First People's Hospital of Chenzhou City and West China Hospital from June 2020 to June 2021 were randomly divided into two groups: a DLT group (n=29, 16 males and 13 females, with a mean age of 54.3±13.2 years) and a VDLT group (n=28, 18 males and 10 females, with a mean age of 55.1±13.7 years) at 1 : 1 with random number table generated by the computer. The clinical data of the two groups were compared. Results Compared with the DLT group, the catheter positioning time in the VDLT group was statistically shorter (74.9±47.5 s vs. 151.6±88.9 s, P<0.001), the right upper lung occlusion rate (21.4% vs. 51.7%) and the intraoperative re-adjustment catheterization rate (14.3% vs. 48.3%) were lower (P<0.05). The quality of lung collapses immediately after thoracotomy (67.9% vs. 24.1%) and 20 minutes after thoracotomy (100.0% vs. 75.9%) were improved (P<0.05). There was no significant difference in the rate of fiberoptic bronchoscope assistance for positioning, or the incidence of pharynx pain and hoarseness between the two groups (P>0.05). Conclusion Compared with common DLT, VDLT is more efficient, accurate and intuitive in the location of right bronchial intubation.
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Abstract Background: Awake fiberoptic tracheal intubation is an established method of securing difficult airways, but there are some reservations about its use because many practitioners find it technically complicated, time-consuming, and unpleasant for patients. Our main goal was to test the safety and efficacy of a 300-mm working length fiberscope (video rhino-laryngoscope) when used for awake nasotracheal intubation in difficult airway cases. Methods: This was a prospective, single-center study involving adult patients, having an ASA physical status between I and IV, with laryngopharyngeal pathology causing distorted airway anatomy. Awake nasotracheal intubation, using topical anesthesia and light sedation, was performed using a 300 mm long and 2.9 mm diameter fiberscope equipped with a lubricated reinforced endotracheal tube. The primary outcomes were the success and duration of the procedure. Patients' periprocedural satisfaction and other incidents were recorded. Results: We successfully intubated all 25 patients included in this study. The mean ± SD duration of the procedure, starting from the passage of the intubating tube through one of the nostrils until the endotracheal intubation, was 76 ± 36 seconds. Most of the patients showed no discomfort during the procedure with statistical significance between the No reaction Group with the Slight grimacing Group (95%CI 0.13, 0.53, p = 0.047) and the Heavy grimacing Group (95%CI 0.05, 0.83, p = 0.003). The mean ±SD satisfaction score 24 hours post-intervention was 1.8 ± 0.86 - mild discomfort. No significant incidents occurred. Conclusions: Our study showed that a 300-mm working length flexible endoscope is fast, safe, and well-tolerated for nasotracheal awake intubation under challenging airways.
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Endoscopy , Airway Management , Patient Satisfaction , Anesthesia, LocalABSTRACT
Resumen ANTECEDENTES: Las mujeres embarazadas e infectadas con SARS-CoV-2 tuvieron 2.9 veces más probabilidad de requerir ventilación invasiva. La colecistitis aguda es la segunda indicación quirúrgica más común en el embarazo. En la búsqueda bibliográfica no se encontraron reportes de concomitancia de ambas enfermedades durante el embarazo, por este motivo se publica el reporte de caso clínico y se revisa la bibliografía. CASO CLÍNICO: Paciente de 32 años, en curso de las 23 semanas de embarazo. Debido a síntomas de COVID-19, con prueba PCR positiva, se hospitalizó para inicio de ventilación mecánica invasiva. Al noveno día de internamiento tuvo elevación de transaminasas y reporte de TAC de colecistitis aguda alitiásica. Se le indicó la colecistostomía percutánea, con la que se alivió el cuadro hepatobiliar. En el segundo tiempo quirúrgico se procedió a la cesárea. Tres días después experimentó mejoría ventilatoria y bioquímica gradual. A los 32 días de hospitalización se logró la intubación y, después de 54 días, se dio de alta del hospital, sin requerimiento de oxígeno suplementario. CONCLUSIONES: Encontrar, en conjunto con el síndrome de insuficiencia respiratoria aguda por COVID-19 grave que requiere ventilación mecánica invasiva, embarazo previable y colecistitis alitiásica pone en grave peligro a la embarazada y al equipo médico en múltiples dilemas médicos, quirúrgicos y bioéticos. La colecistostomía percutánea en pacientes con inestabilidad hemodinámica y la finalización del embarazo en caso de deterioro ventilatorio ante síndrome de insuficiencia respiratoria aguda es una opción controvertida. Lo conducente, sin duda, son los procedimientos basados en evidencia y las sesiones multidisciplinarias, incluyendo a la familia.
Abstract BACKGROUND: Pregnant women infected with SARS-CoV-2 were 2.9 times more likely to require invasive ventilation. Acute cholecystitis is the second most common surgical indication in pregnancy. In the literature search, no reports of concomitance of both diseases during pregnancy were found, for this reason the clinical case report is published and the literature is reviewed. CASE REPORT: 32-year-old female patient, in the course of 23 weeks of pregnancy. Due to symptoms of COVID-19, with positive PCR test, she was hospitalized for initiation of invasive mechanical ventilation. On the ninth day of hospitalization, she had elevated transaminases and CT report of acute cholecystitis alliasis. Percutaneous cholecystostomy was indicated, which relieved the hepatobiliary symptoms. In the second surgical stage, a cesarean section was performed. Three days later she experienced gradual ventilatory and biochemical improvement. After 32 days of hospitalization, intubation was achieved and, after 54 days, she was discharged from the hospital, without requiring supplemental oxygen. CONCLUSIONS: Finding, in conjunction with severe COVID-19 acute respiratory failure syndrome requiring invasive mechanical ventilation, pre-viable pregnancy, alliasic cholecystitis, places the pregnant woman and the medical team in serious medical, surgical, and bioethical dilemmas. Percutaneous cholecystostomy in patients with hemodynamic instability and termination of pregnancy in case of ventilatory deterioration in the face of acute respiratory failure syndrome is a controversial option. Evidence-based procedures and multidisciplinary sessions, including the family, are undoubtedly conducive.
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@#BACKGROUND: It is controversial whether prophylactic endotracheal intubation (PEI) protects the airway before endoscopy in critically ill patients with upper gastrointestinal bleeding (UGIB). The study aimed to explore the predictive value of PEI for cardiopulmonary outcomes and identify high-risk patients with UGIB undergoing endoscopy. METHODS: Patients undergoing endoscopy for UGIB were retrospectively enrolled in the eICU Collaborative Research Database (eICU-CRD). The composite cardiopulmonary outcomes included aspiration, pneumonia, pulmonary edema, shock or hypotension, cardiac arrest, myocardial infarction, and arrhythmia. The incidence of cardiopulmonary outcomes within 48 h after endoscopy was compared between the PEI and non-PEI groups. Logistic regression analyses and propensity score matching analyses were performed to estimate effects of PEI on cardiopulmonary outcomes. Moreover, restricted cubic spline plots were used to assess for any threshold effects in the association between baseline variables and risk of cardiopulmonary outcomes (yes/no) in the PEI group. RESULTS: A total of 946 patients were divided into the PEI group (108/946, 11.4%) and the non-PEI group (838/946, 88.6%). After propensity score matching, the PEI group (n=50) had a higher incidence of cardiopulmonary outcomes (58.0% vs. 30.3%, P=0.001). PEI was a risk factor for cardiopulmonary outcomes after adjusting for confounders (odds ratio [OR] 3.176, 95% confidence interval [95% CI] 1.567-6.438, P=0.001). The subgroup analysis indicated the similar results. A shock index >0.77 was a predictor for cardiopulmonary outcomes in patients undergoing PEI (P=0.015). The probability of cardiopulmonary outcomes in the PEI group depended on the Charlson Comorbidity Index (OR 1.465, 95% CI 1.079-1.989, P=0.014) and shock index >0.77 (compared with shock index ≤0.77 [OR 2.981, 95% CI 1.186-7.492, P=0.020, AUC=0.764]). CONCLUSION: PEI may be associated with cardiopulmonary outcomes in elderly and critically ill patients with UGIB undergoing endoscopy. Furthermore, a shock index greater than 0.77 could be used as a predictor of a worse prognosis in patients undergoing PEI.
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Resumen: Reportamos el manejo exitoso de la vía aérea con intubación orotraqueal a través de una máscara laríngea AuraOnceTM en un paciente con lesión de la médula espinal cervical. Su uso fue como dispositivo de rescate de la vía aérea tras intubación orotraqueal fallida con laringoscopía directa y dificultad para la ventilación con mascarilla en una paciente traumatizada de 46 años. Se tomó la decisión de utilizar la mascarilla laríngea sin intubación como conducto para la colocación de un tubo orotraqueal, lo cual se realizó con éxito. Este uso alternativo de la mascarilla laríngea Ambu AuraOnce podría ser de gran valor para los trabajadores de la salud en países de escasos recursos donde los dispositivos avanzados para las vías respiratorias no están fácilmente disponibles.
Abstract: We reported a successful airway management in a patient with a diagnosed cervical spinal injury with a non-intubating laryngeal mask AuraOnceTM. Its use was as a rescue airway device after failed orotracheal intubation with direct laryngoscopy and difficulty with facemask ventilation in a 46-year-old trauma patient. The decision was made to use the non-intubating laryngeal mask as a conduit for the placement of an orotracheal tube, which was done successfully. This alternative use of the Ambu AuraOnce laryngeal mask could be of great value to healthcare workers in resource-poor countries where advanced airway devices are not readily available.
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Introducción: Muchos enfermos de COVID-19 requieren ser ventilados. La laringoscopia directa (LD) es el método tradicional empleado en el manejo de la vía aérea; sin embargo, la videolaringoscopia (VL) es una alternativa en estos pacientes. Objetivo: Comparar la laringoscopia directa y la videolaringoscopia en el manejo de la vía aérea en pacientes con COVID-19. Métodos: Se realizó un estudio observacional retrospectivo. El universo y la muestra estuvieron conformado por los pacientes intubados por médicos de la brigada Henry Reeve en hospitales de Cancún y Ciudad de México. Se conformaron dos grupos; el Grupo laringoscopia directa con 91 pacientes y el Grupo videolaringoscopia con 103. Las variables estudiadas fueron: edad, sexo, número de predictores de una vía respiratoria anatómicamente difícil (VRAD), visualización de la apertura glótica, intentos de intubación y las complicaciones de la intubación. El análisis estadístico de los datos se realizó con el paquete estadístico SPSS 23.0. Resultados: Los grupos fueron comparables en cuanto a edad, sexo y predictores de vía respiratoria anatómicamente difícil. La visualización glótica completa o parcial en el grupo videolaringoscopia fue de 97 por ciento, mientras que en el grupo laringoscopia directa fue de 86 por ciento. La intubación endotraqueal al primer intento superó el 70 por ciento en el grupo VL y el 50 por ciento en el grupo LD. Las principales complicaciones encontradas fueron la desaturación y la hipotensión arterial con una mayor frecuencia en el grupo LD (40,7 por ciento y 49,5 por ciento). Conclusiones: La videolaringoscopia mejoró la visualización glótica y la intubación endotraqueal al primer intento, con menos complicaciones en los pacientes estudiados(AU)
Introduction: Many COVID-19 patients require ventilation. Direct laryngoscopy is the traditional method used for airway management; however, videolaryngoscopy is an alternative in these patients. Objective: To compare direct laryngoscopy and videolaryngoscopy for airway management in COVID-19 patients. Methods: A retrospective observational study was carried out. The universe and the sample consisted of patients intubated by physicians from Henry Reeve brigade at hospitals in Cancun and Mexico City. Two groups were formed: the direct laryngoscopy group, with 91 patients, and the videolaryngoscopy group, with 103 patients. The variables studied were age, sex, number of predictors of an anatomically difficult airway, visualization of the glottic opening, intubation attempts, and intubation complications. Statistical analysis of the data was performed using the SPSS 23.0 statistical package. Results: The groups were comparable in terms of age, sex and predictors of an anatomically difficult airway. Complete or partial glottic visualization in the videolaryngoscopy group was 97 percent , while in the direct laryngoscopy group it was 86 percent . Endotracheal intubation at the first attempt exceeded 70 percent in the videolaryngoscopy group and 50 percent in the direct laryngoscopy group. The main complications observed were desaturation and arterial hypotension with a higher frequency in the direct laryngoscopy group (40.7 percent and 49.5 percent , respectively). Conclusions: Video laryngoscopy improved glottic visualization and endotracheal intubation at the first attempt, with fewer complications in the patients studied(AU)
Subject(s)
Humans , Male , Female , Video-Assisted Techniques and Procedures , Retrospective Studies , Observational Study , Laryngoscopy/methodsABSTRACT
Background: Hemodynamic stability is an important aspect to the anesthesiologist for patients. Laryngoscopy and endotracheal intubation can cause striking changes in Hemodynamics as result of intense stimulation of sympathetic nervous system. ProSeal LMA (PLMA)minimizes this response without compromising the airway. The aim of this study was to compare PLMA and Endotracheal tube with respect to intra-operative hemodynamic responses in patients undergoing general anaesthesia. Material and Methods: This prospective observational study was conducted on 30 patients of either sex, age group of 18-60 years, ASA (I or II), Mallam Pati (I or II) posted for elective surgery under general anaesthesia. They were randomly divided into two group 15 each. For group A, airway was secured with laryngoscopy and intubation with appropriate size endotracheal tube and for group B, appropriate size PLMA was inserted to secure airway. The hemodynamic responses like Heart rate and Blood pressure were recorded at base line, at insertion, after 1st min, 3rd min, 5th min and after extubation. Mean increase was statistically more after endotra Results: cheal intubation than PLMA insertion. The elevation in these hemodynamic parameters significantly persisted for a longer period of time in the ETT group, where it returned to the baseline value by 5 minutes as compared to the PLMA group where it returned by 3 minutes. The hemodynamic res Conclusion: ponse produced when PLMA was used for securing airway was less than the laryngoscopy and endotracheal intubation. Thus, PLMA proved to be a suitable alternative to endotracheal tube for airway management with stable hemodynamic.
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Lung isolation is an essential anesthetic technique utilized in thoracic surgeries. We present a patient undergoing esophagectomy that developed an iatrogenic injury to the left mainstem bronchus that damaged the bronchial cuff of a left?sided double?lumen endotracheal tube (DLETT). A bronchial blocker (BB) was placed in the tracheal lumen of the DLETT as a rescue method to facilitate continued lung isolation. This unusual combination of a DLETT and a BB proved useful once the bronchial cuff was compromised and may serve as a viable solution to maintain lung isolation in similar circumstances
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El manejo especializado de la vía aérea (VA) es fundamental en las unidades de urgencia donde la intubación orotraqueal ha sido la técnica de elección para lograrlo. Una VA difícil se define como una situación clínica en la cual un equipo médico entrenado experimenta dificultades en la ventilación y/o en intubación. La obstrucción aguda de la VA constituye una de las emergencias médicas más extremas, requiriendo intervención inmediata. Se presenta el caso de un paciente con estridor inspiratorio con criterios inmediatos de intubación donde se evidencia un tumor en cuerdas vocales con obstrucción de la vía aérea.
Specialized airway management is essential in emergency units where endotracheal intubation has been the technique of choice. The difficult airway is defined as a clinical situation in which a trained medical team experiences difficulties in ventilation and, or intubation. Acute airway obstruction is one of the most extreme medical emergencies, requiring immediate intervention. We present the case of a patient with inspiratory stridor with quick criteria for intubation where a tumour in the vocal cords with airway obstruction is found.
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El enfisema subcutáneo se produce como complicación frecuente en intervenciones quirúrgicas, técnicas invasivas, ventilación mecánica, lesiones traqueales y neumotórax. La progresión fuera del tórax con afectación facial, abdominal e incluso inguinal puede producir un síndrome compartimental con compresión de estructuras aledañas como la tráquea y vasos del cuello, tal situación se ha denominado enfisema subcutáneo masivo. En este documento se reporta el caso de un paciente que desarrolló un enfisema subcutáneo masivo como signo precoz de lesión traqueal asociada a la intubación y ventilación a presión positiva.
Subcutaneous emphysema occurs as a frequent complication in surgical interventions, invasive techniques, mechanical ventilation, tracheal injuries and pneumothorax. Progression outside the thorax with facial, abdominal, and even inguinal involvement can produce compartment syndrome with compression of surrounding structures such as the trachea and neck vessels. This situation has been called massive subcutaneous emphysema.This document reports the case of a patient who developed massive subcutaneous emphysema as an early sign of tracheal injury associated with intubation and positive pressure ventilation.
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Resumen: Introducción: La utilización de dispositivos de barrera adicional para la intubación endotraqueal constituye un reto para la práctica médica durante la actual pandemia. Se pueden utilizar múltiples herramientas para intubación del paciente minimizando la exposición del operador sin afectar la seguridad del procedimiento. El médico debe evaluar y comprender adecuadamente cualquier estrategia adicional, ya que podría interferir con la intubación, aumentando el tiempo de manipulación. Objetivo: Comparar preferencia de los anestesiólogos entre dos dispositivos de barrera, uno diseñado con base en una lámina plástica versus caja de acrílico. Material y métodos: Incluimos 102 pacientes intervenidos de cirugías electivas y de urgencias que aceptaron participar en este estudio prospectivo, transversal y comparativo de manera voluntaria con previo consentimiento informado. Resultados: La lámina de plástico permite un menor tiempo de intubación, menos intentos de laringoscopía y disminuye dificultades de abordaje, además genera un grado de satisfacción mayor en el personal en comparación con dispositivos rígidos como la caja de acrílico. Conclusiones: Es posible obtener buenos resultados para instrumentar la vía aérea cuando se utilizan dispositivos de barrera adicional en personal entrenado. No obstante, teniendo en cuenta los hallazgos de este trabajo existen ventajas con el uso de lámina de plástico.
Abstract: Introduction: The use of additional barrier devices for endotracheal intubation constitutes a challenge for medical practice during the current pandemic. Multiple tools can be used for patient intubation minimizing operator exposure without compromising procedural safety. Any additional strategy must be properly evaluated and understood by the physician as it could interfere with intubation, increasing handling time. Objective: To compare anesthesiologists' preference between two barrier devices, one designed based on a plastic sheet vs an acrylic box. Material and methods: We included 102 patients who underwent elective and emergency surgeries who voluntarily agreed to participate in this prospective, cross-sectional and comparative study with prior informed consent. Results: The plastic sheet allows a shorter intubation time, fewer laryngoscopy attempts and reduces approach difficulties, in addition it generates a higher degree of satisfaction in the personnel compared to rigid devices such as the acrylic box. Conclusions: It is possible to obtain good results to instrument the airway when additional barrier devices are used in trained personnel. However, taking into account the findings of this work, there are advantages with the use of plastic sheeting.
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INTRODUCTION: Laryngoscopy and endotracheal intubation has been the mainstay in providing adequate airway management, delivering general anaesthesia but are associated with hypertension, tachycardia and arrhythmias. These haemodynamic responses may be more hazardous in hypertensive patients. OBJECTIVE: In this study, we aimed to compare the haemodynamic response elicited by laryngoscopic endotracheal intubation with laryngeal mask airway insertion, in ASA II of adult hypertensive patients. METHODS: The study conducted on 100 hypertensive patients of either sex aged between 20 and 60 years belonging to ASA II grade and scheduled for elective surgery. The patients were randomly divided into two groups of 50 patients each. In one group (Group I) laryngoscopic endotracheal intubation was done and in another group (Group II) laryngeal mask airway was inserted. Baseline vitals of the patients (SBP, DBP, MAP, HR, SpO2) were documented. Patients were given inj. Midazolam 2mg IM and Phenargan 25 mg IM as premedication before the elective surgery. General anaesthesia was administered. Haemodynamics including heart rate, blood pressure and SpO2 were recorded every minute till intubation or insertion and at 1,3,5 minutes after intubation or insertion and then every 5 minutes till 20 minutes. RESULTS: All the haemodynamic responses (SBP,DBP,MAP,HR) in Laryngoscopy + Endotracheal Intubation Group compared to the Laryngeal Mask Airway Insertion Group was statistically signi?cant as the p value is <0.05. CONCLUSION: The laryngeal mask airway may be used for airway management during anaesthesia in hypertensive patients on treatment in whom the pressor response would be deleterious.
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RESUMEN Introducción: La fístula traqueoesofágica consecutiva a intubación endotraqueal prolongada es una lesión grave con elevada morbimortalidad. El alto índice de sospecha, diagnóstico precoz, resolución de las complicaciones y un tratamiento quirúrgico definitivo son los pilares fundamentales en los cuales descansa su manejo correcto. Objetivo: Describir el comportamiento y manejo de la fístula traqueoesofágica en pacientes con intubación endotraqueal prolongada. Presentación del caso: Paciente de 34 años de edad que sufrió trauma craneoencefálico grave con necesidad de intubación endotraqueal prolongada. Su evolución fue favorable, con recuperación neurológica, pero presentaba tos incontrolable después de la deglución, aumento de las secreciones respiratorias y pérdida de 30 Kg de peso no resuelta, lo que motivó se le realizara tomografía computarizada multicorte dual sincronizada con el electrocardiograma, la que permitió de forma rápida y no invasiva, llegar al diagnóstico de la fístula traqueoesofágica. Conclusiones: La intubación endotraqueal prolongada constituye la causa principal de la aparición de la fístula traqueoesofágica. El mecanismo de producción fundamental fue la isquemia provocada por la compresión de las paredes posterior de la tráquea y anterior del esófago entre el manguito insuflado del tubo endotraqueal y la sonda nasogástrica. La tomografía computarizada multicorte dual sincronizada con el electrocardiograma permite realizar el diagnóstico de esta complicación.
ABSTRACT Introduction: Tracheoesophageal fistula following prolonged endotracheal intubation is a serious lesion with high morbidity and mortality. The high index of suspicion, early diagnosis, resolution of complications and definitive surgical treatment are the fundamental pillars on which its correct management rests. Objective: Describe the behavior and management of tracheoesophageal fistula in patients with prolonged endotracheal intubation. Case Presentation: A 34-year-old patient who suffered severe head trauma with the need of prolonged endotracheal intubation. His evolution was favorable, with neurological recovery, but he presented uncontrollable cough after swallowing, increased respiratory secretions and unsolved loss of 30 Kg of weight, which motivated to perform to him a dual multi-cut computed tomography synchronized with the electrocardiogram, which allowed quickly and non-invasively, to reach the diagnosis of tracheoesophageal fistula. Conclusions: Prolonged endotracheal intubation is the main cause of the appearance of tracheoesophageal fistula. The fundamental production mechanism was ischemia caused by compression of the posterior walls of the trachea and anterior walls of the esophagus between the inflated cuff of the endotracheal tube and the nasogastric tube. The dual multi-cut computed tomography synchronized with the electrocardiogram allows the diagnosis of this complication.