Retrograde tracheal intubation: beyond fibreoptic endotracheal intubation.

BACKGROUND: Flexible fibreoptic laryngoscopy is the method of choice for coping with difficult tracheal intubations, a leading cause of catastrophic outcomes in anaesthesia. However, this technique is not always available or feasible. Retrograde intubation is a minimally invasive airway management technique with a flat learning curve and a high level of skill retention. METHODS: A retrospective review of the anaesthesia records of 24 patients who underwent retrograde intubation. The success rate and the incidence of complications were recorded. RESULTS: Retrograde tracheal intubation was successful in all 24 patients. In 21 patients it succeeded on the first attempt. In two patients it succeeded when the technique was changed from sliding over a guide wire to a pulling technique. The most common complication was a sore throat in almost 60% of the patients. Two patients had mild subcutaneous emphysema and one had minimal bleeding at the puncture site. CONCLUSIONS: In these patients retrograde tracheal intubation was easy to perform, had a high success rate and a low incidence of complications. It is a reliable alternative when fibreoptic intubation is precluded, fails or is unavailable.

Continuous venovenous hemofiltration improves intensive care unit, but not hospital survival rate, in nonoliguric septic patients.

PURPOSE: The purpose of this study was to assess the effect of the early institution of continuous veno-venous hemofiltration on survival rates of nonoliguric, septic patients. MATERIALS AND METHODS: A retrospective study of 48 nonoliguric septic patients with PaO(2)/FIO(2) < or = 250, who were admitted to the General Intensive Care of the Soroka Medical Center. Twenty-six patients were treated with continuous venovenous hemofiltration (CVVH group) and 22 were treated by conventional therapy. The end point of treatment was weaning from mechanical ventilation, adequate oxygenation, and the need for minimal cardiocirculatory support. RESULTS: The study groups were similar in terms of age, gender, percentage of surgical or nonsurgical patients, APACHE II scores, and the Therapeutic Intervention Scoring System (TISS). Baseline serum urea and creatinine levels were similar in the groups, but the PAO(2)/FIO(2) ratio was significantly lower in the CVVH group (150.6 +/- 86 vs. 214.2 +/- 8.9). Twenty of the CVVH patients and 10 of the patients receiving conventional therapy were discharged from the intensive care unit (P =.03), but the hospital discharge rate was only slightly higher in the CVVH group (12 of 26) compared with the conventional therapy group (7 of 22) (P =.145). CONCLUSIONS: In this retrospective uncontrolled study, the mortality rate was considerably lower in nonoliguric septic patients who received continuous venovenous hemofiltration early in the course of the disease. The improved survival rate may be due to the ability of CVVH to eliminate mediators involved in the septic process, thus averting the multiple system organ failure consequent to septic insult.