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1.
BMJ Open ; 11(10): e052977, 2021 10 06.
Artigo em Inglês | MEDLINE | ID: mdl-34615684

RESUMO

INTRODUCTION: Rapid sequence induction of anaesthesia is indicated in patients with an increased risk of pulmonary aspiration. The main objective of the technique is to reduce the critical time period between loss of airway protective reflexes and rapid inflation of the cuff of the endotracheal tube to minimise the chance of aspiration of gastric contents. The COVID-19 pandemic has reinforced the importance of first-pass intubation success to ensure patient and healthcare worker safety. The aim of this study is to compare the first-pass intubation success rate (FPS) using the videolaryngoscopy compared with conventional direct laryngoscopy in surgical patients with a high risk of pulmonary aspiration. METHODS AND ANALYSIS: The LARA trial is a multicentre, patient-blinded, randomised controlled trial. Consecutive patients requiring tracheal intubation are randomly allocated to either the McGrath MAC videolaryngoscope or direct laryngoscopy using the Macintosh laryngoscope. The expected rate of FPS is 92% in the McGrath group and 82% in the Macintosh group. Each group must include a total of 500 patients to achieve 90% power for detecting a difference at the 5% significance level. Successful intubation with the FPS is the primary endpoint. The secondary endpoints are the time to intubation, the number of intubation attempts, the necessity of airway management alternatives, the visualisation of the glottis using the Cormack and Lehane Score and the Percentage Of Glottic Opening Score and definite adverse events. ETHICS AND DISSEMINATION: The project is approved by the local ethics committee of the Medical Association of the Rhineland Palatine state (registration number: 2020-15502) and medical ethics committee of the University of Freiburg (registration number: 21-1303). The results of this study will be made available in form of manuscripts for publication and presentations at national and international meetings. TRIAL REGISTRATION: NCT04794764.


Assuntos
Anestesia , COVID-19 , Laringoscópios , Humanos , Intubação Intratraqueal/efeitos adversos , Laringoscopia , Estudos Multicêntricos como Assunto , Pandemias , Ensaios Clínicos Controlados Aleatórios como Assunto , Indução e Intubação de Sequência Rápida , SARS-CoV-2
2.
Scand J Trauma Resusc Emerg Med ; 29(1): 128, 2021 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-34461967

RESUMO

BACKGROUND: Metabolic and electrolyte imbalances are some of the reversible causes of cardiac arrest and can be diagnosed even in the pre-hospital setting with a mobile analyser for point-of-care testing (POCT). METHODS: We conducted a retrospective observational study, which included analysing all pre-hospital resuscitations in the study region between October 2015 and December 2016. A mobile POCT analyser (Alere epoc®) was available at the scene of each resuscitation. We analysed the frequency of use of POCT, the incidence of pathological findings, the specific interventions based on POCT as well as every patient's eventual outcome. RESULTS: N = 263 pre-hospital resuscitations were included and in n = 98 of them, the POCT analyser was used. Of these measurements, 64% were performed using venous blood and 36% using arterial blood. The results of POCT showed that 63% of tested patients had severe metabolic acidosis (pH < 7.2 + BE < - 5 mmol/l). Of these patients, 82% received buffering treatment with sodium bicarbonate. Potassium levels were markedly divergent normal (> 6.0 mmol/l/ < 2.5 mmol/l) in 17% of tested patients and 14% of them received a potassium infusion. On average, the pre-hospital treatment time between arrival of the first emergency medical responders and the beginning of transport was 54 (± 20) min without POCT and 60 (± 17) min with POCT (p = 0.07). Overall, 21% of patients survived to hospital discharge (POCT 30% vs no POCT 16%, p = 0.01, Φ = 0.16). CONCLUSIONS: Using a POCT analyser in pre-hospital resuscitation allows rapid detection of pathological acid-base imbalances and potassium concentrations and often leads to specific interventions on scene and could improve the probability of survival.


Assuntos
Reanimação Cardiopulmonar , Parada Cardíaca Extra-Hospitalar , Serviço Hospitalar de Emergência , Humanos , Parada Cardíaca Extra-Hospitalar/diagnóstico , Parada Cardíaca Extra-Hospitalar/terapia , Testes Imediatos , Estudos Retrospectivos
3.
Med Klin Intensivmed Notfmed ; 116(3): 238-244, 2021 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-32055866

RESUMO

BACKGROUND: Several studies have described the successful application of extraglottic airways by lay people to a phantom. OBJECTIVES: This study examined the influence of the training method on the success of the application. METHODS: A total of 150 visitors of a shopping mall were asked to place an i­gel laryngeal mask (Intersurgical GmbH, Sankt Augustin, Germany) on a manikin. The short instruction was randomized and performed either as a practical demonstration or through the self-study of an illustrated manual. RESULTS: Application success in the first attempt was 95.8 % for the practical demonstration group and 78.5 % for the written instruction group (p = 0.001). Placement times were also significantly different (median 11.5 s vs. 22.5 s, p < 0.001). CONCLUSIONS: Learning success can be achieved with both training methods. Initially, a hands-on training should be carried out with a practical demonstration.


Assuntos
Máscaras Laríngeas , Alemanha , Humanos , Intubação Intratraqueal , Manequins
4.
Br J Anaesth ; 116(2): 289-94, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26787800

RESUMO

BACKGROUND: The oesophageal leak pressure is defined as the pressure which breaks the seal between the cuff of a supraglottic airway and the peri-cuff mucosa, allowing penetration of fluid into the pharynx and the oral cavity. As a consequence, a decrease in this variable increases the risk of reflux and can lead to pulmonary aspiration. The aim of this study was to analyse the effects of cuff overinflation and pressure on the neck on the oesophageal leak pressure of seven supraglottic airways. METHODS: Three laryngeal masks, two laryngeal tubes, and two oesophageal-tracheal tubes were tested in an experimental setting. In five human cadavers, we simulated a sudden increase in oesophageal pressure. To measure baseline values (control), we used an intracuff pressure as recommended by the manufacturer. The first intervention included overinflation of the cuff by applying twice the amount of pressure recommended. A second intervention was defined as external pressure on the neck. RESULTS: The oesophageal leak pressure was decreased for laryngeal masks (control, 28 cm H2O; overinflation, 9 cm H2O; pressure on the neck, 8 cm H2O; P<0.01) and for laryngeal tubes (control, 68 cm H2O; overinflation, 37 cm H2O; pressure on the neck, 39 cm H2O; P<0.01) and was unaffected for oesophageal-tracheal tubes (control, 126 cm H2O; overinflation/pressure on the neck, 130 cm H2O; n.s.). CONCLUSION: Cuff overinflation and pressure on the neck can enhance the risk of gastro-oesophageal reflux when using supraglottic airways. Therefore, both manoeuvres should be avoided in clinical practice.


Assuntos
Intubação Intratraqueal/instrumentação , Máscaras Laríngeas/efeitos adversos , Pescoço , Aspiração Respiratória/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Cadáver , Feminino , Humanos , Masculino , Pressão
5.
Br J Anaesth ; 109(3): 454-8, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22661751

RESUMO

BACKGROUND: Supraglottic airway devices (SADs) play an increasing role in airway management in clinical anaesthesia and emergency medicine. Until now, no data exist concerning the extent of oesophageal insufflation when oropharyngeal leak pressures are exceeded. METHODS: Laryngeal masks LMA-Supreme™ and LMA-ProSeal™, laryngeal tubes LTS-D and LTS II, Combitube™, and I-Gel were inserted into unfixed human cadavers. The oesophagus was connected to a volumeter, while the trachea was closed surgically to simulate complete airway obstruction. Volumes of oesophageal insufflation resulting from pressure-controlled ventilation at inspiratory pressures of 20, 40, and 60 mbar were measured. RESULTS: No oesophageal insufflation could be detected at a ventilation pressure of 20 mbar in any device. Using inspiratory pressures of 40 and 60 mbar, oesophageal insufflation occurred in all devices, with significantly higher volumes of intraoesophageal air for both laryngeal tubes. CONCLUSIONS: The use of SADs with inspiratory pressures of 20 mbar appears to be safe regarding the risk of intragastric insufflation. Higher inspiratory pressures should be strictly avoided.


Assuntos
Máscaras Laríngeas , Respiração com Pressão Positiva/instrumentação , Respiração Artificial/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Cadáver , Esôfago , Feminino , Humanos , Insuflação , Masculino
6.
J Int Med Res ; 39(1): 267-76, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21672330

RESUMO

This study investigated improvements in pre-hospital care for patients with acute exacerbated chronic obstructive pulmonary disease (aeCOPD) achieved by using a standard operating procedure (SOP). An SOP for pre-hospital treatment of patients with aeCOPD was designed based on valid national guidelines. A total of 1000 Emergency Medical Service patient care reports were analysed prospectively: 500 before and 500 after introduction of the SOP. Overall guideline adherence was 34.6% before and 53.8% after introduction of the SOP; this increase was not statistically significant. After SOP introduction, the administration of ß(2) mimetics by inhalative, intravenous and subcutaneous routes increased significantly. The level of knowledge of the national guidelines was rated at 67% by emergency physicians during self-assessment, but was only 33% when physicians were asked specific questions during interview. Introducing the SOP for patients with aeCOPD did not significantly improve adherence to valid national guidelines, but did help to improve specific elements of therapy.


Assuntos
Agonistas de Receptores Adrenérgicos beta 2/uso terapêutico , Serviço Hospitalar de Emergência/normas , Fidelidade a Diretrizes/normas , Guias de Prática Clínica como Assunto/normas , Padrões de Prática Médica/normas , Doença Pulmonar Obstrutiva Crônica/terapia , Corticosteroides/uso terapêutico , Broncodilatadores/uso terapêutico , Vias de Administração de Medicamentos , Esquema de Medicação , Alemanha , Humanos , Pacientes Internados , Oxigênio/administração & dosagem , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Autoavaliação (Psicologia) , Inquéritos e Questionários
7.
Resuscitation ; 81(8): 1010-3, 2010 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-20471153

RESUMO

AIM: This study investigates if a n impedance threshold valve (ITV) might improve survival after cardiac arrest by increasing vital organ blood flow. The combination of ITV and supraglottic airway devices (SADs) has not been previously studied. This simulation study in a manikin aimed at analysing differences in ventilation with different SADs without and with an ITV. METHODS: In a resuscitation manikin, cardiopulmonary resuscitation (CPR) was performed with interrupted (30:2) and continuous chest compressions using facemask, tracheal tube and 10 SADs (six different laryngeal masks, LT-D, LTS-D, Combitube((R)) and Easy Tube((R))). Ventilation was performed with and without an ITV. A total of 550 CPR cycles of 3-min duration were performed with chest compressions and ventilation standardised by use of a mechanical thumper device and an emergency ventilator. RESULTS: Sufficient ventilation was possible with all devices tested. For ventilation during continuous chest compressions, there were significantly reduced tidal volumes for all airway devices with ITV use. By contrast, during interrupted chest compressions, no differences in tidal volumes with the ITV occurred in the majority of devices. The maximum reduction of tidal volume for any device was 7.8% of the volume reached without the ITV. CONCLUSION: Based on the findings of this manikin trial, the use of an ITV for ventilation during CPR is possible in combination with supraglottic airway devices. Merging these two strategies warrants further clinical evaluation to judge the relevance of tidal volume reduction found in this trial.


Assuntos
Resistência das Vias Respiratórias/fisiologia , Reanimação Cardiopulmonar/instrumentação , Parada Cardíaca/terapia , Máscaras Laríngeas , Manequins , Modelos Cardiovasculares , Respiração Artificial/instrumentação , Desenho de Equipamento , Humanos , Reprodutibilidade dos Testes
8.
Br J Anaesth ; 102(1): 135-9, 2009 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-19011262

RESUMO

BACKGROUND: Supraglottic airway devices are increasingly used in anaesthesia and emergency medicine. This study was designed to investigate the oesophageal seal of the novel supralaryngeal airway device, I-Gel (I-Gel), in comparison with two of the laryngeal mask airways, Classic (cLMA) and ProSeal (pLMA), in a model of elevated oesophageal pressure. METHODS: The three supralaryngeal airway devices were inserted into eight unfixed cadaver models with exposed oesophagi that had been connected to a water column producing both a slow and a fast oesophageal pressure increase. The pressure applied until the loss of oesophageal seal during a slow and fast pressure increase was measured. RESULTS: During the slow increase of pressure, the pLMA withstood an oesophageal pressure up to a median of 58 cm H(2)O, while the cLMA was able to block the oesophagus up to a median of 37 cm H(2)O, and I-Gel already lost its seal at 13 cm H(2)O. One minute after maximum pressure had been applied, the pLMA withstood an oesophageal pressure of 59 cm H(2)O, the cLMA of 46 cm H(2)O, and I-Gel airway of 21 cm H(2)O. A fast release of oesophageal fluid was accomplished through the oesophageal lumen of both the pLMA and I-Gel. CONCLUSIONS: Both the pLMA and cLMA provided a better seal of the oesophagus than the novel I-Gel airway. The pLMA and I-Gel drain off gastrointestinal fluid fast through the oesophageal lumen. Thus, tracheal aspiration may be prevented with their use. Further study is necessary.


Assuntos
Esôfago/fisiologia , Máscaras Laríngeas , Idoso , Idoso de 80 Anos ou mais , Desenho de Equipamento , Feminino , Humanos , Intubação Intratraqueal/instrumentação , Masculino , Pressão , Aspiração Respiratória/prevenção & controle , Vômito/fisiopatologia
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