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4.
Anaesthesist ; 69(5): 316-322, 2020 05.
Artigo em Alemão | MEDLINE | ID: mdl-32333024

RESUMO

The current coronavirus disease 2019 (Covid-19) pandemia is a highly dynamic situation characterized by therapeutic and logistic uncertainties. Depending on the effectiveness of social distancing, a shortage of intensive care respirators must be expected. Concomitantly, many physicians and nursing staff are unaware of the capabilities of alternative types of ventilators, hence being unsure if they can be used in intensive care patients. Intensive care respirators were specifically developed for the use in patients with pathological lung mechanics. Nevertheless, modern anesthesia machines offer similar technical capabilities including a number of different modes. However, conceptual differences must be accounted for, requiring close monitoring and the presence of trained personnel. Modern transport ventilators are mainly for bridging purposes as they can only be used with 100% oxygen in contaminated surroundings. Unconventional methods, such as "ventilator-splitting", which have recently received increasing attention on social media, cannot be recommended. This review intends to provide an overview of the conceptual and technical differences of different types of mechanical ventilators.


Assuntos
Anestesia Geral , Infecções por Coronavirus , Cuidados Críticos , Pandemias , Pneumonia Viral , Respiração Artificial/instrumentação , Ventiladores Mecânicos , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Humanos , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia
5.
Medicine (Baltimore) ; 99(12): e19525, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32195955

RESUMO

BACKGROUND: To assess the arterial oxygen partial pressure (PaO2) at defined time points during preoxygenation and to compare high-flow heated humidified nasal oxygenation with standard preoxygenation using oxygen insufflation via a facemask for at least 5 minutes, before intubation during induction of general anesthesia. METHODS: This randomized, single-blinded, prospective study will be conducted in patients undergoing head and neck surgery. After standard monitoring, the artery catheter at the radial artery or dorsalis pedis artery will be placed and arterial blood gas analysis (ABGA) for baseline values will be performed simultaneously. Each group will be subjected to 1 of 2 preoxygenation methods (high-flow nasal cannula or simple facemask) for 5 minutes, and ABGA will be performed twice. After confirming intubation, we will start mechanical ventilation and check the vital signs and perform the final ABGA. DISCUSSION: This trial aims to examine the trajectory of PaO2 levels during the whole preoxygenation procedure and after intubation. We hypothesize that preoxygenation with the high-flow nasal cannula will be superior to that with the face mask. STUDY REGISTRATION: This trial was registered with the Clinical Trial Registry (NCT03896906; ClinicalTrials.gov).


Assuntos
Anestesia Geral/tendências , Monitorização Transcutânea dos Gases Sanguíneos/métodos , Cabeça/cirurgia , Oxigenação Hiperbárica/tendências , Pescoço/cirurgia , Gasometria , Cânula/normas , Cânula/estatística & dados numéricos , Humanos , Intubação Intratraqueal/métodos , Máscaras/normas , Máscaras/estatística & dados numéricos , Ventilação não Invasiva/instrumentação , Ventilação não Invasiva/métodos , Oxigênio/sangue , Estudos Prospectivos , Artéria Radial/cirurgia , Respiração Artificial/instrumentação , Respiração Artificial/métodos , Dispositivos de Acesso Vascular/normas
6.
Med. intensiva (Madr., Ed. impr.) ; 44(1): 18-26, ene.-feb. 2020. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-ET2-4792

RESUMO

Objetivo: Evaluar si existe asociación entre obesidad y mortalidad en la Unidad de Cuidados Intensivos (UCI) en pacientes adultos que reciben ventilación mecánica invasiva. Diseño: Revisión sistemática con metaanálisis. Ámbito: UCI. Fuente de datos: Se realizó una búsqueda en las bases de datos MEDLINE, Cochrane Library, CINAHL y Global Health sin restricción de lenguaje, hasta el 21 de febrero del año 2017. Selección de estudios: Se incluyeron estudios que informaron mortalidad en UCI en pacientes obesos versus no obesos que recibieron VMI. Variables principal: Mortalidad en UCI. Resultados: Se hallaron 2.163 artículos, de los cuales se incluyeron 14 estudios. No se encontraron diferencias estadísticamente significativas entre los pacientes obesos y no obesos respecto a la variable mortalidad en UCI (odds ratio: 0,94; intervalo de confianza del 95%: 0,81-1,10; p=0,45). Conclusión: No se halló relación entre el subgrupo de pacientes adultos obesos que reciben VMI y la variable mortalidad en UCI


Objective: To evaluate if there is an association between obesity and mortality in the Intensive Care Unit (ICU) in adult patients receiving invasive mechanical ventilation. Design: Systematic review with meta-analysis. Scope: ICU. Data source: A search was made in MEDLINE, Cochrane Library, CINAHL and Global Health databases without language restriction, until February 21, 2017. Selection of studies: Studies that reported mortality in the ICU in obese versus non-obese patients who received IMV were included. Main variables: Mortality in the ICU. Results: 2163 articles were found, of which 14 studies were included. No statistically significant differences were found between obese and non-obese patients with respect to the variable mortality in the ICU (OR: 0.94, 95% CI: 0.81-1.10, P=.45). Conclusion: No relationship was found between the subgroup of obese adult patients receiving IMV and the mortality variable in the ICU


Assuntos
Humanos , Adulto , Obesidade/mortalidade , Respiração Artificial/instrumentação , Cuidados Críticos/métodos , Unidades de Terapia Intensiva , Fatores de Risco , Índice de Massa Corporal , Análise Estatística
7.
Crit Care ; 24(1): 67, 2020 02 26.
Artigo em Inglês | MEDLINE | ID: mdl-32102693

RESUMO

BACKGROUND: The effect of alternative spontaneous breathing trial (SBT) techniques on extubation success and other clinically important outcomes is uncertain. A systematic review and meta-analysis was performed to clarify the preferable SBT (T-piece or pressure support ventilation [PSV]). METHODS: We searched the PubMed, Cochrane, and Embase databases for randomized controlled trials (RCTs) from inception to the 31st of July 2019. We included RCTs involving adult patients (> 18 years) who underwent at least two different SBT methods. All authors reported our primary outcome of successful extubation rate and clearly compared PS versus T-piece with clinically relevant secondary outcomes (rate of reintubation, ICU and hospital length of stay, and ICU and hospital mortality). Results were expressed as odds ratio (OR) and mean difference (MD) with accompanying 95% confidence interval (CI). RESULTS: Ten RCTs including 3165 patients were included. The results of this meta-analysis showed that there was no significant difference in the successful extubation rate between the T-piece group and PS group (odds ratio [OR] = 0.91; 95% CI, 0.78-1.07; P = 0.27; I2 = 79%). In addition, compared with the PS group, the T-piece group showed no significant difference in the rate of reintubation (odds ratio [OR] = 0.99; 95% CI, 0.78-1.26; P = 0.95; I2 = 5%), ICU mortality (odds ratio [OR] = 1.22; 95% CI, 0.83-1.80; P = 0.30; I2 = 0%), hospital mortality (odds ratio [OR] = 1.36; 95% CI, 0.99-1.87; P = 0.06; I2 = 19%), ICU length of stay (mean difference = - 0.10; 95% CI, - 0.59 to 0.39; P = 0.69; I2 = 13%), and hospital length of stay (mean difference = - 0.82;95% CI, - 2.2 to 0.55; P = 0.24; I2 = 0%). CONCLUSIONS: T-piece and PSV as SBTs are considered to have comparable predictive power of successful extubation in critically ill patients. The analysis of secondary outcomes also shows no significant difference in the rate of reintubation, ICU and hospital length of stay, and ICU and hospital mortality between the two groups. Further randomized controlled studies of SBTs are still required.


Assuntos
Extubação , Respiração Artificial , Desmame do Respirador , Extubação/métodos , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva , Intubação Intratraqueal , Razão de Chances , Respiração Artificial/instrumentação , Respiração Artificial/métodos , Resultado do Tratamento , Desmame do Respirador/instrumentação , Desmame do Respirador/métodos
8.
JAMA ; 323(5): 455-465, 2020 02 04.
Artigo em Inglês | MEDLINE | ID: mdl-32016309

RESUMO

Importance: The association of home noninvasive positive pressure ventilation (NIPPV) with outcomes in chronic obstructive pulmonary disease (COPD) and hypercapnia is uncertain. Objective: To evaluate the association of home NIPPV via bilevel positive airway pressure (BPAP) devices and noninvasive home mechanical ventilator (HMV) devices with clinical outcomes and adverse events in patients with COPD and hypercapnia. Data Sources: Search of MEDLINE, EMBASE, SCOPUS, Cochrane Central Registrar of Controlled Trials, Cochrane Database of Systematic Reviews, National Guideline Clearinghouse, and Scopus for English-language articles published from January 1, 1995, to November 6, 2019. Study Selection: Randomized clinical trials (RCTs) and comparative observational studies that enrolled adults with COPD with hypercapnia who used home NIPPV for more than 1 month were included. Data Extraction and Synthesis: Data extraction was completed by independent pairs of reviewers. Risk of bias was evaluated using the Cochrane Collaboration risk of bias tool for RCTs and select items from the Newcastle-Ottawa Scale for nonrandomized studies. Main Outcomes and Measures: Primary outcomes were mortality, all-cause hospital admissions, need for intubation, and quality of life at the longest follow-up. Results: A total of 21 RCTs and 12 observational studies evaluating 51 085 patients (mean [SD] age, 65.7 [2.1] years; 43% women) were included, among whom there were 434 deaths and 27 patients who underwent intubation. BPAP compared with no device was significantly associated with lower risk of mortality (22.31% vs 28.57%; risk difference [RD], -5.53% [95% CI, -10.29% to -0.76%]; odds ratio [OR], 0.66 [95% CI, 0.51-0.87]; P = .003; 13 studies; 1423 patients; strength of evidence [SOE], moderate), fewer patients with all-cause hospital admissions (39.74% vs 75.00%; RD, -35.26% [95% CI, -49.39% to -21.12%]; OR, 0.22 [95% CI, 0.11-0.43]; P < .001; 1 study; 166 patients; SOE, low), and lower need for intubation (5.34% vs 14.71%; RD, -8.02% [95% CI, -14.77% to -1.28%]; OR, 0.34 [95% CI, 0.14-0.83]; P = .02; 3 studies; 267 patients; SOE, moderate). There was no significant difference in the total number of all-cause hospital admissions (rate ratio, 0.91 [95% CI, 0.71-1.17]; P = .47; 5 studies; 326 patients; SOE, low) or quality of life (standardized mean difference, 0.16 [95% CI, -0.06 to 0.39]; P = .15; 9 studies; 833 patients; SOE, insufficient). Noninvasive HMV use compared with no device was significantly associated with fewer all-cause hospital admissions (rate ratio, 0.50 [95% CI, 0.35-0.71]; P < .001; 1 study; 93 patients; SOE, low), but not mortality (21.84% vs 34.09%; RD, -11.99% [95% CI, -24.77% to 0.79%]; OR, 0.56 [95% CI, 0.29-1.08]; P = .49; 2 studies; 175 patients; SOE, insufficient). There was no statistically significant difference in the total number of adverse events in patients using NIPPV compared with no device (0.18 vs 0.17 per patient; P = .84; 6 studies; 414 patients). Conclusions and Relevance: In this meta-analysis of patients with COPD and hypercapnia, home BPAP, compared with no device, was associated with lower risk of mortality, all-cause hospital admission, and intubation, but no significant difference in quality of life. Noninvasive HMV, compared with no device, was significantly associated with lower risk of hospital admission, but there was no significant difference in mortality risk. However, the evidence was low to moderate in quality, the evidence on quality of life was insufficient, and the analyses for some outcomes were based on small numbers of studies.


Assuntos
Respiração com Pressão Positiva/métodos , Doença Pulmonar Obstrutiva Crônica/terapia , Respiração Artificial/métodos , Serviços de Assistência Domiciliar , Hospitalização , Humanos , Hipercapnia/etiologia , Ventilação não Invasiva/instrumentação , Respiração com Pressão Positiva/instrumentação , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/mortalidade , Qualidade de Vida , Respiração Artificial/instrumentação , Resultado do Tratamento
9.
Artigo em Português | LILACS | ID: biblio-1087831

RESUMO

Introdução: o novo coronavírus é semelhante a outras pneumonias coronavirais e também pode levar à síndrome do desconforto respiratório agudo. Métodos: comunicação breve sobre as repercussões pulmonares causadas pela doença e uso da ventilação mecânica invasiva. Resultados: a ventilção mecânica invasiva é a forma de tratamento adequada para pacientes com saturação abaixo de 92%, pressão arterial de O2 abaixo de 65 mm/Hg com ou sem hipercapnia, frequência respiratória > 30 ipm e piora clínica. Conclusão: o uso da ventilação não invasiva ou de oxigenoterapia nasal de alto fluxo não é recomendado na rotina.(AU)


Introduction: the novel coronavirus is similar to other coronaviral pneumonias, and can also lead to acute respiratory distress syndrome. Methods: brief communication about the pulmonary repercussions caused by the disease and the use of invasive mechanical ventilation. Results: Invasive mechanical ventilation is the appropriate form of treatment for patients with saturation below 92%, oxygen arterial pressure below 65 mm /hg with or without hypercapnia, respiratory rate> 30 ipm and clinical worsening. Conclusion: the use of non-invasive ventilation or high-flow nasal oxygen therapy is not recommended in routine.


Assuntos
Humanos , Pneumonia Viral/terapia , Respiração Artificial/instrumentação , Infecções por Coronavirus/terapia , Oxigenoterapia/instrumentação
10.
Rev. chil. anest ; 49(2): [1-9], 2020.
Artigo em Espanhol | LILACS | ID: biblio-1087930

RESUMO

La pandemia de COVID-19 producida por SARS-CoV-2 actualmente en curso anticipa una gran demanda por ventiladores mecánicos (VM), ya que un porcentaje relevante de los contagiados cae rápidamente en insuficiencia respiratoria y requiere de cuidados intensivos. Anticipándose a ese exceso de demanda y considerando que es muy probable que el número actual de ventiladores mecánicos en las unidades de cuidados intensivos (UCI) sean insuficientes, se ha solicitado a la SACH un informe técnico en relación al uso de las máquinas de anestesia como VM.


Assuntos
Pneumonia Viral/terapia , Respiração Artificial/instrumentação , Ventiladores Mecânicos/provisão & distribução , Infecções por Coronavirus/terapia , Betacoronavirus , Pneumonia Viral/epidemiologia , Chile/epidemiologia , Pandemias , Anestesia/métodos
11.
Scand J Trauma Resusc Emerg Med ; 27(1): 93, 2019 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-31640797

RESUMO

BACKGROUND: Studies have shown that providing adequate ventilation during CPR is essential. While hypoventilation is often feared by most caregivers on the scene, the most critical problem remains hyperventilation. We developed a Ventilation Feedback Device (VFD) for manual ventilation which monitors ventilatory parameters and provides direct feedback about ventilation quality to the rescuer. This study aims to compare the quality of conventional manual ventilation to ventilation with VFD on a simulated respiratory arrest patient. METHODS: Forty healthcare providers were enrolled and instructed to ventilate a manikin simulating respiratory arrest. Participants were instructed to ventilate the manikin for 5 min with and without the VFD in random order. They were divided in two groups of 20 people, one group ventilating through a mask and the other through an endotracheal tube. RESULTS: Ventilation with the VFD improved from 15 to 90% (p < 0.001) with the mask and from 15 to 85% (p < 0.001) with the endotracheal tube (ETT) by significantly reducing the proportion of hyperventilation. The mean ventilation rates and tidal volumes were in the recommended ranges in respectively 100% with the mask and 97.5% of participants with the ETT when using the VFD. CONCLUSION: VFD improves the performance of manual ventilation by over 70% in different simulated scenarios. By providing the rescuer direct feedback and analysis of ventilatory parameters, this device can significantly improve ventilation while performing CPR and thus save lives.


Assuntos
Parada Cardíaca/terapia , Respiração Artificial/instrumentação , Respiração Artificial/métodos , Adulto , Estudos Cross-Over , Retroalimentação , Feminino , Humanos , Masculino , Manequins , Volume de Ventilação Pulmonar
12.
Einstein (Sao Paulo) ; 18: eAO4805, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31644676

RESUMO

OBJECTIVE: To simulate different diameters of endotracheal tubes and to verify the fluid dynamics aspects by means of flow and resistance measurements. METHODS: Fluid dynamics software was used to calculate mean flow and airway resistance in endotracheal tube with a diameter of 6.0, 7.0, 7.5, 8.0, 9.0 and 10.0mm at normal body temperature and under constant pressure. The same measurements were taken in the fusion of the first 22cm of a 9.0mm endotracheal tube with 10.0mm diameter, and with the end part in 12cm of a 6.0mm endotracheal tube with 7.0mm diameter. RESULTS: The fusion of the first 22cm of an endotracheal tube of 10.0mm diameter with the terminal part in 12cm of an endotracheal tube of 6.0mm diameter, preserving the total length of 34cm, generated average flow and airway resistance similar to that of a conventional 7.5mm endotracheal tube. CONCLUSION: This simulation study demonstrates that a single-sized endotracheal tube may facilitate endotracheal intubation without causing increased airway resistance.


Assuntos
Simulação por Computador , Desenho de Equipamento/instrumentação , Intubação Intratraqueal/instrumentação , Resistência das Vias Respiratórias , Intubação Intratraqueal/métodos , Respiração Artificial/instrumentação
13.
Vet Clin North Am Exot Anim Pract ; 22(3): 419-439, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31395323

RESUMO

Even when performed by skilled operators, locating the nerves can be challenging in small exotic pets; in such cases, the use of an electrical nerve stimulator may be useful to confirm the correct identification of the target nerve. Exotic animal anesthesia and analgesia have dramatically progressed over the past decade and continue to do so as more research and technologies develop. Technological advancements such as airway devices, endoscopic intubation techniques, positive intermittent pressure ventilators, and invasive and noninvasive blood pressure monitors have played a significant role in improving patient safety and the anesthetic outcomes of exotic animals.


Assuntos
Analgesia/veterinária , Anestesia/veterinária , Animais Exóticos/fisiologia , Manuseio das Vias Aéreas/instrumentação , Manuseio das Vias Aéreas/métodos , Manuseio das Vias Aéreas/normas , Manuseio das Vias Aéreas/veterinária , Analgesia/tendências , Anestesia/tendências , Anestésicos/administração & dosagem , Animais , Aves/fisiologia , Determinação da Pressão Arterial/métodos , Determinação da Pressão Arterial/normas , Determinação da Pressão Arterial/veterinária , Endoscopia/instrumentação , Endoscopia/métodos , Endoscopia/tendências , Endoscopia/veterinária , Humanos , Mamíferos/fisiologia , Bloqueio Nervoso/instrumentação , Bloqueio Nervoso/métodos , Bloqueio Nervoso/tendências , Bloqueio Nervoso/veterinária , Manejo da Dor , Respiração Artificial/instrumentação , Respiração Artificial/métodos , Respiração Artificial/tendências , Respiração Artificial/veterinária
14.
Pediatr Cardiol ; 40(8): 1633-1637, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31468061

RESUMO

We sought to assess acute hemodynamic changes after implementation of negative extrathoracic pressure (NEP) in spontaneously breathing ambulatory Fontan patients with symptomatic heart failure. We hypothesized that application of NEP would result in an acute decrease in pulmonary artery pressure. Ten patients with clinical evidence of Fontan failure underwent baseline hemodynamic catheterization while breathing spontaneously. Hemodynamic measurements were then repeated after 30 min of continuous NEP. After 30 min of continuous NEP, 4/10 patients had a decrease in their Fontan pressure by 2 mmHg and one patient had a decrease by 1 mmHg. There were three patients that had an increase in Fontan pressure by 2 mmHg. In 7/10 patients, indexed pulmonary vascular resistance decreased by an average of 31%. In symptomatic Fontan patients with a favorable hemodynamic response to NEP during catheterization, potential benefit of longer-term NEP to improve clinical status should be explored.


Assuntos
Técnica de Fontan/efeitos adversos , Respiração Artificial/instrumentação , Respiradores de Pressão Negativa , Adolescente , Adulto , Criança , Feminino , Insuficiência Cardíaca/cirurgia , Hemodinâmica/fisiologia , Humanos , Masculino , Projetos Piloto , Adulto Jovem
15.
Crit Care ; 23(1): 245, 2019 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-31277722

RESUMO

BACKGROUND: In critically ill patients, poor patient-ventilator interaction may worsen outcomes. Although sedatives are often administered to improve comfort and facilitate ventilation, they can be deleterious. Whether opioids improve asynchronies with fewer negative effects is unknown. We hypothesized that opioids alone would improve asynchronies and result in more wakeful patients than sedatives alone or sedatives-plus-opioids. METHODS: This prospective multicenter observational trial enrolled critically ill adults mechanically ventilated (MV) > 24 h. We compared asynchronies and sedation depth in patients receiving sedatives, opioids, or both. We recorded sedation level and doses of sedatives and opioids. BetterCare™ software continuously registered ineffective inspiratory efforts during expiration (IEE), double cycling (DC), and asynchrony index (AI) as well as MV modes. All variables were averaged per day. We used linear mixed-effects models to analyze the relationships between asynchronies, sedation level, and sedative and opioid doses. RESULTS: In 79 patients, 14,166,469 breaths were recorded during 579 days of MV. Overall asynchronies were not significantly different in days classified as sedatives-only, opioids-only, and sedatives-plus-opioids and were more prevalent in days classified as no-drugs than in those classified as sedatives-plus-opioids, irrespective of the ventilatory mode. Sedative doses were associated with sedation level and with reduced DC (p < 0.0001) in sedatives-only days. However, on days classified as sedatives-plus-opioids, higher sedative doses and deeper sedation had more IEE (p < 0.0001) and higher AI (p = 0.0004). Opioid dosing was inversely associated with overall asynchronies (p < 0.001) without worsening sedation levels into morbid ranges. CONCLUSIONS: Sedatives, whether alone or combined with opioids, do not result in better patient-ventilator interaction than opioids alone, in any ventilatory mode. Higher opioid dose (alone or with sedatives) was associated with lower AI without depressing consciousness. Higher sedative doses administered alone were associated only with less DC. TRIAL REGISTRATION: ClinicalTrial.gov, NCT03451461.


Assuntos
Analgésicos Opioides/uso terapêutico , Hipnóticos e Sedativos/uso terapêutico , Respiração Artificial/métodos , Mecânica Respiratória/efeitos dos fármacos , Idoso , Analgésicos Opioides/efeitos adversos , Analgésicos Opioides/farmacologia , Estado Terminal/terapia , Feminino , Humanos , Hipnóticos e Sedativos/efeitos adversos , Hipnóticos e Sedativos/farmacologia , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Respiração Artificial/efeitos adversos , Respiração Artificial/instrumentação , Espanha
16.
Saudi Med J ; 40(7): 694-700, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31287130

RESUMO

OBJECTIVES: To compare the clinical performance of the baska mask (PTY Ltd, Australia), i-gel (Intersurgical Ltd, UK) and classic laryngeal mask airway (cLMA) in adult patients undergoing outpatient urologic interventions. METHODS: One hundred fifty patients with American Society of Anesthesiologists I-III physical status were enrolled between January 2017 and September 2017 in Yuksek Ihtisas Research and Educational Hospital, Ankara, Turkey for elective urological surgery for this prospective randomized controlled trial. There were 50 patients in each of the following groups: baska mask, i-gel, and cLMA. In each group, the insertion times, ventilation times, 'first attempt' success rates, airway dynamics-complications and hemodynamic variables were evaluated. RESULTS: No statistically significant values were observed in means of demographic data, airway dynamics, complications, and hemodynamic variables. Insertion and ventilation times were different between groups (p less than 0.001 for each). In cLMA group, insertion and ventilation times were found to be shorter than others (insertion times 5.78±1.72 seconds and ventilation times 11.72±4.72 seconds). The longest insertion and ventilation times were observed in baska mask with 12.04±6.25 and 21.26±8.53 seconds. The 'first attempt' success rates were 98% for cLMA, 92% for i-gel, and 88% for baska mask. The addition maneuvering requirements in baska mask group was  20% (40/10). Conclusion: When cLMA, i-gel and baska mask are compared regarding insertion and ventilating times, first attempt success rates, and additional maneuvers, cLMA and i-gel are superior to baska mask in urological ambulatory surgical cases.


Assuntos
Anestesia Geral/métodos , Máscaras Laríngeas , Respiração Artificial/instrumentação , Adulto , Idoso , Procedimentos Cirúrgicos Ambulatórios , Transtornos de Deglutição/epidemiologia , Feminino , Hemodinâmica , Humanos , Masculino , Máscaras , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Fatores de Tempo , Procedimentos Cirúrgicos Urológicos
17.
Trials ; 20(1): 444, 2019 Jul 19.
Artigo em Inglês | MEDLINE | ID: mdl-31324213

RESUMO

BACKGROUND: Intrapartum-related death is the third leading cause of under-5 mortality. Effective ventilation during neonatal resuscitation has the potential to reduce 40% of these deaths. Face-mask ventilation performed by midwives is globally the most common method of resuscitating neonates. It requires considerable operator skills and continuous training because of its complexity. The i-gel® is a cuffless supraglottic airway which is easy to insert and provides an efficient seal that prevents air leakage; it has the potential to enhance performance in neonatal resuscitation. A pilot study in Uganda demonstrated that midwives could safely resuscitate newborns with the i-gel® after a short training session. The aim of the present trial is to investigate whether the use of a cuffless supraglottic airway device compared with face-mask ventilation during neonatal resuscitation can reduce mortality and morbidity in asphyxiated neonates. METHODS: A randomized phase III open-label superiority controlled clinical trial will be conducted at Mulago Hospital, Kampala, Uganda, in asphyxiated neonates in the delivery units. Prior to the intervention, health staff performing resuscitation will receive training in accordance with the Helping Babies Breathe curriculum with a special module for training on supraglottic airway insertion. A total of 1150 to 1240 babies (depending on cluster size) that need positive pressure ventilation and that have an expected gestational age of more than 34 weeks and an expected birth weight of more than 2000 g will be ventilated by daily unmasked randomization with a supraglottic airway device (i-gel®) (intervention group) or with a face mask (control group). The primary outcome will be a composite outcome of 7-day mortality and admission to neonatal intensive care unit (NICU) with neonatal encephalopathy. DISCUSSION: Although indications for the beneficial effect of a supraglottic airway device in the context of neonatal resuscitation exist, so far no large studies powered to assess mortality and morbidity have been carried out. We hypothesize that effective ventilation will be easier to achieve with a supraglottic airway device than with a face mask, decreasing early neonatal mortality and brain injury from neonatal encephalopathy. The findings of this trial will be important for low and middle-resource settings where the majority of intrapartum-related events occur. TRIAL REGISTRATION: ClinicalTrials.gov. Identifier: NCT03133572 . Registered April 28, 2017.


Assuntos
Asfixia Neonatal/terapia , Países em Desenvolvimento , Acesso aos Serviços de Saúde , Intubação Intratraqueal/instrumentação , Máscaras Laríngeas , Respiração Artificial/instrumentação , Ressuscitação/instrumentação , Asfixia Neonatal/diagnóstico , Asfixia Neonatal/mortalidade , Ensaios Clínicos Fase III como Assunto , Países em Desenvolvimento/economia , Desenho de Equipamento , Estudos de Equivalência como Asunto , Acesso aos Serviços de Saúde/economia , Mortalidade Hospitalar , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Intubação Intratraqueal/efeitos adversos , Intubação Intratraqueal/mortalidade , Respiração Artificial/efeitos adversos , Respiração Artificial/mortalidade , Ressuscitação/efeitos adversos , Ressuscitação/mortalidade , Fatores de Tempo , Resultado do Tratamento , Uganda
18.
Afr Health Sci ; 19(1): 1563-1565, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31148984

RESUMO

Background: Neonatal resuscitation is a method of preventing morbidities & mortality from asphyxia. Up to 85% of facilities in sub-Saharan Africa lack supplies or skilled personnel for neonatal resuscitation. Relative to the place of birth and the skill of the birth attendant, a variety of resuscitative practice are employed to make babies cry instead of helping the baby breathe. Many painful procedures are applied when the baby is unable to cry after birth in the absence of a health care worker trained in bag-mask ventilation. Objectives: To ascertain the resuscitation practices in communities lacking bag-mask-valve devices. Methods: Surveys on the resuscitation practices during NISONM annual community outreach and mENCC trainings for four consecutive years in different geopolitical zones of the country. Results: Spanking of the baby usually in the upside down position (>90%), body massage with hot compress or salicylate containing balms, herbal concoctions, injection hydrocortisone or crystalline penicillin were used. Conclusion: There is an urgent need to address the issue of training on bag-mask ventilation and provision for frontline healthcare workers in Nigeria as a neonatal mortality reduction strategy.


Assuntos
Asfixia Neonatal/terapia , Reanimação Cardiopulmonar/instrumentação , Equipamentos e Provisões/provisão & distribução , Instalações de Saúde/estatística & dados numéricos , Respiração Artificial/instrumentação , Ressuscitação , Competência Clínica , Feminino , Humanos , Recém-Nascido , Nigéria , Gravidez
19.
A A Pract ; 13(7): 257-259, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31206378

RESUMO

One of the many safety features of modern day anesthesia machines is the adjustable pressure limiting (APL) valve. This device regulates pressure within the anesthesia circuit during manual ventilation with the anesthesia bag. We report an unusual case where a crack in the APL valve allowed release of pressure from within the circuit resulting in ineffective bag-valve-mask ventilation of an infant. The appropriate steps to prevent such issues are reviewed, and an algorithm to quickly identify such intraoperative problems is presented.


Assuntos
Doenças das Valvas Cardíacas/terapia , Respiração Artificial/instrumentação , Pressão do Ar , Procedimentos Cirúrgicos Eletivos , Humanos , Hidrocefalia/cirurgia , Lactente , Cuidados Intraoperatórios , Resultado do Tratamento , Derivação Ventriculoperitoneal
20.
Crit Care ; 23(1): 217, 2019 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-31196203

RESUMO

BACKGROUND: Oesophageal pressure (PES) is used for calculation of lung and chest wall mechanics and transpulmonary pressure during mechanical ventilation. Measurements performed with a balloon catheter are suggested as a basis for setting the ventilator; however, measurements are affected by several factors. High-resolution manometry (HRM) simultaneously measures pressures at every centimetre in the whole oesophagus and thereby provides extended information about oesophageal pressure. The aim of the present study was to evaluate the factors affecting oesophageal pressure using HRM. METHODS: Oesophageal pressure was measured using a high-resolution manometry catheter in 20 mechanically ventilated patients (15 in the ICU and 5 in the OR). Different PEEP levels and different sizes of tidal volume were applied while pressures were measured continuously. In 10 patients, oesophageal pressure was also measured using a conventional balloon catheter for comparison. A retrospective analysis of oesophageal pressure measured with HRM in supine and sitting positions in 17 awake spontaneously breathing patients is also included. RESULTS: HRM showed large variations in end-expiratory PES (PESEE) and tidal changes in PES (ΔPES) along the oesophagus. Mean intra-individual difference between the minimum and maximum end-expiratory oesophageal pressure (PESEE at baseline PEEP) and tidal variations in oesophageal pressure (ΔPES at tidal volume 6 ml/kg) recorded by HRM in the different sections of the oesophagus was 23.7 (7.9) cmH2O and 7.6 (3.9) cmH2O respectively. Oesophageal pressures were affected by tidal volume, level of PEEP, part of the oesophagus included and patient positioning. HRM identified simultaneous increases and decreases in PES within a majority of individual patients. Compared to sitting position, supine position increased PESEE (mean difference 12.3 cmH2O), pressure variation within individual patients and cardiac artefacts. The pressure measured with a balloon catheter did not correspond to the average pressure measured with HRM within the same part of the oesophagus. CONCLUSIONS: The intra-individual variability in PESEE and ΔPES is substantial, and as a result, the balloon on the conventional catheter is affected by many different pressures along its length. Oesophageal pressures are not only affected by lung and chest wall mechanics but are a complex product of many factors, which is not obvious during conventional measurements. For correct calculations of transpulmonary pressure, factors influencing oesophageal pressures need to be known. HRM, which is available at many hospitals, can be used to increase the knowledge concerning these factors. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02901158.


Assuntos
Esôfago/fisiologia , Intubação Intratraqueal/instrumentação , Manometria/instrumentação , Pressão , Pesos e Medidas/instrumentação , Adulto , Idoso , Feminino , Humanos , Intubação Intratraqueal/métodos , Intubação Intratraqueal/tendências , Pulmão/fisiopatologia , Complacência Pulmonar/fisiologia , Masculino , Manometria/métodos , Manometria/tendências , Pessoa de Meia-Idade , Respiração Artificial/instrumentação , Respiração Artificial/métodos , Mecânica Respiratória/fisiologia , Suécia , Pesos e Medidas/normas
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