Fiberoptic Intubation vs. Video-Assisted Fiberoptic Intubation in a High-Fidelity Pediatric Simulator: A Randomized Controlled Trial.

INTRODUCTION: Life-threatening hypoxemia during tracheal intubation is more likely to occur in children than adults due to its unique physiological and anatomical nature. Fiberoptic intubation is widely performed in children with difficult airways. However, mastery of fiberoptic intubation requires substantial training, and novice trainees need to attempt fiberoptic intubation in children at high risk of respiratory-related adverse events. Therefore, a safer method than traditional fiberoptic intubation for children with difficult airways is desirable for novice anesthesia trainees. This study aimed to compare the efficacy of video-assisted fiberoptic intubation (VAFI) with that of traditional fiberoptic intubation (FOI) in a high-fidelity pediatric simulator by medical professionals with no experience in tracheal intubation. METHOD: This randomized, controlled, simulation-based study was conducted in a tertiary-care pediatric hospital. Registered nurses working in the operating room were enrolled in this study and randomly assigned to either the FOI or VAFI groups. Participants in the FOI group performed fiberoptic intubation without the aid of any device, whereas those in the VAFI group used a video laryngoscope to obtain a better glottic view. The primary outcome was the time from the moment the tip of the flexible bronchoscope passed between the upper and lower incisors until the completion of tracheal intubation. RESULTS: A total of 28 participants were enrolled in this study. There was no significant difference in the time until the completion of tracheal intubation between FOI and VAFI, with a median time of 55.0 seconds for FOI and 42.5 seconds for VAFI (P = 0.22). Secondary outcomes, including time until passing the vocal cord, the number of intubation attempts, and the first success rate, did not also illustrate the significant difference between the groups. CONCLUSION: This study did not demonstrate the superiority of VAFI over conventional FOI in a high-fidelity pediatric simulator by medical providers with no experience in tracheal intubation.

Is There a Correlation Between Left Ventricular Outflow Tract Velocity Time Integral and Stroke Volume Index in Patients Undergoing Cardiac Surgery?

Introduction Left ventricular outflow tract velocity time integral (LVOT VTI) is a promising surrogate for stroke volume (SV). However, there is controversy in the literature regarding its correlation with thermodilution or newer cardiac output measurement techniques. This study was conducted to determine the correlation between LVOT VTI determined by transesophageal echocardiography (TEE) with stroke volume index (SVI) calculated by thermodilution. Methods Consecutive patients older than 17 years undergoing elective cardiac surgery with pulmonary artery catheter (PAC) and TEE monitoring between September 2021 and February 2022 were included in this prospective, descriptive, single-center study. LVOT VTI was measured using TEE after induction of anesthesia but before skin incision and at least four hours after initial LVOT VTI measurement. SVI was simultaneously measured using the continuous thermodilution technique with a PAC. The correlation between LVOT VTI and SVI was determined with Pearson's correlation index. Results Twelve patients were included and 21 paired measurements were compared. Mean SVI was 31.62 ± 10.71 mL/m2 and mean LVOT VTI was 14.74 ± 4.79 cm. The Pearson's correlation index for the two measurements was r = 0.257, p = 0.262. Conclusion This prospective study demonstrated a weak correlation between LVOT VTI and SVI in patients undergoing cardiac surgery.

Hepatic cyst infection complicated by a hepatobronchial fistula diagnosed with unique features.

A hepatobronchial fistula (HBF) is a rare condition, defined as an abnormal connection of the respiratory system with the liver parenchyma. Although imaging may be helpful for diagnosis, fistulae are often difficult to identify. An 81-year-old woman presented with mild fever and right upper quadrant abdominal pain. Computed tomography (CT) showed bilateral pneumonia and hepatic cyst infection with air-fluid levels. After mechanical ventilation, abdominal CT showed increased air in the hepatic cyst. The drainage bag for the hepatic cyst infection was also inflated by positive pressure ventilation, suggesting a possible HBF. The ventilator was adjusted to minimize pressure on the fistula and prevent retrograde infection. The fistula eventually closed spontaneously. Appropriate antibiotic treatment and continuous drainage resulted in improvement of the hepatic cyst infection; however, the patient died due to respiratory complications. HBF should be suspected when positive pressure ventilation results in increased air at the hepatic infection site.