野外急救多功能气道防护屏的研制

研制一种适合野外急救使用的多功能气道防护屏,以解决气道相关操作时患者呼吸道分泌物喷溅的问题。多功能气道防护屏由一个底部为直角"目"型框架,两个体部为直角"∏"形不锈钢支架,一个双层开放气道体位调节垫和一个透明塑料罩组成,具有可拆卸、可折叠及视野清晰的多功能呼吸道防护装备;防护屏设计具有可调节头颈后仰卧位,能充分显露气道提高气管插管成功率,可提高医护人员安全性和满意度;在防护屏内建立人工气道、实施各种气道护理,可防止患者呼吸道分泌物喷溅,使周围环境处于相对安全状态,有效避免职业暴露及交叉感染。     

Fibreoptic-guided tracheal intubation through i-gel® and LMA® ProtectorTM supraglottic airway devices - a randomised comparison

Fibreoptic-guided tracheal intubation using a supraglottic airway device as a conduit is a technique that can be used in anticipated and unanticipated difficult airway management. Although the i-gel^® supraglottic airway device has been examined for this purpose, the LMA^® Protector^TM, a recently introduced second-generation supraglottic airway device, has not been evaluated for this use in clinical trials. This prospective, randomised clinical trial compared fibreoptic-guided tracheal intubation via i-gel and LMA Protector supraglottic airway devices in two UK hospitals. Patients who were ASA physical status 1 or 2 and undergoing elective surgery requiring tracheal intubation were recruited to the study. A block randomisation list was generated for each study site. The primary outcome measure was time to successful tracheal intubation and secondary outcomes were tracheal intubation success rate, glottic view through flexible fibrescope, ease of tracheal intubation using operator visual analogue score, supraglottic airway device insertion time and insertion success rate. Ninety patients were randomly allocated to each device, and final data analysis was carried out for 92 patients in the i-gel group and 86 patients in the LMA Protector group. Mean (SD) tracheal intubation time in the i-gel and LMA Protector groups were 54.3 (13.8) s and 52.0 (13.0) s, respectively (p = 0.240). There were no significant differences in tracheal intubation success rate, glottic view and ease of tracheal intubation between the two groups. This study demonstrates that the LMA Protector supraglottic airway device is comparable to the i-gel supraglottic airway device as a conduit for fibreoptic-guided tracheal intubation.     

ICU气管插管患者自主呼吸试验通过后拔管失败原因分析

目的:分析ICU气管插管患者通过自主呼吸试验后拔管失败的原因,总结经验以减少I CU气管插管拔管后48h内再插管率。方法:回顾性分析2015年1月至2018年12月,我院ICU收治的气管插管通过自主呼吸试验(SBT)后仍拔管失败的16例患者的临床资料。结果:吞咽功能障碍6例,精神因素3例,运动神经元病3例,声门水肿2例,格林巴利综合征1例,会厌畸形1例。结论:自主呼吸试验指导撤机存在局限性,了解撤机过程中各种失败的原因,并进行针对性预处理,可降低ICU气管插管拔管后48h内再插管率。     

Incidence of difficult airway situations during prehospital airway management by emergency physicians—A retrospective analysis of 692 consecutive patients

IntroductionIn the prehospital setting, advanced airway management is challenging as it is frequently affected by facial trauma, pharyngeal obstruction or limited access to the patient and/or the patient's airway. Therefore, incidence of prehospital difficult airway management is likely to be higher compared to the in-hospital setting and success rates of advanced airway management range between 80 and 99%.Methods3961 patients treated by an emergency physician in Zurich, Switzerland were included in this retrospective analysis in order to determine the incidence of a difficult airway along with potential circumstantial risk factors like gender, necessity of CPR, NACA score, GCS, use and type of muscle relaxant and use of hypnotic drugs.Results692 patients underwent advanced prehospital airway management. Seven patients were excluded due to incomplete or incongruent documentation, resulting in 685 patients included in the statistical analysis. Difficult intubation was recorded in 22 patients, representing an incidence of a difficult airway of 3.2%. Of these 22 patients, 15 patients were intubated successfully, whereas seven patients (1%) had to be ventilated with a bag valve mask during the whole procedure.ConclusionIn this physician-led service one out of five prehospital patients requires airway management. Incidence of advanced prehospital difficult airway management is 3.2% and eventual success rate is 99%, if performed by trained emergency physicians. A total of 1% of all prehospital intubation attempts failed and alternative airway device was necessary.     

(Technically) Difficult colonoscope insertion – Tips and tricks

Cecal intubation is a critical aspect of effective, complete colonoscopy. Difficult colonoscopy is most often considered as one in which it is challenging or impossible to reach the cecum. It may be a common occurrence due to patient and/or endoscopist factors. Incomplete colonoscopies should be avoided, since patients in this context present an important prevalence of lesions that escape examination. The approach to successful cecal intubation should depend on characterization of the problem as redundant colon or difficult sigmoid colon. Most patients with a prior incomplete colonoscopy can be colonoscoped successfully, if careful attention is paid to technique, using a variety of scopes, colonoscopy methods and additional equipment. Sufficient time should be allotted to make the attempt.     

Tracheal intubation

Tracheal intubation is the act of placing a tube into the trachea. The tube enables oxygen delivery and removal of carbon dioxide, while also allowing for the administration of pharmacological agents. Intubation is the most reliable method of maintaining an airway under anaesthesia, and for protection against aspiration of stomach contents. Traditionally, intubation is achieved by direct visualization of the glottis, but now indirect laryngoscopy (via a videolaryngoscope) is a common alternative. Prior to embarking upon intubation, a thorough patient history and examination must be undertaken by the laryngoscopist; equipment must be prepared and checked; a trained assistant present; and an experienced anaesthetist available in case assistance is required. Once the endotracheal tube has been placed, correct positioning must be confirmed via both clinical examination and monitoring, including capnography. Tracheal intubation is a procedure that should only be undertaken by trained operators and is not without risk. It is important to note that it is failure to oxygenate patients rather than failure to intubate that ultimately leads to serious morbidity and mortality. The Difficult Airway Society has produced guidelines on how to manage unanticipated difficulty in tracheal intubation; it is essential that every practitioner trained to intubate patients is familiar with these algorithms and the key principles of safe airway management.