Tracheal gas insufflation

Tracheal gas insufflation (TGI) is an adjunct to mechanical ventilation that reduces CO (2) present in the anatomic deadspace. This is accomplished by flowing fresh gas (typically 6-10 lpm) directly into the trachea via a catheter placed into the endotracheal tube positioned at the distal end or by an embedded catheter in the wall of a specially designed endotracheal tube. This is thought to improve gas mixing because of the turbulent flow created at the tip of the catheter. There are two methods of gas flow delivery and cycling. Gas flow may be delivered directly toward the carina or in a reverse flow fashion. Cycling of TGI flow may be just during exhalation or during both inhalation and exhalation. A system integrated into the monitoring and controls of a mechanical ventilator could eventually prove the safest and most effective. However, currently there are no FDA-approved devices for TGI administration. It is critical to monitor the adverse effects (triggering, auto-PEEP [positive end expiratory pressure], air trapping, and patient comfort) created by the additional flow introduced into the ventilator circuit, while balancing the CO (2) clearance. There are limited data, mostly from animal studies. However, the trials done in both animal and humans are promising with regard to effective CO (2) elimination and avoidance of unacceptably high peak airway pressures. Available equipment has limited studies with infants. Even within the adult population, much work needs to be done to determine the optimal catheter position, the most appropriate TGI flow characteristics, and improve the safety of TGI.     

Maximum insufflation capacity

OBJECTIVE: To investigate the effect of deep lung insufflations on maximum insufflation capacities (MICs) and peak cough flows (PCFs) for patients with neuromuscular disease. METHOD: Forty-three patients with neuromuscular disease were trained in stacking delivered volumes of air to deep lung insufflation and were prescribed a program of air stacking once their vital capacities (VCs) were noted to be < 2,000 mL. VC, MIC, and unassisted and assisted PCF were monitored. The initial data were compared with the highest MICs subsequently achieved. For those patients whose MICs only decreased, we compared the initial data with the most recent data. RESULTS: The MICs increased from (mean +/- SD) 1,402 +/- 530 mL to 1,711 +/- 599 mL (p < 0.001) for 30 patients and only decreased for 13 patients. Patients for whom the MICs increased also had a significant increase in assisted PCF from 3.7 +/- 1.4 to 4.3 +/- 1.6 L/s (p < 0.05) despite having somewhat decreasing VCs and unassisted PCFs. CONCLUSION: With training, the capacity to stack air to deep insufflations can improve despite progressive neuromuscular disease. This can result in increased cough effectiveness.     

A randomized controlled trial comparing water exchange and air insufflation during colonoscopy without sedation

Objectives

Previous studies have shown that water exchange is superior to air insufflation in attenuating insertion pain during colonoscopy. We conducted a randomized controlled trial with head-to-head comparison of these methods to assess their effectiveness in colonoscopy without sedation.

Methods

A total of 447 outpatients were randomized to either water exchange (WE) or the standard air (CO₂) insufflation (AI). The primary outcome was the improvement of patient intraprocedural pain (pain score), evaluated using a questionnaire (scores 1 to 5).

Results

After exclusion of 44 patients from further analysis, 403 patients were analyzed. There was no difference in clinical background between the WE and AI groups. Patients in the WE group reported less intraprocedural pain than those in the AI group (2.17?±?1.06 vs. 2.42?±?1.03; unpaired t test, p?=?0.021). We divided the cases into two groups, more or less painful colonoscopy, based on age, body mass index, use of anti-peristaltic drugs or not, and physician’s experience. In less painful colonoscopy, the WE method could reduce pain effectively but its effect was limited in the more painful group.

Conclusion

WE is superior to AI for attenuating insertion pain during colonoscopy without sedation, but its efficacy is limited in more painful endoscopy.

     

2009-2011年贵州省剑河县农村饮用水水质监测结果

目的 了解贵州省剑河县农村饮用水卫生现状.方法 2009-2011年,分别于枯水期、丰水期对剑河县所辖的12个乡镇48个小型集中式供水点出厂水和末梢水进行监测.监测按照《生活饮用水标准检验方法》(B/T 5750-2006)进行,内容包括:①感官指标:标色度、浑浊度、臭和味、肉眼可见物;②一般化学指标:pH、铁、锰、氯化物、硫酸盐、溶解性总固体、总硬度、耗氧量、氨氮;③毒理学指标:氟化物、砷化物、硝酸盐;④微生物指标:菌落总数、总大肠埃希菌群、耐热大肠埃希菌群.结果评价按照《生活饮用水卫生标准》(GB 5749-2006)进行.结果 2009-2011年共采集饮用水水样192份,水质合格18份,合格率为9.38％.不同年份间水质合格率比较差异有统计学意义(x2=14.74,P＜0.01).其中枯水期水质合格率(18.75％,18/％)高于丰水期(0.00％,0/96;x2=19.76,P＜ 0.01),出厂水水质合格率(16.67％,16/96)高于末梢水(2.08％,2/96;x2=11.95,P＜ 0.01).在192份水样中,感官指标和毒理学指标均合格.一般化学指标中,除4份水样pH值出现超标情况(2009年和2010年各有2份),其他检测指标都合格.微生物指标中,水样中菌落总数、大肠埃希菌群、耐热大肠埃希菌群合格率分别为77.08％(148/192)、9.90％(19/192)、20.31％(39/192).其中枯水期、丰水期微生物合格率分别为18.75％(18/96)、0.00％(0/96),枯水期微生物合格率显著高于丰水期(x2=19.76,P＜0.01);水源水、末梢水微生物合格率分别为16.67％(16/96)、2.08％(2/96),水源水微生物合格率显著高于末梢水(x2=11.95,P＜ 0.01).结论 贵州省剑河县农村饮用水卫生现状欠佳,微生物污染是影响剑河县农村生活饮用水水质量的主要原因.     

Endoscopy Nurse Participation May Increase the Polyp Detection Rate by Second-Year Fellows during Screening Colonoscopies

Background/Aims

The aim of this study was to assess the effects of endoscopy nurse participation on polyp detection rate (PDR) and adenoma detection rate (ADR) of second-year fellows during screening colonoscopies.

Methods

This was a single-center, prospective, randomized study comparing a fellow alone and a fellow plus an endoscopy nurse as an additional observer during afternoon outpatient screening colonoscopies. The primary end points were PDR and ADR.

Results

One hundred ninety-one colonoscopies performed by a fellow alone and 192 colonoscopies performed by a fellow plus an endoscopy nurse were analyzed. The PDR was significantly higher when the nurse was involved (53.1% vs. 41.3%, p<0.05); however, there was no significant difference in the ADR between the two groups (38.5% vs. 29.8%, p=0.073). There was no difference in the percentage of patients with ≥2 polyps, advanced adenomas, polyp size, polyp location, and polyp shapes between the two groups. There was no difference in the PDR according to the level of experience of the endoscopy nurse.

Conclusions

Endoscopy nurse participation as an additional observer during screening colonoscopy performed by second-year fellow increases the PDR; however, the level of experience of the nurse was not an important factor.     

Técnicas colonoscópicas para la detección de pólipos: un estudio egipcio

Introduction and aimsThe polyp detection rate (PDR) is defined as the percentage of colonoscopies in which one or more polyps are detected, and has been shown to be highly correlated with the adenoma detection rate. The aim of the present study was to evaluate the PDR at the Endoscopy Unit of the Kasr Al-Ainy Hospital, Cairo University, Egypt, through the i-SCAN, Endocuff, and underwater colonoscopy techniques.Materials and methodsThe study was conducted on 100 Egyptian subjects over 50 years of age. Their polyp detection rate was measured through 4 different colonoscopic techniques. An equal number of patients were divided into 4 groups: i-SCAN, Endocuff, underwater colonoscopy, and controls. The control group was examined using standard white light colonoscopy. The colonoscopy evaluation included the type of agent utilized for bowel preparation, preparation grade, and colonoscopy withdrawal time.ResultsThe general PDR was 48%. The i-SCAN technique had the highest rate (56%), followed by the underwater (52%) and the Endocuff (48%) techniques.ConclusionThe i-SCAN and underwater colonoscopy techniques produced higher PDR than the Endocuff-assisted and standard techniques, but with no statistical significance.     

黑色先端帽联合窄带光成像在结肠镜检查中的作用

目的评估黑色先端帽辅助结肠镜联合窄带光成像（narrow band imaging,NBI）技术对腺瘤/息肉检出效能的影响。方法连续纳入2016年10月—2018年10月行结肠镜检查的患者,采用随机数字表法分为黑色先端帽组和对照组,黑色端帽组采用黑色先端帽辅助结肠镜联合NBI技术,对照组采用标准白光结肠镜,比较两组的息肉检出率、腺瘤检出率等指标,并进行亚组分析。结果共1 000例患者纳入本研究（每组500例）,黑色先端帽组和对照组近端结肠腺瘤检出率分别为24.2%(121/500)和17.2%(86/500),近端结肠息肉检出率分别为28.8%(144/500)和21.4%(107/500),平均腺瘤检出数分别0.41±0.94和0.26±0.68,平均息肉检出数为0.63±1.16和0.40±0.85,差异均有统计学意义（P均<0.05）,但该联合技术对于远端结直肠病变的检出率相较对照组无明显优势。结论黑色先端帽辅助结肠镜联合NBI能显著提高近端结肠腺瘤和息肉等微小病变的检出效能。