Light-guided tracheal intubation as an alternative for difficult intubation

Airway management is an important skill in resuscitation. Failure to ensure adequate ventilation may have disastrous consequences. Anatomical and pathological causes may preclude tracheal intubation by direct laryngoscopy. A case is described of successful tracheal intubation with laryngoscopic grades III and IV, by two separate light-guided intubations. The device used was the Trachlight® which has the advantages of being safe and inexpensive, and can enable rapid intubation without manipulation of the head and neck. The technique has been shown to be easily learnt. The authors recommend its use in emergency departments where it has applications in patients with cervical spine injuries and in cases of difficult or failed intubations.     

Rescuer position for tracheal intubation on the ground

BACKGROUND: Emergency oral tracheal intubations in the pre-hospital setting can be more difficult because the rescuer's position with respect to a patient lying on the ground may not provide optimal conditions for intubation. Since optimal visualisation of the larynx often depends on the force generated during laryngoscopy, we measured the pressure required for intubation (P(i)) as well as the maximum pressure (P(max)) that can be generated with the laryngoscopy blade in seven intubator positions. METHODS: Nineteen hospital personnel with intubation experience participated in this study. A modified #3 Macintosh laryngoscope blade was used to measure the pressure exerted on the tongue of a manikin placed on the ground during intubation. The following positions were studied: standard, sitting, prone, kneeling, left and right lateral decubitus and straddling. RESULTS: Intubating in the straddling position required the lowest P(i), as a percent of P(max) (68+/-14%). This was significantly less than the prone, right lateral decubitus and sitting positions. (Tukey's W procedure, P<0.05) CONCLUSION: The straddling position affords the intubator significantly more reserve force than the prone, right lateral decubitus or sitting position. We suggest that the straddling position may be an advantageous position for pre-hospital intubations especially when visualisation of the glottis is difficult.     

COPA as an aid for tracheal intubation

The purpose of this study is to verify the usefulness of the cuffed oropharyngeal airway (COPA) as a device to guide a tracheal tube using a semiblind technique with a lightwand. Ten anaesthetised patients (ASA I-II, aged 35-67) undergoing to an elective surgery were analysed. We selected and positioned a correct size of COPA for each patient. A lightwand (Trachlight) was then inserted into the COPA to confirm correct placement of this device. The lightwand was then removed and the first portion of a tube exchanger (TE) was inserted and connected by a 15-mm connector with the breathing circuit and its position was confirmed by End Tidal CO(2) values during ventilation. The patients were then paralysed and ventilation through the first portion of the TE reconfirmed. The COPA was removed, and the second portion of the TE was connected and used as a guide for a tracheal intubation. This combined technique had a success rate of six out of ten patients and could be used for airway management if a fibre optic scope or other devices such as a Combitube, LMA or LMA Fastrach were not available. The preliminary data from this study are not indicative of the statistical validity of this technique. Further studies should be performed to verify the statistical reliability of the technique.     

Retrograde technique for tracheal intubation in trauma patients

Nineteen trauma patients with either maxillofacial trauma or cervical spine fracture were orotracheally intubated over a guidewire percutaneously inserted through the cricothyroid membrane into the mouth in a retrograde fashion. In 13 patients, conventional techniques failed (average number of attempts 6 +/- 1, mean duration 18 +/- 1 min); in six patients, the initial method of choice was a retrograde technique. In all patients, retrograde technique succeeded on only one attempt (duration less than 5 min in all cases). No serious complication could be related to this technique; it is an easy, safe, efficacious method for difficult tracheal intubation in trauma patients.     

清醒气管插管患者非镇静状态时的护理

<正>气管插管作为建立和保持呼吸道通畅的一项重要手段,临床上常常会用于意识清醒的患者。由于气管插管及自身疾病所带来的痛苦,患者极易出现烦躁,导致意外拔管。据研究显示,气管插管非计划性拔管发生率高达10.8%～22.5%,其中87.5%～96%属于自行拔管。临床上为了防止非计划性拔管的发生,对于清醒患者必须使用镇静剂才能达到治疗目的。但长期使用镇静药物可致药物蓄积,过度镇静还可导致患者咳嗽和排痰能力减弱,影响呼吸功能恢复和气道分泌物消除,增加肺部感     

盲探气管插管装置在口腔颌面骨折手术麻醉经鼻气管插管的意义

目的探讨盲探气管插管装置(BTII)在口腔颌面骨折手术麻醉经鼻气管插管的意义。方法选择全身麻醉下行颌面骨折切开复位内固定术患者90例,ASAⅠ~Ⅱ级,患者分为3组,均采用清醒经鼻气管插管,并由专人操作:Ⅰ组为传统盲探组,即根据呼吸的气流声音经鼻气管插管;Ⅱ组为纤维支气管镜(简称纤支镜)引导组,即先把纤支镜插入气管后再由其引导插入气管导管;Ⅲ组为BTII引导插管组,即通过光导把盲探气管插管装置的导管插入气管后再引导插入气管导管。分别记录麻醉插管前、气管插管即刻和插管后5 min的心率(HR)、收缩压(SBP)、舒张压(DBP)、脉搏氧饱和度(SpO2),一次气管插管成功率、气管插管失败率、插管时间和并发症等情况。结果 (1)3组插管即刻的HR、SBP和DBP均较插管前和插管后5min升高,差异有统计学意义(P0.05);3组各时间点SpO2比较差异无统计学意义(P0.05)。(2)Ⅰ组一次气管插管成功率为50.0%,Ⅱ组为96.7%,Ⅲ组为93.3%,Ⅱ组、Ⅲ组与Ⅰ组比较,差异均有统计学意义(P0.05),Ⅲ组与Ⅱ组比较,差异无统计学意义(P0.05)。(3)Ⅰ组气管插管失败率为26.7%,Ⅱ组为0.0%,Ⅲ组为3.3%,Ⅱ组、Ⅲ组与Ⅰ组比较,差异均有统计学意义(P0.05),Ⅲ组与Ⅱ组比较,差异无统计学意义(P0.05)。(4)Ⅰ组气管插管时间为(94.1±14.0)s,Ⅱ组为(64.6±7.8)s,Ⅲ组为(65.3±9.1)s,Ⅱ组、Ⅲ组与Ⅰ组比较,差异均有统计学意义(P0.05),Ⅲ组与Ⅱ组比较,差异无统计学意义(P0.05)。(5)3组经鼻气管插管后并发症情况:Ⅰ组鼻咽部出血12例,Ⅱ组2例,Ⅲ组4例;Ⅰ组术后咽喉痛8例,Ⅱ组1例,Ⅲ组2例。结论 BTII在口腔颌面骨折手术麻醉经鼻引导气管插管安全、简单、可靠,值得临床推广和应用。     

Sonomatic confirmation of tracheal intubation using the SCOTI

This study compares the performance of two commercially available devices (Ambu TubeChek and SCOTI) in establishing endotracheal (ET) tube position (oesophageal vs. tracheal) in a mannequin and in miniature pigs. The Ambu TubeChek is a syringe-type, Oesophageal Detector Device (ODD) that fits to the endotracheal tube connector. Air is aspirated easily from the rigid trachea, but not from the collapsing esophagus. The Sonomatic Confirmation of Tracheal Intubation device (SCOTI) is a lightweight battery-powered, sonomatic device. It emits sound waves into the tube and analyzes the reflection. The SCOTI purports to enable a user-independent and carbon-dioxide-independent assessment of tube position following intubation. Intubation followed by tube position assessment with Ambu TubeChek (ODD) was significantly faster and easier with the ODD than with the SCOTI. The SCOTI cannot differentiate tracheal from oesophageal ET-tube position in mini-pigs. In situations in which capnometry is not available or the CO2 production and transport are compromised (CPR), we recommend the use of an Oesophageal Detector Device (ODD) rather than the SOCTI.     

食管气管联合气管插管在急诊科的应用

迅速开放气道建立人工气道行机械通气是心肺复苏的首要步骤.现在广泛应用的是气管内插管,但这种方法常因操作者技术熟练程度而影响插管成功率,延长建立人工通气道时间.目前,常规使用的气管插管方法即使是熟练的医生操作也仍有3%左右的失败率,且至少需要1 min～3 min.应用食管气管联合气管插管行盲探置管仅需要(30±10)s即可成功置管,且插管成功率100%,近年来在我院院前急救及院内急诊科已广泛应用.     

艾司洛尔预防气管插管所致心血管反应的观察

目的：了解国产盐酸艾司洛尔（简称Ｅ）预防气管插管引起心血管反应的临床效果。方法：９０例全麻病人随机分为３组,Ａ组Ｅ１．０ｍｇ／ｋｇ,Ｂ组Ｅ２．０ｍｇ／ｋｇ,Ｃ组生理盐水１０ｍｌ。观察基础值、插管前、插管后１、２、３、５、１０、１５分钟３组ＨＲ、ＳＢＰ、ＤＢＰ、ＲＰＰ变化。结果：Ａ、Ｂ两组 ＨＲ是,插管后１～１０分钟与Ｃ组比较均有显差异（Ｐ〈０．０５）;Ｃ组插管后ＳＢＰ在１～１０分钟显高于插管前     

Prophylactic tracheal intubation for upper GI bleeding: A meta-analysis

AIM: To evaluate usefulness of prophylactically intubating upper gastrointestinal bleeding (UGIB) patients. METHODS: UGIB results in a significant number of hospital admissions annually with endoscopy being the key intervention. In these patients, risks are associated with the bleeding and the procedure, including pulmonary aspiration. However, very little literature is available assessing the use of prophylactic endotracheal intubation on aspiration in these patients. A comprehensive search was performed in May 2014 in Scopus, CINAHL, Cochrane databases, PubMed/Medline, Embase, and published abstracts from national gastroenterology meetings in the United States (2004-2014). Included studies examined UGIB patients and compared prophylactic intubation to no intubation before endoscopy. Meta-analysis was conducted using RevMan 5.2 by Mantel-Haenszel and DerSimonian and Laird models with results presented as odds ratio for aspiration, pneumonia (within 48 h), and mortality. Funnel plots were utilized for publication bias and I² measure of inconsistency for heterogeneity assessments. RESULTS: Initial search identified 571 articles. Of these articles, 10 relevant peer-reviewed articles in English and two relevant abstracts were selected to review by two independent authors (Almashhrawi AA and Bechtold ML). Of these studies, eight were excluded: Five did not have a control arm, one was a letter the editor, one was a survey study, and one was focused on prevention of UGIB. Therefore, four studies (N = 367) were included. Of the UGIB patients prophylactically intubated before endoscopy, pneumonia (within 48 h) was identified in 20 of 134 (14.9%) patients as compared to 5 of 95 (5.3%) patients that were not intubated prophylactically (P = 0.02). Despite observed trends, no significant differences were found for mortality (P = 0.18) or aspiration (P = 0.11). CONCLUSION: Pneumonia within 48 h is more likely in UGIB patients who received prophylactic endotracheal intubation prior to endoscopy.     

早期气管插管抢救重型颅脑损伤的疗效研究

目的 探讨早期气管插管对蓖型颅脑损伤的救治效果.方法 将134例行气管插管的重型颅脑损伤患者(GCS≤8分)采用随机对照的研究方法分为两组,即早期气管插管组58例和常规气管插管组76例,两组在气管插管前后呼吸生理指标变化、上机概率、呼吸机治疗和ICU监护时间、并发症发生率及重残死亡率等方面进行比较.结果 两组呼吸和生理监测指标在气管插管前后均有不同程度的提高,两组气管插管前后PaO_2、PaCO_2、SaO_2、HR和RR比较差异均有统计学意义.两组在上机概率、机械辅助呼吸治疗时间、ICU监护时间以及并发ALI或ARDS、难治性肺炎、消化道出血、MODS和重残死亡等方面比较均具有统计学意义.结论 重型颅脑损伤早期气管插管能更好地改善机体的缺氧,降低并发症发生率和重残死亡率,改善预后.     

纤维支气管镜在新生儿困难气管插管中的应用

目的评价纤维支气管镜在新生儿困难气管插管中的应用价值。方法对23例困难气管插管的新生儿,经纤维支气管镜引导气管插管的方法和结果进行回顾性分析。结果 23例新生儿在纤维支气管镜引导下经鼻气管插管全部成功,20例一次性操作成功,3例重新调整体位后插管成功,无并发症发生。结论对存在困难气管插管的新生儿,应用纤维支气管镜引导气管插管,能提高插管成功率,减少插管并发症。     

急性重型颅脑损伤早期气管插管的治疗意义

目的 探讨早期气管插管对急性重型颅脑损伤的治疗意义.方法对64例行气管插管的急性重型颅脑损伤患者(GCS≤8分)依据呼吸指标的变化分为两组,即常规气管插管组30例和早期气管插管组34例,比较两组插管治疗前后呼吸指标变化及预后情况.结果早期气管插管组患者预后良好率50%,常规气管插管组预后良好率仅为26.7%,两组比较差异有统计学意义(P＜0.05).结论急性重型颅脑损伤早期行气管插管能明显提高患者的预后良好率.     

The seeing stylet: a new device for tracheal intubation

A new tracheal intubation device is available. The 'Shikani Seeing Stylet' is a new, inexpensive, reusable high resolution endoscope with a malleable stainless-steel sheath which can be inserted through a tracheal tube allowing intubation to be performed under direct vision. We have assessed this new device on 20 patients (ASA I-II; age 25-67) scheduled to undergo elective surgery with tracheal intubation. We measured heart rate (HR), non invasive blood pressure (NIBP), oxygen saturation (SpO(2)) and end tidal carbon dioxide (ETCO(2)) at three different times: T(0) (induction of anesthesia), T(1) (beginning of intubation procedure), T(2) (end of intubation procedure); we also recorded the time interval between T(1) and T(2). All patients were successfully intubated with the device. Eleven patients were intubated at the first attempt (T(1)-T(2) mean time=8. 65 s); three patients were intubated at the first attempt using cricoid pressure (T(1)-T(2) mean time 11.6 s); four patients were intubated at the second attempt (T(1)-T(2) mean time=36.5 s); two patients were intubated at the third attempt (T(1)-T(2) mean time=54. 5 s). The HR, NIBP, SpO(2) and ETCO(2) remained fairly stable. On the basis of our preliminary experience with 20 patients, the 'Shikani Seeing Stylet' seems to be a promising adjunct for airway management.