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Julio E. González-Aguirre Claudia Paola Rivera-Uribe Erick Joel Rendón-Ramírez Rogelio Cañamar-Lomas Juan Antonio Serna-Rodríguez Roberto Mercado-Longoría 《Archivos de bronconeumologia》2019,55(4):195-200
Introduction
Invasive respiratory support is a cornerstone of Critical Care Medicine, however, protocols for withdrawal of mechanical ventilation are still far from perfect. Failure to extubation occurs in up to 20% of patients, despite a successful spontaneous breathing trial (SBT).Methods
We prospectively included ventilated patients admitted to medical and surgical intensive care unit in a university hospital in northern Mexico. At the end of a successful SBT, we measured diaphragmatic shortening fraction (DSF) by the formula: diaphragmatic thickness at the end of inspiration – diaphragmatic thickness at the end of expiration/diaphragmatic thickness at the end of expiration × 100, and the presence of B-lines in five regions of the right and left lung. The primary objective was to determine whether analysis of DSF combined with pulmonary ultrasound improves prediction of extubation failure.Results
Eighty-two patients were included, 24 (29.2%) failed to extubation. At univariate analysis, DSF (Youden's J: >30% [sensibility and specificity 62 and 50%, respectively]) and number of B-lines regions (Youden's J: >1 zone [sensibility and specificity 66 and 92%, respectively]) were significant related to extubation failure (area under the curve 0.66 [0.52–0.80] and 0.81 [0.70–0.93], respectively). At the binomial logistic regression, only the number of B-lines regions remains significantly related to extubation failure (OR 5.91 [2.33–14.98], P < .001).Conclusion
In patients with a successfully SBT, the absence of B-lines significantly decreases the probability of extubation failure. Diaphragmatic shortening fraction analysis does not add predictive power over the use of pulmonary ultrasound. 相似文献44.
《Brazilian Journal of Anesthesiology》2019,69(4):358-368
Background and objectivesProcedural simulation training for difficult airway management offers acquisition opportunities. The hypothesis was that 3 hours of procedural simulation training for difficult airway management improves: acquisition, behavior, and patient outcomes as reported 6 months later.MethodsThis prospective comparative study took place in two medical universities. Second‐year residents of anesthesiology and intensive care from one region participated in 3 h procedural simulation (intervention group). No intervention was scheduled for their peers from the other region (control). Prior to simulation and 6 months later, residents filled‐out the same self‐assessment form collecting experience with different devices. The control group filled‐out the same forms simultaneously. The primary endpoint was the frequency of use of each difficult airway management device within groups at 6 months. Secondary endpoints included modifications of knowledge, skills, and patient outcomes with each device at 6 months. Intervention cost assessment was provided.Results44 residents were included in the intervention group and 16 in the control group. No significant difference was observed for the primary endpoint. In the intervention group, improvement of knowledge and skills was observed at 6 months for each device, and improvement of patient outcomes was observed with the use of malleable intubation stylet and Eschmann introducer. No such improvement was observed in the control group. Estimated intervention cost was 406€ per resident.ConclusionsA 3 h procedural simulation training for difficult airway management did not improve the frequency of use of devices at 6 months by residents. However, other positive effects suggest exploring the best ratio of time/acquisition efficiency with difficult airway management simulation.ClinicalTrials.gov IdentifierNCT02470195. 相似文献
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ObjectiveSinonasal surgery is one of the shared airway surgeries that are not uncommonly complicated intra or postoperatively. The proper anesthetic management of these cases plays a crucial role creating a bloodless field. Sugammadex is a new selective relaxant binding drug as it provides a rapid decrease in free rocuronium in the plasma and at nicotinic receptor that help proper awakening of these patients which is extremely important for minimizing the postoperative respiratory complications. The aim of this study is to compare recovery profile in sinonasal surgery in patients reversed by conventional anticholine esterase (Neostigmine) versus those reversed by Sugammadex.MethodsThis study included 40 patients ASA physical status I and II aged 20–45 years with chronic sinusitis undergoing endoscopic sinus surgery with or without septoplasty, hypotensive anesthesia to maintain MAP (50–60 mm Hg), muscle relaxation throughout the procedure at 1–2 posttetanic count (PTCs) by rocuronium infusion, and anesthetic depth maintained using BIS (50–60). Patients were allocated randomly into two equal groups to receive either Sugammadex 4 mg/kg (group I) or Neostigmine 0.05 mg/kg and atropine 0.02 mg/kg (group II) as a reversal agent, and assessment of postoperative respiratory complications was performed using the Postoperative Respiratory System Evaluation Score (PRSES) at 1st and 5th minutes after extubation.ResultsThe reversal time showed highly significant difference between the two groups. Patients in the Sugammadex group could reach a TOF of 0.9 in a mean time 2.47 (0.51) min versus 24.21 (4.7) min for the Neostigmine group; postoperative respiratory complications, the Sugammadex group and the Neostigmine group did not differ statistically; however, more patients in Neostigmine group showed respiratory complications at 1st and 5th minutes after extubation as shown by PRSES Scoring System.ConclusionThis study showed that the use of Sugammadex in reversing rocuronium induced neuromuscular block in patients undergoing functional endoscopic surgery is superior to Neostigmine. Further studies are required to weigh the cost benefit relationship of the use of Sugammadex in routine clinical practice. 相似文献
46.
目的比较改良Proseal喉罩和改良普通喉罩在无痛纤维支气管镜检查中气道管理的效果。方法选择行纤维支气管镜检查患者40例,随机均分为两组:改良Proseal喉罩组(P组)和改良普通喉罩组(L组)。全麻诱导后徒手插入喉罩,接麻醉机,控制或辅助通气。记录两组麻醉前(T0)、插入喉罩即刻(T1)、插入喉罩3min(T2)的SBP、DBP、HR和SpO2,同时记录喉罩插入时间和并发症,并进行喉罩通气评估、纤维支气管镜评估和气道密封压测定。结果两组患者喉罩插入时间及各时点的SBP、DBP、HR和SpO2差异均无统计学意义;P组气道密封压明显高于L组(P<0.01);P组喉罩通气、纤维支气管镜评分优良率均为100%,明显高于L组的85%、80%(P<0.01);术毕P组1例喉罩粘血,明显少于L组的7例(P<0.05)。结论改良Proseal喉罩在气密性、通气评估、纤维支气管镜评估等方面好于改良普通喉罩,但对血流动力学的影响两者无明显差异。 相似文献
47.
To examine the education of trainees with regard to difficult airway management, we sent a questionnaire to all 89 Japanese University Departments of Anaesthesia (to be answered by a person who was responsible for teaching trainees) and all 280 Royal College of Anaesthetists' Tutors in the UK. The presence or absence of a formal training module for difficult airway management, timing and methods of training, types of airway devices that should be taught, and tutors' expertise with various techniques and devices were surveyed. Sixty-seven of the 89 Japanese tutors (75%) and 167 of 280 UK tutors (60%) replied to the questionnaire. Only 19 of 67 (28%) Japanese anaesthetists and 33 of 167 (20%) UK anaesthetists who replied, indicated that they had a difficult airway training module. In six Japanese departments (9%) and 115 (69%) UK departments, equipment for percutaneous transtracheal ventilation was readily available. Airway devices and techniques that tutors considered necessary to be mastered in the first 2 years of training, differed considerably between Japan and the UK, with notable differences in the use of gum elastic bougies and awake intubation. A training module for difficult airway management is often not provided and equipment for emergency transtracheal ventilation is often unavailable in both countries. 相似文献
48.
We experienced a case of a huge hemangioma occupying the oropharyngeal space in an 11-year-old child. Although urgent surgical
tracheostomy under local anesthesia was suggested initially, medical interview and findings of computerized tomography and
fiberoptic laryngoscopy revealed that the airway of the patient was relatively stable when she was in the semi-left decubitus
position. General anesthetic induction would have had potential risks of airway obstruction. Thus, after placing the patient
in the semi-left decubutus position, we chose semi-awake induction to secure the airway. With a small dose of fentanyl, we
accomplished orotracheal intubation. In this report, we discuss the importance of referring to an airway management algorithm
when encountering a difficult airway. 相似文献
49.
共享气道类手术需要外科医师与麻醉科医师在同一气道解剖空间内实施操作及气道管理,围术期需要麻醉、外科和护理团队间保持密切沟通与合作。患儿上气道尤其狭窄,因病变种类多、对正常通气换气功能影响大,其共享气道手术的麻醉管理实施难度更大、风险更高,是临床麻醉的难点问题。在保障氧合与通气安全的基础上,尽可能为外科提供更好的视野暴露是共享气道工具开发及通气策略优化的目标。本文归纳总结了儿科共享气道类手术的种类与特点,重点分析非插管气道管理技术的应用范围和优缺点,以期为安全个性化地实施患儿共享气道的麻醉管理提供参考。 相似文献
50.
背景 术前对困难气道的准确评估,使麻醉医师对患者气道的管理愈加合理及安全.无症状型会厌囊肿会引起难以预测的紧急困难气道,在全身麻醉快速诱导中易导致通气不畅或插管困难,威胁患者生命安全. 目的 讨论这种突发情况的围手术期气道处理,提高对该病的认识,并为临床提供借鉴. 内容 参考国内外无症状型会厌囊肿病例,收集整理近期困难气道的管理方法,完善无症状型会厌囊肿气道处理流程. 趋向 麻醉医师应迅速对患者的紧急情况进行判断,并选择最佳气道管理方案. 相似文献