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51.
《International Journal of Obstetric Anesthesia》2014,23(3):282-285
The difficult obstetric airway is a well-recognised anaesthetic challenge but little emphasis is placed on the difficulty of performing a safe tracheal extubation. We report the use of an airway exchange technique to extubate a difficult obstetric airway and discuss the role of these techniques in the obstetric population. 相似文献
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目的 探究喉癌患者气管导管的阶段性护理,为医院的临床护理工作提供参考依据。方法 抽取2010年1月~2013年1月收治的42例喉癌患者作为研究对象,给予气管导管的阶段性护理,并结合其临床护理资料进行回顾性分析。结果 42例患者中,有2例出现并发症(内套管脱管、气管黏膜损伤),发生率为4.7%(2/42)。结论 给予喉癌患者气管导管方面的阶段性护理,能够保证患者的临床治疗效果,提高治愈率,并将并发症的发生率控制在最低,具有重要的临床应用价值,值得推广。 相似文献
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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55.
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目的应用决策试验与评价实验室方法(DEMATEL)确定非计划性拔管的关键风险因素,为临床管道管理提供决策依据。方法对49例非计划性拔管不良事件,由管道护理小组现场认证确定19项风险因素;选取35名专家进行2轮函询,以函询结果构建风险因素的直接影响矩阵,运用DEMATEL软件计算综合影响度(Tr)、被影响度(Tc)、中心度(Mi)和原因度(Ri)。结果专家积极性为100%,权威程度0.857,协调系数0.297(P0.05);19项风险因素的Tr为0~2.535,Tc为0~2.321,Mi为0.653~3.891,Ri0的风险因素有10个,Ri0的风险因素有9个。结论基于DEMATEL分析影响非计划性拔管的风险因素,其主要风险因素有操作方法、固定方法、肢体约束、健康教育及高危人群评估,其中操作方法为最关键因素。 相似文献
58.
《Anaesthesia and Intensive Care Medicine》2014,15(8):355-357
Nearly all patients who are seriously difficult to manage are easily identified because they have grossly obvious abnormalities. Conversely, it is difficult to identify the few normal-looking patients that are difficult to manage. 相似文献
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《Anaesthesia and Intensive Care Medicine》2014,15(5):209-214
Alternative rigid blade intubation devices available in recent years include the Glidescope, Airtraq and Bonfils laryngoscopes. The Macintosh blade works by displacing the tongue to one side and into the submandibular space while the tip of the device sits in the vallecula lifting the hyoid and so the epiglottis forward to reveal the laryngeal inlet. Under less favourable intubating conditions, the tongue is not accommodated in the submandibular space and tends to be compressed downwards. As a result the vallecula is not accessible and the blade tip is less able to be drawn forward. The retro-molar Bonfils avoids this problem by starting from a posterior position in the mouth and approaching the larynx below and alongside the tongue. The Bonfils also serves as a rigid stylet inside the tracheal tube again producing minimal tongue displacement. Airtraq also compresses the tongue less and usually sits on the posterior pharyngeal wall where it maintains the laryngeal view with a minimum of effort. It houses the tracheal tube in a channel that delivers it into the device's field of view. While better optical systems have tended to improve visualization of the laryngeal inlet, this has not necessarily resulted in easier intubation conditions, shorter intubation times or improved overall success rates. Part of the problem has been that they have limited fields of view compared with the stereoscopic view of tube advancement down to the larynx as afforded by Macintosh. 相似文献
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