Primary repair of a neonatal bronchial intubation injury

Premature infants who require endotracheal intubation may be subject to iatrogenic tracheobronchial injuries. Such injuries are relatively rare, can be difficult to diagnose, and are often associated with poor outcomes. We report our experience with diagnosing and successfully treating a proximal bronchial perforation in a neonate by primary surgical repair.     

A cluster of patients with severe acute respiratory syndrome in a chest ward in southern Taiwan

Objective Severe acute respiratory syndrome (SARS) is an emerging and easily clustering infectious disease. We describe an outbreak of SARS in a chest ward of a medical center in southern Taiwan and seek to identify the risk factors of those SARS patients who required mechanical ventilation. We focus on previous health patients.Design This retrospective case series was collected during the SARS outbreak. Degrees of severity were established, based on whether intubation and mechanical ventilation was necessary.Setting A 2500-bed medical center in southern Taiwan.Patients Forty-four patients exhibited symptoms that met the modified World Health Organization (WHO) definition of SARS. These included of three subgroups: health-care workers (n=16), relatives (n=14), and patients already admitted for other ailments (n=14). Of these, 20 eventually required mechanical ventilation.Measurements and results Laboratory analyses showed statistically significant differences between intubated and nonintubated patients in white blood cell count, neutrophil percentage, and C-reactive protein level as well as in age and underlying malignancy. Risk factors for SARS patients who had been healthy prior to their illness included old age, high peak fever grade, increased neutrophil count, increased neutrophil percentage, and close or prolonged contact with a SARS patient.Conclusions Old age, high white blood cell counts, high peak grade fever, and close or prolonged contact with a SARS patient increase the risk of intubation in previous healthy SARS patients.     

Paramedicbasierte Notfallrettung im King County

Zusammenfassung Der folgende Bericht aus dem südlichen Landkreis King im Bundesstaat Washington (USA) gibt einen detaillierten Überblick über Ausbildung, Regelkompetenzen und Versorgungsniveau von Paramedics.King County MEDIC ONE stellt das Paradebeispiel eines hoch effektiven Paramedic-Systems dar und ist keineswegs repräsentativ für die Leistungen der Rettungsdienste im Rest des Landes. Anhand der Auswertung von Traumastatistiken, invasiven notfallmedizinischen Maßnahmen und Reanimationserfolgen wird die Frage aufgeworfen, ob die paramedicbasierte Notfallversorgung von King County MEDIC ONE auch für das frankogermane Notarztsystem Modellcharakter haben kann.

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Abkürzungen ACLS Advanced cardiac life support - ACS Akutes Koronarsyndrom - AED Automatic external defibrillator - ÄLRD Ärztlicher Leiter Rettungsdienst - AHA American heart association - ALNW Airlift Northwest - BÄK Bundesärztekammer - BAND Bundesvereinigung der Arbeitsgemeinschaften der Notärzte Deutschland - BLS Basic life support - CME Continuing medical education - CIREN Crash injury research and engineering network - DNR Do not resuscitate - EF Einsatzfahrzeug - EMT Emergency medical technician - FR First responder - HLF Hilfeleistungslöschfahrzeug - HSD Hypertonic saline and dextran - ISS Injury severity score - KCM1 King County Medic one - KH Krankenhaus - MICP Mobile intensive care paramedics - MICU Mobile intensive car unit - MIRF Medical incident report form - MITI Myocardial infarction triage and intervention - NACA National advisory comitee for aeronautics - PAD Public access defibrillation - PCI Perkutane Koronarintervention - PMD Program medical director - RD Rettungsdienst - RSI Rapid sequence induction - RTH Rettungshubschrauber - RTW Rettungswagen - ZVK Zentraler VenenkatheterInteressenkonflikt: Der korrespondierende Autor versichert, dass keine Verbindung mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen.     

A comparison of the intubating laryngeal mask airway and the Bonfils intubation fibrescope in patients with predicted difficult airways

Tracheal intubation with the intubating laryngeal mask airway or the Bonfils intubation fibrescope was performed in 80 patients with predicted difficult airways. Mallampati score, thyromental distance, mouth opening and mobility of the atlanto-occipital joint were used to predict difficult airways. The overall success rate, time to the first adequate lung ventilation and time taken for the successful placement of the tracheal tube were recorded, as well as a subjective assessment of the handling of the device and the incidence of postoperative sore throat and hoarseness. The median [range] time to the first adequate ventilation was significantly shorter with the intubating laryngeal mask airway than with the Bonfils intubation fibrescope (28 [6-85] s vs. 40 [23-77] s, p < 0.005). Tracheal intubation was significantly slower with the intubating laryngeal mask airway than with the Bonfils intubation fibrescope (76 [45-155] s vs. 40 [23-77] s, p < 0.0001. Patients in the Bonfils group suffered less sore throat and hoarseness than those in the other group.     

Tracheal intubation using the Bonfils intubation fibrescope after failed direct laryngoscopy

Failed tracheal intubation due to a difficult airway is an important cause of anaesthetic morbidity and mortality. This study was undertaken to evaluate the effectiveness of the Bonfils intubation fibrescope for tracheal intubation after failed direct laryngoscopy. Twenty-five patients undergoing coronary artery bypass grafting were enrolled in the study after two attempts at conventional laryngoscopy by a board certified anaesthetist had failed. Intubation with the Bonfils fibrescope was successful on the first attempt in 22 patients (88%) and on the first or second attempt in 24 patients (96%); in one patient intubation was impossible. Median (IQR [range]) time to intubation using the Bonfils intubation fibrescope was 47.5 (30-80 [20-200]) s. Tracheal intubation using the Bonfils intubation fibrescope appears to be a simple and effective technique for the management of a difficult intubation.     

常用实验动物全麻后的气管插管

目的 总结常用实验（用）动物气管插管的经验。方法 选择正确的气管插管用具，实施合理的插管步骤，预防导管并发症，对实验（用）动物实施气管插管。结果与讨论气管插管成功率100％。     

Prognostic factors in laryngotracheal injury following intubation and/or tracheotomy in ICU patients

The aim of this study was to determine the incidence of laryngotracheal injuries following intubation and/or tracheotomy in intensive care unit (ICU) patients and to analyze their prognostic factors. This prospective study includes the clinical data and endoscopic exploration of 654 ICU patients who underwent oro-tracheal intubation between September 1992 and February 1999. The prognostic factors for upper airway injuries were analyzed using a multivariate statistical study. Endoscopic exploration of the upper airway 6 to 12 months after extubation revealed laryngotracheal injuries in 30 of the 280 patients examined (11%). The most important factors influencing the development of laryngotracheal lesions were the duration of the oro-tracheal intubation and the length of time in the ICU. Patients at high risk of developing injuries were those with pathological background, a non-neurological or non-surgical (medical) admission or upper-airway injuries at an early stage. The length of oro-tracheal intubation is the most important factor in the development of laryngotracheal injuries. Consequently, it is essential to establish a time limit to perform tracheotomy in ICU patients. Such timing should be adapted to each patient and pathology.     

The peri-operative complications of nasal intubation: a comparison of nostril side

We studied 128 patients undergoing nasal intubation to see whether the nostril side used influenced peri-operative nasal complications. In the apparently normal nostril, there is no significant difference between either nostril in difficulty of intubation (p > 0.8). Similarly, there is no significant difference in the incidence of bleeding at intubation (p > 0.2), at extubation (p > 0.5) and once the patient has returned to recovery (p > 0.1). Postoperative nostril patency is also similar between groups (p > 0.85).     

An assessment of a method of inflating cuffs with a nitrous oxide gas mixture to prevent an increase in intracuff pressure in five different tracheal tube designs apparatus

We assessed the efficacy of inflating cuffs with a nitrous oxide gas mixture to minimise changes in intracuff pressure during anaesthesia. Patients were randomly assigned to one of five groups of 15 subjects each, and the trachea was intubated with the Profile Soft-Seal Cuff, Hi-Contour, Reinforced, Sheridan or Trachelon tracheal tubes. Cuffs were inflated with 40% nitrous oxide and cuff pressure was measured during anaesthesia with 67% nitrous oxide. Concentration of nitrous oxide in the cuff was measured at the end of anaesthesia. Cuff pressure increased slightly but significantly in the Reinforced and Trachelon groups. Nitrous oxide concentration in the Reinforced, Sheridan, or Trachelon groups was slightly but significantly higher than that in the Profile or Hi-Contour groups. Cuff pressure never exceeded 22 mmHg and there were no air leaks. Therefore, inflating cuffs with 40% N2O preserves stable cuff pressure in all five tracheal tubes, despite differences in cuff and pilot balloon design.     

双腔支气管导管不同拔管方式对患者血流动力学的影响

目的:探讨不同拔管方式对插双腔支气管导管的患者拔管时的血流动力学的影响。方法:将30例行双腔支气管插管全麻的胸外科手术的病人随机分为两组,A组为更换单腔气管导管组,B组为瑞芬太尼组,A组患者术毕时将双腔支气管导管更换为单腔气管导管,B组患者手术结束时将双腔支气管导管退至总气管,同时静脉给予瑞芬太尼0.05μg/(kg.min),记录两组患者拔管时间,改良OAA/S评分,拔管时的心率,平均动脉压。结果:两组患者拔管时间,改良OAA/S评分大于等于3分的病人数无显著性差异,拔管时的心率,平均动脉压B组明显低于A组(P<0.05)。结论:插双腔支气管导管的患者拔管时静脉给予0.05μg/(kg.min)的瑞芬太尼能有效降低患者的心血管反应。