1
|
Becker CE, Lorenz W, de Abreu MG, Koch T, Kiss T. Airway management and pulmonary aspiration during surgical interventions in pregnant women in the 2nd/3rd trimester and immediate postpartum - a retrospective study in a tertiary care university hospital. BMC Anesthesiol 2024; 24:166. [PMID: 38702641 PMCID: PMC11067247 DOI: 10.1186/s12871-024-02551-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 04/26/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Pregnancy is associated with an increased risk of pulmonary aspiration during general anaesthesia, but the incidence of this complication is not well defined. METHODS We performed a retrospective database review in a tertiary care university hospital to determine the incidence of pulmonary aspiration in pregnant patients undergoing endotracheal intubation, with and without Rapid Sequence Induction (RSI), as well as face-mask ventilation and supraglottic airway devices. We included Patients in the 2nd or 3rd trimester of pregnancy and immediate postpartum undergoing surgical procedures. The primary endpoint was the occurrence of pulmonary aspiration. RESULTS Data from 2,390 patients undergoing general anaesthesia for cerclage of cervix uteri, manual removal of retained placenta, repair of obstetric laceration, or postpartum bleeding were retrospectively evaluated. A supraglottic airway device or face-mask ventilation was used in 1,425/2,390 (60%) of patients, while 638/2,390 (27%) were intubated. RSI was used in 522/638 (82%) of patients undergoing tracheal intubation, or 522/2,390 (22%) of the entire cohort. In-depth review of the charts, including 54 patients who had been initially classified as "possible pulmonary aspiration" by anaesthetists, revealed that this adverse event did not occur in the cohort. CONCLUSIONS In conclusion, in this obstetric surgery patient population at risk for pulmonary aspiration, supraglottic airway devices were used in approximately 60% of cases. Yet, no aspiration event was detected with either a supraglottic airway or endotracheal intubation.
Collapse
Affiliation(s)
- Charlotte E Becker
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Wolfram Lorenz
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Marcelo Gama de Abreu
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Division of Intensive Care and Resuscitation, Department of Anesthesiology, Integrated Hospital Care Institute, Cleveland Clinic, Cleveland, OH, United States
- Outcomes Research Consortium, Department of Anesthesiology, Integrated Hospital Care Institute, Cleveland Clinic, Cleveland, OH, United States
- Division of Cardiothoracic Anesthesia, Department of Anesthesiology, Integrated Hospital Care Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Thea Koch
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Thomas Kiss
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
- Department of Anesthesiology, Intensive-, Pain- and Palliative Care Medicine, Radebeul Hospital, Academic Hospital of the Technische Universität Dresden, Heinrich-Zille-Straße 13, 01445, Radebeul, Germany.
| |
Collapse
|
2
|
Jahreis T, Kretschmann J, Weidner N, Volk T, Meiser A, Groesdonk HV. Sonographic Evaluation of Gastric Residual Volume during Enteral Nutrition in Critically Ill Patients Using a Miniaturized Ultrasound Device. J Clin Med 2021; 10:jcm10214859. [PMID: 34768380 PMCID: PMC8585036 DOI: 10.3390/jcm10214859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/13/2021] [Accepted: 10/20/2021] [Indexed: 12/01/2022] Open
Abstract
Background: To assess the risk of aspiration, nutrient tolerance, and gastric emptying of patients in ICUs, gastric ultrasound can provide information about the gastric contents. Using established formulas, the gastric residual volume (GRV) can be calculated in a standardized way by measuring the gastric antrum. The purpose of this study was to determine the GRV in a cohort of enterally fed patients using a miniaturized ultrasound device to achieve knowledge about feasibility and the GRV over time during the ICU stay. The findings could contribute to the optimization of enteral nutrition (EN) therapy. Methods: A total of 217 ultrasound examinations with 3 measurements each (651 measurements in total) were performed twice daily (morning and evening) in a longitudinal observational study on 18 patients with EN in the interdisciplinary surgical ICU of Saarland University Medical Center. The measured values of the GRV were analyzed in relation to the clinical course, the nutrition, and other parameters. Results: Measurements could be performed without interrupting the flow of clinical care and without pausing EN. The GRV was significantly larger with sparsely auscultated bowel sounds than with normal and excited bowel sounds (p < 0.01). Furthermore, a significantly larger GRV was present when using a high-caloric/low-protein nutritional product compared to an isocaloric product (p = 0.02). The GRV at the morning and evening measurements showed no circadian rhythm. When comparing the first and last ultrasound examination of each patient, there was a tendency towards an increased GRV (p = 0.07). Conclusion: The GRV measured by miniaturized ultrasound devices can provide important information about ICU patients without restricting treatment procedures in the ICU. Measurements are possible while EN therapy is ongoing. Further studies are needed to establish gastric ultrasound as a management tool in nutrition therapy.
Collapse
Affiliation(s)
- Tizian Jahreis
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Saarland University Medical Center and Saarland University Faculty of Medicine, 66421 Homburg, Germany; (T.J.); (J.K.); (T.V.); (A.M.)
| | - Jessica Kretschmann
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Saarland University Medical Center and Saarland University Faculty of Medicine, 66421 Homburg, Germany; (T.J.); (J.K.); (T.V.); (A.M.)
| | - Nick Weidner
- Department of Interdisciplinary Critical Care Medicine and Intermediate Care, Helios Klinikum Erfurt, 99089 Erfurt, Germany;
| | - Thomas Volk
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Saarland University Medical Center and Saarland University Faculty of Medicine, 66421 Homburg, Germany; (T.J.); (J.K.); (T.V.); (A.M.)
| | - Andreas Meiser
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Saarland University Medical Center and Saarland University Faculty of Medicine, 66421 Homburg, Germany; (T.J.); (J.K.); (T.V.); (A.M.)
| | - Heinrich Volker Groesdonk
- Department of Interdisciplinary Critical Care Medicine and Intermediate Care, Helios Klinikum Erfurt, 99089 Erfurt, Germany;
- Correspondence: ; Tel.: +49-361-781-2056
| |
Collapse
|
3
|
Mencke T, Zitzmann A, Reuter DA. [New aspects of rapid sequence induction including treatment of pulmonary aspiration]. Anaesthesist 2021; 70:171-184. [PMID: 33410921 DOI: 10.1007/s00101-020-00901-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Pulmonary aspiration of solid components leads to displacement of the tracheobronchial tree, the aspiration of acidic gastric juices to chemical pneumonitis (Mendelson's syndrome) and the aspiration of oropharyngeal secretions or gastrointestinal pathogens to aspiration pneumonia. Principally, pulmonary aspiration can occur at any stage of anesthesia. In the clinical routine the aim must therefore be to identify those patients who have an increased risk of aspiration. When this is successful, measures can be taken to reduce the risk; these can be regional anaesthesia or the performance of general anaesthesia as rapid sequence induction (RSI). If severe pulmonary aspiration occurs despite all preventive measures, mostly during induction of anaesthesia, extensive experience and rapid action are necessary. This can only be achieved if the induction to RSI is performed by three persons with supervision of the trainee anaesthetist by a consultant anaesthetist.
Collapse
Affiliation(s)
- T Mencke
- Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universitätsmedizin Rostock, Schillingallee 35, 18057, Rostock, Deutschland.
| | - A Zitzmann
- Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universitätsmedizin Rostock, Schillingallee 35, 18057, Rostock, Deutschland
| | - D A Reuter
- Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universitätsmedizin Rostock, Schillingallee 35, 18057, Rostock, Deutschland
| |
Collapse
|
4
|
Maiese A, La Russa R, Arcangeli M, Volonnino G, De Matteis A, Frati P, Fineschi V. Multidisciplinary approach to suspected sudden unexpected infant death caused by milk-aspiration: A case report. World J Clin Cases 2020; 8:4128-4134. [PMID: 33024771 PMCID: PMC7520785 DOI: 10.12998/wjcc.v8.i18.4128] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 08/02/2020] [Accepted: 08/26/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The term sudden unexpected infant death (SUID) is not always properly invoked. It refers to a broad range of conditions that sometimes defy classification. There is not only a strong emotional impact on the family, but such cases are also quite complex. Underlying causes may be multiple, not always readily apparent, and have potential repercussions, especially in terms of forensics.
CASE SUMMARY A 5-month-old male baby was pronounced dead following acute lung failure and cardiopulmonary arrest. The parents had immediately rushed their child to the hospital, stating the baby was found prone and not breathing. Total-body postmortem computed tomography (PMCT) was performed, revealing a hypodense material of indeterminate nature within the main airways and areas of ground-glass parenchymal change. At autopsy, the respiratory tract mucosa appeared edematous and was coated with a whitish stringy material. There was widespread airspace reduction due to parenchymal collapse. Alveolar sacs and bronchial openings contained abundant amorphous material admixed with white blood cells. Immunohistochemical studies were performed, targeting CD15, CD68, and alpha-lactalbumin. Ultimately, the focus was on alpha-lactalbumin (milk protein), which showed marked immunopositivity within alveolar spaces. Cytoplasmic staining of macrophages was also particularly prominent.
CONCLUSION Postmortem investigations are thus essential to identify causes of death and surrounding circumstances. PMCT is a useful tool in this setting, given the frequent dearth of autopsy findings and ambiguity as to cause of death in SUID cases. These findings, later confirmed by immunohistochemical investigations, were indicative of active pneumonia due to aspirated milk. The present account illustrates the importance a broad diagnostic approach to SUID in cases of forensic concern. PMCT is a very valuable aid in cases of forensic interest, as it can provide useful information in all those situations in which the cause of death is uncertain or there are no suggestive dynamics or lesions.
Collapse
Affiliation(s)
- Aniello Maiese
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, Pisa 56126, Italy
| | - Raffaele La Russa
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University of Roma, Roma 00185, Italy
| | - Mauro Arcangeli
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila 67100, Italy
| | - Gianpietro Volonnino
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University of Roma, Roma 00185, Italy
| | - Alessandra De Matteis
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University of Roma, Roma 00185, Italy
| | - Paola Frati
- Department SAIMLAL, Sapienza University of Roma, Roma 00185, Italy
| | - Vittorio Fineschi
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University of Roma, Roma 00185, Italy
| |
Collapse
|
5
|
Mencke T, Zitzmann A, Reuter DA. Sichere und kontroverse Komponenten der „rapid sequence induction“. Anaesthesist 2018; 67:305-320. [DOI: 10.1007/s00101-018-0416-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
6
|
Cytokine Reduction in the Setting of an ARDS-Associated Inflammatory Response with Multiple Organ Failure. Case Rep Crit Care 2016; 2016:9852073. [PMID: 26885411 PMCID: PMC4739007 DOI: 10.1155/2016/9852073] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 12/27/2015] [Indexed: 12/31/2022] Open
Abstract
A 45-year-old male was admitted to our hospital with a small bowel obstruction due to torsion and was immediately scheduled for surgical intervention. At anesthesia induction, the patient aspirated and subsequently developed a severe SIRS with ARDS and multiple organ failure requiring the use of ECMO, CRRT, antibiotics, and low dose steroids. Due to a rapid deterioration in clinical status and a concurrent surge in inflammatory biomarkers, an extracorporeal cytokine adsorber (CytoSorb) was added to the CRRT blood circuit. The combined treatment resulted in a rapid and significant reduction in the levels of circulating inflammatory mediators. This decrease was paralleled by marked clinical stabilization of the patient including a significant improvement in hemodynamic stability and a reduced need for norepinephrine and improved respiratory function as measured by PaO2/FIO2, ventilator parameters, lung mechanics, and indirect measures of capillary leak syndrome. The patient could be discharged to a respiratory weaning unit where successful respiratory weaning could be achieved later on. We attribute the clinical improvement to the rapid control of the hyperinflammatory response and the reduction of inflammatory mediators using a combination of CytoSorb and these other therapies. CytoSorb treatment was safe and well tolerated, with no device-related adverse effects observed.
Collapse
|
7
|
Bedu AS, Labruyère JJ, Thibaud JL, Barthélémy I, Leperlier D, Saunders JH, Blot S. AGE-RELATED THORACIC RADIOGRAPHIC CHANGES IN GOLDEN AND LABRADOR RETRIEVER MUSCULAR DYSTROPHY. Vet Radiol Ultrasound 2012; 53:492-500. [DOI: 10.1111/j.1740-8261.2012.01948.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2011] [Accepted: 04/02/2012] [Indexed: 12/20/2022] Open
Affiliation(s)
- Anne-Sophie Bedu
- The Unité de radiologie; Université de Paris Est; Ecole Nationale vétérinaire d'Alfort; 94700; Maisons-Alfort; France
| | - Julien J. Labruyère
- Vet CT Specialists Ltd; St John's Innovation Centre; Cowley Road; CB40WS; Cambridge; England
| | - Jean Laurent Thibaud
- UPR de neurobiologie; Université de Paris Est; Ecole Nationale vétérinaire d'Alfort; 94700; Maisons-Alfort; France
| | - Inès Barthélémy
- UPR de neurobiologie; Université de Paris Est; Ecole Nationale vétérinaire d'Alfort; 94700; Maisons-Alfort; France
| | - Dimitri Leperlier
- Unité de chirurgie; Université de Paris Est; Ecole Nationale vétérinaire d'Alfort; 94700; Maisons-Alfort; France
| | - Jimmy H. Saunders
- Veterinary Medical Imaging Department; Faculty of Veterinary Medicine; Ghent University; 9820; Merelbeke; Belgium
| | - Stéphane Blot
- UPR de neurobiologie; Université de Paris Est; Ecole Nationale vétérinaire d'Alfort; 94700; Maisons-Alfort; France
| |
Collapse
|