1
|
Finke SR, Schroeder DC, Ecker H, Böttiger BW, Herff H, Wetsch WA. Comparing suction rates of novel DuCanto catheter against Yankauer and standard suction catheter using liquids of different viscosity—a technical simulation. BMC Anesthesiol 2022; 22:285. [PMID: 36088303 PMCID: PMC9463842 DOI: 10.1186/s12871-022-01830-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 09/06/2022] [Indexed: 11/10/2022] Open
Abstract
Purpose Aspiration is a feared complication that may occur during airway management, and can significantly contribute to morbidity and mortality. Availability of a suctioning device with a suction catheter capable of clearing the airway is mandatory for airway management. However, suction performance may be significantly different amongst different suction catheters. The aim of this study was to compare suction rates of a standard 14 Ch suction catheter (SC), a Yankauer catheter (Y) and a DuCanto catheter (DC) using 4 fluids with different viscosity. Methods In this simulation trial, 4 preparations with standardized viscosity were prepared using a Xanthane-based medical fluid thickener. Lowest viscosity was achieved using tap water without thickener, syrup-like viscosity was achieved by adding 10 g per liter tap water, honey-like viscosity was achieved by adding 20 g per liter, and a pudding-like viscosity was achieved by adding 30 g of thickening powder per liter tap water. Each preparation was suctioned for 15 s with the three different suctioning devices. Measurements were repeated four times. The amount of removed preparation by suctioning was measured using a tared scale. Results Suction rates for water were 580 ± 34 mg for SC, 888 ± 5 mg for Y and 1087 ± 15 for DC; for syrup-like viscosity it was 383 ± 34(SC) vs. 661 ± 64(Y) vs. 935 ± 42(DC); for honey-like viscosity it was 191 ± 21(SC) vs. 426 ± 34(Y) vs. 590 ± 68(DC); and for pudding-like viscosity 74 ± 13(SC) vs. 164 ± 6(Y) vs. 211 ± 8(DC). Conclusion Suctioning liquids of different viscosity, the new DuCanto catheter was more effective than the Yankauer catheter that was more effective than a standard suctioning catheter. The relative superiority of the DuCanto was highest in fluids with high viscosity.
Collapse
|
2
|
Gamberini E, Poletti V, Russo E, Circelli A, Benni M, Scognamiglio G, Santonastaso DP, Martino C, Domenichini L, Biondi R, Bastoni G, Brogi E, Ansaloni L, Coccolini F, Fugazzola P, Spiga M, Agnoletti V. Massive aspiration syndrome: a possible indication for "emergent" veno-venous extracorporeal membrane oxygenation?: a case report. J Med Case Rep 2021; 15:499. [PMID: 34625110 PMCID: PMC8499513 DOI: 10.1186/s13256-021-03050-7] [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: 02/23/2020] [Accepted: 08/06/2021] [Indexed: 11/10/2022] Open
Abstract
Background Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is usually performed in cases of severe respiratory failure in which conventional and advanced mechanical ventilation strategies are ineffective in achieving true lung-protective ventilation, thus triggering ventilatory-induced lung injury. If circulatory failure coexists, veno-arterial ECMO (VA-ECMO) may be preferred over VV-ECMO because of its potential for circulatory support. In VA-ECMO, the respiratory contribution is less effective and the complication rate is higher than in the VV configuration. Case presentation The authors present a case in which VV-ECMO was performed in an emergency setting to treat a 68-year-old White male patient who experienced acute respiratory failure after massive aspiration. Despite intubation and intensive care unit admission, multiple organ failure occurred suddenly, thus prompting referral to a level-1 trauma center with an ECMO facility. The patient’s condition slowly improved with VV-ECMO support along with standard treatment for hemodynamic impairment. VV-ECMO was discontinued on day 8. The patient was extubated on day 14 and discharged home fully recovered 34 days after the event. Conclusions Attention was focused on the decision to initiate VV-ECMO support even in the presence of severe hemodynamic derangement, although VA-ECMO could have provided better hemodynamic support but less effective respiratory support.
Collapse
Affiliation(s)
- Emiliano Gamberini
- Anaesthesia and Intensive Care Department, Major Trauma Centre "Maurizio Bufalini" Hospital, 47251, Cesena, Italy.
| | - Venerino Poletti
- Chest and Respiratory Diseases Division, Interventional Pneumology Department, Morgagni-Pierantoni Hospital, 47121, Forlì, Italy
| | - Emanuele Russo
- Anaesthesia and Intensive Care Department, Major Trauma Centre "Maurizio Bufalini" Hospital, 47251, Cesena, Italy
| | - Alessandro Circelli
- Anaesthesia and Intensive Care Department, Major Trauma Centre "Maurizio Bufalini" Hospital, 47251, Cesena, Italy
| | - Marco Benni
- Anaesthesia and Intensive Care Department, Major Trauma Centre "Maurizio Bufalini" Hospital, 47251, Cesena, Italy
| | - Giovanni Scognamiglio
- Anaesthesia and Intensive Care Department, Major Trauma Centre "Maurizio Bufalini" Hospital, 47251, Cesena, Italy
| | - Domenico Pietro Santonastaso
- Anaesthesia and Intensive Care Department, Major Trauma Centre "Maurizio Bufalini" Hospital, 47251, Cesena, Italy
| | - Costanza Martino
- Anaesthesia and Intensive Care Department, Major Trauma Centre "Maurizio Bufalini" Hospital, 47251, Cesena, Italy
| | - Linda Domenichini
- Anaesthesia and Intensive Care Department, Major Trauma Centre "Maurizio Bufalini" Hospital, 47251, Cesena, Italy
| | - Romina Biondi
- Anaesthesia and Intensive Care Department, Major Trauma Centre "Maurizio Bufalini" Hospital, 47251, Cesena, Italy
| | - Giorgia Bastoni
- Emergency, General and Trauma Surgery Department, Level-1 Trauma Centre "Maurizio Bufalini" Hospital, 47251, Cesena, Italy
| | - Etrusca Brogi
- Anaesthesia and Intensive Care Department, Level-1 Pisa University Hospital, Pisa, Italy
| | - Luca Ansaloni
- Unit of General Surgery, "San Matteo" Foundation Hospital, Pavia University, Pavia, Italy
| | - Federico Coccolini
- Emergency, General and Trauma Surgery Department, Level-1 Pisa University Hospital, Pisa, Italy
| | - Paola Fugazzola
- Emergency, General and Trauma Surgery Department, Level-1 Trauma Centre "Maurizio Bufalini" Hospital, 47251, Cesena, Italy
| | - Martina Spiga
- Anaesthesia and Intensive Care Department, Major Trauma Centre "Maurizio Bufalini" Hospital, 47251, Cesena, Italy
| | - Vanni Agnoletti
- Anaesthesia and Intensive Care Department, Major Trauma Centre "Maurizio Bufalini" Hospital, 47251, Cesena, Italy
| |
Collapse
|
3
|
Vahdatpour C, Sussman A, Mahr T. A case report of severe hypothermia complicated by acute respiratory distress syndrome. Respir Med Case Rep 2019; 28:100869. [PMID: 31194152 PMCID: PMC6554481 DOI: 10.1016/j.rmcr.2019.100869] [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: 03/04/2019] [Revised: 05/28/2019] [Accepted: 05/28/2019] [Indexed: 11/15/2022] Open
Abstract
Acute respiratory distress syndrome has not been a described complication of hypothermia. Causes of hypothermia are commonly associated with alcohol abuse and infection, both of which could lead to acute respiratory distress syndrome. We present a case of severe hypothermia complicated by acute respiratory distress syndrome in a young immunocompetent male treated successfully with mechanical intubation and venovenous extracorpeal membrane oxygenation. Risk factors for known causes of acute respiratory distress syndrome included a witnessed aspiration event and RSV pneumonia. On review of the literature, severe hypothermia has been found to cause pulmonary edema in post-mortem studies, but acute respiratory distress syndrome has not yet been recognized as a known complication. Our case highlights that acute respiratory distress syndrome may be multifactorial in etiology and related to complications of severe hypothermia.
Collapse
Affiliation(s)
- C. Vahdatpour
- Department of Medicine, Pennsylvania Hospital, University of Pennsylvania Health System (UPHS), Philadelphia, PA United States
| | - A. Sussman
- Department of Medicine, Pennsylvania Hospital, University of Pennsylvania Health System (UPHS), Philadelphia, PA United States
| | - T. Mahr
- Pulmonary, Allergy, and Critical Care Division, Department of Medicine, Pennsylvania Hospital, University of Pennsylvania Health System (UPHS), Philadelphia, PA United States
| |
Collapse
|
4
|
Mendes PV, de Albuquerque Gallo C, Besen BAMP, Hirota AS, de Oliveira Nardi R, Dos Santos EV, Li HY, Joelsons D, Costa ELV, Foronda FK, Azevedo LCP, Park M. Transportation of patients on extracorporeal membrane oxygenation: a tertiary medical center experience and systematic review of the literature. Ann Intensive Care 2017; 7:14. [PMID: 28176223 PMCID: PMC5296266 DOI: 10.1186/s13613-016-0232-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 12/25/2016] [Indexed: 12/29/2022] Open
Abstract
Background Utilization of extracorporeal membrane oxygenation (ECMO) has increased worldwide, but its use remains restricted to severely ill patients, and few referral centers are properly structured to offer this support. Inter-hospital transfer of patients on ECMO support can be life-threatening. In this study, we report a single-center experience and a systematic review of the available published data on complications and mortality associated with ECMO transportation. Methods We reported single-center data regarding complications and mortality associated with the transportation of patients on ECMO support. Additionally, we searched multiple databases for case series, observational studies, and randomized controlled trials regarding mortality of patients transferred on ECMO support. Results were analyzed independently for pediatric (under 12 years old) and adult populations. We pooled mortality rates using a random-effects model. Complications and transportation data were also described. Results A total of 38 manuscripts, including our series, were included in the final analysis, totaling 1481 patients transported on ECMO support. A total of 951 patients survived to hospital discharge. The pooled survival rates for adult and pediatric patients were 62% (95% CI 57–68) and 68% (95% CI 60–75), respectively. Two deaths occurred during patient transportation. No other complication resulting in adverse outcome was reported. Conclusion Using the available pooled data, we found that patient transfer to a referral institution while on ECMO support seems to be safe and adds no significant risk of mortality to ECMO patients. Electronic supplementary material The online version of this article (doi:10.1186/s13613-016-0232-7) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Pedro Vitale Mendes
- Intensive Care Unit, Hospital das Clinicas, University of São Paulo School of Medicine, Rua Dr. Enéas Carvalho de Aguiar, 255, Sala 5023, São Paulo, SP, 05403000, Brazil. .,Research and Education Institute, Hospital Sírio-Libanês, São Paulo, Brazil.
| | | | | | | | | | | | - Ho Yeh Li
- Research and Education Institute, Hospital Sírio-Libanês, São Paulo, Brazil
| | - Daniel Joelsons
- Research and Education Institute, Hospital Sírio-Libanês, São Paulo, Brazil
| | - Eduardo Leite Vieira Costa
- Intensive Care Unit, Hospital das Clinicas, University of São Paulo School of Medicine, Rua Dr. Enéas Carvalho de Aguiar, 255, Sala 5023, São Paulo, SP, 05403000, Brazil.,Research and Education Institute, Hospital Sírio-Libanês, São Paulo, Brazil
| | | | - Luciano Cesar Pontes Azevedo
- Intensive Care Unit, Hospital das Clinicas, University of São Paulo School of Medicine, Rua Dr. Enéas Carvalho de Aguiar, 255, Sala 5023, São Paulo, SP, 05403000, Brazil.,Research and Education Institute, Hospital Sírio-Libanês, São Paulo, Brazil
| | - Marcelo Park
- Research and Education Institute, Hospital Sírio-Libanês, São Paulo, Brazil
| |
Collapse
|
5
|
Kim N, Kim KH, Kim JM, Choi SY, Na S. Early Extracorporeal Membrane Oxygenation for Massive Aspiration during Anesthesia Induction. Korean J Crit Care Med 2015. [DOI: 10.4266/kjccm.2015.30.2.109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
6
|
Abstract
Aspiration of foreign matter into the airways and lungs can cause a wide spectrum of pulmonary disorders with various presentations. The type of syndrome resulting from aspiration depends on the quantity and nature of the aspirated material, the chronicity, and the host responses. Aspiration is most likely to occur in subjects with a decreased level of consciousness, compromised airway defense mechanisms, dysphagia, gastroesophageal reflux, and recurrent vomiting. These aspiration-related syndromes can be categorized into airway disorders, including vocal cord dysfunction, large airway obstruction with a foreign body, bronchiectasis, bronchoconstriction, and diffuse aspiration bronchiolitis, or parenchymal disorders, including aspiration pneumonitis, aspiration pneumonia, and exogenous lipoid pneumonia. In idiopathic pulmonary fibrosis, aspiration has been implicated in disease progression and acute exacerbation. Aspiration may increase the risk of bronchiolitis obliterans syndrome in patients who have undergone a lung transplant. Accumulating evidence suggests that a causative role for aspiration is often unsuspected in patients presenting with aspiration-related pulmonary diseases; thus, many cases go undiagnosed. Herein, we discuss the broadening spectrum of these pulmonary syndromes with a focus on presenting features and diagnostic aspects.
Collapse
Affiliation(s)
- Xiaowen Hu
- Department of Respiratory Disease, Anhui Provincial Hospital, Hefei, China
| | - Joyce S Lee
- Department of Medicine, University of California, San Francisco, CA
| | - Paolo T Pianosi
- Pediatric Pulmonology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
| | - Jay H Ryu
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
| |
Collapse
|
7
|
Yoo KD. Is Extracorporeal Membrane Oxygenation Necessary for Community Hospitals? Korean J Crit Care Med 2014. [DOI: 10.4266/kjccm.2014.29.3.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Ki Dong Yoo
- Division of Cardiology, Department of Internal Medicine, Saint Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea
| |
Collapse
|
8
|
Luo L, Li H, Zhou L, Zhou J, Ni J, Zhou R. The lowest effective intracuff pressure of the esophagus obstruction tube to prevent reflux of gastric contents: a study on rabbits. J Anesth 2013; 28:499-504. [PMID: 24306129 DOI: 10.1007/s00540-013-1757-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 11/13/2013] [Indexed: 12/01/2022]
Abstract
PURPOSE To determine the lowest effective cuff pressure of the esophageal obstruction tube to prevent reflux of gastric contents in rabbits. METHODS Twenty-two New Zealand white rabbits (2.0-2.5 kg) were anesthetized. An esophageal obstruction tube, an esophageal observation tube, and a gastric tube were inserted into the esophagus and stomach, respectively. Normal saline containing methylene blue was injected into the stomach for an animal model of gastric contents reflux. Possible saline reflux was observed through the esophageal observation tube. It was considered "regurgitation" when the saline flowed out, and "no regurgitation" when the saline did not. When a "regurgitation" result was obtained in a particular rabbit, the intracuff pressure was increased by 10 cm H(2)O in the following rabbit and vice versa. The trial was not terminated until six crossover points were observed from "no regurgitation" to "regurgitation." A probit regression model was used to analyze the effective intracuff pressure of the esophagus obstruction tube after 50 % and 95 % of the rabbits showed no reflux. RESULTS The lowest effective intracuff pressure to prevent reflux of gastric contents in 50 % of rabbits from the Dixon up-down method was 61.67 ± 8.16 cm H(2)O. The intracuff pressures at which there was 50 % and 95 % probability of lack of gastric contents reflux from a probit regression model were 61.95 and 74.39 cm H(2)O, respectively. CONCLUSION The insertion of an esophageal obstruction tube before endotracheal intubation can be an acceptable method for preventing the reflux of gastric contents in most rabbits under light anesthesia.
Collapse
Affiliation(s)
- LinLi Luo
- Department of Anesthesiology, West China Second Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | | | | | | | | | | |
Collapse
|
9
|
Klein AA, Bailey CR. Who should undertake extracorporeal membrane oxygenation? Anaesthesia 2013; 68:449-52. [DOI: 10.1111/anae.12217] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- A. A. Klein
- Department of Anaesthesia; Papworth Hospital; Cambridge; UK
| | - C. R. Bailey
- Department of Anaesthesia; Guys and St. Thomas' NHS Foundation Trust; London; UK
| |
Collapse
|