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Kamal G, Agarwal D, Agarwal S, Gupta A, Gupta A, Kalra B, Gupta N. A prospective randomized comparative trial of pediatric C-MAC D-blade video laryngoscope with McCoy direct laryngoscope for intubation in children posted for elective surgical procedures under general anesthesia. Paediatr Anaesth 2024. [PMID: 38682461 DOI: 10.1111/pan.14911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 04/16/2024] [Accepted: 04/17/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Pediatric airway management requires careful clinical evaluation and experienced execution due to anatomical, physiological, and developmental considerations. Video laryngoscopy in pediatric airways is a developing area of research, with recent data suggesting that video laryngoscopes are better than standard Macintosh blades. Specifically, there is a paucity of literature on the advantages of the C-MAC D-blade compared to the McCoy direct laryngoscope. METHODS After Ethics Committee approval, 70 American Society of Anesthesiologists physical status 1 and 2 children aged 4-12 years scheduled for elective surgery under general anesthesia were recruited. Patients were randomly allocated to intubation using a C-MAC video laryngoscope size 2 D-blade (Group 1) and a McCoy laryngoscope size 2 blade (Group 2). The Intubation Difficulty Scale (IDS) for ease of intubation was the primary outcome, while Cormack-Lehane grades, duration of laryngoscopy and intubation, hemodynamic responses, and incidence of any airway complications were secondary outcomes. RESULTS Both groups were comparable in terms of patient characteristics. The median (IQR) Intubation Difficulty Scale (IDS) score was better but was statistically nonsignificant with C-MAC (0 [0-0] vs. 0 [0-2], p = .055). The glottic views were superior (CL grade I in 32/35 vs. 23/35, p = .002), and the time to best glottic view (6 s [5-7] vs. 8.0 s [6-10], p = .006) was lesser in the C-MAC D-blade group while the total duration of intubation was comparable (20 s [16-22] vs. 18 s [15-22], p = .374). All the patients could be successfully intubated on the first attempt. None of the patients had any complications. CONCLUSION The C-MAC video laryngoscope size 2 D-blade provided faster and better glottic visualization but similar intubation difficulty compared to McCoy size 2 laryngoscope in children. The shorter time to achieve glottic view demonstrated with the C-MAC failed to translate into a shorter total duration of intubation when compared to the McCoy laryngoscope attributable to a pronounced curvature of the D-blade.
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Affiliation(s)
- Geeta Kamal
- Chacha Nehru Bal Chikitsalya, New Delhi, India
| | | | | | - Anju Gupta
- All India Institute of Medical Sciences, New Delhi, India
| | - Aikta Gupta
- Chacha Nehru Bal Chikitsalya, New Delhi, India
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Otmani M, Mouaden A, Bensaid C, Ghfir I, Guerrouj H. Radioiodine Therapy: Alternative for the Treatment of Complicated Thyroid Ectopia. Cureus 2024; 16:e55162. [PMID: 38558620 PMCID: PMC10980535 DOI: 10.7759/cureus.55162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2024] [Indexed: 04/04/2024] Open
Abstract
Thyroid ectopy is the presence of thyroid tissue outside its normal cervical location. Clinical manifestations of thyroid ectopy are varied. The latter complications can be life-threatening. Emergency treatment is often surgical or endoscopic. We report a case of a 26-year-old man with tracheal thyroid ectopy, complicated by respiratory distress, in whom conventional treatments were not feasible. The patient was treated with radioiodine-131 administered in liquid form. The final control showed the complete resolution of the intra-tracheal mass. Intra-tracheal thyroid ectopy is a rare anomaly in which surgery is the traditional treatment. In certain cases where surgery is not feasible or refused, treatment with iodine-131 is a safe and effective alternative for the removal of ectopic thyroid tissue. The aim of our work is to show the significant efficiency of radioiodine therapy as an alternative for the treatment of complicated thyroid ectopia.
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Affiliation(s)
- Manale Otmani
- Department of Nuclear Medicine, Ibn Sina Hospital Center, Mohammed V University - Souissi, Rabat, MAR
| | - Ayat Mouaden
- Department of Nuclear Medicine, Ibn Sina Hospital Center, Mohammed V University - Souissi, Rabat, MAR
| | - Chaymae Bensaid
- Department of Nuclear Medicine, Ibn Sina Hospital Center, Mohammed V University - Souissi, Rabat, MAR
| | - Imad Ghfir
- Department of Nuclear Medicine, Ibn Sina Hospital Center, Mohammed V University - Souissi, Rabat, MAR
| | - Hasnae Guerrouj
- Department of Nuclear Medicine, Ibn Sina Hospital Center, Mohammed V University - Souissi, Rabat, MAR
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Dominick CL, Blanke BN, Simmons EM, Traynor DM, Fowler M, Nishisaki A, Napolitano N. Outcomes of Unplanned Extubations in a Large Children's Hospital. Respir Care 2024; 69:184-190. [PMID: 38164617 PMCID: PMC10898459 DOI: 10.4187/respcare.10904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
BACKGROUND Unplanned extubation (UE) is defined as unintentional dislodgement of an endotracheal tube (ETT) from the trachea. UEs can lead to instability, cardiac arrest, and may require emergent tracheal re-intubation. As part of our hospital-wide quality improvement (QI) work, a multidisciplinary committee reviewed all UEs to determine contributing factors and evaluation of clinical outcomes to develop QI interventions aimed to minimize UEs. The objective was to investigate occurrence, contributing factors, and clinical outcomes of UEs in the pediatric ICU (PICU), cardiac ICU (CICU), and neonatal ICU (NICU) in a large academic children's hospital. We hypothesized that these would be substantially different across 3 ICUs. METHODS A single-center retrospective review of UEs in the PICU, CICU, and NICU was recorded in a prospective database for the last 5 y. Consensus-based standardized operational definitions were developed to capture contributing factors and adverse events associated with UEs. Data were extracted through electronic medical records by 3 respiratory therapists and local Virtual Pediatric Systems (VPS) database. Consistency of data extraction and classification were evaluated. RESULTS From January 2016-December 2021, 408 UEs in 339 subjects were reported: PICU 52 (13%), CICU 31 (7%), and NICU 325 (80%). The median (interquartile range) of age and weight was 2.0 (0-4.0) months and 5.3 (3.0-8.0) kg. Many UE events were not witnessed (54%). Common contributing factors were routine nursing care (no. = 70, 18%), ETT retaping (no. = 62, 16%), and being held (no. = 15, 3.9%). The most common adverse events with UE were desaturation < 80% (33%) and bradycardia (22.8%). Cardiac arrest occurred in 12%. Sixty-seven percent of UEs resulted in re-intubation within 72 h. The proportion of re-intubation across 3 units was significantly different: PICU 62%, CICU 35%, NICU 71%, P < .001. CONCLUSIONS UEs occurred commonly in a large academic children's hospital. Whereas UE was associated with adverse events, re-intubation rates within 72 h were < 70% and variable across the units.
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Affiliation(s)
- Cheryl L Dominick
- Department of Respiratory Care, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
| | - Brooke N Blanke
- Department of Respiratory Care, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Emily M Simmons
- Department of Respiratory Care, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Danielle M Traynor
- Critical Care Center for Evidence and Outcomes, Pediatric Intensive Care Unit, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Madeline Fowler
- College of Nursing and Health Professionals, Drexel University, Philadelphia, Pennsylvania
| | - Akira Nishisaki
- Division of Anesthesia and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Natalie Napolitano
- Department of Respiratory Care, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Peng Y, Qian J, Mao Y. Comparison of lidocaine viscous gargle and topical application on laryngeal mask airway in general anesthesia: A randomized clinical trial. Saudi Med J 2024; 45:46-53. [PMID: 38220237 PMCID: PMC10807662 DOI: 10.15537/smj.2024.45.1.20230368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 11/08/2023] [Indexed: 01/16/2024] Open
Abstract
OBJECTIVES To investigate the effects and safety of lidocaine viscous gargle on postoperative sore throat (POST) in patients receiving a laryngeal mask airway (LMA) in general anesthesia. METHODS In this randomized controlled trial, 90 patients undergoing urological surgery were allocated into 2 treatment arms (n=45): lidocaine viscous gargle before LMA insertion (Group G) and topical application of lidocaine viscous on the LMA (Group T). Outcome data were collected before placement of LMA (T0), after insertion of LMA (T1), immediately (T2), one hour (T3), and 24 hours after removal of LMA (T4). We analyzed the incidence of POST, pharynx dryness, and adverse events. RESULTS The incidence of POST was lower in Group G than Group T at T2 (11.1% vs. 28.9%; p=0.063), T3 (11.1% vs. 24.4%; p=0.167), and T4 (2.2% vs. 4.4%; p=0.566), but there was no significant difference between groups. No patient in either group experienced severe pain or treatment-related adverse events. There was a significantly lower incidence of pharynx dryness in Group G than Group T (p<0.05) at T2, T3, and T4. CONCLUSION Lidocaine viscous gargle showed no statistically significant difference in incidence of POST and incidence of pharynx dryness compared with topical application of lidocaine on the LMA. Both approaches were safe for patients receiving LMA.Chinese Clinical Trial Register No.: ChiCTR2200059720.
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Affiliation(s)
- Yan Peng
- From the Department of Anesthesiology, The First Affiliated Hospital of Soochow University, Soochow, China.
| | - Ju Qian
- From the Department of Anesthesiology, The First Affiliated Hospital of Soochow University, Soochow, China.
| | - Yiqun Mao
- From the Department of Anesthesiology, The First Affiliated Hospital of Soochow University, Soochow, China.
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Wünsch VA, Köhl V, Breitfeld P, Bauer M, Sasu PB, Siebert HK, Dankert A, Stark M, Zöllner C, Petzoldt M. Hyperangulated blades or direct epiglottis lifting to optimize glottis visualization in difficult Macintosh videolaryngoscopy: a non-inferiority analysis of a prospective observational study. Front Med (Lausanne) 2023; 10:1292056. [PMID: 38098848 PMCID: PMC10720620 DOI: 10.3389/fmed.2023.1292056] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 10/26/2023] [Indexed: 12/17/2023] Open
Abstract
Purpose It is unknown if direct epiglottis lifting or conversion to hyperangulated videolaryngoscopes, or even direct epiglottis lifting with hyperangulated videolaryngoscopes, may optimize glottis visualization in situations where Macintosh videolaryngoscopy turns out to be more difficult than expected. This study aims to determine if the percentage of glottic opening (POGO) improvement achieved by direct epiglottis lifting is non-inferior to the one accomplished by a conversion to hyperangulated videolaryngoscopy in these situations. Methods One or more optimization techniques were applied in 129 difficult Macintosh videolaryngoscopy cases in this secondary analysis of a prospective observational study. Stored videos were reviewed by at least three independent observers who assessed the POGO and six glottis view grades. A linear mixed regression and a linear regression model were fitted. Estimated marginal means were used to analyze differences between optimization maneuvers. Results In this study, 163 optimization maneuvers (77 direct epiglottis lifting, 57 hyperangulated videolaryngoscopy and 29 direct epiglottis lifting with a hyperangulated videolaryngoscope) were applied exclusively or sequentially. Vocal cords were not visible in 91.5% of the cases with Macintosh videolaryngoscopy, 24.7% with direct epiglottis lifting, 36.8% with hyperangulated videolaryngoscopy and 0% with direct lifting with a hyperangulated videolaryngoscope. Conversion to direct epiglottis lifting improved POGO (mean + 49.7%; 95% confidence interval [CI] 41.4 to 58.0; p < 0.001) and glottis view (mean + 2.2 grades; 95% CI 1.9 to 2.5; p < 0.001). Conversion to hyperangulated videolaryngoscopy improved POGO (mean + 43.7%; 95% CI 34.1 to 53.3; p < 0.001) and glottis view (mean + 1.9 grades; 95% CI 1.6 to 2.2; p < 0.001). The difference in POGO improvement between conversion to direct epiglottis lifting and conversion to hyperangulated videolaryngoscopy is: mean 6.0%; 95% CI -6.5-18.5%; hence non-inferiority was confirmed. Conclusion When Macintosh videolaryngoscopy turned out to be difficult, glottis exposure with direct epiglottis lifting was non-inferior to the one gathered by conversion to hyperangulated videolaryngoscopy. A combination of both maneuvers yields the best result. Clinical trial registration ClinicalTrials.gov, NCT03950934.
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Affiliation(s)
- Viktor A. Wünsch
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Vera Köhl
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Philipp Breitfeld
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marcus Bauer
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Phillip B. Sasu
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hannah K. Siebert
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andre Dankert
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maria Stark
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Zöllner
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Petzoldt
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Park J, Park G, Kim DS, Kim M, Heo S, Jeong D, Chang H, Lee SU, Choi G, Lee GT, Shin TG, Park JE, Hwang SY. Effect of Blade Size on the First-Pass Success Rate of Endotracheal Intubation Using the C-MAC Video Laryngoscope. J Clin Med 2023; 12:7055. [PMID: 38002668 PMCID: PMC10672131 DOI: 10.3390/jcm12227055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 10/31/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023] Open
Abstract
We sought to determine whether blade size influences the first-pass success (FPS) rate when performing endotracheal intubation (ETI) with a C-MAC video laryngoscope (VL) in emergency department (ED) patients. This single-center, retrospective, observational study was conducted between August 2016 and July 2022. A total of 1467 patients was divided into two categories based on the blade size used during the first ETI attempt: blade-3 (n = 365) and blade-4 groups (n = 1102). The primary outcome was the FPS rate. The secondary outcomes included the glottic view, multiple attempt rate, and ETI-related complications. We used propensity score matching to reduce the potential confounders between the two groups. Among these, 363 pairs of matched propensity scores were generated. The FPS rate did not differ between the blade-3 (84.8%) and blade-4 groups (87.3%) in the matched cohort (p = 0.335). The multiple attempt rate did not differ significantly between groups (p = 0.289) and was 3.9% and 2.5% in the blade-3 and blade-4 groups, respectively. The difficult glottic view (11.3 vs. 6.9%, p = 0.039) and complication rates (15.4% vs. 10.5%, p = 0.047) were significantly higher in the blade-3 group than in the blade-4 group. The FPS rates of ETI with the blade-3 and blade-4 groups in adult patients in the ED did not differ significantly.
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Affiliation(s)
- Jeongyong Park
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea
| | - Goeun Park
- Biomedical Statistics Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul 06351, Republic of Korea
| | - Da Seul Kim
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea
| | - Minha Kim
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea
| | - Sejin Heo
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea
| | - Daun Jeong
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea
| | - Hansol Chang
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul 06355, Republic of Korea
| | - Se Uk Lee
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea
| | - Goosang Choi
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea
| | - Gun Tak Lee
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea
- Department of Emergency Medicine, College of Medicine, Kangwon National University, Chuncheon 20341, Republic of Korea
| | - Tae Gun Shin
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea
| | - Jong Eun Park
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea
- Department of Emergency Medicine, College of Medicine, Kangwon National University, Chuncheon 20341, Republic of Korea
| | - Sung Yeon Hwang
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea
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Mondal AK, Maiti AK, Chattopadhyay S, Bhar D. A randomised, double-blind, comparative study of preoperative magnesium sulphate versus zinc sulphate gargle for prevention of postoperative sore throat following endotracheal intubation. Indian J Anaesth 2023; 67:S261-S267. [PMID: 38187966 PMCID: PMC10768894 DOI: 10.4103/ija.ija_975_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 09/21/2023] [Accepted: 09/22/2023] [Indexed: 01/09/2024] Open
Abstract
Background and Aims Magnesium sulphate and zinc sulphate have been reported to attenuate postoperative sore throat (POST). The study aims to compare the effect of preoperative magnesium sulphate and zinc sulphate gargle on the incidence and severity of POST following endotracheal intubation within 24 h. Methods After ethics committee approval, 132 patients were randomly allocated to three groups (M, Z and D). Fifteen minutes before laryngoscopy and tracheal intubation, patients assigned to groups M and Z received a solution for gargle containing magnesium sulphate 20 mg/kg and zinc sulphate containing 40 mg of elemental zinc dissolved in 20 ml of 5% dextrose solution, respectively. Group D received 20 ml of 5% dextrose solution. Incidence and severity of POST (4-point score: Grade 0- no sore throat, Grade 1- mild sore throat, Grade 2- moderate sore throat, Grade 3- severe sore throat) was assessed for 24 h after extubation. Statistica, Version 8.0 (StatSoft, Inc., Tulsa, Oklahoma, USA) was used for analysing the data. Results The lowest incidence of POST in group M was 13.6% (95% confidence interval [CI] 3.5-23.7) compared to 0% in group Z, whereas the highest incidence recorded in group M was 25% (95% CI 12.2-37.7) in contrast to 13.6% (95% CI 3.5-23.7) in group Z during the first 24 h after operation. It was observed that the incidence of mild POST (POST score 1) was significantly lower (P < 0.05) in group Z compared to group M in the first 4 h postoperatively. Conclusion Zinc sulphate gargle before laryngoscopy and tracheal intubation is more effective for reducing the incidence of POST than magnesium sulphate gargle.
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Affiliation(s)
- Amit Kumar Mondal
- Department of Anaesthesiology, Midnapore Medical College, Vidyasagar Road, Midnapore, Paschim Medinipur, West Bengal, India
| | - Asim Kumar Maiti
- Department of Anaesthesiology, Midnapore Medical College, Vidyasagar Road, Midnapore, Paschim Medinipur, West Bengal, India
| | - Suman Chattopadhyay
- Department of Anaesthesiology, Midnapore Medical College, Vidyasagar Road, Midnapore, Paschim Medinipur, West Bengal, India
| | - Debasish Bhar
- Department of Anaesthesiology, Midnapore Medical College, Vidyasagar Road, Midnapore, Paschim Medinipur, West Bengal, India
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Perelló-Campaner C, González-Trujillo A, Alorda-Terrassa C, González-Gascúe M, Pérez-Castelló JA, Morales-Asencio JM, Molina-Mula J. Determinants of Communication Failure in Intubated Critically Ill Patients: A Qualitative Phenomenological Study from the Perspective of Critical Care Nurses. Healthcare (Basel) 2023; 11:2645. [PMID: 37830682 PMCID: PMC10572283 DOI: 10.3390/healthcare11192645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 09/21/2023] [Accepted: 09/22/2023] [Indexed: 10/14/2023] Open
Abstract
AIM To explore what factors determine communication with awake intubated critically ill patients from the point of view of critical care nursing professionals. BACKGROUND Impaired communication frequently affects mechanically ventilated patients with artificial airways in the intensive care unit. Consequences of communication breaches comprise emotional and ethical aspects as well as clinical safety, affecting both patients and their conversation partners. Identification of determining factors in communication with awake intubated patients is needed to design effective action strategies. DESIGN A qualitative phenomenological approach was used. METHODS Semi-structured interviews were used as the data collection method. A total of 11 participants from three intensive care units of three Majorcan public hospitals, selected by purposive sampling, were interviewed. FINDINGS Three major themes regarding the communication determinants of the awake intubated critically ill patients were identified from the interviewees' statements: factors related to the patient (physical and cognitive functionality to communicate, their relational and communicative style and their personal circumstances), to the context (family presence, ICU characteristics, workload, availability/adequacy of communication aids, features of the messages and communication situations) and, finally, those related to the professionals themselves (professional experience and person-centredness). CONCLUSIONS The present study reveals determinants that influence communication with the awake intubated patient, as there are attitudes and professional beliefs. RELEVANCE TO CLINICAL PRACTICE The discovery of relations between different kinds of determinants (of patient, context or professionals) provides a multi-factor perspective on the communicative problem which should be considered in the design of new approaches to improve communicative effectiveness. This study is reported according to the COREQ checklist.
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Affiliation(s)
- Catalina Perelló-Campaner
- Emergency Care Service 061, 07011 Palma, Spain
- SATSE CIDEFIB, c/Antoni Marques, 4. Bjs izqda, 07003 Palma, Spain
| | - Antonio González-Trujillo
- SATSE CIDEFIB, c/Antoni Marques, 4. Bjs izqda, 07003 Palma, Spain
- Emergency Hospital Care Service, Hospital de Manacor, 07500 Manacor, Spain
| | - Carme Alorda-Terrassa
- Nursing and Physiotherapy Department, University of Balearic Islands, 07122 Palma, Spain (J.M.-M.)
| | | | | | - José Miguel Morales-Asencio
- Universidad de Málaga, Faculty of Health Sciences, Department of Nursing, Instituto de Investigación Biomédica de Málaga (IBIMA-Bionand), 29016 Málaga, Spain
| | - Jesús Molina-Mula
- Nursing and Physiotherapy Department, University of Balearic Islands, 07122 Palma, Spain (J.M.-M.)
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Huertas MG, Rodríguez M, Castro P, Cruz SD, Cifuentes EA, Yepes AF, Zambrano MM, Baldión AM. Description of the colonizing mycobiota of endotracheal tubes from patients admitted to two intensive care units in Bogotá, Colombia. Biomedica 2023; 43:181-193. [PMID: 37721909 PMCID: PMC10586799 DOI: 10.7705/biomedica.6884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 05/15/2023] [Indexed: 09/20/2023]
Abstract
Introduction. Medical device colonization by pathogenic microorganisms is a risk factor for increasing infections associated with health care and, consequently, the morbidity and mortality of intubated patients. In Colombia, fungal colonization of endotracheal tubes has not been described, and this information could lead to new therapeutic options for the benefit of patients. Objective. To describe the colonizing fungi of the endotracheal tubes from patients in the intensive care unit, along with its antifungal sensitivity profile. Materials and methods. We conducted a descriptive, observational study in two health centers for 12 months. Endotracheal tubes were collected from patients in intensive care units. Samples were processed for culture, fungi identification, and antifungal sensitivity profile assessment. Results. A total of 121 endotracheal tubes, obtained from 113 patients, were analyzed: 41.32 % of the tubes were colonized by Candida albicans (64.62%), C. non‑albicans (30.77%), Cryptococcus spp. (3.08%) or molds (1.54%). All fungi evaluated showed a high sensitivity to antifungals, with a mean of 91%. Conclusion. Fungal colonization was found in the endotracheal tubes of patients under invasive mechanical ventilation. The antifungal sensitivity profile in these patients was favorable. A clinical study is required to find possible correlations between the colonizing microorganisms and infectivity.
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Affiliation(s)
- Mónica Gabriela Huertas
- Genética Molecular, Corporación CorpoGen, Bogotá, D.C., Colombia; Escuela de Medicina, Universidad Pedagógica y Tecnológica de Colombia, Tunja, Colombia.
| | - Miguel Rodríguez
- Departamento de Patología y Laboratorios, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, D.C., Colombia.
| | - Patricia Castro
- Departamento de Patología y Laboratorios, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, D.C., Colombia.
| | - Sergio Danilo Cruz
- Departamento de Patología y Laboratorios, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, D.C., Colombia.
| | | | - Andrés Felipe Yepes
- Departamento de Patología y Laboratorios, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, D.C., Colombia.
| | | | - Ana Margarita Baldión
- Departamento de Patología y Laboratorios, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, D.C., Colombia.
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Seo Y, Qiu L, Magnen M, Conrad C, Moussavi-Harami SF, Looney MR, Cleary SJ. Optimizing anesthesia and delivery approaches for dosing into lungs of mice. Am J Physiol Lung Cell Mol Physiol 2023; 325:L262-L269. [PMID: 37401383 PMCID: PMC10625824 DOI: 10.1152/ajplung.00046.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 06/06/2023] [Accepted: 06/28/2023] [Indexed: 07/05/2023] Open
Abstract
Microbes, toxins, therapeutics, and cells are often instilled into lungs of mice to model diseases and test experimental interventions. Consistent pulmonary delivery is critical for experimental power and reproducibility, but we observed variation in outcomes between handlers using different anesthetic approaches for intranasal dosing in mice. We therefore used a radiotracer to quantify lung delivery after intranasal dosing under inhalational (isoflurane) versus injectable (ketamine/xylazine) anesthesia in C57BL/6 mice. We found that ketamine/xylazine anesthesia resulted in delivery of a greater proportion (52 ± 9%) of an intranasal dose to lungs relative to isoflurane anesthesia (30 ± 15%). This difference in pulmonary dose delivery altered key outcomes in models of viral and bacterial pneumonia, with mice anesthetized with ketamine/xylazine for intranasal infection with influenza A virus or Pseudomonas aeruginosa developing more robust lung inflammation responses relative to control animals randomized to isoflurane anesthesia. Pulmonary dosing efficiency through oropharyngeal aspiration was not affected by anesthetic method and resulted in delivery of 63 ± 8% of dose to lungs, and a nonsurgical intratracheal dosing approach further increased lung delivery to 92 ± 6% of dose. The use of either of these more precise dosing methods yielded greater experimental power in the bacterial pneumonia model relative to intranasal infection. Both anesthetic approach and dosing route can impact pulmonary dosing efficiency. These factors affect experimental power and so should be considered when planning and reporting studies involving delivery of fluids to lungs of mice.NEW & NOTEWORTHY Many lung research studies involve dosing fluids into lungs of mice. In this study, the authors measure lung deposition using intranasal (i.n.), oropharyngeal aspiration (o.a.), and intratracheal (i.t.) dosing methods in mice. Anesthetic approach and administration route were found to affect pulmonary dosing efficiency. The authors demonstrate that refinements to dosing techniques can enable reductions in the number of animals needed for bacterial and viral pneumonia studies.
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Affiliation(s)
- Yurim Seo
- Department of Medicine, University of California, San Francisco, California, United States
| | - Longhui Qiu
- Department of Medicine, University of California, San Francisco, California, United States
| | - Mélia Magnen
- Department of Medicine, University of California, San Francisco, California, United States
| | - Catharina Conrad
- Department of Medicine, University of California, San Francisco, California, United States
| | | | - Mark R Looney
- Department of Medicine, University of California, San Francisco, California, United States
| | - Simon J Cleary
- Department of Medicine, University of California, San Francisco, California, United States
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11
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Abhyankar P, Sabharwal N, Gupta A, Das AK. Comparative evaluation of C-MAC and McGrath MAC videolaryngoscopes with Macintosh direct laryngoscope for endotracheal intubation in adult patients undergoing elective surgeries. J Anaesthesiol Clin Pharmacol 2023; 39:422-428. [PMID: 38025548 PMCID: PMC10661630 DOI: 10.4103/joacp.joacp_451_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 02/04/2022] [Accepted: 02/11/2022] [Indexed: 12/01/2023] Open
Abstract
Background and Aims Videolaryngoscopes have an undisputed role in difficult airway management, but their role in routine intubation scenarios remains underappreciated. McGrath MAC is a lightweight laryngoscope with a disposable blade. It remains to be proven if it performs as efficiently as the reusable videolaryngoscopes like C-MAC and whether it has an advantage over standard Macintosh laryngoscope in predicted normal airways. Material and Methods We recruited 180 adult patients and randomly divided them into three groups for intubation with either Macintosh laryngoscope (Group-A), C-MAC (Group-B), and McGrath (Group-C). The primary objective was to compare the first attempt success rate. Secondary objectives included Cormack-Lehane (CL) grades, laryngoscopy time, intubation time, ease of intubation, need for optimization manoeuver, and the number of passes to place the endotracheal tube. Results The two videolaryngoscopes provided a superior first attempt success rate as compared to Macintosh laryngoscope (P = 0.027). The CL grade-I was 100% in group B, 41.7% in group-A and 90% in group-C (B vs C; P = 0.037). Laryngoscopy time was 9.9 ± 2.5 s, 12.6 ± 0.8 s, and 13.1 ± 0.8 s for groups A, B, and C, respectively (B vs C; P = 0.001). Intubation time was 24.4 ± 12 s, 28.3 ± 1.9 s, and 37.3 ± 5.8 s for groups A, B, and C, respectively (P < 0.0001). The number of tube passes was highest in group C. Conclusion Videolaryngoscopes provided a superior glottic view and resulted in a superior first attempt success rate as compared to Macintosh laryngoscope. When comparing the two videolaryngoscopes, C-MAC resulted in better intubation characteristics (shorter intubation time, better glottic views, and higher first-attempt success rates) and should be preferred over McGrath for intubation in adult patients with normal airways.
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Affiliation(s)
- Prachi Abhyankar
- Department of Anaesthesiology and Intensive Care, VMMC and Safdarjung Hospital, New Delhi, India
| | - Nikki Sabharwal
- Department of Anaesthesiology and Intensive Care, VMMC and Safdarjung Hospital, New Delhi, India
| | - Anju Gupta
- Department of Anaesthesiology, Pain Medicine and Critical Care, AIIMS, New Delhi, India
| | - Akshaya K. Das
- Department of Anaesthesiology and Intensive Care, VMMC and Safdarjung Hospital, New Delhi, India
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12
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Bai L, Hao W, Zhang C, Guan Z. Effects of right stellate ganglion block combined with topical anesthesia on heart rate variability in awake patients receiving tracheal intubation. Afr Health Sci 2023; 23:380-385. [PMID: 38223581 PMCID: PMC10782361 DOI: 10.4314/ahs.v23i2.43] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024] Open
Abstract
Objective General anesthesia is commonly performed with tracheal intubation. We aimed to evaluate the effects of right stellate ganglion block combined with topical anesthesia on the heart rate variability in awake patients receiving tracheal intubation. Methods A total of 120 eligible patients were equally divided into observation and control groups using a random number table. The observation group underwent right stellate ganglion block combined with topical anesthesia. The excellent and good rate of anesthesia, indicators of vital signs and heart rate variability, incidence rate of adverse reactions, success rate and time consumption of tracheal intubation, postoperative resuscitation and cognitive function score of the two groups were compared. Results The systolic pressure, diastolic pressure and heart rate significantly increased in both groups during tracheal intubation compared with those before tracheal intubation, which they were lower in the observation group than those in the control group during tracheal intubation (P<0.05). Low-frequency power, ratio of low-frequency power to high-frequency power and heart rate variability index significantly decreased in both groups during tracheal intubation compared with those before tracheal intubation (P<0.05). Conclusion Right stellate ganglion block combined with topical anesthesia can work well for awake patients during tracheal intubation.
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Affiliation(s)
- Liping Bai
- Department of Anesthesiology, Shanxi Bethune Hospital, Taiyuan 030032, Shanxi Province, China
| | - Weihong Hao
- Department of Anesthesiology, Shanxi Bethune Hospital, Taiyuan 030032, Shanxi Province, China
| | - Chunmin Zhang
- Department of Anesthesiology, Shanxi Bethune Hospital, Taiyuan 030032, Shanxi Province, China
| | - Zhiming Guan
- Department of Respiratory Medicine, Second Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
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13
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Sanabria-Rodríguez OO, Cardozo-Avendaño SL, Muñoz-Velandia OM. Factors associated with a nonresponse to prone positioning in patients with severe acute respiratory distress syndrome due to SARS-CoV-2. Crit Care Sci 2023; 35:156-162. [PMID: 37712804 PMCID: PMC10406407 DOI: 10.5935/2965-2774.20230343-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 03/04/2023] [Indexed: 09/16/2023]
Abstract
OBJECTIVE To identify risk factors for nonresponse to prone positioning in mechanically ventilated patients with COVID-19-associated severe acute respiratory distress syndrome and refractory hypoxemia in a tertiary care hospital in Colombia. METHODS Observational study based on a retrospective cohort of mechanically ventilated patients with severe acute respiratory distress syndrome due to SARS-CoV-2 who underwent prone positioning due to refractory hypoxemia. The study considered an improvement ≥ 20% in the PaO2/FiO2 ratio after the first cycle of 16 hours in the prone position to be a 'response'. Nonresponding patients were considered cases, and responding patients were controls. We controlled for clinical, laboratory, and radiological variables. RESULTS A total of 724 patients were included (58.67 ± 12.37 years, 67.7% males). Of those, 21.9% were nonresponders. Mortality was 54.1% for nonresponders and 31.3% for responders (p < 0.001). Variables associated with nonresponse were time from the start of mechanical ventilation to pronation (OR 1.23; 95%CI 1.10 - 1.41); preintubation PaO2/FiO2 ratio (OR 0.62; 95%CI 0.40 - 0.96); preprone PaO2/FiO2 ratio (OR 1.88. 95%CI 1.22 - 2.94); and radiologic multilobe consolidation (OR 2.12; 95%CI 1.33 - 3.33) or mixed pattern (OR 1.72; 95%CI 1.07 - 2.85) compared with a ground-glass pattern. CONCLUSION This study identified factors associated with nonresponse to prone positioning in patients with refractory hypoxemia and acute respiratory distress syndrome due to SARS-CoV-2 receiving mechanical ventilation. Recognizing such factors helps identify candidates for other rescue strategies, including more extensive prone positioning or extracorporeal membrane oxygenation. Further studies are needed to assess the consistency of these findings in populations with acute respiratory distress syndrome of other etiologies.
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14
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Wu J, Liu Z, Shen D, Luo Z, Xiao Z, Liu Y, Huang H. Prevention of unplanned endotracheal extubation in intensive care unit: An overview of systematic reviews. Nurs Open 2023; 10:392-403. [PMID: 35971250 PMCID: PMC9834196 DOI: 10.1002/nop2.1317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 07/07/2022] [Accepted: 07/29/2022] [Indexed: 02/05/2023] Open
Abstract
AIMS This study was performed to identify and summarize systematic reviews focusing on the prevention of unplanned endotracheal extubation in the intensive care unit. DESIGN Overview of systematic reviews. METHODS This overview was conducted according to the Preferred Reporting Items for Overviews of Systematic Reviews, including the harms checklist. A literature search of PubMed, the Cochrane Library, CINAH, Embase, Web of Science, SINOMED and PROSPERO was performed from January 1, 2005-June 1, 2021. A systematic review focusing on unplanned extubation was included, resulting in an evidence summary. RESULTS Thirteen systematic reviews were included. A summary of evidence on unplanned endotracheal extubation was developed, and the main contents were risk factors, preventive measures and prognosis. The most important nursing measures were restraint, fixation of the tracheal tube, continuous quality improvement, psychological care and use of a root cause analysis for the occurrence of unplanned endotracheal extubation. CONCLUSIONS This overview re-evaluated risk factors and preventive measures for unplanned endotracheal extubation in the intensive care unit, resulting in a summary of evidence for preventing unplanned endotracheal extubation and providing direction for future research. TRIAL REGISTRATION DETAILS The study was registered on the PROSPERO website.
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Affiliation(s)
- Jinhua Wu
- Shantou University Medical College, Shantou, China
- Shantou University Medical College Affiliated First Hospital, Shantou, China
| | - Zhili Liu
- Shantou University Medical College Affiliated First HospitalShantouChina
| | - Danqiao Shen
- Shantou University Medical College Affiliated First HospitalShantouChina
| | - Zebing Luo
- Shantou University Medical CollegeShantouChina
- Cancer Hospital of Shantou University Medical CollegeShantouChina
| | - Zewei Xiao
- Shantou University Medical CollegeShantouChina
| | - Yeling Liu
- Shantou University Medical College Affiliated First HospitalShantouChina
| | - Haixing Huang
- Shantou University Medical College Affiliated First Hospital, No.57 Changping Road, Shantou, Guangdong 515041, China
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15
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Bharadwaj A, Neema PK, Karim HMR, Borthakur MP, Khetarpal M. A Holistic Approach to Managing Secondary Dysphagia Following Prolonged Intubation and Tracheostomy: A Case Report. Cureus 2023; 15:e34620. [PMID: 36895537 PMCID: PMC9988438 DOI: 10.7759/cureus.34620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2023] [Indexed: 02/05/2023] Open
Abstract
The ability to swallow and maintain the airway is a critical rehabilitation milestone for patients with swallowing disorders following prolonged tracheal intubation. Tracheostomy and dysphagia often coexist in critically ill patients and given the medical complexity analyzing the evidence to optimize swallowing assessment and management is challenging. It takes a holistic approach to dealing with issues in a critical care patient as we also need to deal with issues other than medical. We present a case of a 68-year-old gentleman who was admitted to the critical care unit following a double barrel ileostomy and had multiple complications and organ dysfunction requiring prolonged supportive management, tracheostomy, and mechanical ventilation. After recovering from primary illness and complications, he had a swallowing disorder (secondary dysphagia), which was managed successfully over the next month. The case highlights the need for screening, a multidisciplinary team, empathy, and effort as a part of a holistic management approach.
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Affiliation(s)
- Abhishek Bharadwaj
- Anesthesiology, Critical Care, and Pain Medicine, All India Institute of Medical Sciences, Raipur, IND
| | - Praveen K Neema
- Cardiac Anesthesiology, Amrita Institute of Medical Sciences and Research Centre, Kochi, IND
| | - Habib Md R Karim
- Anesthesiology, Critical Care, and Pain Medicine, All India Institute of Medical Sciences, Raipur, IND
| | - Manas P Borthakur
- Anesthesiology and Critical Care, Sarathi Multispeciality Hospital, Nalbari, IND
| | - Monica Khetarpal
- Anesthesiology, Critical Care, and Pain Medicine, All India Institute of Medical Sciences, Raipur, IND
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16
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Lundstrøm LH, Nørskov AK, Kjeldgaard LD, Wetterslev J, Rosenstock CV. Implementation of video laryngoscopes and the development in airway management strategy and prevalence of difficult tracheal intubation: A national cohort study. Acta Anaesthesiol Scand 2023; 67:159-168. [PMID: 36307961 DOI: 10.1111/aas.14165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 10/18/2022] [Accepted: 10/19/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND We aimed to determine the development in the use of video laryngoscopy over a 9-year period, and its possible impact on airway planning and management. METHODS We retrieved 822,259 records of tracheal intubations recorded from 2008 to 2016 in the Danish Anaesthesia Database. The circumstances regarding pre-operative airway assessment, the scheduled airway management plan and the actual airway management concerning video laryngoscopy were reported for each year of observation. Further, the association between year of observation and various airway management related outcomes was evaluated by multivariate logistic regression. RESULTS There was a significant increase in airway management with 'advanced technique successfully used within two attempts' from 2.7% in 2008 to 15.5% in 2016 (p < .0001). This predominantly reflects use of video laryngoscopy. The prevalence of tracheal intubations 'scheduled for video laryngoscopy' increased from 3.5% in 2008 to 10.6% in 2016 (p < .0001). We found a significant increase in the prevalence of anticipated difficulties with intubations by direct laryngoscopy from 1.8% in 2008 to 5.2% in 2016 (p < .0001). The prevalence of failed tracheal intubations decreased from 0.14% in 2008 to 0.05% in 2016 (p < .0001). CONCLUSION From 2008 to 2016, a period of massive implementation of video laryngoscopes, a significant change in airway management behaviour was recorded. Increasingly, video laryngoscopy is becoming a first-choice device for both acute and routine airway management. Most importantly, the data showed a noticeable reduction in failed intubation over the time of observation.
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Affiliation(s)
- Lars Hyldborg Lundstrøm
- Department of Anaesthesiology and Intensive Care, Nordsjaellands Hospital, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Anders K Nørskov
- Department of Anaesthesiology and Intensive Care, Nordsjaellands Hospital, University of Copenhagen, Copenhagen, Denmark.,Department of Anaesthesiology, Centre for Anaesthesiological Research, Zealand University Hospital, Køge, Denmark
| | - Line D Kjeldgaard
- Department of Anaesthesiology and Intensive Care, Nordsjaellands Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jørn Wetterslev
- Private Office, Tuborg Sundpark 3, Hellerup, Copenhagen, Denmark
| | - Charlotte V Rosenstock
- Department of Anaesthesiology and Intensive Care, Nordsjaellands Hospital, University of Copenhagen, Copenhagen, Denmark
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17
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Arruda DG, Kieling GA, Melo-Diaz LL. Effectiveness of high-flow nasal cannula therapy on clinical outcomes in adults with COVID-19: A systematic review. Can J Respir Ther 2023; 59:52-65. [PMID: 36741308 PMCID: PMC9854387 DOI: 10.29390/cjrt-2022-005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Introduction/Background Coronavirus disease 2019 (COVID-19) has high transmissibility and mortality rates. High-flow nasal cannula therapy (HFNC) might reduce the need for orotracheal intubation, easing the burden on the health system caused by COVID-19. The objective of the present study was to examine the effectiveness of HFNC in adult patients hospitalized with COVID-19. Specifically, the present study explores the effects of HFNC on rates of mortality, intubation and intensive care units (ICU) length of stay. The present study also seeks to define predictors of success and failure of HFNC. Methods A systematic literature search was conducted in the PubMed, EMBASE and SCOPUS databases, and the study was prepared according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Study quality was assessed using the National Heart, Lung, and Blood Institute's Study Quality Assessment Tools. Results The search identified 1,476 unique titles; 95 articles received full-text reviews and 40 studies were included in this review. HFNC was associated with a reduction in the rate of orotracheal intubation, notably when compared to conventional oxygen therapy. Studies reported inconsistency in whether HFNC reduced ICU length of stay or mortality rates. Among the predictors of HFNC failure/success, a ratio of oxygen saturation index of approximately 5 or more was associated with HFNC success. Conclusion In adult patients hospitalized with COVID-19, HFNC may prove effective in reducing the rate of orotracheal intubation. The ratio of the oxygen saturation index was the parameter most examined as a predictor of HFNC success. Low-level research designs, inherent study weaknesses and inconsistent findings made it impossible to conclude whether HFNC reduces ICU length of stay or mortality. Future studies should employ higher level research designs.
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Affiliation(s)
- Daiana Gonçalves Arruda
- Multiprofessional Residency Program in Hospital Care in Adult and Elderly Health – Hospital de Clínicas – Federal University of Paraná, Curitiba, Paraná, Brazil
| | - George Alvício Kieling
- Multiprofessional Unit – Hospital de Clínicas – Federal University of Paraná, Curitiba, Paraná, Brazil
| | - Lucélia Luna Melo-Diaz
- Multiprofessional Unit – Hospital de Clínicas – Federal University of Paraná, Curitiba, Paraná, Brazil
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18
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Nahar AR, Gopinath V, Ruth MS. Can low dose of intratracheal dexmedetomidine be used to attenuate peri-extubation cough? - A prospective, double-blinded, randomized clinical trial. Saudi J Anaesth 2023; 17:39-44. [PMID: 37032667 PMCID: PMC10077806 DOI: 10.4103/sja.sja_619_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/06/2022] [Accepted: 09/19/2022] [Indexed: 12/24/2022] Open
Abstract
Background Peri-extubation cough is an undesirable event during extubation, prevention of which has been studied with multiple drugs, amongst which intravenous dexmedetomidine has emerged as one of the favourable drugs. Intratracheal route is attractive because of its ease of administration, provided it avoids the hypotension and bradycardia that occurs during intravenous bolus administration. There is a paucity of data exploring the utility, doses, and adverse effect of intratracheal dexmedetomidine. Methods After obtaining ethical committee approval, 60 eligible, consenting adult patients undergoing surgery under general anesthesia in a tertiary teaching hospital were recruited and randomised into three groups-DEX0.3, DEX0.5, and NS. The plan of general anesthesia was standardized. Half an hour prior to extubation, study drug was instilled intratracheally-dexmedetomidine 0.3 mic/kg, 0.5 mic/kg, and NS in groups DEX0.3, DEX0.5, and NS, respectively. 4-point cough score was used to assess extubation response. Hemodynamic response and time to Ramsay sedation score 3 was also recorded. Results Majority of patients in DEX0.3 (60%) and DEX0.5 (85%) group had no cough (cough score 0), while majority of the patients in the NS group (70%) had either mild or moderate cough (cough score 1, 2). Kruskal Wallis test followed by post-hoc pairwise comparison showed statistically significant difference in 4-point cough score between GroupDEX0.3 and GroupNS (P < 0.001) and between GroupDEX0.5 and GroupNS (P = 0.038). DEX0.5 group, compared to DEX0.3 group, had significantly higher time from reversal to extubation (P < 0.001) and time to achieve Ramsay sedation score of 3 (P < 0.001). Conclusion We conclude that both 0.3 mic/kg and 0.5 mic/kg of dexmedetomidine when given intratracheally are effective in preventing peri-extubation cough. Further, 0.3 mic/kg dexmedetomidine showed a better recovery profile compared to 0.5 mic/kg dexmedetomidine when administered intratracheally.
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Affiliation(s)
- Afreen R. Nahar
- Department of Anaesthesiology, Chettinad Hospital and Research Institute, Chennai, Tamil Nadu, India
| | - V Gopinath
- Department of Anaesthesiology, Chettinad Hospital and Research Institute, Chennai, Tamil Nadu, India
| | - Merlin Shalini Ruth
- Department of Anaesthesiology, Chettinad Hospital and Research Institute, Chennai, Tamil Nadu, India
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19
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Corral-Gudino L, Cusacovich I, Martín-González JI, Muela-Molinero A, Abadía-Otero J, González-Fuentes R, Ruíz-de-Temiño Á, Tapia-Moral E, Cuadrado-Medina F, Martín-Asenjo M, Miramontes-González P, Delgado-González JL, Ines S, Abad-Manteca L, Usategui-Martín I, Ruiz-Albi T, Miranda-Riaño S, Rodríguez-Fortúnez P, Rodríguez-Jiménez C, López-Franco E, Marcos M. Effect of intravenous pulses of methylprednisolone 250 mg versus dexamethasone 6 mg in hospitalised adults with severe COVID-19 pneumonia: An open-label randomised trial. Eur J Clin Invest 2023; 53:e13881. [PMID: 36169086 PMCID: PMC9538428 DOI: 10.1111/eci.13881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 08/10/2022] [Accepted: 09/25/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND The efficacy and safety of high versus medium doses of glucocorticoids for the treatment of patients with COVID-19 has shown mixed outcomes in controlled trials and observational studies. We aimed to evaluate the effectiveness of methylprednisolone 250 mg bolus versus dexamethasone 6 mg in patients with severe COVID-19. METHODS A randomised, open-label, controlled trial was conducted between February and August 2021 at four hospitals in Spain. The trial was suspended after the first interim analysis since the investigators considered that continuing the trial would be futile. Patients were randomly assigned in a 1:1 ratio to receive dexamethasone 6 mg once daily for up to 10 days or methylprednisolone 250 mg once daily for 3 days. RESULTS Of the 128 randomised patients, 125 were analysed (mean age 60 ± 17 years; 82 males [66%]). Mortality at 28 days was 4.8% in the 250 mg methylprednisolone group versus 4.8% in the 6 mg dexamethasone group (absolute risk difference, 0.1% [95% CI, -8.8 to 9.1%]; p = 0.98). None of the secondary outcomes (admission to the intensive care unit, non-invasive respiratory or high-flow oxygen support, additional immunosuppressive drugs, or length of stay), or prespecified sensitivity analyses were statistically significant. Hyperglycaemia was more frequent in the methylprednisolone group at 27.0 versus 8.1% (absolute risk difference, -18.9% [95% CI, -31.8 to - 5.6%]; p = 0.007). CONCLUSIONS Among severe but not critical patients with COVID-19, 250 mg/d for 3 days of methylprednisolone compared with 6 mg/d for 10 days of dexamethasone did not result in a decrease in mortality or intubation.
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Affiliation(s)
- Luis Corral-Gudino
- Internal Medicine Department, Hospital Universitario Río Hortega, Gerencia Regional de Salud de Castilla y Leon (SACYL), Valladolid, Spain.,Department of Medicine, Dermatology and Toxicology. School of Medicine, Universidad de Valladolid, Valladolid, Spain
| | - Ivan Cusacovich
- Department of Medicine, Dermatology and Toxicology. School of Medicine, Universidad de Valladolid, Valladolid, Spain.,Internal Medicine Department, Hospital Clínico Universitario de Valladolid, Gerencia Regional de Salud de Castilla y Leon (SACYL), Valladolid, Spain
| | - Jose Ignacio Martín-González
- Internal Medicine Department, Hospital Universitario de Salamanca-IBSAL, Gerencia Regional de Salud de Castilla y Leon (SACYL), Salamanca, Spain.,School of Medicine, Universidad de Salamanca, Salamanca, Spain
| | - Alberto Muela-Molinero
- Internal Medicine Department, Hospital Universitario de León, Gerencia Regional de Salud de Castilla y Leon (SACYL), León, Spain
| | - Jésica Abadía-Otero
- Internal Medicine Department, Hospital Universitario Río Hortega, Gerencia Regional de Salud de Castilla y Leon (SACYL), Valladolid, Spain.,Department of Medicine, Dermatology and Toxicology. School of Medicine, Universidad de Valladolid, Valladolid, Spain
| | - Roberto González-Fuentes
- Internal Medicine Department, Hospital Clínico Universitario de Valladolid, Gerencia Regional de Salud de Castilla y Leon (SACYL), Valladolid, Spain
| | - Ángela Ruíz-de-Temiño
- Internal Medicine Department, Hospital Universitario Río Hortega, Gerencia Regional de Salud de Castilla y Leon (SACYL), Valladolid, Spain.,Department of Medicine, Dermatology and Toxicology. School of Medicine, Universidad de Valladolid, Valladolid, Spain
| | - Elena Tapia-Moral
- Internal Medicine Department, Hospital Clínico Universitario de Valladolid, Gerencia Regional de Salud de Castilla y Leon (SACYL), Valladolid, Spain
| | - Francisca Cuadrado-Medina
- Internal Medicine Department, Hospital Universitario Río Hortega, Gerencia Regional de Salud de Castilla y Leon (SACYL), Valladolid, Spain.,Department of Medicine, Dermatology and Toxicology. School of Medicine, Universidad de Valladolid, Valladolid, Spain
| | - Miguel Martín-Asenjo
- Internal Medicine Department, Hospital Clínico Universitario de Valladolid, Gerencia Regional de Salud de Castilla y Leon (SACYL), Valladolid, Spain
| | - Pablo Miramontes-González
- Internal Medicine Department, Hospital Universitario Río Hortega, Gerencia Regional de Salud de Castilla y Leon (SACYL), Valladolid, Spain.,Department of Medicine, Dermatology and Toxicology. School of Medicine, Universidad de Valladolid, Valladolid, Spain
| | - Jose Luis Delgado-González
- Internal Medicine Department, Hospital Clínico Universitario de Valladolid, Gerencia Regional de Salud de Castilla y Leon (SACYL), Valladolid, Spain
| | - Sandra Ines
- Internal Medicine Department, Hospital Universitario de Salamanca-IBSAL, Gerencia Regional de Salud de Castilla y Leon (SACYL), Salamanca, Spain.,School of Medicine, Universidad de Salamanca, Salamanca, Spain
| | - Laura Abad-Manteca
- Internal Medicine Department, Hospital Universitario Río Hortega, Gerencia Regional de Salud de Castilla y Leon (SACYL), Valladolid, Spain.,Department of Medicine, Dermatology and Toxicology. School of Medicine, Universidad de Valladolid, Valladolid, Spain
| | - Iciar Usategui-Martín
- Internal Medicine Department, Hospital Clínico Universitario de Valladolid, Gerencia Regional de Salud de Castilla y Leon (SACYL), Valladolid, Spain
| | - Tomás Ruiz-Albi
- Pneumology Department, Hospital Universitario Río Hortega, Gerencia Regional de Salud de Castilla y Leon (SACYL), Valladolid, Spain
| | - Sara Miranda-Riaño
- Internal Medicine Department, Hospital Clínico Universitario de Valladolid, Gerencia Regional de Salud de Castilla y Leon (SACYL), Valladolid, Spain
| | - Patricia Rodríguez-Fortúnez
- Clinical Trials Unit, Pharmacology Department, Complejo Hospitalario Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - Consuelo Rodríguez-Jiménez
- Clinical Trials Unit, Pharmacology Department, Complejo Hospitalario Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - Esperanza López-Franco
- UICEC, Complejo Asistencial Universitario de Salamanca - Instituto de Investigación Biomédica de Salamanca (IBSAL), Plataforma SCReN, Salamanca, Spain
| | - Miguel Marcos
- Internal Medicine Department, Hospital Universitario de Salamanca-IBSAL, Gerencia Regional de Salud de Castilla y Leon (SACYL), Salamanca, Spain.,School of Medicine, Universidad de Salamanca, Salamanca, Spain.,UICEC, Complejo Asistencial Universitario de Salamanca - Instituto de Investigación Biomédica de Salamanca (IBSAL), Plataforma SCReN, Salamanca, Spain
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Cho HY, Lee K, Kong HJ, Yang HL, Jung CW, Park HP, Hwang JY, Lee HC. Deep-learning model associating lateral cervical radiographic features with Cormack-Lehane grade 3 or 4 glottic view. Anaesthesia 2023; 78:64-72. [PMID: 36198200 DOI: 10.1111/anae.15874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2022] [Indexed: 12/13/2022]
Abstract
Unanticipated difficult laryngoscopy is associated with serious airway-related complications. We aimed to develop and test a convolutional neural network-based deep-learning model that uses lateral cervical spine radiographs to predict Cormack-Lehane grade 3 or 4 direct laryngoscopy views of the glottis. We analysed the radiographs of 5939 thyroid surgery patients at our hospital, 253 (4%) of whom had grade 3 or 4 glottic views. We used 10 randomly sampled datasets to train a model. We compared the new model with six similar models (VGG, ResNet, Xception, ResNext, DenseNet and SENet). The Brier score (95%CI) of the new model, 0.023 (0.021-0.025), was lower ('better') than the other models: VGG, 0.034 (0.034-0.035); ResNet, 0.033 (0.033-0.035); Xception, 0.032 (0.031-0.033); ResNext, 0.033 (0.032-0.033); DenseNet, 0.030 (0.029-0.032); SENet, 0.031 (0.029-0.032), all p < 0.001. We calculated mean (95%CI) of the new model for: R2 , 0.428 (0.388-0.468); mean squared error, 0.023 (0.021-0.025); mean absolute error, 0.048 (0.046-0.049); balanced accuracy, 0.713 (0.684-0.742); and area under the receiver operating characteristic curve, 0.965 (0.962-0.969). Radiographic features around the hyoid bone, pharynx and cervical spine were associated with grade 3 and 4 glottic views.
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Affiliation(s)
- H-Y Cho
- Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Anaesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - K Lee
- Department of Electrical Engineering and Computer Science, Daegu Gyeongbuk Institute of Science and Technology, Daegu, Republic of Korea.,Medical Big data Research Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - H-J Kong
- Transdisciplinary Department of Medicine and Advanced Technology, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - H-L Yang
- Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea.,Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - C-W Jung
- Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Anaesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - H-P Park
- Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Anaesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - J Y Hwang
- Department of Electrical Engineering and Computer Science, Daegu Gyeongbuk Institute of Science and Technology, Daegu, Republic of Korea.,Department of Interdisciplinary Studies of Artificial Intelligence, Daegu Gyeongbuk Institute of Science and Technology, Daegu, Republic of Korea
| | - H-C Lee
- Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Anaesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
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21
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MacKinnon J, McCoy C. Use of video laryngoscopy versus direct laryngoscopy as a teaching tool for neonatal intubation: A systematic review. Can J Respir Ther 2023; 59:111-116. [PMID: 37056577 PMCID: PMC10089680 DOI: 10.29390/cjrt-2022-056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
Introduction Endotracheal intubation and positive pressure ventilation following delivery are required in 32.9% of neonates <31 weeks gestational age and in 5.9% of older newborn babies [1]. Competency in intubation is important, yet opportunities for learners to develop this skill in the clinical environment are limited. Direct laryngoscopy (DL) provides a direct view of the airway during intubation. Unfortunately, visualization of the airway is only available to the primary operator, preventing supervising instructors from simultaneously viewing the airway and allowing them to provide real-time feedback to learners. Video laryngoscopy (VL) is a specialized clinical instrument that utilizes an indirect view of the airway that is digitally projected onto a screen via camera, which allows multiple simultaneous viewers to view the airway during intubation attempts and permits instructors to provide real-time feedback to learners accordingly. Objectives This systematic review explores whether VL-supported learning is superior to DL for the development of skill in neonatal intubation. Methods Systematic searches of MEDLINE, EMBASE, CINAHL and the Cochrane Library were conducted without language restrictions. Studies published between January 2011 and November 2021 were examined. Randomized controlled trials (RCTs) comparing the effectiveness of VL versus DL for supporting neonatal intubation learning were included. Rate of successful intubation was the primary outcome measure. Both authors independently extracted study data and conducted risk of bias assessment. Results Four RCTs met the inclusion criteria, with two incorporating crossover designs. Each examined the effectiveness of VL versus DL, with concurrent supervisor support, as a tool for learning neonatal intubation in medical residents. All studies reported significantly higher intubation success rates with VL. Conclusion VL and real-time supervisor feedback is a more effective tool for supporting the development of neonatal intubation skill, compared with DL. Future investigations should include learners from other professions whose scope of practice includes neonatal intubation (eg, respiratory therapists).
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Affiliation(s)
| | - Carolyn McCoy
- Canadian Society of Respiratory Therapists, Ottawa, ON, Canada
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22
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Sriramka B, Warsi ZH, Sahoo J. Effects of adding dexmedetomidine to nebulized lidocaine on control of hemodynamic responses to laryngoscopy and intubation: A randomized clinical trial. J Anaesthesiol Clin Pharmacol 2023; 39:11-17. [PMID: 37250266 PMCID: PMC10220189 DOI: 10.4103/joacp.joacp_93_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/05/2021] [Accepted: 04/09/2021] [Indexed: 03/21/2023] Open
Abstract
Background and Aims Hemodynamic responses (HDR) to laryngoscopy and intubation are a significant concern for the anesthesiologist. This study aimed to compare the effects of intravenous Dexmedetomidine and nebulized Lidocaine for control of HDR to laryngoscopy and intubation when used in combination or alone. Material and Methods This double-blind, parallel group, randomized clinical trial included 90 patients (30 for each group) aged 18-55 years with ASA grade 1-2. Group DL received intravenous (IV) Dexmedetomidine (1 μg kg-1) and nebulized Lidocaine 4% (3 mg kg-1) before laryngoscopy. Group D received IV Dexmedetomidine (1 μg kg-1) and group L received nebulized Lidocaine 4% (3 mg kg-1). Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) were recorded at baseline, post nebulization, and at 1, 3, 5, 7, and 10 min post-intubation. Data analysis was done by SPSS 20.0. Results Post-intubation HR was better controlled in group DL than group D and group L (76.40 ± 5.61, 95.16 ± 10.60, 103.90 ± 12.98 respectively, P value <0.01). Group DL > D > L controlled SBP changes significantly (118.93 ± 7.70, 131.10 ± 9.20, 142.66 ± 19.62 respectively, P value <0.01). At 7 and 10 minutes, group D and L found similarly effective in preventing a rise in SBP. Group DL showed significantly better control of DBP than group L and D till 7 minutes (P < 0.01). Group DL also had better control of MAP post-intubation (92.86 ± 5.50) than group D (102.70 ± 6.64) and L (112.66 ± 7.66) and continued to be better till 10 minutes. Conclusion We found the addition of intravenous Dexmedetomidine to nebulized Lidocaine to be superior in controlling the increase in HR and MBP post-intubation with no adverse effects.
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Affiliation(s)
- Bhavna Sriramka
- Department of Anesthesia and Critical Care, IMS and Sum Hospital, Bhubaneswar, Odisha, India
| | - Zeeshan Haider Warsi
- Department of Anesthesia and Critical Care, IMS and Sum Hospital, Bhubaneswar, Odisha, India
| | - Janmejaya Sahoo
- Department of Anesthesia and Critical Care, IMS and Sum Hospital, Bhubaneswar, Odisha, India
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23
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Kim KM, Seo KH, Kim YJ, John H, Moon HS, Kim N, Yeon N. Comparison of the C-MAC D-blade video laryngoscope and the McCoy laryngoscope for double-lumen endotracheal tube intubation: A prospective randomized controlled study. Medicine (Baltimore) 2022; 101:e31775. [PMID: 36397435 PMCID: PMC9666159 DOI: 10.1097/md.0000000000031775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Inserting a double-lumen endotracheal tube (DLT) poses more challenge than inserting a single-lumen tube. The C-MAC D-blade videolaryngoscope is a useful alternative to the direct laryngoscope. However, no study has compared its performance with that of the McCoy laryngoscope, which has a hyperangulated blade tip similar to that of the C-MAC D-blade. We aimed to compare the performance of the C-MAC D-blade videolaryngoscope with that of the McCoy laryngoscope in DLT intubation. METHODS In this prospective randomized controlled study, 90 patients requiring DLT intubation were randomly allocated to either the C-MAC D-blade videolaryngoscope group (group C, n = 47) or McCoy laryngoscope group (group M, n = 43). During intubation, the percentage of glottic opening, modified Cormack-Lehane grade, time taken for intubation, malposition of the bronchial lumen, and hemodynamic parameters were recorded. After intubation, we assessed the intubation difficulty scale score and, a postoperative sore throat in the recovery room. RESULTS The time taken for intubation was 35.85 ± 10.77 seconds and 33.18 ± 11.97 seconds in groups C and M, respectively (P = .269). The modified Cormack-Lehane grade was significantly lower in group C than in group M (P = .000). Percentage of glottic opening was significantly higher in group C (79.36 ± 13.42%) than in group M (53.49 ± 29.83%) (P = .000). The intubation difficulty scale score was significantly lower in group C than in group M (P = .030). There were no significant differences between the 2 groups in terms of malposition status, hemodynamic parameters, or visual analog scale score for a postoperative sore throat. CONCLUSION Although the time taken for intubation was comparable between the 2 intubation devices, the C-MAC D-blade videolaryngoscope facilitated glottis visualization and reduced the intubation difficulty scale better than the McCoy laryngoscope in patients undergoing DLT intubation.
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Affiliation(s)
- Kyung Mi Kim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Kwon Hui Seo
- Department of Anesthesiology and Pain Medicine, The Catholic University of Korea, Yeouido St. Mary’s Hospital, Seoul, Republic of Korea
- *Correspondence: Kwon Hui Seo, Department of Anesthesiology and Pain Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea,10 63-ro, Yeoungdeungpo-gu, Seoul 07345, Republic of Korea (e-mail: )
| | - You Jung Kim
- Department of Anesthesiology and Pain Medicine, Hallym University Sacred Heart Hospital, Hallym University School of Medicine, Anyang, Republic of Korea
| | - Hyunji John
- Department of Anesthesiology and Pain Medicine, Hallym University Sacred Heart Hospital, Hallym University School of Medicine, Anyang, Republic of Korea
| | - Hyun Soo Moon
- Department of Anesthesiology and Pain Medicine, Hallym University Sacred Heart Hospital, Hallym University School of Medicine, Anyang, Republic of Korea
| | - Namhyun Kim
- Department of Anesthesiology and Pain Medicine, Hallym University Sacred Heart Hospital, Hallym University School of Medicine, Anyang, Republic of Korea
| | - Nayoung Yeon
- Department of Anesthesiology and Pain Medicine, Hallym University Sacred Heart Hospital, Hallym University School of Medicine, Anyang, Republic of Korea
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24
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Wenzel AA, Kagalwalla AF, Wechsler JB. Pre-endoscopy Symptoms and Age, But Not Esophageal Biopsy Number Are Associated With Post-endoscopy Adverse Events. J Pediatr Gastroenterol Nutr 2022; 75:656-660. [PMID: 36305884 PMCID: PMC9627599 DOI: 10.1097/mpg.0000000000003594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Esophagogastroduodenoscopy (EGD) is a frequently utilized investigative tool in the management of gastrointestinal conditions in children. Biopsies obtained during EGD may pose risk for post-operative adverse events (AEs), and further understanding of risk is imperative to provide informed consent to families and safe patient care. In particular, the impact of biopsy number and location on the development of AEs has not been studied in pediatric patients. We prospectively assessed for AEs by telephone survey 3-7 days after 209 EGDs performed on patients ages 1-21 years over a 1-year period. Demographic, endoscopic, and histologic data were collected. The most common symptoms reported were throat pain (61%), chest pain (26%), and dysphagia (26%). Binary regression models identified age and pre-operative symptoms as factors that influenced the likelihood of post-operative morbidity. Multiple biopsies from 3 different locations of the esophagus did not impact the risk of post-operative AEs.
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Affiliation(s)
- Amanda A Wenzel
- From the Division of Gastroenterology, Hepatology and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Amir F Kagalwalla
- From the Division of Gastroenterology, Hepatology and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
- the Division of Pediatric Gastroenterology John H Stroger Hospital of Cook County, Chicago, IL
| | - Joshua B Wechsler
- From the Division of Gastroenterology, Hepatology and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
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25
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Kim DS, Jeong D, Park JE, Lee GT, Shin TG, Chang H, Kim T, Lee SU, Yoon H, Cha WC, Sim YJ, Park SY, Hwang SY. Endotracheal Intubation Using C-MAC Video Laryngoscope vs. Direct Laryngoscope While Wearing Personal Protective Equipment. J Pers Med 2022; 12:jpm12101720. [PMID: 36294859 PMCID: PMC9605128 DOI: 10.3390/jpm12101720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/01/2022] [Accepted: 10/06/2022] [Indexed: 11/07/2022] Open
Abstract
This study sought to determine whether the C-MAC video laryngoscope (VL) performed better than a direct laryngoscope (DL) when attempting endotracheal intubation (ETI) in the emergency department (ED) while wearing personal protective equipment (PPE). This was a retrospective single-center observational study conducted in an academic ED between February 2020 and March 2022. All emergency medical personnel who participated in any ETI procedure were required to wear PPE. The patients were divided into the C-MAC VL group and the DL group based on the device used during the first ETI attempt. The primary outcome measure was the first-pass success (FPS) rate. A multiple logistic regression was used to determine the factors associated with FPS. Of the 756 eligible patients, 650 were assigned to the C-MAC group and 106 to the DL group. The overall FPS rate was 83.5% (n = 631/756). The C-MAC group had a significantly higher FPS rate than the DL group (85.7% vs. 69.8%, p < 0.001). In the multivariable logistic regression analysis, C-MAC use was significantly associated with an increased FPS rate (adjusted odds ratio, 2.86; 95% confidence interval, 1.69−4.08; p < 0.001). In this study, we found that the FPS rate of ETI was significantly higher when the C-MAC VL was used than when a DL was used by emergency physicians constrained by cumbersome PPE.
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Affiliation(s)
- Da Saem Kim
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Daun Jeong
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Jong Eun Park
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
- Department of Emergency Medicine, College of Medicine, Kangwon National University, Chuncheon 20341, Korea
| | - Gun Tak Lee
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
- Department of Emergency Medicine, College of Medicine, Kangwon National University, Chuncheon 20341, Korea
| | - Tae Gun Shin
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Hansol Chang
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Taerim Kim
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Se Uk Lee
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Hee Yoon
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Won Chul Cha
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul 06355, Korea
- Health Information and Strategy Center, Samsung Medical Center, Seoul 06351, Korea
| | - Yong Jin Sim
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Song Yi Park
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Sung Yeon Hwang
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
- Correspondence: ; Tel.: +82-2-3410-2053
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26
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Kumar A, Taluja A, Saxena B, Dwivedi P. A Comparative Evaluation of 2 Videolaryngoscopes as an Intubation Aid in a Simulated Difficult Airway: A Prospective Randomised Study. Turk J Anaesthesiol Reanim 2022; 50:340-345. [PMID: 36301282 PMCID: PMC9682938 DOI: 10.5152/tjar.2022.21285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 12/22/2021] [Indexed: 09/10/2023] Open
Abstract
OBJECTIVE Several videolaryngoscopes have been developed for using in difficult airway. We conducted this study to evaluate the performance of McGrath® MAC and King Vision® videolaryngoscopes in a simulated difficult airway. METHODS This prospective, randomised, comparative study was conducted in 140 surgical patients. Anaesthesia was administered as per standard protocol. A cervical collar was applied to simulate a difficult airway. Patients were randomised into 2 groups. In group M (n=70), laryngoscopy was performed first with King Vision® videolaryngoscope and second time with McGrath® MAC videolaryngoscope and trachea was intubated using the second device, while in group K (n=70), laryngoscopy was performed first with McGrath® MAC videolaryngoscope and second time with King Vision® videolaryngoscope and trachea was intubated using the second device. The laryngeal view, time taken for optimal laryngeal view, number of intubation attempts, ease of intubation, first attempt intubation success, time to tracheal intubation, haemodynamic parameters, and complications such as airway trauma, if any, were noted. RESULTS Tracheal intubation was faster with McGrath® MAC (34.89 ± 3.7 seconds) compared to King Vision® videolaryngoscope (43.43 ± 4.3 seconds, P <.001) with comparable first attempt intubation success by 100% vs 97.1%, P =.496, respectively. The laryngeal view obtained with both the devices was comparable but the mean time taken for optimal laryngeal view was significantly longer with King Vision® videolaryngoscope, both in group M (P <.001) and group K (P <.001). Ease of intubation and complications were comparable in the 2 groups. CONCLUSION McGrath® MAC videolaryngoscope in comparison to King Vision® videolaryngoscope resulted in a shorter time taken for optimal laryngeal view and time to tracheal intubation with comparable first attempt intubation success.
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Affiliation(s)
- Ajay Kumar
- Department of Anaesthesia and Critical Care, Deen Dayal Upadhyay Hospital, New Delhi, India
| | - Anupma Taluja
- Department of Anaesthesia and Critical Care, Deen Dayal Upadhyay Hospital, New Delhi, India
| | - Bhavna Saxena
- Department of Anaesthesia and Critical Care, Deen Dayal Upadhyay Hospital, New Delhi, India
| | - Puneet Dwivedi
- Department of Anaesthesia and Critical Care, Deen Dayal Upadhyay Hospital, New Delhi, India
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27
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Vijayakumar EN, Ramachandran S, Hiremath VR, Kuppusamy S, Shanmugam B, Dhamodharan DB. Evaluation of Glottic View and Intubation Conditions with Sniffing Position Using Three Different Pillow Heights during Direct Laryngoscopy: A Prospective Analytical Study. Anesth Essays Res 2022; 16:412-415. [PMID: 36620120 PMCID: PMC9814001 DOI: 10.4103/aer.aer_130_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 09/29/2022] [Accepted: 10/03/2022] [Indexed: 12/14/2022] Open
Abstract
Background Limited studies are available for assessing the optimal pillow height for sniffing position to obtain the best glottic view during laryngoscopy and intubation in the Indian population. Aims This study was designed to evaluate laryngoscopic view and intubation conditions in sniffing position using three different pillow heights (without a pillow, 4 cm, and 7 cm) during direct laryngoscopy. Settings and Design This prospective analytical study was done in a tertiary care teaching institute. Materials and Methods In 60 patients, direct laryngoscopy was performed in the sniffing position first without a pillow (0 cm), followed by a 4-cm pillow, and then a 7-cm pillow to assess the glottic view after administration of anesthesia. The laryngoscopic views were graded using the percentage of glottic opening (POGO) score and Cormack and Lehane (CL) grade. The pillow with the best laryngoscopic view was subsequently used to intubate the patient. Intubation difficulty was assessed by the Intubation Difficulty Score (IDS). The patient was followed up for 24 h postoperatively to evaluate postoperative complications due to intubation. Statistical Analysis The categorical data were expressed in frequency and percentages and analyzed using the Chi-square test. Results With a 4-cm pillow, there are a lower CL grade and a higher POGO score compared to views without a pillow and a 7-cm pillow which was statistically significant. There is a significantly lesser IDS score with a 4-cm pillow. Conclusions The sniffing position with a 4-cm pillow provides a better laryngoscopic view and improved intubation condition than without a pillow and a 7-cm pillow in the study population.
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Affiliation(s)
| | - Srinivasan Ramachandran
- Department of Anesthesiology, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India
| | - Vishwanath R. Hiremath
- Department of Anesthesiology, Sree Lakshmi Narayana Institute of Medical Sciences, Puducherry, India
| | - Sureshkumar Kuppusamy
- Department of Anesthesiology, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India
| | - Balasubramanian Shanmugam
- Department of Anesthesiology, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India
| | - Dinesh Babu Dhamodharan
- Department of Anesthesiology, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India
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28
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Zhang Y, Guo H, Hu Z, Wang L, Du H. Comparison of the success with two bending angles for lighted stylet intubation in children: A prospective randomised study. Paediatr Anaesth 2022; 32:531-538. [PMID: 35049111 DOI: 10.1111/pan.14398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 12/17/2021] [Accepted: 01/13/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIM The bend angle of a lighted stylet is an important factor for successful orotracheal intubation. The aim of this study was to test the differences in the success of endotracheal intubation using lighted stylet with 70° versus 90° bend angles in children aged 4-6 years with normal airways. METHODS A total of 136 children with normal airways required orotracheal intubation were enrolled and were randomly allocated to the 90° or 70° bend angle groups. The first-attempt success rate was assessed as the primary outcome. The intubation time, lighted stylet search time, lighted stylet withdrawal time, hemodynamic responses, and perioperative complications were recorded as secondary outcomes. RESULTS All intubations were completed within three attempts (the 90° group, 63/5/0; the 70° group, 55/11/2). The first-attempt success rate was higher in the 90° group than that in the 70° group (92.6% [63/68 patients] versus 80.9% [55/68 patients], respectively; risk ratio, 1.15; 95% CI, 1.01-1.31; p = .04). Esophageal entry occurred in nine of 83 intubation attempts in the 70° group and two of 73 intubation attempts in the 90° group (risk ratio, 1.09; 95% CI, 1.01-1.19; p = .04). The intubation time and the lighted stylet search time were significantly shorter in the 90° group than that in the 70° group (intubation time: 12.2 ± 2.0 s versus 14.9 ± 2.6 s, respectively; mean difference, 2.65; 95% CI, 1.87-3.43; p < .01; effect size, 1.16; lighted stylet search time: 5.4 ± 1.0 s versus 8.0 ± 1.6 s, respectively; mean difference, 2.66; 95% CI, 2.21-3.12; p < .01; effect size, 1.95). CONCLUSIONS Lighted stylet intubation with a 90° bend angle improved the first-attempt success rate and reduced esophageal intubation in children aged 4-6 years with normal airways.
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Affiliation(s)
- Yanjun Zhang
- The First Central Clinical School, Tianjin Medical University, Tianjin, China.,Department of Anesthesiology, Tianjin Children 's Hospital, Tianjin, China
| | - Hao Guo
- The First Central Clinical School, Tianjin Medical University, Tianjin, China.,Department of Anesthesiology, Shanxi provincial people's Hospital, Taiyuan, China
| | - Zhanfei Hu
- Department of Anesthesiology, Chifeng Municipal Hospital, Chifeng, China
| | - Li Wang
- The First Central Clinical School, Tianjin Medical University, Tianjin, China
| | - Hongyin Du
- The First Central Clinical School, Tianjin Medical University, Tianjin, China
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ArunimaPattnayak. 3: Comparison of the blockbustertm and air-q®supraglottic airway devices as a conduit to blind endotracheal intubation in paediatric patients: a randomised controlled trial. Indian J Anaesth 2022; 66. [PMCID: PMC9116747 DOI: 10.4103/0019-5049.340655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background and Aims: Methods: Results: Conclusion:
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Saikia P, Thottan RS. Length of the middle finger of hand as a simple and reliable predictor of optimal size of uncuffed endotracheal tube in paediatric patients: An observational study. Indian J Anaesth 2022; 65:813-819. [PMID: 35001954 PMCID: PMC8680412 DOI: 10.4103/ija.ija_711_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 11/05/2021] [Accepted: 11/07/2021] [Indexed: 11/04/2022] Open
Abstract
Background and Aims A recent study suggested middle finger length-based formula as a better predictive guide compared with age-based formula for selecting uncuffed endotracheal tubes (ETTs) in children. But that study did not meet sample size requirement. Thus, we primarily aimed to determine the accuracy of formula using length of the middle finger to determine the internal diameter of the uncuffed ETT and to compare its accuracy with the Cole's formula. As a secondary objective, we desired to compare its accuracy with some commonly used length and weight-based formulae. Methods This prospective observational study included children aged up to 12 years posted for elective surgery under general anaesthesia. The length of the middle finger on the palmar aspect of the hand was measured in the preoperative period and the characteristics of the airway used were noted. A predefined criterion of optimal size of the uncuffed ETT was used. Results A total of 139 patients were included in the final analysis. It was observed that the formula based on middle finger length can predict the optimal size of uncuffed ETT within an error of 0.5 mm in more than 90% instances and its predictive performance is better than Cole's formula. As a secondary outcome, we also observed that its accuracy is better than other formulae under evaluation. Conclusion Formula based on middle finger length can be used as a predictor of optimal size of uncuffed ETT in paediatric patients and it is a better predictor than Cole's formula.
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Affiliation(s)
- Priyam Saikia
- Department of Anaesthesiology and Critical Care, Gauhati Medical College and Hospital, Guwahati, Assam, India
| | - Rohan S Thottan
- Department of Anaesthesiology and Critical Care, Gauhati Medical College and Hospital, Guwahati, Assam, India
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Demarzo SE, Melo JBC, Carranza MXM, Oliveira FND, Ferreira ADP, Palomino ALM, Figueiredo VR, Jacomelli M. Bronchoscopy in COVID-19 inpatients: experience of a university hospital in the first outbreak of the disease in Brazil. Einstein (Sao Paulo) 2022; 20:eAO6858. [PMID: 35649053 PMCID: PMC9126607 DOI: 10.31744/einstein_journal/2022ao6858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 11/02/2021] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To describe the indications and endoscopic findings of bronchoscopy performed at a reference university hospital for inpatients diagnosed with COVID-19 during the first outbreak of the disease in Brazil. METHODS A retrospective analysis of medical records of adult patients diagnosed with COVID-19 who underwent bronchoscopy at the intensive care units of Instituto do Coração and Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, from March to August 2020. RESULTS A total of 132 bronchoscopies were performed in 103 patients diagnosed with COVID-19. Mean age was 56.1±14.5 years, and distribution was similar in both sexes. More than one test was performed in 16 patients. The most frequent indications were diagnostic endoscopic evaluation and therapeutic procedures in 78.6% of cases (n=81) and material collection in 21.4% of cases (n=22). The most frequent endoscopic findings were presence of secretion or clots in 34% of cases, the presence of acute inflammatory changes in 22.3%, and tracheal wall laceration in 20.4%. In 27.2% of patients, no relevant bronchoscopic findings were observed. In three patients, bronchoscopy was indicated to assess hemoptysis, but there was only one case of active bleeding. Procedure-related complications were not observed in this group of patients. CONCLUSION Bronchoscopy proved to be a safe and effective procedure to assist in treatment of COVID-19 patients, and the most frequent indications were related to investigation of airway involvement or to evaluate infectious and inflammatory pulmonary processes.
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Affiliation(s)
- Sergio Eduardo Demarzo
- Universidade de São PauloFaculdade de MedicinaHospital das ClínicasSão PauloSPBrazilInstituto do Coração (Incor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
- Corresponding author: Sergio Eduardo Demarzo, Avenida Dr. Enéas de Carvalho Aguiar, 44, 2nd floor, building 3, Broncoscopy sector – Pinheiros Zip code: 05403-900 – São Paulo, SP, Brazil. Phone: (11) 2661-5612 E-mail:
| | - Júlia Bamberg Cunha Melo
- Universidade de São PauloFaculdade de MedicinaHospital das ClínicasSão PauloSPBrazilInstituto do Coração (Incor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Mariasol Ximena Martínez Carranza
- Universidade de São PauloFaculdade de MedicinaHospital das ClínicasSão PauloSPBrazilInstituto do Coração (Incor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Felipe Nominando Diniz Oliveira
- Universidade de São PauloFaculdade de MedicinaHospital das ClínicasSão PauloSPBrazilInstituto do Coração (Incor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Anarégia de Pontes Ferreira
- Universidade de São PauloFaculdade de MedicinaHospital das ClínicasSão PauloSPBrazilInstituto do Coração (Incor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Addy Lidvina Mejia Palomino
- Universidade de São PauloFaculdade de MedicinaHospital das ClínicasSão PauloSPBrazilInstituto do Coração (Incor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Viviane Rossi Figueiredo
- Universidade de São PauloFaculdade de MedicinaHospital das ClínicasSão PauloSPBrazilInstituto do Coração (Incor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Marcia Jacomelli
- Universidade de São PauloFaculdade de MedicinaHospital das ClínicasSão PauloSPBrazilInstituto do Coração (Incor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
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Ruiz VM, Goldsmith MP, Shi L, Simpao AF, Gálvez JA, Naim MY, Nadkarni V, Gaynor JW, Tsui FR. Early prediction of clinical deterioration using data-driven machine-learning modeling of electronic health records. J Thorac Cardiovasc Surg 2021; 164:211-222.e3. [PMID: 34949457 DOI: 10.1016/j.jtcvs.2021.10.060] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 10/13/2021] [Accepted: 10/28/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To develop and evaluate a high-dimensional, data-driven model to identify patients at high risk of clinical deterioration from routinely collected electronic health record (EHR) data. MATERIALS AND METHODS In this single-center, retrospective cohort study, 488 patients with single-ventricle and shunt-dependent congenital heart disease <6 months old were admitted to the cardiac intensive care unit before stage 2 palliation between 2014 and 2019. Using machine-learning techniques, we developed the Intensive care Warning Index (I-WIN), which systematically assessed 1028 regularly collected EHR variables (vital signs, medications, laboratory tests, and diagnoses) to identify patients in the cardiac intensive care unit at elevated risk of clinical deterioration. An ensemble of 5 extreme gradient boosting models was developed and validated on 203 cases (130 emergent endotracheal intubations, 34 cardiac arrests requiring cardiopulmonary resuscitation, 10 extracorporeal membrane oxygenation cannulations, and 29 cardiac arrests requiring cardiopulmonary resuscitation onto extracorporeal membrane oxygenation) and 378 control periods from 446 patients. RESULTS At 4 hours before deterioration, the model achieved an area under the receiver operating characteristic curve of 0.92 (95% confidence interval, 0.84-0.98), 0.881 sensitivity, 0.776 positive predictive value, 0.862 specificity, and 0.571 Brier skill score. Performance remained high at 8 hours before deterioration with 0.815 (0.688-0.921) area under the receiver operating characteristic curve. CONCLUSIONS I-WIN accurately predicted deterioration events in critically-ill infants with high-risk congenital heart disease up to 8 hours before deterioration, potentially allowing clinicians to target interventions. We propose a paradigm shift from conventional expert consensus-based selection of risk factors to a data-driven, machine-learning methodology for risk prediction. With the increased availability of data capture in EHRs, I-WIN can be extended to broader applications in data-rich environments in critical care.
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Affiliation(s)
- Victor M Ruiz
- Tsui Laboratory, Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Michael P Goldsmith
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pa; Pereleman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Lingyun Shi
- Tsui Laboratory, Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Allan F Simpao
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pa; Pereleman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Jorge A Gálvez
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pa; Pereleman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Maryam Y Naim
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pa; Pereleman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Vinay Nadkarni
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pa; Pereleman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - J William Gaynor
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pa; Pereleman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Fuchiang Rich Tsui
- Tsui Laboratory, Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pa; Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pa; Pereleman School of Medicine, University of Pennsylvania, Philadelphia, Pa.
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Gadepalli C, Stepien KM, Tol G. Hyo-Mental Angle and Distance: An Important Adjunct in Airway Assessment of Adult Mucopolysaccharidosis. J Clin Med 2021; 10:4924. [PMID: 34768446 DOI: 10.3390/jcm10214924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 10/20/2021] [Accepted: 10/21/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Mucopolysaccharidosis (MPS) is a rare congenital lysosomal storage disorder with complex airways. High anterior larynx is assessed by thyromental distance (TMD) nasendoscopy. A simpler method to assess this hyoid bone is described. The distance between the central-hyoid and symphysis of the mandible (hyo-mental distance; HMD) and inclination of this line to the horizontal axis (hyo-mental angle; HMA) in neutrally positioned patients is investigated. Methods: HMA, HMD in MPS, and non-MPS were compared, and their correlation with height and weight were assessed. Results: 50 adult MPS patients (M = 32, F = 18, age range = 19–66 years; mean BMI = 26.8 kg/m2) of MPS I, II, III, IV, and VI were compared with 50 non-MPS (M = 25, F = 25; age range = 22–84 years; mean BMI = 26.5 kg/m2). Mean HMA in MPS was 25.72° (−10 to +50) versus 2.42° (−35 to +28) in non-MPS. Mean HMD was 46.5 (25.7–66) millimeters in MPS versus 41.8 (27–60.3) in non-MPS. HMA versus height and weight showed a moderate correlation (r = −0.4, p < 0.05) in MPS and no significant correlation (r < 0.4, p > 0.05) in non-MPS. HMD versus height and weight showed no correlation (r < 0.4, p > 0.05) in both groups. Conclusions: HMA seems more acute in MPS despite nearly the same HMD as non-MPS, signifying a high larynx, which may be missed by TMD.
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Saafan HA, Ibrahim KM, Thabet Y, Elbeltagy SM, Eissa RA, Ghaleb AH, Ibrahim F, Elsabahy M, Eissa NG. Intratracheal Administration of Chloroquine-Loaded Niosomes Minimize Systemic Drug Exposure. Pharmaceutics 2021; 13:1677. [PMID: 34683971 PMCID: PMC8539513 DOI: 10.3390/pharmaceutics13101677] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 09/28/2021] [Accepted: 10/08/2021] [Indexed: 12/14/2022] Open
Abstract
Pulmonary administration provides a useful alternative to oral and invasive routes of administration while enhancing and prolonging the accumulation of drugs into the lungs and reducing systemic drug exposure. In this study, chloroquine, as a model drug, was loaded into niosomes for potential pulmonary administration either via dry powder inhalation or intratracheally. Chloroquine-loaded niosomes have been prepared and extensively characterized. Furthermore, drug-loaded niosomes were lyophilized and their flowing properties were evaluated by measuring the angle of repose, Carr's index, and Hausner ratio. The developed niosomes demonstrated a nanosized (100-150 nm) spherical morphology and chloroquine entrapment efficiency of ca. 24.5%. The FT-IR results indicated the incorporation of chloroquine into the niosomes, whereas in vitro release studies demonstrated an extended-release profile of the drug-loaded niosomes compared to the free drug. Lyophilized niosomes exhibited poor flowability that was not sufficiently improved after the addition of lactose or when cryoprotectants were exploited throughout the lyophilization process. In vivo, intratracheal administration of chloroquine-loaded niosomes in rats resulted in a drug concentration in the blood that was 10-fold lower than the oral administration of the free drug. Biomarkers of kidney and liver functions (i.e., creatinine, urea, AST, and ALT) following pulmonary administration of the drug-loaded nanoparticles were of similar levels to those of the control untreated animals. Hence, the use of a dry powder inhaler for administration of lyophilized niosomes is not recommended, whereas intratracheal administration might provide a promising strategy for pulmonary administration of niosomal dispersions while minimizing systemic drug exposure and adverse reactions.
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Affiliation(s)
- Hesham A. Saafan
- School of Biotechnology, Badr University in Cairo, Cairo 11829, Egypt; (H.A.S.); (K.M.I.); (Y.T.); (S.M.E.); (R.A.E.)
| | - Kamilia M. Ibrahim
- School of Biotechnology, Badr University in Cairo, Cairo 11829, Egypt; (H.A.S.); (K.M.I.); (Y.T.); (S.M.E.); (R.A.E.)
| | - Yasmeena Thabet
- School of Biotechnology, Badr University in Cairo, Cairo 11829, Egypt; (H.A.S.); (K.M.I.); (Y.T.); (S.M.E.); (R.A.E.)
- Department of Biomedical Sciences, Florida State University College of Medicine, Tallahassee, FL 32304, USA
| | - Sara M. Elbeltagy
- School of Biotechnology, Badr University in Cairo, Cairo 11829, Egypt; (H.A.S.); (K.M.I.); (Y.T.); (S.M.E.); (R.A.E.)
| | - Rana A. Eissa
- School of Biotechnology, Badr University in Cairo, Cairo 11829, Egypt; (H.A.S.); (K.M.I.); (Y.T.); (S.M.E.); (R.A.E.)
| | - Ashraf H. Ghaleb
- Galala University, Galala, Suez 43527, Egypt;
- Department of Surgery, Faculty of Medicine, Cairo University, Cairo 12613, Egypt
| | - Fathy Ibrahim
- International Center for Bioavailability, Pharmaceutical and Clinical Research, Obour City 11828, Egypt;
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Al-Azhar University, Cairo 11651, Egypt
| | - Mahmoud Elsabahy
- School of Biotechnology, Badr University in Cairo, Cairo 11829, Egypt; (H.A.S.); (K.M.I.); (Y.T.); (S.M.E.); (R.A.E.)
| | - Noura G. Eissa
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Zagazig University, Zagazig 44519, Egypt;
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Solano JJ, Clayton LM, Parks DJ, Polley SE, Hughes PG, Hennekens CH, Shih RD, Alter SM. Prehospital Ketamine Administration for Excited Delirium with Illicit Substance Co-Ingestion and Subsequent Intubation in the Emergency Department. Prehosp Disaster Med 2021; 36:697-701. [PMID: 34551849 DOI: 10.1017/S1049023X21000935] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction: Excited delirium, which has been defined as combativeness, agitation, and altered sensorium, requires immediate treatment in prehospital or emergency department (ED) settings for the safety of both patients and caregivers. Prehospital ketamine use is prevalent, although the evidence on safety and efficacy is limited. Many patients with excited delirium are intoxicated with illicit substances. This investigation explores whether patients treated with prehospital ketamine for excited delirium with concomitant substance intoxication have higher rates of subsequent intubation in the ED compared to those without confirmed substance usage. Methods: Over 28 months at two large community hospitals, all medical records were retrospectively searched for all patients age 18 years or greater with prehospital ketamine intramuscular (IM) administration for excited delirium and identified illicit and prescription substance co-ingestions. Trained abstractors collected demographic characteristics, history of present illness (HPI), urine drug screens (UDS), alcohol levels, and noted additional sedative administrations. Substance intoxication was determined by UDS and alcohol positivity or negativity, as well as physician HPI. Patients without toxicological testing or documentation of substance intoxication, or who may have tested positive due to ED sedation, were excluded from relevant analyses. Subsequent ED intubation was the primary pre-specified outcome. Odds ratios (OR) and 95% confidence intervals (CI) were calculated to compare variables. Results: Among 86 patients given prehospital ketamine IM for excited delirium, baseline characteristics including age, ketamine dose, and body mass index were similar between those who did or did not undergo intubation. Men had higher intubation rates. Patients testing positive for alcohol, amphetamines, barbiturates, benzodiazepines, ecstasy, marijuana, opiates, and synthetic cathinones, both bath salts and flakka, had similar rates of intubation compared to those negative for these substances. Of 27 patients with excited delirium and concomitant cocaine intoxication, nine (33%) were intubated compared with four of 50 (8%) without cocaine intoxication, yielding a 5.75 OR (95%, CI 1.57 to 21.05; P = .009). Conclusion: Patients treated with ketamine IM for excited delirium with concomitant cocaine intoxication had a statistically significant 5.75-fold increased rate of subsequent intubation in the ED. Amongst other substances, no other trends with intubation were noted, but further study is warranted.
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Duplessis C, Warawa JM, Lawrenz MB, Henry M, Biswas B. Successful Intratracheal Treatment of Phage and Antibiotic Combination Therapy of a Multi-Drug Resistant Pseudomonas aeruginosa Murine Model. Antibiotics (Basel) 2021; 10:946. [PMID: 34438996 DOI: 10.3390/antibiotics10080946] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 07/29/2021] [Accepted: 07/31/2021] [Indexed: 01/21/2023] Open
Abstract
Background: Pseudomonas aeruginosa (PsA) is a common etiology of bacteria-mediated lower respiratory tract infections, including pneumonia, hospital acquired pneumonia (HAP), and ventilator-associated pneumonia (VAP). Given the paucity of novel antibiotics in our foreseeable pipeline, developing novel non-antibiotic antimicrobial therapies saliently targeting drug resistant PsA isolates remains a priority. Lytic bacteriophages (or phages) have come under scrutiny as a potential antimicrobial for refractory bacterial infections. We evaluated intratracheally and intraperitoneally (IP) administered phage therapy (with/without meropenem) in an acute immunocompromised mouse model of multi-drug resistant (MDR) PsA pulmonary infection. The MDR P. aeruginosa respiratory disease model used in these studies was developed to investigate novel therapies that might have efficacy as either monotherapies or as combination therapy with meropenem. Methods: We utilized eight-week-old, 18 g BALB/cJ female mice and an MDR strain of PsA (UNC-D). Mice were immunosuppressed with cyclophosphamide. We employed a three-phage cocktail targeting PsA (PaAH2ΦP (103), PaBAP5Φ2 (130), and PaΦ (134)), confirmed to exhibit in vitro suppression of the infecting isolate out to 45 h. Suppression was confirmed with phages acting in isolation and in combination with meropenem. Results: IP administration of phage did not protect mice from death. A one-time delivery of phage directly to the lungs via a single intubation-mediated, intratracheal (IMIT) instillation protected mice from lethal infection. Protection was observed despite delaying therapy out to 6 h. Finally, we observed that, by slowing the progression of infection by treatment with a sub-efficacious dose of meropenem, we could protect the mice from lethal infection via IP phage administration coupled to meropenem, observing partial additive effects of phage–antibiotic combination therapy. Conclusions: A personalized phage cocktail administered via IMIT exhibits high therapeutic efficacy, despite delayed treatment of 6 h in a lethal MDR PsA pneumonia model. IP phage alone did not forestall mortality, but exhibited efficacy when combined with meropenem and IMIT-administered phage. These additive effects of combined IP phage and meropenem confirm that phage may indeed reach the lung bed via the systemic circulation and protect mice if the infection is not too acute. Therefore, adjunctive phage therapy with concerted attention to identifying optimal phage targeting of the infecting isolate in vitro may exhibit transformative potential for combating the specter of MDR bacterial infections. Phage should serve as an integral component of a four-pronged approach coupled with antibiotics, source control, and immune optimization.
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Nauka PC, Chen JT, Shiloh AL, Eisen LA, Fein DG. Practice, Outcomes, and Complications of Emergent Endotracheal Intubation by Critical Care Practitioners During the COVID-19 Pandemic. Chest 2021; 160:2112-2122. [PMID: 34139207 PMCID: PMC8204844 DOI: 10.1016/j.chest.2021.06.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 06/06/2021] [Accepted: 06/07/2021] [Indexed: 01/15/2023] Open
Abstract
Background For patients with COVID-19 who undergo emergency endotracheal intubation, data are limited regarding the practice, outcomes, and complications of this procedure. Research Question For patients with COVID-19 requiring emergency endotracheal intubation, how do the procedural techniques, the incidence of first-pass success, and the complications associated with the procedure compare with intubations of critically ill patients before the COVID-19 pandemic? Study Design and Methods We conducted a retrospective study of adult patients with COVID-19 at Montefiore Medical Center who underwent first-time endotracheal intubation by critical care physicians between July 19, 2019, and May 1, 2020. The first COVID-19 patient was admitted to our institution on March 11, 2020; patients admitted before this date are designated the prepandemic cohort. Descriptive statistics were used to compare groups. A Fisher exact test was used to compare categorical variables. For continuous variables, a two-tailed Student t test was used for parametric variables or a Wilcoxon rank-sum test was used for nonparametric variables. Results One thousand two hundred sixty intubations met inclusion criteria (782 prepandemic cohort, 478 pandemic cohort). Patients during the pandemic were more likely to be intubated for hypoxemic respiratory failure (72.6% vs 28.1%; P < .01). During the pandemic, operators were more likely to use video laryngoscopy (89.4% vs 53.3%; P < .01) and neuromuscular blocking agents (86.0% vs 46.2%; P < .01). First-pass success was higher during the pandemic period (94.6% vs 82.9%; P < .01). The rate of associated complications was higher during the pandemic (29.5% vs 15.2%; P < .01), a finding driven by a higher rate of hypoxemia during or immediately after the procedure (25.7% vs 8.2%; P < .01). Interpretation Video laryngoscopy and neuromuscular blockade were used increasingly during the COVID-19 pandemic. Despite a higher rate of first-pass success during the pandemic, the incidence of complications associated with the procedure was higher.
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Affiliation(s)
- Peter C Nauka
- Internal Medicine Residency Program, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY
| | - Jen-Ting Chen
- Division of Critical Care Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY
| | - Ariel L Shiloh
- Division of Critical Care Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY
| | - Lewis A Eisen
- Division of Critical Care Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY
| | - Daniel G Fein
- Division of Pulmonary Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY.
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Tang ZH, Chen Q, Wang X, Su N, Xia Z, Wang Y, Ma WH. A systematic review and meta-analysis of the safety and efficacy of remifentanil and dexmedetomidine for awake fiberoptic endoscope intubation. Medicine (Baltimore) 2021; 100:e25324. [PMID: 33832107 PMCID: PMC8036033 DOI: 10.1097/md.0000000000025324] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 03/01/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Awake fiberoptic endoscope intubation (AFOI) is the primary strategy for managing anticipated difficult airways. Adequate sedation, most commonly being achieved with remifentanil and dexmedetomidine, is integral to this procedure. This meta-analysis aimed to compare the safety and efficacy of these 2 sedatives. METHODS We conducted electronic searches in Embase, Web of Science, PubMed, Google Scholar, Medline, Springer, and Web of Science with no language restrictions. Studies comparing safety and efficacy between the sole use of remifentanil and dexmedetomidine among patients who underwent AFOI were included. Eight randomized controlled trials, comprising 412 patients, met the inclusion criteria. The primary outcomes were first attempt intubation success rate and incidence of hypoxia. The secondary outcomes were the Ramsay Sedation Scale score at intubation, memory recall of endoscopy, and unstable hemodynamic parameters during intubation. RESULTS Dexmedetomidine significantly reduced the incidence of hypoxemia during AFOI (risk ratio: 2.47; 95% confidence [CI]: 1.32-4.64]) compared with remifentanil; however, the first intubation success rates were equivalent (risk ratio: 1.12; 95% CI: 0.87-1.46]. No significant differences between the 2 sedatives were found for the Ramsay Sedation Scale score at intubation (mean difference: -0.14; 95% CI: -0.66-0.38) or unstable hemodynamic parameters during intubation (risk ratio: 0.83; 95% CI: 0.59-1.17). Dexmedetomidine reduced memory recall of endoscopy (risk ratio: 1.39; 95% CI: 1.13-1.72). CONCLUSIONS While both remifentanil and dexmedetomidine are effective for AFOI and well-tolerated, dexmedetomidine may be more effective in reducing the incidence of hypoxemia and memory recall of endoscopy. PROSPERP REGISTRATION NUMBER CRD42020169612.
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Affiliation(s)
- Zhi-hang Tang
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou
| | - Qi Chen
- Anesthesiology Department of Chongqing University Cancer Hospital/Chongqing Cancer institute, Chongqing
| | - Xia Wang
- Guangzhou University of Chinese Medicine, Guangzhou
| | - Nan Su
- Inner Mongolia People's Hospital, Inner Mongolia
| | - Zhengyuan Xia
- Department of Anesthesiology, the University of Hong Kong, Hong Kong, China
| | - Yong Wang
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou
| | - Wu-hua Ma
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou
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Saito M, Maruyama K, Mihara T, Hoshijima H, Hirabayashi G, Andoh T. Comparison of polyurethane tracheal tube cuffs and conventional polyvinyl chloride tube cuff for prevention of ventilator-associated pneumonia: A systematic review with meta-analysis. Medicine (Baltimore) 2021; 100:e24906. [PMID: 33655952 PMCID: PMC7939195 DOI: 10.1097/md.0000000000024906] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 01/30/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The aim of this meta-analysis with trial sequential analysis (TSA) was to evaluate the effect of a polyurethane (PU) tracheal tube cuff on the prevention of ventilator-associated pneumonia (VAP). METHODS We performed a systematic search using the MEDLINE database through PubMed, Cochrane Central Register of Controlled Trial, SCOPUS, and Web of Science.Randomized controlled trials comparing the incidence of VAP and clinically relevant outcomes between PU cuff tubes and polyvinyl chloride (PVC) cuff tubes in adult patients. Two authors independently extracted study details, patient characteristics, and clinical outcomes such as incidence of VAP, bacterial colonization of tracheal aspirate, duration of mechanical ventilation, ICU stay, and ICU mortality. RESULTS From 309 studies identified as potentially eligible, six studies with 1226 patients were included in this meta-analysis. All studies compared the incidence of VAP between PU cuffs and PVC cuffs. Use of a PU cuff was not associated with a reduction in VAP incidence (RR = 0.68; 95% CI, 0.45-1.03) with significant statistical heterogeneity (I2 = 65%). The quality of evidence was "very low." According to the TSA, the actual sample size was only 15.8% of the target sample size, and the cumulative Z score did not cross the trial sequential monitoring boundary for benefit. No positive impact was reported for the other relevant outcomes for PU cuffs. CONCLUSIONS The use of a PU cuff for mechanical ventilation did not prevent VAP. Further trials with a low risk of bias need to be performed.
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Affiliation(s)
- Minami Saito
- Department of Anesthesiology, Mizonokuchi Hospital, Teikyo University School of Medicine, Takatsu-ku, Kawasaki
| | - Koichi Maruyama
- Department of Anesthesiology, Mizonokuchi Hospital, Teikyo University School of Medicine, Takatsu-ku, Kawasaki
| | - Takahiro Mihara
- Department of Anesthesiology and Critical Care Medicine, Yokohama City University Graduate School of Medicine, Kanazawa-ku, Yokohama, Kanagawa
| | - Hiroshi Hoshijima
- Department of Anesthesiology, Saitama Medical University, Moroyama Town, Iruma District, Saitama, Japan
| | - Go Hirabayashi
- Department of Anesthesiology, Mizonokuchi Hospital, Teikyo University School of Medicine, Takatsu-ku, Kawasaki
| | - Tomio Andoh
- Department of Anesthesiology, Mizonokuchi Hospital, Teikyo University School of Medicine, Takatsu-ku, Kawasaki
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Choi J, Shin TG, Park JE, Lee GT, Kim YM, Lee SA, Kim S, Hwang NY, Hwang SY. Impact of Personal Protective Equipment on the First-Pass Success of Endotracheal Intubation in the ED: A Propensity-Score-Matching Analysis. J Clin Med 2021; 10:jcm10051060. [PMID: 33806528 PMCID: PMC7961519 DOI: 10.3390/jcm10051060] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 01/15/2023] Open
Abstract
Various types and levels of personal protective equipment (PPE) are currently available to protect health-care workers against infectious diseases. However, wearing cumbersome PPE may negatively affect their performance in life-saving procedures. This study aimed to evaluate the impact of wearing extensive PPE, including a powered air-purifying respirator with a loose-fitting hood or an N95 filtering facepiece respirator, on the first-pass success (FPS) rate of endotracheal intubation (ETI) in the emergency department (ED). This study was a single-center, observational before-and-after study of 934 adult (≥18 years old) patients who underwent ETI in the academic ED. The study period was divided into a control period (from 20 January 2019, to 30 September 2019, and from 20 January 2018, to 30 September 2018) and an intervention period (from 20 January 2020, to 30 September 2020). Extensive PPE was not donned during the control period (control group, n = 687) but was donned during the intervention period (PPE group, n = 247). The primary outcome was the FPS rate. We used propensity score matching between the PPE and control groups to reduce potential confounding. Propensity score matching identified 247 cases in the PPE group and 492 cases in the control group. In the matched cohort, no significant difference was found in the FPS rate between the PPE and control groups (83.8% (n = 207) vs. 81.9% (n = 403); p = 0.522). In multivariable analysis, wearing PPE was not associated with the FPS rate (adjusted odds ratio, 0.90; 95% confidence interval, 0.57–1.40; p = 0.629) after adjusting for the level of the intubator (junior resident, senior resident, or emergency medicine (EM) specialist). In conclusion, the FPS rate is not significantly affected by wearing extensive PPE in the ED.
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Affiliation(s)
- Jeonghyun Choi
- Samsung Medical Center, Department of Emergency Medicine, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (J.C.); (T.G.S.); (J.E.P.); (G.T.L.); (Y.M.K.); (S.A.L.)
| | - Tae Gun Shin
- Samsung Medical Center, Department of Emergency Medicine, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (J.C.); (T.G.S.); (J.E.P.); (G.T.L.); (Y.M.K.); (S.A.L.)
| | - Jong Eun Park
- Samsung Medical Center, Department of Emergency Medicine, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (J.C.); (T.G.S.); (J.E.P.); (G.T.L.); (Y.M.K.); (S.A.L.)
- Department of Emergency Medicine, College of Medicine, Kangwon National University, Chuncheon 24289, Korea
| | - Gun Tak Lee
- Samsung Medical Center, Department of Emergency Medicine, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (J.C.); (T.G.S.); (J.E.P.); (G.T.L.); (Y.M.K.); (S.A.L.)
- Department of Emergency Medicine, College of Medicine, Kangwon National University, Chuncheon 24289, Korea
| | - Young Min Kim
- Samsung Medical Center, Department of Emergency Medicine, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (J.C.); (T.G.S.); (J.E.P.); (G.T.L.); (Y.M.K.); (S.A.L.)
| | - Soo Ah Lee
- Samsung Medical Center, Department of Emergency Medicine, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (J.C.); (T.G.S.); (J.E.P.); (G.T.L.); (Y.M.K.); (S.A.L.)
| | - Seonwoo Kim
- Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (S.K.); (N.Y.H.)
| | - Na Young Hwang
- Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (S.K.); (N.Y.H.)
| | - Sung Yeon Hwang
- Samsung Medical Center, Department of Emergency Medicine, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (J.C.); (T.G.S.); (J.E.P.); (G.T.L.); (Y.M.K.); (S.A.L.)
- Correspondence: ; Tel.: +82-2-3410-2053
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Huh H, Go DY, Cho JE, Park J, Lee J, Kim HC. Influence of two-handed jaw thrust during tracheal intubation on postoperative sore throat: a prospective randomised study. J Int Med Res 2021; 49:300060520961237. [PMID: 33535830 PMCID: PMC7869173 DOI: 10.1177/0300060520961237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective General anaesthesia with tracheal intubation results in sore throat. We
evaluated the influence of the two-handed jaw thrust on postoperative sore
throat in patients who require tracheal intubation. Methods In this prospective, double-blind, single-centre, parallel-arm, and
randomised trial, 92 patients who were scheduled for general anaesthesia for
total hip arthroplasty were allocated to one of two groups. In the jaw
thrust group (n = 46), the two-handed jaw thrust manoeuvre was applied at
intubation. In the control group (n = 46), conventional intubation with sham
jaw thrust was performed. Incidences of airway morbidities including sore
throat, hoarseness, and cough at 2, 4, and 24 hours postoperatively were
compared. Results During the postoperative 24 hours, the incidence of sore throat (8 [17%] vs.
20 [44%]) and hoarseness were lower in the jaw thrust group (8 [17%] vs. 18
[39%]) compared with the control group. The incidence of cough during the
postoperative 24 hours was similar between the groups. Conclusions The jaw thrust manoeuvre significantly reduced sore throat and hoarseness in
patients after general anaesthesia using tracheal intubation. Clinical trial registration: NCT 03568279.
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Affiliation(s)
- Hyub Huh
- Department of Anaesthesiology and Pain Medicine, College of Medicine, Kyung Hee University Hospital at Gang Dong, Seoul, Korea
| | - Doo Yeon Go
- Department of Anaesthesiology and Pain Medicine, College of Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Jang Eun Cho
- Department of Anaesthesiology and Pain Medicine, College of Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Jihoon Park
- Department of Anaesthesiology and Pain Medicine, College of Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Jiwon Lee
- Department of Anaesthesiology and Pain Medicine and Anaesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun-Chang Kim
- Department of Anaesthesiology and Pain Medicine and Anaesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
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Haddadi S, Parvizi A, Niknama R, Nemati S, Farzan R, Kazemnejad E. Baseline Characteristics and Outcomes of Patients with Head and Neck Burn Injuries; a Cross-Sectional Study of 2181 Cases. Arch Acad Emerg Med 2020; 9:e8. [PMID: 33490965 PMCID: PMC7812157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/11/2023]
Abstract
INTRODUCTION Despite recent progress in treatment of burn injuries, head and neck burn and its complications is still considered a challenge. This study aimed to evaluate the baseline characteristics and outcomes of patients with head and neck burn. METHODS In this retrospective cross-sectional study, the medical profiles of patients with head and neck burn referring to a burn care center during 2 years were reviewed and analyzed regarding the baseline characteristics and outcomes of participants. RESULTS 392 (17.97%) cases suffered from head and neck burns. The mean burn percentage of participants was 29.31 ± 24.78, and 126 (32.14%) cases required tracheal intubation. There was a direct correlation between length of hospital stay and the degree of burn (p < 0.001). The length of hospitalization for patients burned by electricity was longer than those burned by other mechanisms (p = 0.003). There was a significant correlation between degree of burn and abnormal laryngoscopy findings (p = 0.036), developing acute respiratory distress syndrome (ARDS) (p < 0.001) and pneumonia (p < 0.001), need for mechanical ventilation (p < 0.001), and mortality rate (p < 0.001). CONCLUSION Based on the findings of the present study, the prevalence of head and neck burn injuries was about 18% and 32.14% of these cases required airway management. 19 (4.85%) cases developed ARDS, 41 (10.46%) developed pneumonia, and 50 (12.76%) cases died. There was a significant correlation between degree of burn and abnormal laryngoscopy findings, developing ARDS and pneumonia, need for mechanical ventilation, and mortality rate.
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Affiliation(s)
- Soudabeh Haddadi
- Anesthesiology Research Center, Department of Anesthesiology, Alzahra Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Arman Parvizi
- Anesthesiology Research Center, Department of Anesthesiology, Alzahra Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Reza Niknama
- Guilan University of Medical Sciences, Rasht, Iran
| | - Shadman Nemati
- Otorhinolaryngology Research Center, Department of ENT, Head and Neck Surgery, Amiralmomenin Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Ramyar Farzan
- Department of General Surgery, Velayat Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Ehsan Kazemnejad
- Otorhinolaryngology Research Center, Department of ENT, Head and Neck Surgery, Amiralmomenin Hospital, Guilan University of Medical Sciences, Rasht, Iran
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Haddadi S, Parvizi A, Niknama R, Nemati S, Farzan R, Kazemnejad E. Baseline Characteristics and Outcomes of Patients with Head and Neck Burn Injuries; a Cross-Sectional Study of 2181 Cases. Arch Acad Emerg Med 2020; 9:e8. [PMID: 33490965 PMCID: PMC7812157 DOI: 10.22037/aaem.v9i1.948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Despite recent progress in treatment of burn injuries, head and neck burn and its complications is still considered a challenge. This study aimed to evaluate the baseline characteristics and outcomes of patients with head and neck burn. METHODS In this retrospective cross-sectional study, the medical profiles of patients with head and neck burn referring to a burn care center during 2 years were reviewed and analyzed regarding the baseline characteristics and outcomes of participants. RESULTS 392 (17.97%) cases suffered from head and neck burns. The mean burn percentage of participants was 29.31 ± 24.78, and 126 (32.14%) cases required tracheal intubation. There was a direct correlation between length of hospital stay and the degree of burn (p < 0.001). The length of hospitalization for patients burned by electricity was longer than those burned by other mechanisms (p = 0.003). There was a significant correlation between degree of burn and abnormal laryngoscopy findings (p = 0.036), developing acute respiratory distress syndrome (ARDS) (p < 0.001) and pneumonia (p < 0.001), need for mechanical ventilation (p < 0.001), and mortality rate (p < 0.001). CONCLUSION Based on the findings of the present study, the prevalence of head and neck burn injuries was about 18% and 32.14% of these cases required airway management. 19 (4.85%) cases developed ARDS, 41 (10.46%) developed pneumonia, and 50 (12.76%) cases died. There was a significant correlation between degree of burn and abnormal laryngoscopy findings, developing ARDS and pneumonia, need for mechanical ventilation, and mortality rate.
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Affiliation(s)
- Soudabeh Haddadi
- Anesthesiology Research Center, Department of Anesthesiology, Alzahra Hospital, Guilan University of Medical Sciences, Rasht, Iran.,Corresponding Author: Soudabeh Haddadi; Anesthesiology Research Center, Department of Anesthesiology, Alzahra Hospital, Rasht, Iran. , Phone: +981332338306-7, ORCID:0000-0002-0585-3235
| | - Arman Parvizi
- Anesthesiology Research Center, Department of Anesthesiology, Alzahra Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Reza Niknama
- Guilan University of Medical Sciences, Rasht, Iran
| | - Shadman Nemati
- Otorhinolaryngology Research Center, Department of ENT, Head and Neck Surgery, Amiralmomenin Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Ramyar Farzan
- Department of General Surgery, Velayat Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Ehsan Kazemnejad
- Otorhinolaryngology Research Center, Department of ENT, Head and Neck Surgery, Amiralmomenin Hospital, Guilan University of Medical Sciences, Rasht, Iran
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Brady AK, Brown W, Denson JL, Winter G, Niroula A, Santhosh L, Carlos WG. Variation in Intensive Care Unit Intubation Practices in Pulmonary Critical Care Medicine Fellowship. ATS Sch 2020; 1:395-405. [PMID: 33728421 DOI: 10.34197/ats-scholar.2020-0004OC] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background: Endotracheal intubation in the intensive care unit (ICU) is a high-risk procedure. Competence in endotracheal intubation is a requirement for Pulmonary and Critical Care Medicine (PCCM) training programs, but fellow experience as the primary operator in intubating ICU patients has not been described on a large scale. Objective: We hypothesized that significant variation surrounding endotracheal intubation practices in medical ICUs exists in U.S. PCCM training programs. Methods: We administered a survey to a convenience sample of U.S. PCCM fellows to elicit typical intubation practices in the medical ICU. Results: Eighty-nine discrete U.S. PCCM and Internal Medicine Critical Care Medicine training programs (77% response rate) were represented. At 43% of programs, the PCCM fellow was “always or almost always” designated the primary operator for intubation of a medical ICU patient, whereas at 21% of programs, the PCCM fellow was “rarely or never” the primary operator responsible for intubating in the ICU. Factors influencing this variation included time of day, hospital policies, attending skill or preference, ICU census and acuity, and patient factors. There was an association between location of the training program, but not program size, and whether the PCCM fellow was the primary operator. Conclusion: There is significant variation in whether PCCM fellows are the primary operators to intubate medical ICU patients during training. Further work should explore how this variation affects fellow career development and competence in intubation.
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Antoine J, Inglis GDT, Way M, O'Rourke P, Davies MW. Bacterial colonisation of the endotracheal tube in ventilated very preterm neonates: A retrospective cohort study. J Paediatr Child Health 2020; 56:1607-1612. [PMID: 32808358 DOI: 10.1111/jpc.15046] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 05/26/2020] [Accepted: 05/27/2020] [Indexed: 11/29/2022]
Abstract
AIM To determine the rate, type and timing of bacterial endotracheal tube (ETT) colonisation in neonates born <32 weeks gestational age (GA); and if bacterial colonisation is associated with chronic lung disease (CLD), septicaemia, length-of-stay or mortality. METHODS All intubated newborns born <32 weeks GA were included. Endotracheal aspirates were routinely obtained three times-per-week. Cohort was divided into three colonisation groups: no growth, normal respiratory flora only, significant bacteria. Logistic regression was performed to identify if ETT bacterial colonisation was associated with CLD, septicaemia or mortality. A general linear model was fitted for length-of-stay. RESULTS ETT aspirates were sent from 1054 infants: no growth n = 319, only normal respiratory flora n = 357, and significant bacteria n = 378. ETTs became colonised in 70%, most in the first week of life (82%). Most grew normal respiratory flora (642 infants). In those with significant bacteria, 40% grew Gram-negative species; Klebsiella in 34%. Staphylococcus aureus grew in 104 patients. Adjusted odds ratios for CLD (43% of cohort) compared with no growth were, for normal respiratory flora, 0.58 (95% confidence interval (CI) 0.34-0.99) and, for significant bacteria, 0.48 (95% CI 0.24-0.93). With no overall association between colonisation group and CLD in the adjusted model P = 0.07. The odds of septicaemia (10% of cohort) were 4.50 (95% CI 1.98-10.23, P < 0.001) times greater for significant bacteria compared with no growth. No significant associated was found with mortality or length-of-stay. CONCLUSIONS Bacterial colonisation of ETTs is common. It is associated with more septicaemia. There was no significant association with CLD, longer admission or mortality.
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Affiliation(s)
- Jasmine Antoine
- Grantley Stable Neonatal Unit, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Garry D T Inglis
- Grantley Stable Neonatal Unit, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Mandy Way
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Peter O'Rourke
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Mark W Davies
- Grantley Stable Neonatal Unit, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,School of Clinical Medicine - Royal Brisbane Clinical Unit, University of Queensland, Brisbane, Queensland, Australia
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Lim WY, Fook-Chong S, Wong P. Comparison of glottic visualisation through supraglottic airway device (SAD) using bronchoscope in the ramped versus supine 'sniffing air' position: A pilot feasibility study. Indian J Anaesth 2020; 64:681-687. [PMID: 32934402 PMCID: PMC7457982 DOI: 10.4103/ija.ija_320_20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 04/21/2020] [Accepted: 06/03/2020] [Indexed: 01/03/2023] Open
Abstract
Background and Aims: Airway management in obese patients is associated with increased risk of difficult airway and intubation. After failed intubation, supraglottic airway-guided flexible bronchoscopic intubation (SAGFBI) may be required. It is uncertain whether SAGFBI is best performed in the ramped versus conventional supine “sniffing air” position. We conducted a feasibility study to evaluate the logistics of positioning, compared glottic views, and evaluated SAGFBI success rates. Methods: We conducted a prospective, pilot study in patients with a body mass index (BMI) 30–40 kg/m2 undergoing elective operations requiring tracheal intubation. All patients were placed in a ramped position. After induction, a supraglottic airway device (SAD) was inserted. A flexible bronchoscope was inserted into the SAD and a photograph of the glottic view taken. The patient was repositioned to the supine position. A second photograph was taken. SAGFBI was performed. Images were randomised and assessed by two independent anesthetists. Results: Of 17 patients recruited, 15 patients were repositioned successfully. There were no differences in glottic views observed in the two positions. SAGFBI was successful in 92.9% of patients (median time 91.5 s). Haemodynamic changes were noted in 42.7% of patients which resolved spontaneously. Conclusion: Our pilot study was completed within 5 months, achieved low dropout rate and protocol feasibility was established. SAGFBI was successfully and safely performed in obese patients, with a median time of 91.5 s. The time taken for SAGFBI was similar to awake intubation using FBI and videolaryngoscopy. Our study provided preliminary data supporting future, larger-scale studies to evaluate glottic views in the ramped versus supine positions.
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Affiliation(s)
- Wan Yen Lim
- Department of Anaesthesiology, Singapore General Hospital, Singapore
| | | | - Patrick Wong
- Department of Anaesthesiology, Singapore General Hospital, Singapore
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Taschauer A, Polzer W, Pöschl S, Metz S, Tepe N, Decker S, Cyran N, Scholda J, Maier J, Bloß H, Anton M, Hofmann T, Ogris M, Sami H. Combined Chemisorption and Complexation Generate siRNA Nanocarriers with Biophysics Optimized for Efficient Gene Knockdown and Air-Blood Barrier Crossing. ACS Appl Mater Interfaces 2020; 12:30095-30111. [PMID: 32515194 PMCID: PMC7467563 DOI: 10.1021/acsami.0c06608] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Current nucleic acid (NA) nanotherapeutic approaches face challenges because of shortcomings such as limited control on loading efficiency, complex formulation procedure involving purification steps, low load of NA cargo per nanoparticle, endosomal trapping, and hampered release inside the cell. When combined, these factors significantly limit the amount of biologically active NA delivered per cell in vitro, delivered dosages in vivo for a prolonged biological effect, and the upscalability potential, thereby warranting early consideration in the design and developmental phase. Here, we report a versatile nanotherapeutic platform, termed auropolyplexes, for improved and efficient delivery of small interfering RNA (siRNA). Semitelechelic, thiolated linear polyethylenimine (PEI) was chemisorbed onto gold nanoparticles to endow them with positive charge. A simple two-step complexation method offers tunable loading of siRNA at concentrations relevant for in vivo studies and the flexibility for inclusion of multiple functionalities without any purification steps. SiRNA was electrostatically complexed with these cationic gold nanoparticles and further condensed with polycation or polyethyleneglycol-polycation conjugates. The resulting auropolyplexes ensured complete complexation of siRNA into nanoparticles with a high load of ∼15,500 siRNA molecules/nanoparticle. After efficient internalization into the tumor cell, an 80% knockdown of the luciferase reporter gene was achieved. Auropolyplexes were applied intratracheally in Balb/c mice for pulmonary delivery, and their biodistribution were studied spatio-temporally and quantitatively by optical tomography. Auropolyplexes were well tolerated with ∼25% of the siRNA dose remaining in the lungs after 24 h. Importantly, siRNA was released from auropolyplexes in vivo and a fraction also crossed the air-blood barrier, which was then excreted via kidneys, whereas >97% of gold nanoparticles were retained in the lung. Linear PEI-based auropolyplexes offer a combination of successful endosomal escape and better biocompatibility profile in vivo. Taken together, combined chemisorption and complexation endow auropolyplexes with crucial biophysical attributes, enabling a versatile and upscalable nanogold-based platform for siRNA delivery in vitro and in vivo.
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Affiliation(s)
- Alexander Taschauer
- Faculty of Life
Sciences, Center of Pharmaceutical Sciences, Department of Pharmaceutical
Chemistry, Laboratory of MacroMolecular Cancer Therapeutics (MMCT), University of Vienna, Althanstrasse 14, 1090 Vienna, Austria
| | - Wolfram Polzer
- Faculty of Life
Sciences, Center of Pharmaceutical Sciences, Department of Pharmaceutical
Chemistry, Laboratory of MacroMolecular Cancer Therapeutics (MMCT), University of Vienna, Althanstrasse 14, 1090 Vienna, Austria
| | - Stefan Pöschl
- Faculty of Life
Sciences, Center of Pharmaceutical Sciences, Department of Pharmaceutical
Chemistry, Laboratory of MacroMolecular Cancer Therapeutics (MMCT), University of Vienna, Althanstrasse 14, 1090 Vienna, Austria
| | - Slavica Metz
- Faculty of Life
Sciences, Center of Pharmaceutical Sciences, Department of Pharmaceutical
Chemistry, Laboratory of MacroMolecular Cancer Therapeutics (MMCT), University of Vienna, Althanstrasse 14, 1090 Vienna, Austria
| | - Nathalie Tepe
- Department of Environmental Geosciences, University of Vienna, Althanstraße 14, 1090 Vienna, Austria
| | - Simon Decker
- Faculty of Life
Sciences, Center of Pharmaceutical Sciences, Department of Pharmaceutical
Chemistry, Laboratory of MacroMolecular Cancer Therapeutics (MMCT), University of Vienna, Althanstrasse 14, 1090 Vienna, Austria
| | - Norbert Cyran
- Core Facility Cell
Imaging and Ultrastructure Research (CIUS), University of Vienna, 1090 Vienna, Austria
| | - Julia Scholda
- Faculty of Life
Sciences, Center of Pharmaceutical Sciences, Department of Pharmaceutical
Chemistry, Laboratory of MacroMolecular Cancer Therapeutics (MMCT), University of Vienna, Althanstrasse 14, 1090 Vienna, Austria
| | - Julia Maier
- Faculty of Life
Sciences, Center of Pharmaceutical Sciences, Department of Pharmaceutical
Chemistry, Laboratory of MacroMolecular Cancer Therapeutics (MMCT), University of Vienna, Althanstrasse 14, 1090 Vienna, Austria
| | - Hermann Bloß
- Faculty of Life
Sciences, Center of Pharmaceutical Sciences, Department of Pharmaceutical
Chemistry, Laboratory of MacroMolecular Cancer Therapeutics (MMCT), University of Vienna, Althanstrasse 14, 1090 Vienna, Austria
| | - Martina Anton
- Institutes of Molecular Immunology and Experimental Oncology, Klinikum
rechts der Isar, Technische Universität
München, 81675 Munich, Germany
| | - Thilo Hofmann
- Department of Environmental Geosciences, University of Vienna, Althanstraße 14, 1090 Vienna, Austria
| | - Manfred Ogris
- Faculty of Life
Sciences, Center of Pharmaceutical Sciences, Department of Pharmaceutical
Chemistry, Laboratory of MacroMolecular Cancer Therapeutics (MMCT), University of Vienna, Althanstrasse 14, 1090 Vienna, Austria
- Center for NanoScience (CeNS), Ludwig Maximilians
University, 80539 Munich, Germany
| | - Haider Sami
- Faculty of Life
Sciences, Center of Pharmaceutical Sciences, Department of Pharmaceutical
Chemistry, Laboratory of MacroMolecular Cancer Therapeutics (MMCT), University of Vienna, Althanstrasse 14, 1090 Vienna, Austria
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Nikolla DA, Beaumont RR, Lerman JL, Datsko JS, Carlson JN. Impact of bed angle and height on intubation success during simulated endotracheal intubation in the ramped position. J Am Coll Emerg Physicians Open 2020; 1:257-262. [PMID: 33000040 PMCID: PMC7493484 DOI: 10.1002/emp2.12035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 01/29/2020] [Accepted: 02/11/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The ramped position is often used during endotracheal intubation to improve oxygenation, improve laryngeal views, and reduce airway complications. We sought to compare the impact of ramp angle and bed height on intubation outcomes during simulated endotracheal intubation. METHODS We enrolled emergency medicine residents and fourth-year medical students to perform simulated direct laryngoscopy and endotracheal intubation in random order with the mannequin in the following combinations of ramp angles and bed heights; ramp angles of 25° and 45° at bed heights including knee, mid-thigh, umbilicus, xiphoid, and nipple/intermammary fold. Our primary outcome was the reported percentage of glottic opening (POGO) score. Secondary outcomes included number of laryngoscopy attempts and intubation time. RESULTS We enrolled 25 participants. There was no difference in reported POGO scores at 25° between bed heights, but at 45°, the umbilicus bed height had an improved reported POGO score (20; 95% confidence interval [CI] 7-33, P < 0.01) relative to xyphoid. The nipple/inframammary fold height required longer intubation times in seconds (mean difference [MD] 95% CI) at 25°, (MD, 23.9 [4.6-37.6], P < 0.01) and more laryngoscopy attempts at 45° (MD, 0.48 [0.16-0.79], P < 0.01) relative to xyphoid. There was no difference in laryngoscopy attempts and video POGO between 25° and 45° at all bed heights, but reported POGO at the umbilicus position was better at 25° than 45° (12 [1-23], P = 0.03). CONCLUSION The umbilicus bed height resulted in the highest reported POGO at 45°. Nipple/inframammary fold height resulted in worse intubating conditions.
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Affiliation(s)
- Dhimitri A. Nikolla
- Department of Emergency MedicineAllegheny Health Network—Saint Vincent Hospital, EriePennsylvania
| | - Ryann R. Beaumont
- Department of Emergency MedicineAllegheny Health Network—Saint Vincent Hospital, EriePennsylvania
| | - Jessica L. Lerman
- Department of Emergency MedicineAllegheny Health Network—Saint Vincent Hospital, EriePennsylvania
| | - Joseph S. Datsko
- Department of Emergency MedicineAllegheny Health Network—Saint Vincent Hospital, EriePennsylvania
| | - Jestin N. Carlson
- Department of Emergency MedicineAllegheny Health Network—Saint Vincent Hospital, EriePennsylvania
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49
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Keshwani M, Karim HMR, Gourh G. Floppy epiglottis together with extra-laryngeal mass causing an inducible laryngeal obstruction and hypoxemic event in an adult: A case report. Saudi J Anaesth 2020; 14:400-402. [PMID: 32934639 PMCID: PMC7458017 DOI: 10.4103/sja.sja_760_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 12/04/2019] [Indexed: 11/10/2022] Open
Abstract
Floppy epiglottis in an adult is rare and often pathological. Airway obstruction caused by floppy epiglottis in an adult is rarely reported. Neck mass, however, can affect the airway in many ways; however, inducible upper airway obstruction by extra-laryngeal neck mass is hardly been reported. In most of the instances of inducible laryngeal obstruction, the tumor is found in and around the laryngeal inlet. Herein, we report such an unusual incident happened to a 40-year-old gentleman, a case of oral carcinoma for 3 months and a rapidly increasing swelling (6 × 5 cm) over the right side of the neck for 8 days. He presented to us for emergency tracheostomy with the feature of acute upper airway obstruction, unable to lie down; and having difficulty in breathing, desaturation, and chocking even in propped up position. The case highlights the importance of clinical findings and difficulties faced for airway management in such patients.
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Affiliation(s)
- Manish Keshwani
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Habib M R Karim
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Govind Gourh
- Department of ENT and Head and Neck Surgery, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
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Falach R, Sapoznikov A, Evgy Y, Aftalion M, Makovitzki A, Agami A, Mimran A, Lerer E, Ben David A, Zichel R, Katalan S, Rosner A, Sabo T, Kronman C, Gal Y. Post-Exposure Anti-Ricin Treatment Protects Swine Against Lethal Systemic and Pulmonary Exposures. Toxins (Basel) 2020; 12:toxins12060354. [PMID: 32481526 PMCID: PMC7354453 DOI: 10.3390/toxins12060354] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/21/2020] [Accepted: 05/25/2020] [Indexed: 12/04/2022] Open
Abstract
Ricin, a plant-derived toxin originating from the seeds of Ricinus communis (castor bean plant), is one of the most lethal toxins known. To date, there is no approved post-exposure therapy for ricin exposures. This work demonstrates for the first time the therapeutic efficacy of equine-derived anti-ricin F(ab’)2 antibodies against lethal pulmonary and systemic ricin exposures in swine. While administration of the antitoxin at 18 h post-exposure protected more than 80% of both intratracheally and intramuscularly ricin-intoxicated swine, treatment at 24 h post-exposure protected 58% of the intramuscular-exposed swine, as opposed to 26% of the intratracheally exposed animals. Quantitation of the anti-ricin neutralizing units in the anti-toxin preparations confirmed that the disparate protection conferred to swine subjected to the two routes of exposure stems from variance between the two models. Furthermore, dose response experiments showed that approximately 3 times lesser amounts of antibody are needed for high-level protection of the intramuscularly compared to the intratracheally intoxicated swine. This study, which demonstrates the high-level post-exposure efficacy of anti-ricin antitoxin at clinically relevant time-points in a large animal model, can serve as the basis for the formulation of post-exposure countermeasures against ricin poisoning in humans.
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Affiliation(s)
- Reut Falach
- Department of Biochemistry and Molecular Genetics, Israel Institute for Biological Research, Ness-Ziona 76100, Israel; (R.F.); (A.S.); (Y.E.); (M.A.); (T.S.)
| | - Anita Sapoznikov
- Department of Biochemistry and Molecular Genetics, Israel Institute for Biological Research, Ness-Ziona 76100, Israel; (R.F.); (A.S.); (Y.E.); (M.A.); (T.S.)
| | - Yentl Evgy
- Department of Biochemistry and Molecular Genetics, Israel Institute for Biological Research, Ness-Ziona 76100, Israel; (R.F.); (A.S.); (Y.E.); (M.A.); (T.S.)
| | - Moshe Aftalion
- Department of Biochemistry and Molecular Genetics, Israel Institute for Biological Research, Ness-Ziona 76100, Israel; (R.F.); (A.S.); (Y.E.); (M.A.); (T.S.)
| | - Arik Makovitzki
- Department of Biotechnology, Israel Institute for Biological Research, Ness-Ziona 76100, Israel; (A.M.); (A.A.); (A.M.); (E.L.); (A.B.D.); (R.Z.)
| | - Avi Agami
- Department of Biotechnology, Israel Institute for Biological Research, Ness-Ziona 76100, Israel; (A.M.); (A.A.); (A.M.); (E.L.); (A.B.D.); (R.Z.)
| | - Avishai Mimran
- Department of Biotechnology, Israel Institute for Biological Research, Ness-Ziona 76100, Israel; (A.M.); (A.A.); (A.M.); (E.L.); (A.B.D.); (R.Z.)
| | - Elad Lerer
- Department of Biotechnology, Israel Institute for Biological Research, Ness-Ziona 76100, Israel; (A.M.); (A.A.); (A.M.); (E.L.); (A.B.D.); (R.Z.)
| | - Alon Ben David
- Department of Biotechnology, Israel Institute for Biological Research, Ness-Ziona 76100, Israel; (A.M.); (A.A.); (A.M.); (E.L.); (A.B.D.); (R.Z.)
| | - Ran Zichel
- Department of Biotechnology, Israel Institute for Biological Research, Ness-Ziona 76100, Israel; (A.M.); (A.A.); (A.M.); (E.L.); (A.B.D.); (R.Z.)
| | - Shahaf Katalan
- Department of Pharmacology, Israel Institute for Biological Research, Ness-Ziona 76100, Israel;
| | - Amir Rosner
- Veterinary Center for Preclinical Research, Israel Institute for Biological Research, Ness-Ziona 76100, Israel;
| | - Tamar Sabo
- Department of Biochemistry and Molecular Genetics, Israel Institute for Biological Research, Ness-Ziona 76100, Israel; (R.F.); (A.S.); (Y.E.); (M.A.); (T.S.)
| | - Chanoch Kronman
- Department of Biochemistry and Molecular Genetics, Israel Institute for Biological Research, Ness-Ziona 76100, Israel; (R.F.); (A.S.); (Y.E.); (M.A.); (T.S.)
- Correspondence: (C.K.); (Y.G.); Tel.: +972–8–9381522 (C.K.); +972–8–9381479 (Y.G.)
| | - Yoav Gal
- Department of Biochemistry and Molecular Genetics, Israel Institute for Biological Research, Ness-Ziona 76100, Israel; (R.F.); (A.S.); (Y.E.); (M.A.); (T.S.)
- Correspondence: (C.K.); (Y.G.); Tel.: +972–8–9381522 (C.K.); +972–8–9381479 (Y.G.)
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