scholarly journals Point of care airway ultrasound to select tracheal tube and determine insertion depth in cleft repair surgery

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jung Hwan Ahn ◽  
Jae Hyun Park ◽  
Min Soo Kim ◽  
Hyun Cheol Kang ◽  
Il Seok Kim
Keyword(s):  
Adverse Events ◽  
Tracheal Tube ◽  
Point Of Care ◽  
Conventional Group ◽  
Insertion Depth ◽  
Tube Size ◽  
Airway Complications ◽  
Ultrasound Application ◽  
Ultrasound Group ◽  
Airway Ultrasound

AbstractWe aimed to evaluate the efficacy of using airway ultrasonography to select the correct tracheal tube size and insertion depth in pediatric patients who underwent cleft repair surgery as a way to decrease airway complications and adverse events during perioperative periods. Fifty-one patients (age < 28 months) were consecutively divided into conventional (n = 28) and ultrasound (n = 23) groups. Tracheal tube size and insertion depth were determined using the age-based formula and auscultation in the conventional group, whereas using ultrasonographic measurement of subglottic diameter with auscultation and lung ultrasonography in the ultrasound group. We evaluated the initially selected tube size, insertion depth, ventilatory indices, and the incidence of airway complications and adverse events. Tube insertion depth (median [interquartile range]) was significantly greater in the ultrasound group than in the conventional group (13.5 cm [12.5–14.0] vs 13.0 cm [11.8–13.0], P = 0.045). The number of complications and adverse events was significantly higher in the conventional group than in the ultrasound group (32.1% vs 4.3%, P = 0.013). Airway ultrasound application could reduce airway-related complications and adverse events by determining the appropriate tracheal tube size and insertion depth.

P2Y12 inhibitors in neuroendovascular surgery: An opportunity for precision medicine

2021 ◽  
pp. 159101992199139
Author(s):  
Axel Rosengart ◽  
Malie K Collins ◽  
Philipp Hendrix ◽  
Ryley Uber ◽  
Melissa Sartori ◽  
...  
Keyword(s):  
Adverse Events ◽  
Precision Medicine ◽  
Point Of Care ◽  
Indirect Evidence ◽  
Cost Benefit ◽  
Interventional Cardiology ◽  
Platelet Inhibition ◽  
Response Monitoring ◽  
P2y12 Inhibitor ◽  
P2y12 Inhibitors

Introduction Dual antiplatelet therapy (DAPT), primarily the combination of aspirin with a P2Y12 inhibitor, in patients undergoing intravascular stent or flow diverter placement remains the primary strategy to reduce device-related thromboembolic complications. However, selection, timing, and dosing of DAPT is critical and can be challenging given the existing significant inter- and intraindividual response variations to P2Y12 inhibitors. Methods Assessment of indexed, peer-reviewed literature from 2000 to 2020 in interventional cardiology and neuroendovascular therapeutics with critical, peer-reviewed appraisal and extraction of evidence and strategies to utilize DAPT in cardio- and neurovascular patients with endoluminal devices. Results Both geno- and phenotyping for DAPT are rapidly and conveniently available as point-of-care testing at a favorable cost-benefit ratio. Furthermore, systematic inclusion of a quantifying clinical risk score combined with an operator-linked, technical risk assessment for potential adverse events allows a more precise and individualized approach to new P2Y12 inhibitor therapy. Conclusions The latest evidence, primarily obtained from cardiovascular intervention trials, supports that combining patient pharmacogenetics with drug response monitoring, as part of an individually tailored, precision medicine approach, is both predictive and cost-effective in achieving and maintaining individual target platelet inhibition levels. Indirect evidence supports that this gain in optimizing drug responses translates to reducing main adverse events and overall treatment costs in patients undergoing DAPT after intracranial stent or flow diverting treatment.

scholarly journals A pump-independent function of the Na,K-ATPase is required for epithelial junction function and tracheal tube-size control

Development ◽  
2007 ◽  
Vol 134 (1) ◽  
pp. 147-155 ◽  
Author(s):  
S. M. Paul ◽  
M. J. Palladino ◽  
G. J. Beitel
Keyword(s):  
Tracheal Tube ◽  
Size Control ◽  
Independent Function ◽  
Tube Size ◽  
Epithelial Junction

scholarly journals The Drosophila Claudin Kune-kune Is Required for Septate Junction Organization and Tracheal Tube Size Control

Genetics ◽  
2010 ◽  
Vol 185 (3) ◽  
pp. 831-839 ◽  
Author(s):  
Kevin S. Nelson ◽  
Mikio Furuse ◽  
Greg J. Beitel
Keyword(s):  
Tracheal Tube ◽  
Size Control ◽  
Septate Junction ◽  
Tube Size

Evaluation of cuffed tracheal tube size predicted using the Khine formula in children

2008 ◽  
Vol 18 (11) ◽  
pp. 1105-1105
Author(s):  
Markus Weiss ◽  
Andreas Gerber
Keyword(s):  
Tracheal Tube ◽  
Tube Size ◽  
Cuffed Tracheal Tube

scholarly journals Application of a simple point-of-care test to reduce UK healthcare costs and adverse events in outpatient acute respiratory infections

2020 ◽  
Vol 23 (7) ◽  
pp. 673-682 ◽  
Author(s):  
John E. Schneider ◽  
Catharina Boehme ◽  
Bettina Borisch ◽  
Sabine Dittrich
Keyword(s):  
Adverse Events ◽  
Healthcare Costs ◽  
Respiratory Infections ◽  
Point Of Care ◽  
Acute Respiratory Infections ◽  
Simple Point ◽  
Point Of Care Test

Airway ultrasound: Point of care in children—The time is now

2020 ◽  
Vol 30 (3) ◽  
pp. 347-352 ◽  
Author(s):  
Sam J. Daniel ◽  
Gianluca Bertolizio ◽  
Tobial McHugh
Keyword(s):  
Point Of Care ◽  
Airway Ultrasound

scholarly journals Carbon dioxide versus room air insufflation during balloon-assisted enteroscopy: A systematic review with meta-analysis

2017 ◽  
Vol 05 (01) ◽  
pp. E67-E75 ◽  
Author(s):  
Ashok Shiani ◽  
Seth Lipka ◽  
Andrew Lai ◽  
Andrea Rodriguez ◽  
Christian Andrade ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Systematic Review ◽  
Adverse Events ◽  
Diagnostic Yield ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Insertion Depth ◽  
Co2 Insufflation ◽  
Air Insufflation

Abstract Background and study aims Carbon dioxide (CO2) insufflation has been suggested to be an ideal alternative to room air insufflation to reduce trapped air within the bowel lumen after balloon assisted enteroscopy (BAE). We performed a systematic review and meta-analysis to assess the safety and efficacy of utilizing CO2 insufflation as compared to room air during BAE. Patients and methods The primary outcome is mean change in visual analog scale (VAS; 10 cm) at 1, 3, and 6 hours to assess pain. Secondary outcomes include insertion depth (anterograde or retrograde), adverse events, total enteroscopy rate, diagnostic yield, mean anesthetic dosage, and PaCO2 at procedure completion. We searched MEDLINE and the Cochrane Central Register of Controlled Trials (CENTRAL) from inception until May 2015. Multiple independent extractions were performed, the process was executed as per the standards of the Cochrane collaboration. Results Four randomized controlled trials (RCTs) were included in the meta-analysis. VAS at 6 hours favored CO2 over room air (MD 0.13; 95 % CI 0.01, 0.25; p = 0.03). Anterograde insertion depth (cm) was improved in the CO2 group (MD, 58.2; 95 % CI 17.17, 99.23; p = 0.005), with an improvement in total enteroscopy rate in the CO2 group (RR 1.91; 95 % CI 1.20, 3.06; p = 0.007). Mean dose of propofol (mg) favored CO2 compared to air (MD, – 70.53; 95 % CI – 115.07, – 25.98; P = 0.002). There were no differences in adverse events in either group. Conclusions Despite the ability of CO2 to improve insertion depth and decrease amount of anesthesia required, further randomized control trials are needed to determine the agent of choice for insufflation in balloon assisted enteroscopy.

96 Treatment of Donor Sites in Large TBSA Burn Injuries with an Autologous Skin Cell Suspension Supports Early Reharvesting

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S62-S63
Author(s):  
Kevin N Foster ◽  
James H Holmes ◽  
William L Hickerson ◽  
Jeffrey W Shupp ◽  
Robert Sheridan ◽  
...  
Keyword(s):  
Adverse Events ◽  
Cell Suspension ◽  
Point Of Care ◽  
Donor Site ◽  
Burn Injuries ◽  
Severe Injuries ◽  
Skin Cell ◽  
Skin Loss ◽  
One Year ◽  
Delayed Closure

Abstract Introduction Treatment of large TBSA burn injuries is often limited by donor site availability and requires reharvesting to obtain definitive closure. Patients with severe injuries may have delayed closure compared to uncompromised patients that typically have their donor sites healed in 7–14 days. Autologous skin cell suspension (ASCS) can be prepared to treat burn wounds at the point-of-care. The safety and effectiveness have not yet been established for use in the treatment of donor sites. This study presents the use of ASCS for the treatment of donor sites in patients with life-threatening burn injuries that were enrolled in a prospective uncontrolled observational study (IDE 15945—NCT02992249). Methods ASCS was applied to the donor site after harvesting of STSGs. Clinical outcomes out to one year were evaluated including percentage of re-epithelialization, long-term cosmetic outcomes, and adverse events. Results Ninety-six subjects from 22 burn centers had their donor sites treated with ASCS as part of their treatment regimen. The average subject age was 30.1 and the average TBSA injury was 53.7 ±17.3%. The mean Baux score was 89.2 with 36% of subjects having a score greater than 100. Collectively, 528 donor sites were individually treated. In this compromised patient population 37.5% were ≥95% re-epithelialized by week 1 (n=435), and by week 2, 82.7% of the donor sites were ≥95% re-epithelialized (n=434), regardless of how many times they were harvested. Approximately 19% of the donor sites treated with ACSC were reharvested multiple times following initial healing (15% two times, 2.3% three times, and 7 donor sites were harvested 4 times) and retreated. Of donor sites harvested more than once, 39.3% (n=84), 81% (n=79), and 85.7% (n=77) of sites were ≥ 95% re-epithelialized by week 1, 2 and 4, respectively. One-year data was available for 427 donor sites and the majority had matched or mildly mismatched color, pigment, and texture. Adverse events included one site with a hematoma, one patient with donor sites that had fragile skin loss secondary to traumatic friction, one patient with active bleeding, two patients with anemia secondary to donor site bleeding, one patient with delayed closure due to mild infection of staph species. All AEs were unlikely or unrelated to the device. Conclusions ASCS has been successfully used to achieve closure of donor site wounds without significant safety risk in patients with extensive burn injuries. Applicability of Research to Practice Application of ASCS for donor site healing may be particularly relevant for patients with large burn injuries requiring subsequent reharvesting to achieve definitive closure.

Tracheal tube size in adults undergoing elective surgery – a narrative review

Anaesthesia ◽  
2020 ◽  
Vol 75 (11) ◽  
pp. 1529-1539
Author(s):  
S. Karmali ◽  
P. Rose
Keyword(s):  
Tracheal Tube ◽  
Elective Surgery ◽  
Narrative Review ◽  
Tube Size
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