Endotracheal and Enteric Tubes

Chest Imaging ◽  
2019 ◽  
pp. 35-39
Author(s):  
Tyler H. Ternes
Keyword(s):  
Mechanical Ventilation ◽  
Gas Exchange ◽  
Endotracheal Tube ◽  
Medical Devices ◽  
Esophageal Intubation ◽  
Ideal Position ◽  
Tracheostomy Tubes ◽  
Tube Malposition ◽  
The Ideal

The Endotracheal and Enteric Tubes chapter addresses these frequently used medical devices. An endotracheal tube (ETT) is a catheter placed into the airway for mechanical ventilation. It serves to protect the airway and provide adequate gas exchange. The ideal position of the endotracheal tube tip is approximately 5 cm above the carina. Complications of ETT placement include inadequate ventilation if placed too high or too low, esophageal intubation and tracheal injury. Tracheostomy tubes are used in patients who require long-term intubation. Enteric tubes are thin flexible hollow catheters that course into the stomach and beyond. They may be placed via nasal (nasogastic) or oral (orogastric) approach. When used for suctioning, the ideal position of the tube tip is within the stomach. When used for administration of drugs or nutrition, the tube tip is ideally advanced beyond the pylorus. Enteric tube malposition may be due to coiling within the esophagus or inadvertent malposition within the airway. Malpositioning could result in aspiration, lung injury, and pneumothorax.

Long-term Effects of Different Humidification Systems on Endotracheal Tube Patency

2004 ◽  
Vol 100 (4) ◽  
pp. 782-788 ◽  
Author(s):  
Samir Jaber ◽  
Jérôme Pigeot ◽  
Redouane Fodil ◽  
Salvatore Maggiore ◽  
Alain Harf ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Endotracheal Tube ◽  
Heated Humidifier ◽  
Long Term Effects ◽  
Moisture Exchanger ◽  
Acoustic Reflection ◽  
Heat And Moisture ◽  
The Impact

Background Accumulation of mucous secretions in an endotracheal tube (ETT) increases its resistance, and the amount of deposit may be affected by the quality of humidification and heating of the inspired gas. Methods The authors assessed the impact of two humidification systems, a heated humidifier (HH) and a hygroscopic-hydrophobic heat and moisture exchanger (HME), on the ETT patency in patients selected to require mechanical ventilation for more than 48 h. This comparison was performed over two consecutive periods and used the acoustic reflection method, which characterizes the amount and site of ETT obstruction and allows estimating ETT inner volume and resistance. Measurements were performed three times a week over the period of mechanical ventilation. Comparisons were performed at mid duration and at the end of the mechanical ventilation period. Results The HH was used in 34 patients, and the HME was used in 26 patients. The two groups had similar severity and duration of mechanical ventilation. At mid duration of mechanical ventilation (5.5 +/- 3.3 vs. 4.8 +/- 3.3 days; P = 0.4), no difference was observed in ETT volume and resistance between the two groups. At the end of the study period (10.5 +/- 5.8 vs. 9.6 +/- 6.3 days of mechanical ventilation; P = 0.4), ETT volume was reduced to a greater extent with HME than with HH (-3.3 +/- 2.9 vs. -5.1 +/- 2.5%; P = 0.008), and ETT resistance increased significantly more with the HME than with the HH (8.4 +/- 12.2 vs. 19.4 +/- 17.7%; P = 0.001). Conclusion Prolonged use of humidification systems results in progressive reduction of ETT patency, and to a greater extent with HMEs than with HHs.

scholarly journals Long term effects of non-invasive mechanical ventilation on pulmonary haemodynamics in patients with chronic respiratory failure

Thorax ◽  
2001 ◽  
Vol 56 (7) ◽  
pp. 524-528
Author(s):  
B Schönhofer ◽  
T Barchfeld ◽  
M Wenzel ◽  
D Köhler
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Gas Exchange ◽  
Pulmonary Artery ◽  
Pulmonary Artery Pressure ◽  
Chronic Respiratory Failure ◽  
Artery Pressure ◽  
Mean Pulmonary Artery Pressure ◽  
Pulmonary Haemodynamics

BACKGROUNDIt is not known whether long term nocturnal mechanical ventilation (NMV) reduces pulmonary hypertension in patients with chronic respiratory failure (CRF).METHODSPulmonary haemodynamics, spirometric values, and gas exchange were studied in 33 patients requiring NMV due to CRF (20 with thoracic restriction, 13 with chronic obstructive pulmonary disease (COPD)) at baseline and after 1 year of NMV given in the volume cycled mode. Patients with COPD also received supplemental oxygen.RESULTSLong term NMV improved gas exchange while lung function remained unchanged. Mean pulmonary artery pressure at rest before NMV was higher in patients with thoracic restriction than in those with COPD (33 (10) mm Hgv 25 (6) mm Hg). After 1 year of NMV mean pulmonary artery pressure decreased in patients with thoracic restriction to 25 (6) mm Hg (mean change –8.5 mm Hg (95% CI –12.6 to –4.3), p<0.01) but did not change significantly in patients with COPD (mean change 2.2 mm Hg (95% CI –0.3 to 4.8)).CONCLUSIONSLong term NMV in CRF improves pulmonary haemodynamics in patients with thoracic restriction but not in patients with COPD.

scholarly journals Surface Immobilization of Nano-Silver on Polymeric Medical Devices to Prevent Bacterial Biofilm Formation

Pathogens ◽  
2019 ◽  
Vol 8 (3) ◽  
pp. 93 ◽  
Author(s):  
Riau ◽  
Aung ◽  
Setiawan ◽  
Yang ◽  
Yam ◽  
...  
Keyword(s):  
Medical Devices ◽  
Biofilm Formation ◽  
Culture Media ◽  
Silver Ions ◽  
Bacterial Biofilm ◽  
Surface Immobilization ◽  
Nano Silver ◽  
Gram Positive Bacteria ◽  
Tissue Microenvironment

: Bacterial biofilm on medical devices is difficult to eradicate. Many have capitalized the anti-infective capability of silver ions (Ag+) by incorporating nano-silver (nAg) in a biodegradable coating, which is then laid on polymeric medical devices. However, such coating can be subjected to premature dissolution, particularly in harsh diseased tissue microenvironment, leading to rapid nAg clearance. It stands to reason that impregnating nAg directly onto the device, at the surface, is a more ideal solution. We tested this concept for a corneal prosthesis by immobilizing nAg and nano-hydroxyapatite (nHAp) on poly(methyl methacrylate), and tested its biocompatibility with human stromal cells and antimicrobial performance against biofilm-forming pathogens, Pseudomonas aeruginosa and Staphylococcus aureus. Three different dual-functionalized substrates—high Ag (referred to as 75:25 HAp:Ag); intermediate Ag (95:5 HAp:Ag); and low Ag (99:1 HAp:Ag) were studied. The 75:25 HAp:Ag was effective in inhibiting biofilm formation, but was cytotoxic. The 95:5 HAp:Ag showed the best selectivity among the three substrates; it prevented biofilm formation of both pathogens and had excellent biocompatibility. The coating was also effective in eliminating non-adherent bacteria in the culture media. However, a 28-day incubation in artificial tear fluid revealed a ~40% reduction in Ag+ release, compared to freshly-coated substrates. The reduction affected the inhibition of S. aureus growth, but not the P. aeruginosa. Our findings suggest that Ag+ released from surface-immobilized nAg diminishes over time and becomes less effective in suppressing biofilm formation of Gram-positive bacteria, such as S. aureus. This advocates the coating, more as a protection against perioperative and early postoperative infections, and less as a long-term preventive solution.

The Adjustment of the Rotational Alignment of the Distal End of the Extramedullary Guide to the Anteroposterior Axis of the Proximal Tibia in Total Knee Arthroplasty

2021 ◽  
Author(s):  
Hideki Mizu-uchi ◽  
Hidehiko Kido ◽  
Tomonao Chikama ◽  
Kenta Kamo ◽  
Satoshi Kido ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Navigation System ◽  
Proximal Tibia ◽  
Rotational Alignment ◽  
Coronal Alignment ◽  
Ideal Position ◽  
Total Knee ◽  
Alignment Guide ◽  
The Ideal

AbstractThe optimal placement within 3 degrees in coronal alignment was reportedly achieved in only 60 to 80% of patients when using an extramedullary alignment guide for the tibial side in total knee arthroplasty (TKA). This probably occurs because the extramedullary alignment guide is easily affected by the position of the ankle joint which is difficult to define by tibial torsion. Rotational direction of distal end of the extramedullary guide should be aligned to the anteroposterior (AP) axis of the proximal tibia to acquire optimal coronal alignment in the computer simulation studies; however, its efficacy has not been proven in a clinical setting. The distal end of the guide can be overly displaced from the ideal position when using a conventional guide system despite the alignment of the AP axis to the proximal tibia. This study investigated the effect of displacement of the distal end of extramedullary guide relative to the tibial coronal alignment while adjusting the rotational alignment of the distal end to the AP axis of the proximal tibia in TKA. A total of 50 TKAs performed in 50 varus osteoarthritic knees using an image-free navigation system were included in this study. The rotational alignment of the proximal side of the guide was adjusted to the AP axis of the proximal tibia. The position of the distal end of the guide was aligned to the center of the ankle joint as viewed from the proximal AP axis (ideal position) and as determined by the navigation system. The tibial intraoperative coronal alignments were recorded as the distal end was moved from the ideal position at 3-mm intervals. The intraoperative alignments were 0.5, 0.9, and 1.4 degrees in valgus alignment with 3-, 6-, and 9-mm medial displacements, respectively. The intraoperative alignments were 0.7, 1.2, and 1.7 degrees in varus alignment with 3-, 6-, and 9-mm lateral displacements, respectively. In conclusion, the acceptable tibial coronal alignment (within 2 degrees from the optimal alignment) can be achieved, although some displacement of the distal end from the ideal position can occur after the rotational alignment of the distal end of the guide is adjusted to the AP axis of the proximal tibia.

Local Delivery of Mometasone Furoate from an Eluting Endotracheal Tube Reduces Airway Morbidity Following Long-Term Animal Intubation

2021 ◽  
Author(s):  
Forsan Jahshan ◽  
Aiman Abu Ammar ◽  
Offir Ertracht ◽  
Netanel Eisenbach ◽  
Amani Daoud ◽  
...  
Keyword(s):  
Endotracheal Tube ◽  
Local Delivery ◽  
Mometasone Furoate

Long-term liming improves soil fertility and soybean root growth, reflecting improvements in leaf gas exchange and grain yield

2021 ◽  
Vol 128 ◽  
pp. 126308
Author(s):  
João William Bossolani ◽  
Carlos Alexandre Costa Crusciol ◽  
José Roberto Portugal ◽  
Luiz Gustavo Moretti ◽  
Ariani Garcia ◽  
...  
Keyword(s):  
Gas Exchange ◽  
Root Growth ◽  
Soil Fertility ◽  
Grain Yield ◽  
Leaf Gas Exchange ◽  
Soybean Root
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