scholarly journals Bedside Prediction of Airway Length in Adults and Children

2009 ◽  
Vol 111 (3) ◽  
pp. 556-560 ◽  
Author(s):  
Bong-Jae Lee ◽  
Jae-Woo Yi ◽  
Jun Young Chung ◽  
Dong-Ok Kim ◽  
Jong-Man Kang
Keyword(s):  
Endotracheal Tube ◽  
Regression Line ◽  
Coefficient Of Determination ◽  
Neutral Position ◽  
Fiberoptic Bronchoscope ◽  
Extended Position ◽  
Adults And Children ◽  
Manubriosternal Joint ◽  
Extension Length ◽  
Tracheal Carina

Background Malpositioning of the endotracheal tube within the airway leads to serious complications such as endobronchial intubation. Prediction of the correct depth of an endotracheal tube is important and should be individualized. The manubriosternal joint (MSJ) is on the same horizontal plane with the tracheal carina. We compared the straight length from the upper incisor to the MSJ in the fully extended position (incisor-MSJ extension length) with the length from the upper incisor to the carina after intubation with a flexible fiberoptic bronchoscope through the endotracheal tube in the neutral position (incisor-carina neutral length). Methods One hundred adults and 50 children were studied. Induction of anesthesia was achieved with 1.5 mg/kg propofol and 0.6 mg/kg rocuronium IV. The incisor-MSJ extension length was measured after adequate mask ventilation. After intubation, the endotracheal tube was positioned properly at the upper incisor teeth, and the incisor-carina neutral length was measured with the fiberoptic bronchoscope at the carina. Results The correlation between the incisor-MSJ extension length and the incisor-carina neutral length is significant (P < 0.001) in both adults and children. A formula for the regression line in adults (children) can be obtained as the incisor-carina neutral length (cm) = 0.868 (1.009) x the incisor-MSJ extension length (cm) + 4.260 (0.468) with a high coefficient of determination; r(2) = 0.88 (0.98). Conclusions The airway length from the upper incisor to the carina in the neutral position can be predicted by the straight length from the upper incisor to the MSJ in the fully extended position.

scholarly journals Effects of head positions on awake fiberoptic bronchoscope oral intubation: a randomized controlled trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Zhuo Liu ◽  
Li Zhao ◽  
Zhongfeng Ma ◽  
Meiqi Liu ◽  
Xiaohang Qi ◽  
...  
Keyword(s):  
Tracheal Tube ◽  
Orotracheal Intubation ◽  
Neutral Position ◽  
Fiberoptic Bronchoscope ◽  
Glottic Opening ◽  
Vocal Cords ◽  
Oral Intubation ◽  
Vas Scores ◽  
Head Positions ◽  
Position Group

Abstract Background There are many factors affecting the success rate of awake orotracheal intubation via fiberoptic bronchoscope. We performed this study was to investigate the effects of head positions on awake Fiberoptic bronchoscope oral intubation. Methods Seventy-five adult patients, received general anaesthesia were included in this study. After written informed consent, these patients were undergoing awake orotracheal intubation via fiberoptic-bronchoscope and according to the head position, the patients were randomized allocated to neutral position group (NP group), sniffing position group (SP group) or extension position group (EP group). After sedation the patients were intubated by an experienced anesthesiologist. The time to view the vocal cords, the percentage of glottic opening scores (POGO), the time to insert the tracheal tube into trachea and the visual analog scale (VAS) scores for ease experienced of passing the tracheal tube through glottis, the hemodynamic changes and the adverse events after surgery were recorded. Results The time to view the vocal cords was significantly shorter and the POGO scores was significantly higher in the EP group compared with the other two groups (P < 0.05); The SpO2 in the EP group was higher than NP group at before intubation and higher than SP group and NP group at immediate after intubation (P < 0.05); The time to insert the tracheal tube into trachea, the VAS scores for passing the tracheal tube through glottis, the coughing scores had no significant differences among groups (P > 0.05). There were also no significant differences regard to the incidence of postoperative complications, mean arterial pressure and heart rate among the groups (P > 0.05). Conclusions The head at extension position had a best view of glottic opening than neutral position or sniffing position during awake Fiberoptic bronchoscope oral intubation, so extension position was recommended as the starting head position for awake Fiberoptic bronchoscope oral intubation. Trial registration Clinical Trials.gov. no. NCT02792855. Registered at https://register.clinicaltrials.gov on 23 september 2017.

Event-Free Survival Is a Surrogate for Overall Survival in Patients Treated for Acute Myeloid Leukemia

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 3744-3744 ◽  
Author(s):  
Richard F. Schlenk ◽  
Hartmut Döhner ◽  
Konstanze Döhner ◽  
Arnold Ganser ◽  
Michael Heuser ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
Treatment Effect ◽  
Myeloid Leukemia ◽  
Research Funding ◽  
Treatment Effects ◽  
Regression Line ◽  
Threshold Effect ◽  
Coefficient Of Determination ◽  
Surrogate Threshold Effect ◽  
Acute Myeloid

Abstract Purpose: We evaluated whether event-free survival (EFS) can be used as a surrogate for overall survival (OS) in patients treated for acute myeloid leukemia. Material: We carried out a meta-analysis of individual patient data from four randomized clinical trials carried out under the auspices of the German-Austrian Acute Myeloid Leukemia Study Group (AMLSG): AMLHD 98B (Schlenk et al. Leukemia 2004 18:1798-803; n=254), AMLSG 06-04 (NCT00151255, n=189), AMLSG 07-04 (NCT00151242, n=1,100) and AMLSG 12-09 (NCT01180322, n=268). Some of these trials addressed multiple therapeutic questions, which resulted in a total of 7 independent treatment comparisons. Methods: A two-level modelling approach was used to estimate the association between EFS and OS, and between the treatment effects on EFS and on OS. At the individual level, a copula was fitted to model the joint distribution of EFS and OS, and Spearman's rank correlation coefficient (rho) was used to quantify the association between the endpoints. At the trial-level, a linear regression was fitted through the estimated treatment effects (Weibull-model-based log hazard ratios) on EFS and OS, taking into account the estimation error. The coefficient of determination (R²) was used to quantify the association between the treatment effects. The surrogate threshold effect (STE) was estimated as the treatment effect on EFS that would predict a significant treatment effect on OS. Results: A total of n=1,811 patients were included in the analysis. Spearman's correlation coefficient was equal to 0.76 (standard error, SE, 0.015). The coefficient of determination (R²) of the linear regression between log hazard ratios on EFS and on OS was equal to 0.97 (SE 0.13). The intercept of the regression line was equal to -0.04 (SE 0.04) and the slope was equal to 0.80 (SE 0.21). The surrogate threshold effect was equal to 0.90. Using an alternative method of estimation of treatment effects, marginal proportional hazards models for EFS and OS, the R² was equal to 0.98 (SE 0.21), the intercept of the regression line was equal to -0.02 (SE 0.05), the slope was equal to 0.82 (SE 0.28), and the surrogate threshold effect was equal to 0.89. Further results for different subsets of patients, for example, those with activating FLT3 mutations, will be presented at the meeting. Interpretation: In this population of intensively-treated AML patients, there was a tight association between the treatment effect on EFS and OS, suggesting that the former can be used as a surrogate for the latter in clinical trials assessing the efficacy of new treatments. The surrogate threshold effect of about 0.90 and the regression analysis suggest that a reduction of at least 10% in the risk of an event would reliably predict a reduction of approximately 8% in the risk of death. Disclosures Schlenk: Celgene: Honoraria, Research Funding; Pfizer: Honoraria, Research Funding; Novartis: Honoraria, Research Funding; Teva: Honoraria, Research Funding; AROG: Honoraria, Research Funding; Amgen: Research Funding; Böhringer Ingelheim: Honoraria; Daiichi Sankyo: Membership on an entity's Board of Directors or advisory committees; Janssen: Honoraria, Membership on an entity's Board of Directors or advisory committees. Buyse:IDDI: Employment; Novartis: Research Funding. Burzykowski:IDDI: Employment; Novartis: Research Funding.

scholarly journals PENGARUH PERSEPSI SISWA TENTANG KETERAMPILAN MENJELASKAN GURU TERHADAP PEMAHAMAN MATERI AKUNTANSI (Studi Kasus di SMAN 1 Pakusari Semester Genap Tahun Ajaran 2016/2017)

2017 ◽  
Vol 11 (1) ◽  
pp. 124
Author(s):  
Tri Suci Ulamatullah ◽  
Retna Ngesti Sedyati ◽  
Bambang Suyadi
Keyword(s):  
Positive Impact ◽  
Regression Line ◽  
Coefficient Of Determination ◽  
Collection Method ◽  
Independent Variables ◽  
Inferential Analysis ◽  
Learning Interest ◽  
Line Analysis ◽  
Simple Regression

The purpose of this research is to know the significant influence of students perception about explaining skill of the teachers which consists of 6 indicators those are clear, structured, using example, emphasis, interesting and reversal to the understanding of accounting material in SMAN 1 Pakusari. Determining method of research location used Purposive area in SMAN 1 Pakusari, Jember. Determination of respondents in this study used population method and there were 61 students. Data collection method used consists of some methods: questionnaires, interviews, observations and documents. Data analysis used is inferential analysis that is by simple regression line analysis, regression line variance analysis, F test and effectiveness of regression line / coefficient of determination. The results showed that students' perception on the teachers' explaining skill has a significant effect on the understanding of accounting material that is equal to 79.3%, is mean the perception of students on explaining skill given a positive impact to the understanding of accounting material ,while the remaining 20.7% is influenced by other independent variables that are not examined in this study such as the use of learning media, motivation and students learning interest

scholarly journals Estimates of daily global solar radiation based on the daily temperature extremes and precipitation sums

2004 ◽  
Vol 52 (5) ◽  
pp. 13-28
Author(s):  
Miroslav Trnka
Keyword(s):  
Solar Radiation ◽  
Sunshine Duration ◽  
Regression Line ◽  
Global Solar Radiation ◽  
Daily Temperature ◽  
Coefficient Of Determination ◽  
Mean Bias Error ◽  
Daily Maximum ◽  
Bias Error ◽  
Temperature Extremes

Two methods for estimating daily global solar radiation (RG) based on the daily temperature extremes and precipitation sum are compared in the study. All parameters necessary for application of both methods were derived either from literature or from climatic characteristics easily available at the given meteorological stations excluding need for measured RG data. The performance of both methods was assessed with a help of meteorological database including 4 stations in the Czech Republic (data were provided by the Czech Hydrometeorological Institute) and 6 in Austria (data provided by the Austrian Weather Service) containing in total 41 640 observational day. For each day in the database observed daily sum of RG, daily maximum and minimum temperatures and precipitation sum were available. Coefficient of determination, slope of regression line forced through origin, mean bias error (MBE) and root mean square error (RMSE) were used as performance indicators. The first method proposed by Winslow et al. (2001) – Eq. (1) is capable to explain 86% of daily RG variability, with systematic error represented by MBE equaling to 0.19 MJ.m–2.day-1 and random error indicated by RMSE reaching up to 3.09. The second method published by Thornton and Running (1999)-Eq. (2) was found to be in almost all parameters inferior to the Eq. (1) and thus the Eq. (1) is recommended to be used in the Central European region (up to 600 m above the sea level). This method might be recommended for stations where neither measured RG or sunshine duration hours exist. However, one should take into consideration that relative MBE and RMSE are in some months higher than 10% and 30% respectively, which may compromise results of subsequent calculations made with use of estimated solar radiation data and alter the order of the method suitability.

scholarly journals Comparison of vocal cord view between neutral and sniffing position during orotracheal intubation using fiberoptic bronchoscope: A prospective, randomized cross over study

2019 ◽  
Author(s):  
Sanghee Park ◽  
Hyung Gon Lee ◽  
Jeong Il Choi ◽  
Seongheon Lee ◽  
Eun-A Jang ◽  
...  
Keyword(s):  
Vocal Cord ◽  
Upper Airway ◽  
Orotracheal Intubation ◽  
Fiberoptic Intubation ◽  
Neutral Position ◽  
Fiberoptic Bronchoscope ◽  
Glottic Opening ◽  
Head Positioning ◽  
Head Positions ◽  
To Receive

Abstract Background: In intubation using fiberoptic bronchoscope (FOB), partial or complete obstruction of upper airway makes the FOB insertion difficult. Thus, maneuvers to relieve such obstructions are recommended. There have been no studies to determine whether the sniffing or neutral position is superior for this purpose. Therefore, this study was performed to examine the effects of these two positions including vocal cord view. Methods: Fifty-four patients scheduled to receive general anesthesia by orotracheal intubation were eligible for inclusion in the study with informed consent. After confirmation of proper head positioning depending on the group, the view of the vocal cord was acquired in each position. Images were reviewed using the percentage of glottic opening (POGO) score. Results: A total of 106 images of vocal cords from 53 patients were obtained. The mean of difference of POGO score was 11.09, higher for the neutral position and standard deviation was 23.73 (p = 0.002). Neutral position increased POGO score in 31 patients and decreased POGO score in 13 patients compare to sniffing position (p = 0.017). There were no significant differences between the two head positions with regard to intubation time or degree of convenience during intubation. Conclusions: Neutral position improved the view of glottic opening than sniffing position during oral fiberoptic intubation. However, there was no difference in the difficulty of tube insertion between the two positions. Trial registration: Clinical Trials.gov identifier: NCT02931019, registered on October 12, 2016

Optical Stylet

1979 ◽  
Vol 88 (6) ◽  
pp. 828-831 ◽  
Author(s):  
G. Berci ◽  
R. Katz
Keyword(s):  
Endotracheal Tube ◽  
Endotracheal Intubation ◽  
Optical System ◽  
Beam Splitter ◽  
Vocal Cords ◽  
Invaluable Tool ◽  
Adults And Children

An optical stylet was developed which can be inserted into an endotracheal tube, and the passage through the vocal cords and position of the cuff in the trachea could be controlled visually. It is of great help in difficult intubations in adults and children. It became an invaluable tool in teaching endotracheal intubation by coupling a teaching attachment (beam splitter) to the optical system. The operator and the second observer (student) can see the actual manipulations simultaneously.

Special New Low Resistance to Flow Tube and Endotracheal Tube Adapter for Use during Fiberoptic Bronchoscopy

1975 ◽  
Vol 84 (5) ◽  
pp. 631-634 ◽  
Author(s):  
Edward Carden ◽  
Phulchand P. Raj
Keyword(s):  
Endotracheal Tube ◽  
Laboratory Data ◽  
Fiberoptic Bronchoscopy ◽  
Fiberoptic Bronchoscope ◽  
Flow Tube ◽  
Endotracheal Tubes ◽  
Low Resistance ◽  
System A ◽  
Thin Walled

This paper describes endotracheal tubes and adapters which are designed specially for fiberoptic bronchoscopy; the tubes are designed in such a way that they are wide at the upper part but are narrow and thin walled in the part of the tube which goes through and below the cords. By designing tubes in this manner, the resistance to flow of gas through the tube when the fiberoptic bronchoscope is in place is very much reduced and the safety of the whole precedure is enhanced. A special adapter for use under these circumstances is also described which utilizes a commercially available swivel tracheostomy adapter with a special silicone diaphragm fitted onto the top to enable the fiberoptic bronchoscope to be placed through the diaphragm and keep a sealed system. A plug is available for the hole in the diaphragm when the fiberoptic bronchoscope is not being used. Clinical and laboratory data show that these pieces of equipment perform the function for which they were designed.

scholarly journals Effectiveness of Breathing through Nasal and Oral Routes in Unconscious Apneic Adult Human Subjects

2011 ◽  
Vol 115 (1) ◽  
pp. 129-135 ◽  
Author(s):  
Yandong Jiang ◽  
Fang Ping Bao ◽  
Yafen Liang ◽  
William R. Kimball ◽  
Yanhong Liu ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Human Subjects ◽  
Oral Route ◽  
Neutral Position ◽  
Muscle Paralysis ◽  
Emergency Situations ◽  
Extended Position ◽  
Single Operator ◽  
Effective Ventilation ◽  
Improve Patient

Background The authors hypothesized that mouth ventilation by a resuscitator via the nasal route ensures a more patent airway and more effective ventilation than does ventilation via the oral route and therefore would be the optimal manner to ventilate adult patients in emergencies, such as during cardiopulmonary resuscitation. They tested the hypothesis by comparing the effectiveness of mouth-to-nose breathing (MNB) and mouth-to-mouth breathing (MMB) in anesthetized, apneic, adult subjects without muscle paralysis. Methods Twenty subjects under general anesthesia randomly received MMB and MNB with their heads placed first in a neutral position and then an extended position. A single operator performed MNB and MMB at the target breathing rate of 10 breaths/min, inspiratory:expiratory ratio 1:2 and peak inspiratory airway pressure 24 cm H₂O. A plethysmograph was used to measure the amplitude change during MMB and MNB. The inspiratory and expiratory tidal volumes during MMB and MNB were calculated retrospectively using the calibration curve. Results All data are presented as medians (interquartile ranges). The rates of effective ventilation (expired volume &gt; estimated anatomic dead space) during MNB and MMB were 91.1% (42.4-100%) and 43.1% (42.5-100%) (P &lt; 0.001), and expired tidal volume with MMB 130.5 ml (44.0-372.8 ml) was significantly lower than with MNB 324.5 ml (140.8-509.0 ml), regardless of the head position (P &lt; 0.001). Conclusions Direct mouth ventilation delivered exclusively via the nose is significantly more effective than that delivered via the mouth in anesthetized, apneic adult subjects without muscle paralysis. Additional studies are needed to establish whether using this breathing technique during emergency situations will improve patient outcomes.

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