Difficult extubation with silicone endotracheal tubes in three dogs

2020 ◽  
Vol 8 (1) ◽  
pp. e000976
Author(s):  
Marta Romano ◽  
Diego A. Portela
Keyword(s):  
Computed Tomography ◽  
Endotracheal Intubation ◽  
Outer Surface ◽  
Tracheal Wall ◽  
Tube Size ◽  
Endotracheal Tubes ◽  
Size Selection

Three dogs were anaesthetised for various procedures. Endotracheal intubation was achieved with cuffed silicone tubes. No difficulty was reported during the intubation in two out of the three cases, whereas in one case the tube could only be advanced a few centimetres past the glottis. Before extubation, the cuff was deflated in all cases, but the tubes could not be withdrawn past the point where the cuff was positioned within the arytenoids. Endoscopy was performed in two of the three cases and revealed no visible causes of movement hindrance. Computed tomography (CT) previously performed in one of the cases revealed that the outer surface of the tube was in contact with the tracheal wall. In all cases, the tubes could eventually be removed with lubrication and movement. These cases suggest that large silicone endotracheal tubes relative to the airway diameter may result in difficult extubation, and care should be taken with tube size selection.

scholarly journals Efficacy of Pressure Support in Compensating for Apparatus Work

1993 ◽  
Vol 21 (1) ◽  
pp. 67-71 ◽  
Author(s):  
A. D. Bersten ◽  
A. J. Rutten ◽  
A. E. Vedig
Keyword(s):  
Endotracheal Tube ◽  
Flow Rate ◽  
Pressure Support ◽  
Work Of Breathing ◽  
Inspiratory Flow ◽  
Inspiratory Flow Rate ◽  
Respiratory Muscle Fatigue ◽  
Tube Size ◽  
Endotracheal Tubes ◽  
Endotracheal Tube Size

Breathing through an endotracheal tube, connector, and ventilator demand valve imposes an added load on the respiratory muscles. As respiratory muscle fatigue is thought to be a frequent cause of ventilator dependence, we sought to examine the efficacy of five different ventilators in reducing this imposed work through the application of pressure support ventilation. Using a model of spontaneous breathing, we examined the apparatus work imposed by the Servo 900-C, Puritan Bennett 7200a, Engstrom Erica, Drager EV-A or Hamilton Veolar ventilators, a size 7.0 and 8.0 mm endotracheal tube, and inspiratory flow rates of 40 and 60 l/min. Pressure support of 0, 5, 10, 15, 20 and 30 cm H2O was tested at each experimental condition. Apparatus work was greater with increased inspiratory flow rate and decreased endotracheal tube size, and was lowest for the Servo 900-C and Puritan Bennett 7200a ventilators. Apparatus work fell in a curvilinear fashion when pressure support was applied, with no major difference noted between the five ventilators tested. At an inspiratory flow rate of 40 l/min, a pressure support of 5 and 8 cm H2O compensated for apparatus work through size 8.0 and 7.0 endotracheal tubes and the Servo 900-C and Puritan Bennett 7200a ventilators. However, the maximum negative pressure was greater for the Servo 900-C. The added work of breathing through endotracheal tubes and ventilator demand valves may be compensated for by the application of pressure support. The level of pressure support required depends on inspiratory flow rate, endotracheal tube size, and type of ventilator.

Dimensional variations of left-sided double-lumen endobronchial tubes: an observational study

2019 ◽  
Author(s):  
Niels Hegland ◽  
Sebastian Schnitzler ◽  
Jan Ellensohn ◽  
Marc P Steurer ◽  
Markus Weiss ◽  
...  
Keyword(s):  
Observational Study ◽  
Airway Management ◽  
Double Lumen ◽  
Tube Size ◽  
Size Selection ◽  
Dimensional Parameters

Abstract Background: Tube size selection is critical in ventilating patient`s lungs using double-lumen endobronchial tubes. Little information about relevant parameters is readily available from manufacturers. Methods: In this observational study in a benchmark in-vitro setup, several dimensional parameters of four sizes of left-sided double-lumen endobronchial tubes from six different manufacturers were assessed, such as distances and diameters of tube shaft, cuff lengths and diameters as well the angle at the tip. Results: Endobronchial tubes of ostensibly the same size revealed wide variation in measured parameters between brands from different manufacturers. In some parameters, there was an overlap between different sizes from the same manufacturer, i.e. diameters and distances did not increase with increasing nominal endobronchial tube size. The information about dimensions of endobronchial tubes provided by manufacturers’ leaflets is insufficient. Conclusions: Endobronchial tube size selection is complicated because clinically relevant parameters are unknown and vary considerably between different manufacturers. Keywords: Airway management, double-lumen endobronchial tubes

scholarly journals Comparison of i-Gel as a Conduit for Intubation between under Fiberoptic Guidance and Blind Endotracheal Intubation during Cardiopulmonary Resuscitation: A Randomized Simulation Study

2019 ◽  
Vol 2019 ◽  
pp. 1-7
Author(s):  
Hyun Young Choi ◽  
Wonhee Kim ◽  
Yong Soo Jang ◽  
Gu Hyun Kang ◽  
Jae Guk Kim ◽  
...  
Keyword(s):  
Success Rate ◽  
Endotracheal Intubation ◽  
Macintosh Laryngoscope ◽  
Secondary Outcome ◽  
Intubation Time ◽  
Chest Compressions ◽  
Intubation Technique ◽  
Endotracheal Tubes ◽  
Significant Difference ◽  
Post Hoc

Purpose. This study aimed to compare intubation performances among i-gel blind intubation (IGI), i-gel bronchoscopic intubation (IBRI), and intubation using Macintosh laryngoscope (MCL) applying two kinds of endotracheal tube during chest compressions. We hypothesized that IGI using wire-reinforced silicone (WRS) tube could achieve endotracheal intubation most rapidly and successfully. Methods. In 23 emergency physicians, a prospective randomized crossover manikin study was conducted to examine the three intubation techniques using two kinds of endotracheal tubes. The primary outcome was the intubation time. The secondary outcome was the cumulative success rate for each intubation technique. A significant difference was considered when identifying p<0.05 between two devices or p<0.017 in post hoc analysis of the comparison among three devices. Results. The mean intubation time using IGI was shorter (p<0.017) than that of using IBRI and MCL in both endotracheal tubes (17.6 vs. 29.3 vs. 20.2 in conventional polyvinyl chloride (PVC) tube; 14.6 vs. 27.4 vs. 19.9 in WRS tube; sec). There were no significant (p<0.05) differences between PVC and WRS tubes for each intubation technique. The intubation time to reach 100% cumulative success rate was also shorter in IGI (p<0.017) than that in IBRI and MCL in both PVC and WRS tubes. Conclusions. IGI was an equally successful and faster technique compared with IBRI or MCL regardless of the use of PVC or WRS tube. IGI might be an appropriate technique for emergent intubation by experienced intubators during chest compressions.

Stent Size Selection Using 64-Detector Coronary Computed Tomography Angiography

2008 ◽  
Vol 15 (7) ◽  
pp. 820-826 ◽  
Author(s):  
Troy LaBounty ◽  
Baskaran Sundaram ◽  
Stanley Chetcuti ◽  
Cyril Ruwende ◽  
Ella A. Kazerooni ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Computed Tomography Angiography ◽  
Coronary Computed Tomography Angiography ◽  
Coronary Computed Tomography ◽  
Size Selection

Laryngopharyngeal complaints following short-term endotracheal intubation: peculiarities of males and females

2012 ◽  
Vol 19 (2) ◽  
pp. 51-57 ◽  
Author(s):  
Iveta PAULAUSKIENĖ ◽  
Eugenijus LESINSKAS
Keyword(s):  
Endotracheal Intubation ◽  
Female Group ◽  
Short Term ◽  
Cuff Volume ◽  
Vocal Fatigue ◽  
Tube Size ◽  
Globus Pharyngeus ◽  
Throat Pain ◽  
Male Group ◽  
Throat Clearing

Background. Laryngopharyngeal complaints are classified as minor post-intubation complications. They cause great discomfort, have some influence on the quality of life and can limit patient’s casual activity. The extent of complaints ranges from 12 to 65%. Undesirable complications can be avoided by ascertaining factors that are able to provoke or decrease laryngopharyngeal symptoms after endotracheal intubation. In this study, we assessed predominant laryngopharyngeal symptoms following a short-term endotracheal intubation and their peculiarities subject to gender, and we estimated the most important influencing factors. Materials and methods. 218 patients were examined before endotracheal anesthesia, 1–2 and 24 hours after extubation. The following laryngopharyngeal complaints were recorded: hoarseness, vocal fatigue, globus pharyngeus, throat pain and throat clearing. These factors were also assessed in relation to endotracheal intubation parameters: endotracheal tube size, cuff volume and pressure, number of intubation attempts, length of anesthesia, experience of anesthesiologist and additional parameters: smoking, allergy, GERD symptoms, laryngitis and singing skills subject to gender. Results. All laryngopharyngeal symptoms increased significantly in 2 hours after extubation and remained increased after 24 hours in both male and female groups. In 1–2 hours after extubation, females complained of throat pain more than males (61.3 vs. 42.9%; p = 0,014). The following significant relations were found 1–2 hours after extubation: between throat pain and length of anesthesia, globus pharyngeus and tube size and cuff volume in the male group; between globus pharyngeus, vocal fatigue and smoking, throat clearing and cuff volume in the female group. After 24 hours, the relation was noticed between vocal fatigue and cuff volume and number of intubation attempts, globus pharyngeus and length of anesthesia, between hoarseness and number of intubation attempts and between throat pain and singing skills in the male group. Some relation between throat clearing and cuff volume remained for 24 hours after extubation, smoking had influence on hoarseness and vocal fatigue in the female group. Conclusions. Laryngopharyngeal symptoms remain an important cause of discomfort for 24 hours after extubation. Females complain of laryngeal and pharyngeal symptoms more than males and throat pain following extubation is also more frequent in females. The most important parameters of short-term endotracheal intubation that influence laryngopharyngeal complaints are as follows: cuff volume, length of anesthesia and number of intubation attempts that affect males more than females. Smoking affects females more, though singing skills are more significant in the male group.

Endotracheal tube narrowing after closed-system suctioning: prevalence and risk factors

1999 ◽  
Vol 8 (2) ◽  
pp. 93-100 ◽  
Author(s):  
C Glass ◽  
MJ Grap ◽  
CN Sessler
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Endotracheal Tube ◽  
Closed System ◽  
Contributing Factors ◽  
Tube Size ◽  
Endotracheal Tubes ◽  
Few Data ◽  
Endotracheal Tube Size

BACKGROUND: Few data exist about buildup of secretions within endotracheal tubes of patients treated with closed-system suctioning in the intensive care unit. OBJECTIVES: To describe the extent, prevalence, and distribution of narrowing of endotracheal tubes related to buildup of secretions and to determine contributing factors. METHODS: Forty endotracheal tubes were examined within 4 hours of extubation, after at least 72 hours of use. Data on patients' daily weight and fluid balance, ventilator humidification temperatures, and nurses' descriptions of secretions during the 3 days preceding extubation were recorded. Any secretion debris in the endotracheal tubes was weighed. At 1-cm intervals along the tube, the debris was described and the depth of the debris was measured to the nearest 0.5 mm. RESULTS: Mean duration of intubation was 6.6 days. Two tubes had no debris. Mean overall depth of debris was 0.64 mm, mean greatest depth was 2.0 mm (range, 0-5 mm), and mean weight was 1.16 g. The entire tube was affected, with the greatest depth of debris at the 6- to 9-cm and 13- to 14-cm markings. Duration of intubation correlated with mean greatest depth of debris (r = 0.37, P = .02), mean overall depth of debris (r = 0.48, P = .002), and mean weight of debris (r = 0.38, P = .02). CONCLUSIONS: Endotracheal tubes are markedly narrowed by the buildup of secretions after closed-system suctioning. Duration of intubation, but not endotracheal tube size or amount of secretions, was associated with the degree of narrowing.

Modification of Umbilical Plastic Clamp To Secure Nasopharyngeal Prongs Used To Administer CPAP

PEDIATRICS ◽  
1976 ◽  
Vol 58 (1) ◽  
pp. 118-120
Author(s):  
Bedford W. Bonta ◽  
Joseph B. Warshaw
Keyword(s):  
Continuous Positive Airway Pressure ◽  
Endotracheal Tube ◽  
Endotracheal Intubation ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Endotracheal Tubes

Since the introduction of continuous positive airway pressure (CPAP) via endotracheal tube by Gregory et al.1 in 1971, several alternate methods of delivering CPAP without the need for endotracheal intubation have been suggested, including the use of nasopharyngeal prongs.2 A major peoblem, however, in delivering CPAP either by endotracheal tube or by nasal prongs has been that of securing the endotracheal tube (or prongs) in place. Recently, Cussel et al.3 have suggested the use of a Hollister plastic clamp adapted for this use. We have used this method successfully for securing endotracheal tubes in place and recently have modified the clamp to secure nasal prongs used to deliver "benign" CPAP without the need for endotracheal intubation in selected patients.

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