Application of bedside real-time tracheal ultrasonography for confirmation of emergency endotracheal intubation in patients in the intensive care unit

Objective Critically ill patients often require emergency endotracheal intubation and mechanical ventilation. When esophageal intubation is not confirmed early, treatment may be delayed, even for life-threatening conditions. We examined the accuracy of bedside real-time airway ultrasonography in confirming the endotracheal tube (ETT) position during emergency endotracheal intubation in patients in the intensive care unit (ICU). Methods This single-center prospective observational study included 118 patients who underwent urgent endotracheal intubation in the ICU of Taizhou Hospital of Integrated Traditional Chinese and Western Medicine. Tracheal ultrasonography was used to confirm the ETT position during endotracheal intubation, after which fiberoptic bronchoscopy was performed. The accuracy of bedside real-time tracheal ultrasonography in determining the ETT position was examined. Results Twelve (10.2%) patients underwent endotracheal intubation. The kappa value was 0.844, indicating perfect consistency between tracheal ultrasonography and fiberoptic bronchoscopy in identifying esophageal intubation. The sensitivity, specificity, and positive and negative predictive values of tracheal ultrasonography in determining the ETT position were 75.0%, 100%, 100%, and 97.2%, respectively. Conclusions Bedside real-time tracheal ultrasonography accurately assesses the ETT position in the ICU and can identify the ETT position during intubation. These findings have important clinical applications and are of great significance for treatment of ICU patients.

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A Novel Cause of Error in Capnographic Confirmation of Intubation in the Neonatal Intensive Care Unit

PEDIATRICS ◽

10.1542/peds.95.1.140 ◽

1995 ◽

Vol 95 (1) ◽

pp. 140-142

Author(s):

William A. Roberts ◽

William M. Maniscalco

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Endotracheal Intubation ◽

Neonatal Intensive Care ◽

Routine Care ◽

Esophageal Intubation ◽

Neurologic Injury ◽

Clinical Indicators ◽

Clinical Criteria ◽

Cause Of Error

Failure to recognize esophageal intubation can result in hypoxia and may lead to permanent neurologic injury. Clinical criteria commonly used to comfirm endotracheal intubation can fail to identify esophageal misplacement.1-9 The risk of this error has been reduced in the operating room by using capnography, which is both sensitive and specific for correct endotracheal intubation.4,6,7,10-12 Capnography is able to identify errant tube placements more rapidly and specifically than clinical indicators alone.10 We report here a novel cause of error in the capnographic findings at intubation in a neonate. CASE REPORT A 26-week gestational age, 690-g neonate was accidentally extubated during routine care.

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Outcome of Patients with Systemic Sclerosis in the Intensive Care Unit

The Journal of Rheumatology ◽

10.3899/jrheum.141617 ◽

2015 ◽

Vol 42 (8) ◽

pp. 1406-1412 ◽

Cited By ~ 10

Author(s):

Frédéric Pène ◽

Tarik Hissem ◽

Alice Bérezné ◽

Yannick Allanore ◽

Guillaume Geri ◽

...

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Systemic Sclerosis ◽

Endotracheal Intubation ◽

Noninvasive Ventilation ◽

Invasive Mechanical Ventilation ◽

Mortality Rates ◽

Icu Admission ◽

Life Threatening

Objective.Patients with systemic sclerosis (SSc) are prone to disease-specific or treatment-related life-threatening complications that may warrant intensive care unit (ICU) admission. We assessed the characteristics and current outcome of patients with SSc admitted to the ICU.Methods.We performed a single-center retrospective study over 6 years (November 2006–December 2012). All patients with SSc admitted to the ICU were enrolled. Short-term (in-ICU and in-hospital) and longterm (6-mo and 1-yr) mortality rates were studied, and the prognostic factors were analyzed.Results.Forty-one patients with a median age of 50 years [interquartile range (IQR) 40–65] were included. Twenty-nine patients (72.5%) displayed diffuse cutaneous SSc. The time from diagnosis to ICU admission was 78 months (IQR 34–128). Twenty-eight patients (71.7%) previously had pulmonary fibrosis, and 12 (31.5%) had pulmonary hypertension. The main reason for ICU admission was acute respiratory failure in 27 patients (65.8%). Noninvasive ventilation was first attempted in 13 patients (31.7%) and was successful in 8 of them, whereas others required endotracheal intubation within 24 h. Altogether, 13 patients (31.7%) required endotracheal intubation and mechanical ventilation. The overall in-ICU, in-hospital, 6-month, and 1-year mortality rates were 31.8%, 39.0%, 46.4%, and 61.0%, respectively. Invasive mechanical ventilation was the worst prognostic factor, associated with an in-hospital mortality rate of 84.6%.Conclusion.This study provides reliable prognostic data in patients with SSc who required ICU admission. The devastating outcome of invasive mechanical ventilation in patients with SSc requires a reappraisal of indications for ICU admission and early identification of patients likely to benefit from noninvasive ventilation.

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Development and Validation of Early Warning Criteria to Identify Escalated Care Events in Neonatal Intensive Care Unit Patients

American Journal of Perinatology ◽

10.1055/s-0039-1688997 ◽

2019 ◽

Vol 37 (07) ◽

pp. 754-761

Author(s):

Sandesh Shivananda ◽

Jennifer Twiss ◽

Debie Paterson ◽

Gillian Dyck ◽

Stephanie Becker ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Neonatal Intensive Care Unit ◽

Early Warning ◽

Neonatal Intensive Care ◽

Time Interval ◽

Predictive Values ◽

Warning Criteria ◽

Sensitivity Specificity ◽

Development And Validation

Objective This study aimed to identify and validate the diagnostic utility of a set of clinical and laboratory criteria (early warning criteria [EWC]) that portend a clinical deterioration event (escalated care event [ECE]) in neonatal intensive care unit (NICU) patients. Study Design Using the RAND appropriateness method, we first established a consensus on seven ECE, that is, events that require additional monitoring, treatment, or stay in the NICU or that were associated with morbidity. We then established consensus on EWC that could portend an ECE from an initial set of 32 potential EWC items to a final set of 10 items. The occurrence and nonoccurrence of EWC and ECE were prospectively identified and tracked over 9 weeks. Results Among 170 NICU patients studied (2,502 patient-days), the frequency of an EWC was 53 per 1,000 patient-days. Of these patients, 41% had an EWC and 16% had an ECE. An EWC was followed by an ECE within 72 hours, 37% of the time, and within a median time interval of 113 minutes. The sensitivity, specificity, positive predictive values, and negative predictive values of EWC in identifying an ECE were 0.96, 0.69, 0.37, and 0.99, respectively. Conclusion A simple bedside NICU-specific EWC identifies neonates likely to develop ECEs in the NICU.

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Methicillin-resistant S. aureus colonization in intensive care unit patients: Early identification and molecular typing

The Journal of Infection in Developing Countries ◽

10.3855/jidc.6575 ◽

2016 ◽

Vol 10 (05) ◽

pp. 465-471 ◽

Cited By ~ 7

Author(s):

Gul Durmaz ◽

Ozlem Sanci ◽

Yasemin Oz ◽

Kiymet Guven ◽

Abdurrahman Kiremitci ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Real Time ◽

Real Time Pcr ◽

Screening Tests ◽

Isolation And Identification ◽

High Genetic Diversity ◽

Predictive Values ◽

Methicillin Resistant ◽

Mrsa Colonization

Introduction: Early detection of methicillin-resistant Staphylococcus aureus (MRSA) in colonized patients is very important for infection control procedures to prevent MRSA spread. We aimed to monitor MRSA carriage in intensive care unit (ICU) patients and to evaluate the speed and efficiency of conventional culture, immunological, chromogenic, and molecular methods together with genotyping. Methodology: Nasal and axillar swab specimens were obtained from patients in the ICUs of the general surgery and neurosurgery wards in a tertiary hospital once a week over four weeks between December 2009 and July 2010. Oxacillin and cefoxitin disk diffusion tests, oxacillin agar screening test, latex agglutination test, chromogenic agar, and real-time polymerase chain reaction (PCR) tests were used for isolation and identification of MRSA. MRSA isolates were typed using ribotyping and pulsed-field gel electrophoresis (PFGE) typing. Results: MRSA colonization was detected in 48 of 306 patients by real-time PCR. The MRSA colonization rate was 6.2%, 15.5%, and 38.5% at admission and in the first and second weeks, respectively. Sensitivity, specificity, positive and negative predictive values for all phenotypic tests were 98%, 99.6%, 98%, and 99.6%, respectively. The shortest handle time was observed in PCR. A total of three banding patterns were obtained from MRSA isolates by ribotyping, and PFGE analyses revealed 17 different pulsotypes varying from 11 to 18 distinct bands, showing high genetic diversity among the samples. Conclusion: Phenotypic MRSA screening tests in our study exhibited similar performances. The superiority of real-time PCR is its short turnaround time.

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Presepsin - New Marker of Sepsis Romanian Neonatal Intensive Care Unit Experience

Revista de Chimie ◽

10.37358/rc.19.8.7475 ◽

2019 ◽

Vol 70 (8) ◽

pp. 3008-3013

Author(s):

Silvia Maria Stoicescu ◽

Ramona Mohora ◽

Monica Luminos ◽

Madalina Maria Merisescu ◽

Gheorghita Jugulete ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Neonatal Intensive Care Unit ◽

Neonatal Sepsis ◽

Predictive Value ◽

Neonatal Intensive Care ◽

Complete Blood Count ◽

Clinical Manifestations ◽

Receiver Operating Curve ◽

Predictive Values

Difficulties in establishing the onset of neonatal sepsis has directed the medical research in recent years to the possibility of identifying early biological markers of diagnosis. Overdiagnosing neonatal sepsis leads to a higher rate and duration in the usage of antibiotics in the Neonatal Intensive Care Unit (NICU), which in term leads to a rise in bacterial resistance, antibiotherapy complications, duration of hospitalization and costs.Concomitant analysis of CRP (C Reactive Protein), procalcitonin, complete blood count, presepsin in newborn babies with suspicion of early or late neonatal sepsis. Presepsin sensibility and specificity in diagnosing neonatal sepsis. The study group consists of newborns admitted to Polizu Neonatology Clinic between 15th February- 15th July 2017, with suspected neonatal sepsis. We analyzed: clinical manifestations and biochemical markers values used for diagnosis of sepsis, namely the value of CRP, presepsin and procalcitonin on the onset day of the disease and later, according to evolution. CRP values may be influenced by clinical pathology. Procalcitonin values were mainly influenced by the presence of jaundice. Presepsin is the biochemical marker with the fastest predictive values of positive infection. Presepsin can be a useful tool for early diagnosis of neonatal sepsis and can guide the antibiotic treatment. Presepsin value is significantly higher in neonatal sepsis compared to healthy newborns (939 vs 368 ng/mL, p [ 0.0001); area under receiver operating curve (AUC) for presepsine was 0.931 (95% confidence interval 0.86-1.0). PSP has a greater sensibility and specificity compared to classical sepsis markers, CRP and PCT respectively (AUC 0.931 vs 0.857 vs 0.819, p [ 0.001). The cut off value for presepsin was established at 538 ng/mLwith a sensibility of 79.5% and a specificity of 87.2 %. The positive predictive value (PPV) is 83.8 % and negative predictive value (NPV) is 83.3%.

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Tick-Borne-Associated Illnesses in the Pediatric Intensive Care Unit

Journal of Pediatric Infectious Diseases ◽

10.1055/s-0040-1717149 ◽

2020 ◽

Vol 15 (06) ◽

pp. 269-275

Author(s):

Kaila Lessner ◽

Conrad Krawiec

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Pediatric Intensive Care Unit ◽

Early Recognition ◽

Spotted Fever ◽

Pediatric Intensive Care ◽

Rocky Mountain ◽

Rocky Mountain Spotted Fever ◽

Life Threatening ◽

Human Ehrlichiosis

AbstractWhen unrecognized and antibiotic delay occurs, Lyme disease, Rocky Mountain–spotted fever, babesiosis, and human ehrlichiosis and anaplasmosis can result in multiorgan system dysfunction and potentially death. This review focuses on the early recognition, evaluation, and stabilization of the rare life-threatening sequelae seen in tick-borne illnesses that require admission in the pediatric intensive care unit.

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Characterisation of Textile Embedded Electrodes for Use in a Neonatal Smart Mattress Electrocardiography System

Sensors ◽

10.3390/s21030999 ◽

2021 ◽

Vol 21 (3) ◽

pp. 999

Author(s):

Henry Dore ◽

Rodrigo Aviles-Espinosa ◽

Zhenhua Luo ◽

Oana Anton ◽

Heike Rabe ◽

...

Keyword(s):

Intensive Care Unit ◽

Heart Rate ◽

Intensive Care ◽

High Resolution ◽

Neonatal Intensive Care Unit ◽

Real Time ◽

Neonatal Intensive Care ◽

Delivery Room ◽

Proof Of Concept ◽

Heart Rate Monitoring

Heart rate monitoring is the predominant quantitative health indicator of a newborn in the delivery room. A rapid and accurate heart rate measurement is vital during the first minutes after birth. Clinical recommendations suggest that electrocardiogram (ECG) monitoring should be widely adopted in the neonatal intensive care unit to reduce infant mortality and improve long term health outcomes in births that require intervention. Novel non-contact electrocardiogram sensors can reduce the time from birth to heart rate reading as well as providing unobtrusive and continuous monitoring during intervention. In this work we report the design and development of a solution to provide high resolution, real time electrocardiogram data to the clinicians within the delivery room using non-contact electric potential sensors embedded in a neonatal intensive care unit mattress. A real-time high-resolution electrocardiogram acquisition solution based on a low power embedded system was developed and textile embedded electrodes were fabricated and characterised. Proof of concept tests were carried out on simulated and human cardiac signals, producing electrocardiograms suitable for the calculation of heart rate having an accuracy within ±1 beat per minute using a test ECG signal, ECG recordings from a human volunteer with a correlation coefficient of ~ 87% proved accurate beat to beat morphology reproduction of the waveform without morphological alterations and a time from application to heart rate display below 6 s. This provides evidence that flexible non-contact textile-based electrodes can be embedded in wearable devices for assisting births through heart rate monitoring and serves as a proof of concept for a complete neonate electrocardiogram monitoring system.

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Collective aeromedical evacuations of SARS-CoV-2-related ARDS patients in a military tactical plane: a retrospective descriptive study

BMJ Military Health ◽

10.1136/bmjmilitary-2021-001876 ◽

2021 ◽

pp. bmjmilitary-2021-001876

Author(s):

Thibault Martinez ◽

K Simon ◽

L Lely ◽

C Nguyen Dac ◽

M Lefevre ◽

...

Keyword(s):

Intensive Care Unit ◽

Acute Respiratory Distress Syndrome ◽

Intensive Care ◽

Respiratory Distress Syndrome ◽

Selection Criteria ◽

Distress Syndrome ◽

Descriptive Study ◽

Military Aircraft ◽

Life Threatening ◽

The Military

After the appearance of the COVID-19 pandemic in France, MEROPE system was created to transform the military tactical ATLAS A400M aircraft into a flying intensive care unit. Collective aeromedical evacuations (aero-MEDEVAC) of patients suffering from SARS-CoV-2-related acute respiratory distress syndrome was performed from June to December 2020. A total of 22 patients were transported during seven missions. All aero-MEDEVAC was performed in safe conditions for patients and crew. No life-threatening conditions occurred during flight. Biohazard controls were applied according to French guidelines and prevented crew contamination. Thanks to rigorous selection criteria and continuous in-flight medical care, the safe transportation of these patients was possible. To the best of our knowledge, this is the first description of collective aero-MEDEVAC of these kinds of patients using a tactical military aircraft. We here describe the patient’s characteristics and the flight’s challenges.

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Comparison of three fixation methods for orotracheal intubation in 95 adults

European Journal of Medical Research ◽

10.1186/s40001-020-00446-x ◽

2020 ◽

Vol 25 (1) ◽

Author(s):

Ye Sun ◽

Hua Fan ◽

Xiao-Xia Song ◽

Hua Zhang

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Tracheal Intubation ◽

Older People ◽

Endotracheal Intubation ◽

Orotracheal Intubation ◽

The Other ◽

Fixation Methods ◽

The Difference

Abstract Background The present study aimed to compare three fixation methods for orotracheal intubation. Methods Through literature retrieval, the effects of the adhesive/twill tape method, fixator method, and adhesive/twill tape–fixator alternation method on patients with tracheal intubation in the intensive care unit (ICU) were compared. Results The fixator and alternation methods were more effective in protecting the tongue mucosa and teeth. The alternation method was superior to the other two methods in maintaining the position of the endotracheal intubation. However, the difference in facial and lip injuries between the three methods was not statistically significant. Conclusion The fixator method can significantly reduce intraoral injury and is more suitable for older people with weak tongue mucosa and loose teeth. These are worth popularizing among a wider group.

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