scholarly journals Spontaneous Breathing for Panendoscopy? Retrospective Cohort and Results of a French Practice Survey

OTO Open ◽  
2022 ◽  
Vol 6 (1) ◽  
pp. 2473974X2110650
Author(s):  
Pierre Habrial ◽  
Maxime Léger ◽  
Fabienne Costerousse ◽  
Julie Debiasi ◽  
Renaud Breheret ◽  
...  
Keyword(s):  
Intensive Care ◽  
Tracheal Intubation ◽  
Spontaneous Breathing ◽  
Odds Ratio ◽  
Face Mask ◽  
University Hospital ◽  
Mask Ventilation ◽  
French Society ◽  
Laryngeal Tumor ◽  
History Of

Objective Avoiding tracheal intubation by using general anesthesia with spontaneous breathing (GASB) is attractive for upper airway panendoscopy. The aim of this study was to estimate the incidence of adverse events during panendoscopy under GASB and to assess the practices of French anesthesiologists. Study Design Two-phase study: monocentric retrospective study and national survey. Setting University hospital center. Methods Patients who underwent a panendoscopy under GASB at the University Hospital of Angers between January 1 and December 31, 2014, were reviewed. Failure of GASB was defined as an episode of hypoxemia (SpO2 ≤88%) or the need for face mask ventilation with or without tracheal intubation. Then, we sent an electronic survey to all members of the French Society of Anaesthesia and Intensive Care. Results Among the 95 included patients, 22 (23%) experienced a failure of GASB: 3 tolerated hypoxemia, 15 had face mask ventilation episodes, and 4 were intubated. Three factors were associated with failure: obesity (odds ratio, 11.94; 95% CI, 3.20-44.64), history of difficult intubation defined as a Cormack score ≥3 (odds ratio, 6.20; 95% CI, 1.51-25.41), and laryngeal tumor (odds ratio, 2.81; 95% CI, 1.04-7.56). Among the 3930 members of the French Society of Anaesthesia and Intensive Care in 2018, 662 (16.8%) responded to the survey. The 2 preferred techniques to perform panendoscopy were intubation (62%) and intravenous sedation with spontaneous breathing (37%). Conclusion Although general anesthesia with orotracheal intubation remains the preferred technique for panendoscopy in France, GASB is an attractive alternative with a low failure rate. Risk factors for failure are obesity, history of difficult intubation, and laryngeal tumor.

scholarly journals Preoxygenation in difficult airway management: high-flow oxygenation by nasal cannula versus face mask (the PREOPTIDAM study). Protocol for a single-centre randomised study

BMJ Open ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. e025909 ◽  
Author(s):  
Mickael Vourc’h ◽  
Donatien Huard ◽  
Fanny Feuillet ◽  
Gabrielle Baud ◽  
Arthur Guichoux ◽  
...  
Keyword(s):  
Airway Management ◽  
Face Mask ◽  
High Flow ◽  
Nasal Cannula ◽  
University Hospital ◽  
Rapid Sequence Intubation ◽  
Controlled Study ◽  
Mask Ventilation ◽  
Single Centre ◽  
Randomised Study

IntroductionAlthough preoxygenation and airway management respond to precise algorithms, difficult intubation (DI) remains a daily challenge in intensive care units and in the operating rooms because of its frequent complications, including hypoxaemia. To prevent desaturation during DI, high-flow oxygenation by nasal cannula (HFNC) could prove beneficial. Indeed, contrary to standard preoxygenation device, it can be held in place throughout the intubation trying to perform apnoeic oxygenation during DI. Hence, recent guidelines recommend HFNC during DI, but its relevance has never been evaluated in this setting in a large randomised study until now.Methods and analysisThe PREOPTIDAM trial is a prospective, single-centre, randomised, controlled study in Nantes University Hospital. In anticipated DI, we hypothesised that HFNC can decrease the incidence of desaturation ≤94% or face mask ventilation from 16% to 4% compared with standard device. Using a two-sided t-test with a first species risk of 5% and 80% power, a total of 186 patients will be included. Using a computer-generated randomisation, with a 1:1 allocation ratio, patients will be randomised to HFNC or face mask preoxygenation. Randomisation will be stratified on intubation sequence: Rapid sequence intubation or awake fibreoptic intubation. The primary objective is to determine whether HFNC is more efficient than standard oxygenation techniques to prevent desaturation ≤94% or face mask ventilation during DI. Intent-to-treat and per-protocol analysis are planned for the primary outcome.Ethics and disseminationThe study project has been approved by an independent ethics committee. Written informed consent will be obtained before study inclusion. Participant recruitment begins in September 2018. Results will be submitted to international peer-reviewed medical journals.Trial registration numberNCT03604120.

Bag-Mask Ventilation Versus Apneic Oxygenation During Tracheal Intubation in Critically Ill Adults: A Secondary Analysis of 2 Randomized Trials

2021 ◽  
pp. 088506662110586
Author(s):  
Erin M. Vaughan ◽  
Kevin P. Seitz ◽  
David R. Janz ◽  
Derek W. Russell ◽  
James Dargin ◽  
...  
Keyword(s):  
Intensive Care ◽  
Tracheal Intubation ◽  
Oxygen Saturation ◽  
Critically Ill ◽  
Randomized Trials ◽  
Secondary Analysis ◽  
Mask Ventilation ◽  
Apneic Oxygenation ◽  
Bag Mask Ventilation ◽  
To Receive

Background: Hypoxemia is common during tracheal intubation in intensive care units. To prevent hypoxemia during intubation, 2 methods of delivering oxygen between induction and laryngoscopy have been proposed: bag-mask ventilation and supplemental oxygen delivered by nasal cannula without ventilation (apneic oxygenation). Whether one of these approaches is more effective for preventing hypoxemia during intubation of critically ill patients is unknown. Methods: We performed a secondary analysis of data from 138 patients enrolled in 2, consecutive randomized trials of airway management in an academic intensive care unit. A total of 61 patients were randomized to receive bag-mask ventilation in a trial comparing bag-mask ventilation to none, and 77 patients were randomized to receive 100% oxygen at 15 L/min by nasal cannula in a trial comparing apneic oxygenation to none. Using multivariable linear regression accounting for age, body mass index, severity of illness, and oxygen saturation at induction, we compared patients assigned to bag-mask ventilation with those assigned to apneic oxygenation regarding lowest oxygen saturations from induction to 2 min after intubation. Results: Patients assigned to bag-mask ventilation and apneic oxygenation were similar at baseline. The median lowest oxygen saturation was 96% (interquartile range [IQR] 89%-100%) in the bag-mask ventilation group and 92% (IQR 84%-99%) in the apneic oxygenation group. After adjustment for prespecified confounders, bag-mask ventilation was associated with a higher lowest oxygen saturation compared to apneic oxygenation (mean difference, 4.2%; 95% confidence interval, 0.7%-7.8%; P = .02). The incidence of severe hypoxemia (oxygen saturation<80%) was 6.6% in the bag-mask ventilation group and 15.6% in the apneic oxygenation group (adjusted odds ratio, 0.33; P = .09). Conclusions: This secondary analysis of patients assigned to bag-mask ventilation and apneic oxygenation during 2 clinical trials suggests that bag-mask ventilation is associated with higher oxygen saturation during intubation compared to apneic oxygenation.

Beneficial Effect of Acupuncture on Adult Patients with Asthma Bronchiale

1993 ◽  
Vol 21 (02) ◽  
pp. 113-117 ◽  
Author(s):  
W. Zwölfer ◽  
W. Keznickl-Hillebrand ◽  
A. Spacek ◽  
M. Cartellieri ◽  
G. Grubhofer
Keyword(s):  
Intensive Care ◽  
Retrospective Study ◽  
Beneficial Effect ◽  
Asthma Bronchiale ◽  
Acupuncture Treatment ◽  
Adult Patients ◽  
University Hospital ◽  
Outpatient Unit ◽  
History Of ◽  
The University

In a retrospective study 17 patients with long-standing history of asthma bronchiale were treated with acupuncture at the outpatient unit of the Department of Anaesthesia and Intensive Care in the University Hospital of Vienna. The subjective effectiveness of the treatment was determined using a standard questionnaire, which was sent to the patients' homes half a year after starting acupuncture treatment. Over 70% of our patients reported a significant improvement of their ailments after ten weeks of treatment as well as half a year after starting acupuncture.

Ventilator-Associated Pneumonia: Incidence and risk factors six intensive care units in Tunisia

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
A Ben Cheikh ◽  
S Bhiri ◽  
N ketaka ◽  
A Gara ◽  
S Khefacha ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
University Hospital ◽  
Ventilator Associated Pneumonia ◽  
Factors Associated ◽  
History Of ◽  
Independent Risk Factors ◽  
The University ◽  
Very High

Abstract Background Ventilator-Associated Pneumonia (VAP) continues to cause significant morbidity, mortality, and hospital costs, especially in the intensive care unit (ICU). This study aimed to determine incidence and factors associated with VAP in six ICUs of the University Hospital-Sahloul (Sousse, Tunisia) in 2018. Methods We conducted a prospective observational cohort study over a three months period in six ICUs of the University Hospital-Sahloul (Sousse, Tunisia) in 2018. All patients hospitalized with mechanical ventilation (MV) for more than 48 hours in the ICUs were included. Logistic regression with the stepwise method of Hosmer and Lemeshow was used to identify factors associated with VAP. Results Overall, 110 patients were enrolled. The mean age of patients was 44 ± 25 years. Of them, 66.4% were male. The median duration of MV was 5 days [2-16]. The incidence of VAP was 32% and the density incidence was 33/1000 ventilator days. The most common organism were Pseudomonas aeruginosa (n = 14). Of them, 12 were ceftazidime-resistant and thee were resistant to imipenem. Independent risk factors associated with VAP in ICU were history of antibiotic therapy during last 6 months (p = 0.007), tracheotomy (p &lt; 0.001) and reintubation (p &lt; 0.001). Conclusions VAP rates in our ICUs were very high. Antimicrobial stewardship programs involving pharmacists and physicians must be elaborated to optimize the antibiotic prescribing. Mechanical ventilation require more-effective interventions control in our hospital. Key messages Ventilator-Associated Pneumonia rates were very high. Independent risk factors associated with Ventilator-Associated Pneumonia were history of antibiotic therapy during last 6 months, tracheotomy and reintubation.

Thrombocytopenia and Bloodstream Infection: Incidence and Implication on Length of Stay in the Pediatric Intensive Care Unit

2021 ◽  
Author(s):  
Reut Kassif Lerner ◽  
Dana Levinkopf ◽  
Inna Zaslavsky Paltiel ◽  
Tal Sadeh ◽  
Marina Rubinstein ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Bloodstream Infection ◽  
Critically Ill ◽  
Pediatric Intensive Care Unit ◽  
Odds Ratio ◽  
Pediatric Patients ◽  
Pediatric Intensive Care ◽  
University Hospital

AbstractThe incidence and prognosis of thrombocytopenia in critically ill patients with bloodstream infection (BSI) is not well delineated in the pediatric intensive care unit (PICU) setting. We assessed these variables in our PICU and sought to determine whether thrombocytopenia could serve as a prognostic marker for length of stay (LOS). The study was conducted at the medical PICU of a university hospital, on all critically ill pediatric patients consecutively admitted during a 3-year period. Patient surveillance and data collection have been used to identify the risk factors during the study period. The main outcomes were BSI incidence and implication on morbidity and LOS. Data from 2,349 PICU patients was analyzed. The overall incidence of BSI was 3.9% (93/2,349). Overall, 85 of 93 patients (91.4%) with BSI survived and 8 patients died (8.6% mortality rate). The overall incidence of thrombocytopenia among these 93 patients was 54.8% (51/93) and 100% (8/8) for the nonsurvivors. Out of the 85 survivors, 27 thrombocytopenic patients were hospitalized for >14 days versus 14 of nonthrombocytopenic patients (p = 0.007). Thrombocytopenia was associated with borderline significance with an increased LOS (adjusted odds ratio = 3.00, 95% confidence interval: 0.93–9.71, p = 0.066). Thrombocytopenia is common in critically ill pediatric patients with BSI and constitutes a simple and readily available risk marker for PICU LOS.

scholarly journals An Anesthesiologist’s Perspective on the History of Basic Airway Management

2019 ◽  
Vol 130 (5) ◽  
pp. 686-711 ◽  
Author(s):  
Adrian A. Matioc
Keyword(s):  
Airway Management ◽  
Operating Room ◽  
Positive Pressure Ventilation ◽  
Face Mask ◽  
Intermittent Positive Pressure Ventilation ◽  
Positive Pressure ◽  
Mask Ventilation ◽  
Advanced Airway ◽  
History Of ◽  
Effective Seal

Abstract This fourth and last installment of my history of basic airway management discusses the current (i.e., “modern”) era of anesthesia and resuscitation, from 1960 to the present. These years were notable for the implementation of intermittent positive pressure ventilation inside and outside the operating room. Basic airway management in cardiopulmonary resuscitation (i.e., expired air ventilation) was de-emphasized, as the “A-B-C” (airway-breathing-circulation) protocol was replaced with the “C-A-B” (circulation-airway-breathing) intervention sequence. Basic airway management in the operating room (i.e., face-mask ventilation) lost its predominant position to advanced airway management, as balanced anesthesia replaced inhalation anesthesia. The one-hand, generic face-mask ventilation technique was inherited from the progressive era. In the new context of providing intermittent positive pressure ventilation, the generic technique generated an underpowered grip with a less effective seal and an unspecified airway maneuver. The significant advancement that had been made in understanding the pathophysiology of upper airway obstruction was thus poorly translated into practice. In contrast to consistent progress in advanced airway management, progress in basic airway techniques and devices stagnated.

Prevalence and Impact on Weaning of Pleural Effusion at the Time of Liberation from Mechanical Ventilation

2017 ◽  
Vol 126 (6) ◽  
pp. 1107-1115 ◽  
Author(s):  
Martin Dres ◽  
Damien Roux ◽  
Tài Pham ◽  
Alexandra Beurton ◽  
Jean-Damien Ricard ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Pleural Effusion ◽  
Spontaneous Breathing ◽  
Odds Ratio ◽  
Spontaneous Breathing Trial ◽  
Ventilatory Support ◽  
Weaning Failure ◽  
Weaning Outcome

Abstract Background Pleural effusion is frequent in intensive care unit patients, but its impact on the outcome of weaning remains unknown. Methods In a prospective study performed in three intensive care units, pleural ultrasound was performed at the first spontaneous breathing trial to detect and quantify pleural effusion (small, moderate, and large). Weaning failure was defined by a failed spontaneous breathing trial and/or extubation requiring any form of ventilatory support within 48 h. The primary endpoint was the prevalence of pleural effusion according to weaning outcome. Results Pleural effusion was detected in 51 of 136 (37%) patients and was quantified as moderate to large in 18 (13%) patients. As compared to patients with no or small pleural effusion, their counterparts were more likely to have chronic renal failure (39 vs. 7%; P = 0.01), shock as the primary reason for admission (44 vs. 19%; P = 0.02), and a greater weight gain (+4 [0 to 7] kg vs. 0 [−1 to 5] kg; P = 0.02). The prevalence of pleural effusion was similar in weaning success and weaning failure patients (odds ratio, 1.23; 95% CI, 0.61 to 2.49; P = 0.56), as was the prevalence of moderate to large pleural effusion (odds ratio, 0.89; 95% CI, 0.33 to 2.41; P = 1.00). Duration of mechanical ventilation and intensive care unit length of stay were similar between patients with no or small pleural effusion and those with moderate to large pleural effusion. Conclusions Significant pleural effusion was observed in 13% of patients at the time of liberation from mechanical ventilation and was not associated with an alteration of weaning outcome. (Anesthesiology 2017; 126:1107–15)

Pathophysiology of visual disturbances occurring after foam sclerotherapy

2010 ◽  
Vol 25 (5) ◽  
pp. 261-266 ◽  
Author(s):  
J L Gillet ◽  
A Donnet ◽  
M Lausecker ◽  
J M Guedes ◽  
J J Guex ◽  
...  
Keyword(s):  
Average Rate ◽  
University Hospital ◽  
French Society ◽  
Foam Sclerotherapy ◽  
Vascular Events ◽  
Prospective Multicentre Study ◽  
History Of ◽  
Weighted Magnetic Resonance Imaging ◽  
Magnetic Resonance Imaging Mri ◽  
Visual Disturbances

Background Visual disturbances (VDs) are reported with an average rate of 1.4% after foam sclerotherapy (FS). Some clinical clues indicate that they could correspond to migraine with aura (MA). Aims To validate the hypothesis that VDs occurring after FS correspond to MA and are not transient ischaemic cerebro-vascular events. Method A prospective multicentre study was carried out by the French Society of Phlebology in collaboration with the Neurology Department of the Marseille University Hospital (France). We included prospectively and consecutively all patients who experienced VDs after FS using air to make the foam. The patients were assessed (1) clinically with a specific form describing procedures of FS and recording neurological symptoms, later analysed by a neurologist specialized in migraine; and (2) by a brain diffusion-weighted magnetic resonance imaging (MRI) (T1, T2, T2*, diffusion) carried out within two weeks and analysed by a neuroradiologist. Results Twenty patients, 16 women and four men, were included in 11 phlebology clinics. All kinds of veins were treated. VDs occurred in average seven minutes after FS. Clinical assessment showed that VDs presented characteristics of MA in all patients, with headache in 10 and without in 10. Paresthesia was observed in five patients and dysphasic speech disturbance in one. Fifteen patients (75%) had a personal history of migraine. Fifteen MRIs were performed within two weeks (mean: 8 days) and three were late (26 days). All of them were normal. MRI was not performed in two patients. Conclusion These results show that VDs occurring after FS correspond to MA and are not transient ischaemic cerebro-vascular events. We suggest a pathophysiological hypothesis resting on the release of endothelin that would reach the cerebral cortex through a paten foramen ovale.

scholarly journals I-gel viršgerklinio vamzdelio naudojimas esant sudėtingai endotrachėjinei intubacijai

2011 ◽  
Vol 9 (1-2) ◽  
Author(s):  
Karolis Urbonas ◽  
Robertas Samalavičius
Keyword(s):  
Cardiac Surgery ◽  
Intensive Care ◽  
Pain Management ◽  
Tracheal Intubation ◽  
Difficult Airway ◽  
University Hospital ◽  
Elective Cardiac Surgery ◽  
First Case ◽  
Difficult Airways ◽  
Vilnius University

Karolis Urbonas1, Robertas Samalavičius2 1 II Reanimacijos ir intensyviosios terapijos skyrius, Anesteziologijos, intensyviosios terapijos ir skausmo gydymo centras, Vilniaus universiteto ligoninė Santariškių klinikos,Santariškių g. 2, LT-08661 Vilnius2 II Anesteziologijos ir reanimacijos skyrius, Anesteziologijos, intensyviosios terapijos ir skausmo gydymo centras, Vilniaus universiteto ligoninė Santariškių klinikos,Santariškių g. 2, LT-08661 VilniusEl. paštas: [email protected] Nesėkminga trechėjos intubacija yra reta, tačiau grėsminga komplikacija, ji net gali sukelti mirtį ar hipoksinį smegenų pažeidimą. Užtikrinti ventiliaciją ir oksigenaciją yra nepaprastai svarbu šioje situacijoje. Straipsnyje nagrinėjame du klinikinius sudėtingos intubacijos atvejus ligoniams, kuriems buvo atliekamos planinės kardiochirurginės operacijos. Abiem atvejais nepavykus intubuoti ligonio taikant laringoskopiją, kvėpavimo takų praeinamumas užtikrintas I-gel viršgerkliniu vamzdeliu. Per šį prietaisą pirmajam pacientui fibrobronchoskopu, o antrajam akluoju būdu į trachėją įkištas endotrachėjinis vamzdelis. Aprašyti atvejai rodo, kad ši naujoviška kvėpavimo takų preinamumą užtikrinanti priemonė gali būti sėkmingai taikoma esant sudėtingai intubacijai. Reikšminiai žodžiai: kvėpavimo takai, pasunkėjusi intubacija, viršgerklinis vamzdelis. Intubation through an i-gel supraglottic device in cardiac surgery patients with difficult airway Karolis Urbonas1, Robertas Samalavičius2 1 II Department of Intensive Care, Centre of Anaesthesia, Intensive Care and Pain Management, Vilnius University Hospital Santariškių klinikos, Santariškių Str. 2, LT-08661 Vilnius, Lithuania2 II Department of Anaesthesia, Centre of Anaesthesia, Intensive Care and Pain Management, Vilnius University Hospital Santariškių klinikos, Santariškių Str. 2, LT-08661 Vilnius, LithuaniaE-mail: [email protected] Failed tracheal intubation and prolonged attempts at intubation are the major causes of morbidity or mortality directly associated with anaesthesia. The management of difficult airway and the maintenance of oxygenation are very important. In this article, we present two cases of airway rescue management in patients undergoing elective cardiac surgery. In both cases, the failed tracheal intubation with conventional laryngoscopy was managed with the I-gel, a novel supragllottic device. The mechanical ventilation after insertion of a supraglottic tube was effective. Intubation after visualization of the vocal cords with a fibrobronchoscope through the I-gel in the first case and blind intubation with a tube through the device in the second case were successfully performed. I-gel can be used as an alternative rescue technique in cases of difficult airways. Keywords: airway, difficult intubation, supraglottic device

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