Comparative study of the reliability of ultrasound to confirm the position of
            endotracheal tube with cuff inflated with saline versus air

Aim: To compare the reliability of transtracheal ultrasound to confirm the endotracheal tube position with saline versus air inflated cuff. Methods: This was a prospective randomized cadaveric study. Four techniques were randomized: endotracheal tube in the trachea with air or saline inflated cuff, and endotracheal tube in the esophagus with air or saline inflated cuff. The investigator used the Mcgrath to randomly place the endotracheal tube in the trachea or in the esophagus with saline or air inflated cuff. During the first series of measurements, nine residents performed transtracheal ultrasound with linear transducer placed transversely at the suprasternal notch. They were recorded with a cut off fixed to 30 seconds, and a questionnaire was completed by the residents after each transtracheal ultrasound in order to report where the endotracheal tube is positioned according to them. The second series followed the same protocol and included three residents who had participated in the first series. The primary outcome was the success rate in determining the position of the endotracheal tube. Results: In the first series, the success rate was 46.5%. In the second series, the success rate was 72.9%. There was no significant difference between cuff inflated with saline and air (p = 1.00). The overall mean time required was 20.6 s (95% CI 13.0–28.2 s). Based on an empirical data set, transtracheal ultrasound had a sensitivity of 62.2%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 26.08%. Conclusion: This investigation shows that regardless of the contents of the endotracheal tube cuff, the use of transtracheal ultrasound to confirm the position of endotracheal tube reports disappointing results.

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Comparison of Two Techniques for Retrograde Tracheal Intubation in Human Fresh Cadavers

Anesthesiology ◽

10.1097/00000542-200601000-00009 ◽

2006 ◽

Vol 104 (1) ◽

pp. 48-51 ◽

Cited By ~ 13

Author(s):

François Lenfant ◽

Mehdi Benkhadra ◽

Pierre Trouilloud ◽

Marc Freysz

Keyword(s):

Tracheal Intubation ◽

Endotracheal Tube ◽

Success Rate ◽

Guide Wire ◽

Cricothyroid Membrane ◽

Simple Modification ◽

Classic Technique ◽

Clinical Conditions ◽

The Impact ◽

Mean Time

Background During retrograde tracheal intubation, the short distance existing between the cricothyroid membrane and vocal cords may be responsible for accidental extubation. The insertion of a catheter into the trachea before the removal of the guide wire may help to cope with this problem. This work was conducted to study the impact of such a modification on the success rate and the duration of the procedure. Methods Procedures of retrograde tracheal intubation following the classic and modified techniques were randomly performed in cadavers (n = 70). The duration of the procedure from the puncture of the cricothyroid membrane to the inflation of the balloon of the endotracheal tube was measured, and, at the end of the procedure, the position of the endotracheal tube was checked under laryngoscopy. The procedure was considered to have failed if it had taken more than 5 min or when the endotracheal tube was not positioned in the trachea. Results The mean time to achieve tracheal intubation was similar in both groups (123 +/- 51 vs. 127 +/- 41 s; not significant), but intubation failed significantly more frequently with the classic technique (22 vs. 8 failures; P < 0.05). All failures were related to incorrect positioning of the endotracheal tube. In four cases, both techniques failed. Conclusions This efficient, simple modification of the technique significantly increases the success rate of the procedure, without prolonging its duration. These data should be confirmed in clinical conditions but may encourage a larger use of the retrograde technique in cases of difficult intubation.

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Convolutional Neural Network for Breast and Thyroid Nodules Diagnosis in Ultrasound Imaging

BioMed Research International ◽

10.1155/2020/1763803 ◽

2020 ◽

Vol 2020 ◽

pp. 1-9

Author(s):

Xiaowen Liang ◽

Jinsui Yu ◽

Jianyi Liao ◽

Zhiyi Chen

Keyword(s):

Predictive Value ◽

Area Under The Curve ◽

Roc Curves ◽

Diagnostic Efficiency ◽

Clinical Value ◽

Data Set ◽

Multiple Organs ◽

Significant Difference ◽

Segmented Images ◽

The Impact

Objective. The incidence of superficial organ diseases has increased rapidly in recent years. New methods such as computer-aided diagnosis (CAD) are widely used to improve diagnostic efficiency. Convolutional neural networks (CNNs) are one of the most popular methods, and further improvements of CNNs should be considered. This paper aims to develop a multiorgan CAD system based on CNNs for classifying both thyroid and breast nodules and investigate the impact of this system on the diagnostic efficiency of different preprocessing approaches. Methods. The training and validation sets comprised randomly selected thyroid and breast nodule images. The data were subgrouped into 4 models according to the different preprocessing methods (depending on segmentation and the classification method). A prospective data set was selected to verify the clinical value of the CNN model by comparison with ultrasound guidelines. Diagnostic efficiency was assessed based on receiver operating characteristic (ROC) curves. Results. Among the 4 models, the CNN model using segmented images for classification achieved the best result. For the validation set, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and area under the curve (AUC) of our CNN model were 84.9%, 69.0%, 62.5%, 88.2%, 75.0%, and 0.769, respectively. There was no statistically significant difference between the CNN model and the ultrasound guidelines. The combination of the two methods achieved superior diagnostic efficiency compared with their use individually. Conclusions. The study demonstrates the probability, feasibility, and clinical value of CAD in the ultrasound diagnosis of multiple organs. The use of segmented images and classification by the nature of the disease are the main factors responsible for the improvement of the CNN model. Moreover, the combination of the CNN model and ultrasound guidelines results in better diagnostic performance, which will contribute to the improved diagnostic efficiency of CAD systems.

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Comparative Study between Automatic Tube Compensation (ATC) and Pressure Support Ventilation (PSV) as a Mode of Weaning from Mechanical Ventilation in Patients with Respiratory Failure

QJM ◽

10.1093/qjmed/hcab086.065 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Ahmed N Elshaer ◽

Ahmed A Elshebiny ◽

Mariam K Habib ◽

Mohammed G Abdelrasol

Keyword(s):

Mechanical Ventilation ◽

Endotracheal Tube ◽

Predictive Value ◽

Spontaneous Breathing ◽

Spontaneous Breathing Trial ◽

Weaning From Mechanical Ventilation ◽

Group I ◽

Number Of Patients ◽

Significant Difference ◽

Successful Extubation

Abstract Background Weaning covers the entire process of liberating the patient from mechanical support and from the endotracheal tube (ETT). Weaning from mechanical ventilation (MV) is a challenge. Its prolongation is related to increased mortality. Aim of the Work is to assess the value of ATC in predicting successful weaning and hastening the weaning process. This study will compare the benefits and effects of ATC versus PSV as weaning modes on spontaneous breathing trials and work of breathing. Patients and Mehtods This prospective non randomized was done on 50 adult patients admitted to the Critical Care Medicine Department in Ain shams University Hospital presenting with ARF and mechanically ventilated for at least 24 hours. They were divided into two groups: Group I “ATC group” Each underwent a 1-hour spontaneous breathing trial, using ATC mode and Group II “PSV group” PSV mode was used. Results In the present study we have found that the use of ATC during a spontaneous breathing trial was as effective as PSV in predicting the ability of patients to maintain spontaneous, unassisted breathing for more than 48 hours after removal of the endotracheal tube. In our study, there was no significant difference in the number of patients who tolerated the spontaneous breathing trial and then extubated between ATC and PSV groups (60 % vs. 56% respectively, p > 0.05). Both modes had comparable sensitivity, and +ve predictive value. Sensitivity was 80.0% versus 75.0% and the positive predictive value was 88.0%, versus 87.0% for ATC versus PSV respectively. The specificity was comparable (76.8% versus 80.0 % in ATC versus PSV respectively). ATC group had higher negative predictive than PSV group (82.0% versus 70.1%, respectively). In our study, criteria for successful extubation were met in 56.0%. In ATC group 60.0% met the criteria for successful extubation vs. 60% in PSV group. In the present study it was found that male patients were the most predominant in both groups (72.0% in ATC group and 68% in PSV group). This is expected as cigarette smoking is prevalent among males and is the single most important and most prevalent risk factor for the development of COPD. In our study, about one third of patients had COPD exacerbation as a cause for ARF. Conclusion In ICU population, ATC was safe, reliable, and can be reasonably used for weaning trials. ATC confers a potential benefit in weaning duration, weaning category, number of Ss, failure of first SBT extubation outcome, ICU length of stay, complication, and mortality rate. In addition, ATC improves the predictive value of RR/TV and IWI in predicting weaning success.

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Processing and Interpretation Times of CT Angiogram and CT Perfusion in Stroke

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100004480 ◽

2005 ◽

Vol 32 (4) ◽

pp. 483-486 ◽

Cited By ~ 13

Author(s):

Ashok Srinivasan ◽

Mayank Goyal ◽

Cheemun Lum ◽

Thanh Nguyen ◽

William Miller

Keyword(s):

Acute Stroke ◽

Ct Perfusion ◽

Group Iii ◽

Ct Angiogram ◽

Group I ◽

Or Groups ◽

Significant Difference ◽

The Mean ◽

Time Required ◽

Mean Time

ABSTRACT:Objective:To determine the mean time for acquiring computed tomogram perfusion (CTP) and CT angiogram (CTA) images in acute stroke. To determine and compare processing and interpretation times amongst three groups of radiologists with varying degree of expertise: two radiology residents (Group I), two neuroradiology fellows (Group II) and four consultant neuroradiologists (Group III).Methods:The mean time of acquisition of CTA and CTP studies was calculated among ten patients presenting with acute stroke. All readers had to process the CTA and CTP images, interpret them (for presence or absence of thrombus and penumbra) and save them on the GE Advantage Windows workstation. The mean time for processing and interpreting these studies was calculated.Results:The mean time for acquisition of CTA and CTP studies in the ten patients was 14.6 ± 5.9 minutes. The time taken for CTA processing and interpretation in Groups I, II and III was 2.3 ± 1.3 min, 1.6 ± 0.4 min and 1.5 ± 0.7 min respectively. The time required for CTP processing and interpretation by the same groups was 5.2 ± 1.7 min, 4.5 ± 1.5 min and 4.1 ± 1.1 min respectively. There was a statistically significant difference of means between Groups I and III in the CTA and CTP processing and interpretation times (p=0.02, p=0.01 respectively) but no statistical difference between Groups I and II (p=0.15, p=0.22 respectively) or Groups II and III (p=0.31, p=0.30 respectively).Conclusion:The CTA and CTP studies can be performed, processed and interpreted quickly in acute stroke.

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Prehospital and Emergency Department Verification of Endotracheal Tube Position Using a Portable, Non-Directable, Fiberoptic Bronchoscope

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00026704 ◽

1990 ◽

Vol 5 (2) ◽

pp. 131-136 ◽

Cited By ~ 6

Author(s):

Kevin C. Hutton ◽

Vincent P. Verdile ◽

Donald M. Yealy ◽

Paul M. Paris

Keyword(s):

Emergency Department ◽

Endotracheal Tube ◽

Prehospital Setting ◽

Promising Method ◽

Fiberoptic Bronchoscope ◽

Relative Difficulty ◽

Tube Position ◽

Time Required

AbstractVerification of endotracheal tube (ETT) location in prehospital setting and the emergency department (ED) is a challenging task. Unrecognized esophageal intubations with potentially dangerous consequences may occur more frequently in these environments than in less hectic settings. To evaluate the capabilities of a portable, non-directable, fiberoptic bronchoscope (Visicath; Saratoga Medical, Saratoga, Calif., USA) to detect appropriate ETT placement, a prospective series of 22 intubated prehospital, air-medical, or ED patients underwent fiberoptic verification (FOV) of a newly placed ETT. Each patient was intubated under urgent circumstances. The time required for FOV, ETT location, the relative difficulty of intubation, and the changes in management as a result of FOV were recorded. A total of 24 FOVs were performed, twenty-one tracheal (88%), and two esophageal (8%) intubations were identified. Position could not be identified in one case (4%). FOV confirmed placement in 23 intubations (96%) in less than 25 seconds. Seven intubations (29%) were judged to be “difficult.” FOV resulted in five minor changes in management (22%) and was the sole confirmation method for five intubations. We conclude that fiberoptic verification is a promising method of ETT position in air-medical and ED intubations.

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Determining correct tracheal tube insertion depth by measuring distance between endotracheal tube cuff and vocal cords by ultrasound in Chinese adults: a prospective case-control study

BMJ Open ◽

10.1136/bmjopen-2018-023374 ◽

2018 ◽

Vol 8 (12) ◽

pp. e023374 ◽

Cited By ~ 3

Author(s):

Xuanling Chen ◽

Wenwen Zhai ◽

Zhuoying Yu ◽

Jiao Geng ◽

Min Li

Keyword(s):

Endotracheal Tube ◽

General Anaesthesia ◽

Predictive Value ◽

Case Control Study ◽

Case Control ◽

Vocal Cords ◽

Insertion Depth ◽

Inflated Cuff ◽

Control Study ◽

Prospective Case Control Study

ObjectivesUnrecognised malposition of the endotracheal tube can lead to severe complications in patients under general anaesthesia. The purpose of this study was to verify the feasibility of using ultrasound to measure the distance between the upper edge of saline-inflated cuff and the vocal cords.DesignProspective case-control study.SettingA tertiary hospital in Beijing, China.MethodsIn this prospective study, 105 adult patients who required general anaesthesia were enrolled. Prior to induction, ultrasound was used to identify the position of the vocal cords. After intubation, the endotracheal tube (ETT) was fixed at a depth of 23 cm at the upper incisors in men and 21 cm in women. The depth of intubation was verified by video-assisted laryngoscopy. The distance between the upper edge of the saline-inflated cuff and the vocal cords was measured by ultrasound; the ideal distance was considered to be 1.9–4.1 cm.ResultsAmong the 105 cases, two cuffs were too close to the vocal cords and one too far away from the vocal cords. These diagnoses were made by ultrasound and were in agreement with results from direct laryngoscopy. The overall accuracy of ultrasound in identifying malposition of the cuff was 100.0% (95% CI: 96.6% to 100%). The sensitivity, specificity, positive predictive value and negative predictive value of ultrasound were, respectively, 100% (95% CI: 96.5% to 100%), 100% (95% CI: 29.2% to 100%), 100% (95% CI: 96.5% to 100%) and 100% (95% CI: 29.2% to 100%).ConclusionIdentification of the upper edge of the saline-inflated cuff and the vocal cords by ultrasound to assess the location of the ETT is a reliable method. It can be used to avoid malposition of the ETT cuff and reduce the incidence of vocal cords injury after intubation.Trial registration numberChiCTR-DDD-17011048.

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Cluster cross-over randomised trial of paediatric airway management devices in the simulation lab and operating room among paramedic students

Emergency Medicine Journal ◽

10.1136/emermed-2020-209929 ◽

2020 ◽

Vol 38 (1) ◽

pp. 27-32

Author(s):

Matthew Lee Hansen ◽

Adam Wagner ◽

Ashley Schnapp ◽

Amber Lin ◽

Nancy Le ◽

...

Keyword(s):

Laryngeal Mask Airway ◽

Airway Management ◽

Endotracheal Tube ◽

Operating Room ◽

Randomised Trial ◽

Multivariable Analysis ◽

Random Order ◽

Laryngeal Mask ◽

Significant Difference ◽

Mean Time

ObjectivesThe objective of this study was to compare paediatric emergency airway management strategies in the simulation lab and operating room environments.MethodsThis was a two-part cluster cross-over randomised trial including simulation lab and operating room environments conducted between January 2017 and June 2018 in Portland, Oregon, USA. In simulated infant cardiac arrests, paramedic students placed an endotracheal tube, an i-gel or a laryngeal mask airway in random order. In the operating room, paramedic students placed a laryngeal mask airway or i-gel device in random order in sequential patients. The primary outcome for both portions of the study was time to ventilation. In the operating room portion, we also evaluated leak pressures and average initial tidal volumes.ResultsThere were 58 paramedic students who participated in the simulation lab and 22 who participated in the operating room study. The mean time to airway placement in the simulation lab was 48.5 s for the i-gel, 68.9 s for the laryngeal mask and 129.5 s for the endotracheal tube. In the operating room, mean time to i-gel placement was 34.3 s with 45.2 s for the laryngeal mask. In multivariable analysis of the simulation study, the laryngeal mask and i-gel were significantly faster than the endotracheal tube, and the i-gel was faster than the laryngeal mask. In the operating room, there was no significant difference in time to placement, leak pressure and average volume of the first five breaths between the i-gel and laryngeal mask.ConclusionsWe found that paramedic students were able to place supraglottic devices rapidly with high success rates in simulation lab and operating room environments. Supraglottic devices, particularly the i-gel, were rated as easy to use. The i-gel may be easiest to use since it lacks an inflable cuff and requires fewer steps to place.

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A technique for fast and safe collection of urine in newborns

Journal of Kathmandu Medical College ◽

10.3126/jkmc.v5i3.18419 ◽

2017 ◽

Vol 5 (3) ◽

pp. 82-84 ◽

Cited By ~ 1

Author(s):

Archana Nepal ◽

Rydam Basnet ◽

Rukma Acharya ◽

Sushma Shrestha ◽

Satish Koirala ◽

...

Keyword(s):

Success Rate ◽

Urine Sample ◽

Urine Collection ◽

Older Children ◽

Sample Collection ◽

Non Invasive ◽

Wide Range ◽

Safe Technique ◽

Time Required ◽

Mean Time

Background: Urine collection in children especially in new born is a great challenge. A wide range of clinical interventions for urine collection is described in the literature, including non-invasive and invasive methods. Mid-stream urine collection is considered the most appropriate technique for older children. Here we are testing a method for obtaining mid- stream urine sample in newborns.Objective: To test a technique of urine collection for obtaining mid-stream urine sample in newborns.Method: A prospective feasibility study of a technique of urine sample collection based on bladder and lumbar stimulation maneuvers done in 100 newborns of less than 28 days of life over a period of one month. The main variable was the success rate in obtaining a midstream urine sample collection within four minutes and secondary variables were time required to obtain the sample and associated complications.Results: Mid- stream urine sample was collected successfully in 91% of babies. Mean time required for urine collection was 59.7 seconds with standard deviation of 46.4 seconds and median time was 47 seconds. No untoward complication other than controlled crying was seen.Conclusion: This is a quick and safe technique for mid-stream urine sample collection in newborn with high success rate and minimal discomfort.Journal of Kathmandu Medical CollegeVol. 5, No. 3, Issue 17, Jul.-Sep., 2016, Page: 82-84

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Effectiveness of Sofscale™ Calculus Scaling Gel as an AID during Dental Scaling of Teeth of Dogs

Journal of Veterinary Dentistry ◽

10.1177/089875649401100104 ◽

1994 ◽

Vol 11 (1) ◽

pp. 14-17 ◽

Cited By ~ 2

Author(s):

Bonnie R. Miller ◽

Colin E. Harvey ◽

Frances Shofer

Keyword(s):

Dental Scaling ◽

Significant Difference ◽

Cadaver Dogs ◽

Time Required ◽

Mean Time

The effect of pre-scaling application of SofScale™ Calculus Scaling Gel was studied on teeth of cadaver dogs, comparing scaling time and effort among pre-treated and untreated pairs of teeth. Teeth with light, moderate and heavy calculus were studied, treated by either hand-scaling only or hand and ultrasonic scaling. No significant difference was found in overall mean time required, comparing SofScale™ treated and untreated teeth. Scaling time was faster for SofScale™ treated teeth with light calculus, and slower for SofScale™ treated teeth with heavy calculus. There were no differences observed in the effort required for scaling, comparing SofScale™ treated and untreated teeth.

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Introduction of intraoperative neuromonitoring does not necessarily improve overall long-term outcome in elective aneurysm clipping

Journal of Neurosurgery ◽

10.3171/2018.12.jns182177 ◽

2020 ◽

Vol 132 (4) ◽

pp. 1188-1196 ◽

Cited By ~ 2

Author(s):

Tobias Greve ◽

Veit M. Stoecklein ◽

Franziska Dorn ◽

Sophia Laskowski ◽

Niklas Thon ◽

...

Keyword(s):

Evoked Potentials ◽

Predictive Value ◽

Neurological Outcome ◽

Positive Impact ◽

Case Series ◽

Intraoperative Neuromonitoring ◽

Neurosurgical Procedures ◽

Long Term Outcome ◽

Unruptured Intracranial Aneurysms ◽

Significant Difference

OBJECTIVEIntraoperative neuromonitoring (IOM), particularly of somatosensory-evoked potentials (SSEPs) and motor-evoked potentials (MEPs), evolved as standard of care in a variety of neurosurgical procedures. Case series report a positive impact of IOM for elective microsurgical clipping of unruptured intracranial aneurysms (ECUIA), whereas systematic evaluation of its predictive value is lacking. Therefore, the authors analyzed the neurological outcome of patients undergoing ECUIA before and after IOM introduction to this procedure.METHODSThe dates of inclusion in the study were 2007–2014. In this period, ECUIA procedures before (n = 136, NIOM-group; 2007–2010) and after introduction of IOM (n = 138, IOM-group; 2011–2014) were included. The cutoff value for SSEP/MEP abnormality was chosen as an amplitude reduction ≥ 50%. SSEP/MEP changes were correlated with neurological outcome. IOM-undetectable deficits (bulbar, vision, ataxia) were not included in risk stratification.RESULTSThere was no significant difference in sex distribution, follow-up period, subarachnoid hemorrhage risk factors, aneurysm diameter, complexity, and location. Age was higher in the IOM-group (57 vs 54 years, p = 0.012). In the IOM group, there were 18 new postoperative deficits (13.0%, 5.8% permanent), 9 hemisyndromes, 2 comas, 4 bulbar symptoms, and 3 visual deficits. In the NIOM group there were 18 new deficits (13.2%; 7.3% permanent, including 7 hemisyndromes). The groups did not significantly differ in the number or nature of postoperative deficits, nor in their recovery rate. In the IOM group, SSEPs and MEPs were available in 99% of cases. Significant changes were noted in 18 cases, 4 of which exhibited postoperative hemisyndrome, and 1 suffered from prolonged comatose state (5 true-positive cases). Twelve patients showed no new detectable deficits (false positives), however 2 of these cases showed asymptomatic infarction. Five patients with new hemisyndrome and 1 comatose patient did not show significant SSEP/MEP alterations (false negatives). Overall sensitivity of SSEP/MEP monitoring was 45.5%, specificity 89.8%, positive predictive value 27.8%, and negative predictive value 95.0%.CONCLUSIONSThe assumed positive impact of introducing SSEP/MEP monitoring on overall neurological outcome in ECUIA did not reach significance. This study suggests that from a medicolegal point of view, IOM is not stringently required in all neurovascular procedures. However, future studies should carefully address high-risk patients with complex procedures who might benefit more clearly from IOM than others.

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