The Comparison of Duration Endotracheal Tube Insertion Using Aerosol Box And without Aerosol Box in Elective Surgery Patients in the Covid-19 Pandemic

Introduction. The aerosol box can reduce the risk of droplet and aerosol transmission from the patient to the operator when performing intubation, but in practice, an aerosol box makes the glottis visualization less evident, and the operator moves less space with less space the aerosol box. This study aimed to compare ETT duration using an aerosol box and without an aerosol box using a video laryngoscope. Methods: This study was a clinical trial with a post-test-only control design. The study was carried out from February 2021 to May 2021 at the Central Operating Theater of dr. Mohammad Hoesin General Hospital Palembang. The sample in this study was all patients who underwent elective surgery under general anesthesia using intubation at the Central Surgical Installation of dr. Mohammad Hoesin Palembang. After the data is collected, it is analyzed using the SPSS 22.0 program with the appropriate test. Results. There were no differences in subject characteristics (age, sex, BMI, Mallampati score, TMD, Cormack Lehane, limited mouth opening, short neck, limited mouth movement) between the group using the aerosol box and the group without the aerosol box. The duration of intubation without an aerosol box is 30.67 + 2.63 seconds, and using an aerosol box is 44.53 + 2.89 seconds. There was a significant difference between the two groups in the duration of patient intubation (p < 0.001). However, there was no significant difference in complications in the two groups (p >0.05). Conclusion. The duration of the endotracheal tube insertion using an aerosol box is more extended than without an aerosol box in elective surgery patients.

Improve the success rate of inserting and intubating the spiral nasojejunal tube with bare hands

[Objective] To improve the success rate of spiral nasojejunal tube insertion through training of blind insertion of spiral nasojejunal tube with bare hands. [Methods] A total of 49 patients (5 of them were secondary intubation) who were admitted to the emergency department of our hospital from April 2, 2019 to June 17, 2021 needed to undergo blind hand intubation treatment with a nasal jejunal tube. The nurses who were recruited to participate in Guangdong. The enteral nutrition intubation training class hosted by the Provincial Nursing Society Critical Care Committee has been divided into two groups: the experimental group after training (n=28) and the control group before training (n=21) at the aim of comparing the success rate of one-time catheterization of patients in the two groups. [Results] The success rate of nurses' bare-handed blind insertion of the nasal jejunal tube increased from 43% to 86% (p<0.01). [Conclusion] Carrying out the training of blind insertion of nasal jejunal tube with bare hands can improve the success rate of tube placement for nurses in emergency department.

Intravenous Metoclopramide to Improve the Success Rate of Blind Bedside Post-pyloric Placement of Feeding Tube in Critically Ill Children: A Randomized, Double-Blind, Placebo-Controlled Study

Objective: Impaired gastric emptying is a common cause of delayed feeding in critically ill children. Post-pyloric feeding may help improve feeding intolerance and nutritional status and, hence, contribute to a better outcome. However, post-pyloric feeding tube insertion is usually delayed due to a technical difficulty. Therefore, prokinetic agents have been used to facilitate blind bedside post-pyloric feeding tube insertion. Metoclopramide is a potent prokinetic agent that has also been used to improve motility in adults and children admitted to intensive care units. The objective of this study was to determine the efficacy of intravenous metoclopramide in promoting the success rate of blind bedside post-pyloric feeding tube placement in critically ill children.Design: The design of this study is randomized, double blind, placebo controlled.Setting: The setting of the study is a single-center pediatric intensive care unit.Patients: Children aged 1 month−18 years admitted to the pediatric intensive care unit with severe illness or feeding intolerance were enrolled in this study.Intervention: Patients were randomly selected to receive intravenous metoclopramide or 0.9% normal saline solution (the placebo) prior to the tube insertion. The study outcome was the success rate of post-pyloric feeding tube placement confirmed by an abdominal radiography 6–8 h after the insertion.Measurements and Main Results: We found that patients receiving metoclopramide had a higher success rate (37/42, 88%) of post-pyloric feeding tube placement than the placebo (28/40, 70%) (p = 0.04). Patients who received sedative drug or narcotic agent showed a tendency of higher success rate (p = 0.08).Conclusion: Intravenous metoclopramide improves the success rate of blind bedside post-pyloric placement of feeding tube in critically ill children.Trial Registration: Thai Clinical Trial Registry TCTR20190821002. Registered 15th August 2019.

Spontaneous Pneumothorax Mimicking Perforated Viscus in Covid-19 patient

Case presentation: A 65-year-old female diagnosed with COVID-19 developed worsening respiratory distress requiring invasive ventilation. Chest radiography post-intubation revealed air under the diaphragm, pneumomediastinum and subcutaneous emphysema. The case was referred to the surgical team for emergency laparotomy for suspected perforated viscus. Clinically, her abdomen was distended but there was no sign of peritonism. In view of the high risk of perioperative morbidity and absence of peritonism, a CT scan was done to rule out the cause of pneumoperitoneum. CT scan showed bilateral pneumothorax, presence of air in the extra peritoneum and retroperitoneum. There was no air in the peritoneum and no evidence of perforated viscus. She was treated conservatively with bilateral chest tube insertion. Unfortunately, she developed multiorgan failure and succumbed to death.

Congenital Pulmonary Airway Malformation in Children: Advantages of an Additional Trocar in the Lower Thorax for Pulmonary Lobectomy

Aim: To present the use of an additional trocar (AT) in the lower thorax during thoracoscopic pulmonary lobectomy (TPL) in children with congenital pulmonary airway malformation.Methods: For a lower lobe TPL (LL), an AT is inserted in the 10th intercostal space (IS) in the posterior axillary line after trocars for a 5-mm 30° scope, and the surgeon's left and right hands are inserted conventionally in the 6th, 4th, and 8th IS in the anterior axillary line, respectively. For an upper lobe TPL (UL), the AT is inserted in the 9th IS, and trocars are inserted in the 5th, 3rd, and 7th IS, respectively. By switching between trocars (6th↔8th for the scope, 4th↔6th for the left hand, and 8th↔10th for the right hand during LL and 5th↔7th, 3rd↔5th, and 7th↔9th during UL, respectively), vital anatomic landmarks (pulmonary veins, bronchi, and feeding arteries) can be viewed posteriorly. The value of AT was assessed from blood loss, operative time, duration of chest tube insertion, requirement for post-operative analgesia, and incidence of perioperative complications.Results: On comparing AT+ (n = 28) and AT– (n = 27), mean intraoperative blood loss (5.6 vs. 13.0 ml), operative time (3.9 vs. 5.1 h), and duration of chest tube insertion (2.2 vs. 3.4 days) were significantly decreased with AT (p &lt; 0.05, respectively). Differences in post-operative analgesia were not significant. There were three complications requiring conversion to open/mini-thoracotomy: AT– (n = 2; bleeding), AT+: (n = 1; erroneous stapling).Conclusions: An AT and switching facilitated posterior dissection during TPL in children with congenital pulmonary airway malformation enhancing safety and efficiency.

P-OGC58 Preoperative Enteral Feeding in Patients with Oesophagogastric Cancer

Background Patients with Oesophagogastric (OG) cancer undergoing multimodal treatment have a higher risk for progressive decline in their nutritional status. Our centre has seen increased numbers of patients using jejunostomy and gastrostomy tube feeding as an additional support during neoadjuvant chemotherapy and radiotherapy (nCRT). This audit aimed to evaluate the processes surrounding and the impact of this intervention. Methods A retrospective review of 2019 medical records. Patients with OG cancer for treatment with curative intent that underwent an elective feeding tube insertion for preoperative supplementary feeding were included. Results 14 patients were admitted for elective feeding tube insertion in 2019. On admission N = 10 patients (71%) had clinically severe weight loss (defined as ≥ 10% in 6 months, or ≥ 7.5% in 3 months or ≥ 5% in 1 month). Four (29%) had a dietetic assessment pre admission, with 1 patient (7%) trained on home enteral nutrition pre admission. Conclusions This service is growing rapidly, patient numbers have more than doubled in 3 years. Enteral feeding is effective in preventing clinically significant weight loss in patients undergoing nCRT who progress to surgery. Short LOS: dietetic consult pre admission is essential to improve patient flow, education, preparation. Jejunostomy tube dislodged in 46% patients (n = 6), aim to improve strategies to avoid or best manage this. For future work: Examine effect on body composition (CT: sarcopenia) and examine patient’s perspectives and quality of life.