Search

We reported a successful airway management in a patient with a diagnosed cervical spinal injury with a non-intubating laryngeal mask AuraOnceTM. Its use was as a rescue airway device after failed orotracheal intubation with direct laryngoscopy and difficulty with facemask ventilation in a 46-year-old trauma patient. The decision was made to use the non-intubating laryngeal mask as a conduit for the placement of an orotracheal tube, which was done successfully. This alternative use of the Ambu AuraOnce laryngeal mask could be of great value to healthcare workers in resource-poor countries where advanced airway devices are not readily available. [ABSTRACT FROM AUTHOR]

Introduction: Simulation-based training has become a comprehensive practice to improve skill levels in procedures such as intubation. Clinicians performing endotracheal intubation must be competent to perform this technical skill safely. Objective: Determine the success of the use of mobile remote technology in learning intubation laryngoscopy during training in the hospital. Material and methods: Experimental, cross-sectional, comparative, nonblind, randomized study which was made up of 117 students of the Bachelor of Medicine degree at the Autonomous University of Nuevo Leon. Results: Group A with conventional laryngoscopy achieved successful intubation in an average of 106.86 ± 84.87 seconds, group B in 62.90 ± 65.81 and when crossing the groups in the technique, the time of video laryngoscopy was taken, where group A reported an average time of 64.25 ± 34.23, while the time recorded in group B was 84.25 ± 55.67 seconds. Conclusion: The use of mobile remote technology is effective for the preparation of doctors and future doctors when performing an orotracheal intubation. Videolaryngoscopy was significant to conventional laryngoscopy when performed in inexperienced personnel. [ABSTRACT FROM AUTHOR]

Health Care Associated Infections (HAIs) are a mayor problem in hospitals around the World. The World Health Organization (WHO) estimates that 7% of patients hospitalized in developed countries and 10% in developing countries will develop a HAI. These infections are related with a significant rise in morbimortality and health care costs. Infections are mostly associated with prolonged length of stay, intravascular devices, permanent urinary catheters, orotracheal intubation and use of mechanical ventilation among others. In addition, in recent years Multi Drug Resistant (MDR) organisms are often isolated in HAIs, which contributes to the significantly rise in morbidity, mortality, use of broader spectrum antimicrobials and cost. Efforts around the world are destined to reduce HAIs by using specific isolation precautions regarding the type of microorganism, its transmission and its drug susceptibility. These are primarily based on a high percentage of health care workers correct hand-wash, fast and adequate identification of HAIs and subsequently, the specific isolation recommendation to further prevent outbreaks. These measures are based on the three main transmission methods: contact precautions, droplet precautions and airborne precautions. Therefore, we present an actualization of the 2009 recommendations for prevention of HAIs according to our local epidemiology and to the latest WHO and the Centers for Disease Control (CDC) recommendations. [ABSTRACT FROM AUTHOR]

medigraphic.org.mx Introduction: Videolaryngoscopy has gained popularity for its usefulness during anticipated and unexpected difficult airway management in adults. It's use is rare for normal airway intervention and much less common in children. Our goal is to compare the effectiveness of Bonfils fiberscope versus Airtraq videolaryngoscope for airway management during a normal pediatric airway to encourage routine use of videolaryngoscopy technique in this age specific population. material and methods: 138 ASA I patients aged between one month and five years scheduled for elective surgery requiring endotracheal intubation were recruited. They were randomized into the Bonfils group or Airtraq group. Characteristics of laryngeal view, consequences and ease of use during intubation and post intubation complications were evaluated. We recorded intubation time, Cormack Lehane, POGO score, image quality, ease for intubation, oxygen saturation, amount of attempts to intubate and number of operators needed for a successful intubation. results: Endotracheal intubation was successful at first attempt in 94.1% in the Bonfils group; significantly higher than the Airtraq group with 82.6%. Mean time to intubation was significantly longer in the Airtraq group (59.39 versus 39.96 seconds, p = 0.001). There were no significant differences in laryngeal view, image quality and post intubation complications between the groups. Conclusions: Both video laryngoscopes provide better glottis visualization, improving POGO and Cormack-Lehane scores in pediatric patients with normal airways. The Airtraq video laryngoscope showed less effectiveness by having better image quality at the expense of prolonged intubation times and lower successful intubation rates. [ABSTRACT FROM AUTHOR]

The ventilator-associated pneumonia occurs in patients undergoing mechanical ventilation for periods longer than 48 hours. Ventilator- associated pneumonia incidence is reported in literature of 10 to 20% of patients. The early-onset ventilator-associated pneumonia is defi ned as pneumonia diagnosed between the third and seventh day. The late-onset ventilator-associated pneumonia is defi ned as pneumonia diagnosed after the seventh day. Many risk factors contribute to the development of ventilator-associated pneumonia. The most frequent associated are gram-negative bacilli: Aeuriginosa pseudomonas, Acinetobacter baumannii, and Stenotrophomonas maltophilia (40%), Enterobacter sp (29%), and Gram-positive cocci: Staphylococcus aureus (21%). Set a proper diagnosis of ventilator-associated pneumonia is one of the most important and diffi cult issues in the care of critically ill patients. There are strategies for the prevention of ventilator-associated pneumonia, but only a few have proven effective. The attributable mortality is still debated, and has been associated with ranges of 20-70%. [ABSTRACT FROM AUTHOR]

Objective: To identify acute complications that occur during tracheal intubation and if the physician's experience is crucial in presenting them. Material and methods: An observational, transversal, descriptive, which included patients over 16 years of both sexes admitted to the Emergency Department from 1 September 2007 to January 31, 2008 with pathology requiring advanced management air. Results: A total of 150 intubation was realized, esophageal intubation main complication was 13.24%, where 52% of intubations were performed by residents. Conclusions: Esophageal intubation is a major acute complication in intubation, infl uencing the experience of the medical staff for their presentation. [ABSTRACT FROM AUTHOR]

BACKGROUND Orotracheal intubation is a routine procedure to assure the airway. Complications after orotracheal intubation are widely recognized; they affect 4-13% of cases. OBJECTIVE To assess, in the period immediate to extubation, the airway of adult patients from the Intensive Therapy service, who were intubated. PATIENTS AND METHODS In the intensive therapy service a prospective study was done assessing --during the first 12 hours after extubation by rigid or flexible laryngoscopy-- patients who required orotracheal intubation. Findings were described by a data capture form. RESULTS Thirty patients were evaluated, 11 patients had pneumonia; 5, diabetes mellitus; 4, high blood pressure and 2, sepsis. Orotracheal intubation lasted a mean of 14.3 days. Flexible laryngoscopy was used in 21 patients; in 22 patients tracheotomy was done due to prolonged intubation. The most affected region was the supraglotic one (21 patients), although this was transitory in all cases and was resolved with conservative measures. Four patients had vocal cord paresis; two, vocal cord paralysis and one, vocal process granuloma. Only one patient had subglotic affection due to postintubation stenosis with light of 15%. CONCLUSIONS Laryngoscopy should be done to all patients submitted to intubation in the first hours postextubation, this will make easy an early diagnosis of laryngeal lesions and, thus, an opportune treatment and less functional sequelae for patients. [ABSTRACT FROM AUTHOR]

The Do¨rges universal laryngoscope blade has several features designed to facilitate tracheal intubation. The number of laryngoscope blades may be reduced from four to two, or even one, which indicate less space requirement and costs. This new universal laryngoscope blade, has a lower profile (height 15 vs. 22 mm) than a Macintosh laryngoscope blade size 3 and 4, which may facilitate manoeuvring of the laryngoscope in the mouth. In random order, 40 non-anaesthesia senior house officers used a Macintosh laryngoscope blade size 3 or 4 in an adult airway management trainer, a Macintosh laryngoscope blade size 2 in a paediatric airway management trainer, and the Do¨rges universal laryngoscope blade for both airway management trainers to perform orotracheal intubation. The number of intubation attempts and failures was counted. Participants reported the laryngoscopic view according to Cormack and Lehane. The time from touching the laryngoscope to the first adequate lung insufflation was measured, and subjective assessment regarding handling of both blades was recorded. Number of intubation failures, the laryngoscopic view according to Cormack and Lehane, and subjective assessment was comparable between groups. Orotracheal intubation of the adult airway management trainer with the Do¨rges universal laryngoscope blade took significantly less time compared to the Macintosh laryngoscope blades (14 (7–57) vs. 20 (8–43) s; P<0.001); all other intubating times were comparable. In conclusion, in this model, the Do¨rges universal laryngoscope blade was comparable to the Macintosh laryngoscope blades size 2–4, and may save time, cost and space. [Copyright &y& Elsevier]