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Background Stenotrophomonas maltophilia causes opportunistic infections in immunocompromised and patients in intensive care units (ICUs). An outbreak of S. maltophilia in ICU is described which highlights the importance of the risk of infection from contaminated medical devices and suction fluids in ventilated patients. Methods The investigation of the outbreak was carried out. Environmental sampling was done. This was followed by MALDI-TOF MS typing and recA gene-based-phylogeny. Results In February, S. maltophilia was reported from the central line blood of six patients from ICU within a span of two weeks. The peripheral line blood cultures were sterile in all patients. Relevant environmental sampling of the high-touch surface and fluids revealed S. maltophilia strains in normal saline used for suction and in the inspiratory circuit of two patients. The isolated strains from patients and environment (inspiratory fluid) showed a minimum of 95.41% recA gene sequence identity between each other. Strict cleaning and disinfection procedures were followed. Continuous surveillance was done and no further case of S. maltophilia was detected. Timely diagnosis and removal of central line prevented development of central-line associated blood stream infection. Conclusion This outbreak report illustrates that environmental sources like suction fluid and normal saline could be the source of S. maltophilia in ICU patients.

Ventricular suction is a common adverse event in ventricular assist device (VAD) patients and can be due to multiple underlying causes. The aim of this study is to analyze the potential of different therapeutic interventions to mitigate suction events induced by different pathophysiological conditions. To do so, a suction module was embedded in a cardiovascular hybrid (hydraulic-computational) simulator reproducing the entire cardiovascular system. An HVAD system (Medtronic) was connected between a compliant ventricular apex and a simulated aorta. Starting from a patient profile with severe dilated cardiomyopathy, four different pathophysiological conditions leading to suction were simulated: hypovolemia (blood volume: -900 ml), right ventricular failure (contractility -70%), hypotension (systemic vascular resistance: 8.3 Wood Units), and tachycardia (heart rate:185 bpm). Different therapeutic interventions such as volume infusion, ventricular contractility increase, vasoconstriction, heart rate increase, and pump speed reduction were simulated. Their effects were compared in terms of general hemodynamics and suction mitigation. Each intervention elicited a different effect on the hemodynamics for every pathophysiological condition. Pump speed reduction mitigated suction but did not ameliorate the hemodynamics. Administering volume and inducing a systemic vasoconstriction were the most efficient interventions in both improving the hemodynamics and mitigating suction. When simulating volume infusion, the cardiac powers increased, respectively, by 38%, 25%, 42%, and 43% in the case of hypovolemia, right ventricular failure, hypotension, and tachycardia. Finally, a management algorithm is proposed to identify a therapeutic intervention suited for the underlying physiologic condition causing suction.

Objective: Skin fibrosis places an enormous burden on patients and society, but disagreement exists over methods to quantify severity of skin scarring. A suction cutometer measures skin elasticity ...

INTRODUCTION The role of closed suction drainage during elective total joint arthroplasty is still unclear. The present study compared the use of closed suction drains to no drainage for elective total knee arthroplasty (TKA) and in total hip arthroplasty (THA) through a meta-analysis of randomized clinical trials (RCTs). METHODS Following the PRISMA guidelines, a meta-analysis of randomized controlled trials identified in December 2021. All randomized clinical trials comparing the use of closed suction drains to no drainage for elective THA or TKA were considered. RESULTS Twenty-five RCTs were included in the final analysis. 49% (1722 of 3505) of patients received no-drainage, and 51% (1783 of 3505) received closed suction drainage. There was no evidence of a statistically significant evidence between the two groups in occurrence of postoperative infections (P = 0.4), mean total postoperative hemoglobin (P = 0.2) or length of hospital stay (P = 0.1). The no-drainage group showed a lower rate of blood transfusion (P

Background The Penumbra Indigo aspiration system (Penumbra Inc., Alameda, CA, USA) is a suction embolectomy device that was cleared by the Food and Drug Administration for use in acute pulmonary embolism (PE). While this device has proven to be safe in clinical trials, real-world data are minimal. Methods The “Manufacturer and User Facility Device Experience” MAUDE database was queried for reports of Penumbra indigo system from January 2020 to August 2021. Results A total of 2118 reports were found during the study period. After the exclusion of duplicate and incomplete reports as well as reports not related to PE , our final cohort included 67 reports related to Penumbra indigo device failure. The most common failure mode was Lightning unit malfunction (35.8%, n = 24) followed by rotating hemostasis valve malfunction (31.3%, n = 21). Three (4.5%) patients died; two (3%) from fatal pulmonary vessel perforation , and one from fatal right-sided heart failure. There was one case (1.5%) of pericardial effusion , while there were no cases of hemoptysis or blood transfusion . Conclusion The overall number of reports in the MAUDE registry related to the Penumbra Indigo aspiration system is small (67 reports in 20 months). The most common reported failure mode was Lightning unit malfunction. These data serve to inform operators about potential issues when using the Penumbra Indigo thrombus aspiration system and identify areas on which to focus further device iteration.

Symptomatic postoperative epidural hematomas are rare, with an incidence of 0.10% to 0.69%. Risk factors have varied in the literature, but multiple studies have reported advanced age, preoperative or postoperative coagulopathy, and multilevel laminectomy as risk factors for hematoma. The role of pharmacologic anticoagulation after spine surgery remains unclear, but multiple studies suggest it can be done safely with a low risk of epidural hematoma. Prophylactic suction drains have not been found to lower hematoma incidence. Most symptomatic postoperative epidural hematomas present within the first 24 to 48 hours after surgery but can present later. Diagnosis of a symptomatic hematoma requires correlation of clinical signs and symptoms with a compressive hematoma on MRI. Patients will usually first complain of a marked increase in axial pain, followed by radicular symptoms in the extremities, followed by motor weakness and sphincter dysfunction. An MRI should be obtained emergently, and if it confirms a compressive hematoma, surgical evacuation should be carried out as quickly as possible. The prognosis for neurologic improvement after evacuation depends on the time delay and the degree of neurologic impairment before evacuation.

The portable digitalized suction was used widely in thoracic surgery. The aim of the study was to access the early outcomes of using the portable digitalized suction system after cardiac surgery. We invested 80 patients including 30 women (mean age 72.7 ± 9.2 years) who underwent cardiac surgery at our hospital, excluded coronary artery bypass grafting only, with or only aortic surgery, emergency operation, and patients with hemodialysis. Patients were categorized as those treated with digital chest drainage system (DCS group, n = 38) or analog chest drainage system (ACS group, n = 42), and the following data were analyzed in two groups. The primary endpoint was the duration of chest drainage, and the secondary endpoints were the rate of drainage-related complications and the length of hospitalization. The duration of drainage was significantly shorter in the DCS group (ACS vs. DCS = 94.8 ± 31.5 vs. 81.1 ± 20.6 h, p = 0.036). The duration needed for rehabilitation completion was significantly shorter in the DCS group (ACS vs. DCS = 10.7 ± 1.2 vs. 9.6 ± 1.5 days, p = 0.047), and the length of hospitalization was significantly shorter in the DCS group (ACS vs. DCS = 21.9 ± 5.3 vs. 18.8 ± 7.2 days, p = 0.031). This study provided evidence that DCS might be effective for patients who underwent cardiac valve surgery.

Dental procedures produce aerosols which may remain suspended and travel significant distances from the source. Dental aerosols and droplets contain oral microbes and there is potential for infectious disease transmission and major disruption to dental services during infectious disease outbreaks. One method to control hazardous aerosols often used in industry is Local Exhaust Ventilation (LEV). The aim of this study was to investigate the effect of LEV on aerosols and droplets produced during dental procedures. Experiments were conducted on dental mannequins in an 825.4 m3 open plan clinic, and a 49.3 m3 single surgery. 10-minute crown preparations were performed with an air-turbine handpiece in the open plan clinic, and 10-minute full mouth ultrasonic scaling in the single surgery. Fluorescein was added to instrument irrigation reservoirs as a tracer. In both settings, Optical Particle Counters (OPCs) were used to measure aerosol particles between 0.3 – 10.0 μm and liquid cyclone air samplers were used to capture aerosolised fluorescein tracer. Additionally, in the open plan setting fluorescein tracer was captured by passive settling onto filter papers in the environment. Tracer was quantified fluorometrically. An LEV device with High Efficiency Particulate Air (HEPA) filtration and a flow rate of 5,000 L/min was used. LEV reduced aerosol production from the air-turbine handpiece by 90% within 0.5 m, and this was 99% for the ultrasonic scaler. OPC particle counts were substantially reduced for both procedures, and air-turbine settled droplet detection reduced by 95% within 0.5 m. The effect of LEV was substantially greater than suction alone for the air-turbine and was similar to the effect of suction for the ultrasonic scaler. LEV reduces aerosol and droplet contamination from dental procedures by at least 90% in the breathing zone of the operator and it is therefore a valuable tool to reduce the dispersion of dental aerosols.

Background Adenoidal hypertrophy is a common condition in children and can cause symptoms such as mouth breathing, nasal discharge, snoring, sleep apnea, and hyponasal speech. The curettage adenoidectomy has some disadvantages, especially the intranasal extension of the adenoid tissue that makes this technique inadequate. This study is conducted to evaluate and compare between assisted suction coagulation adenoidectomy and traditional curettage techniques. Results One hundred twenty-two patients with symptomatic adenoid hypertrophy such as nasal obstruction, snoring, and mouth breathing were included in our study. Patients underwent adenoidectomy either traditional curettage adenoidectomy (60 patients as group A) or endoscopic assisted suction coagulation adenoidectomy (62 patients as group B). Patients were scheduled for follow-up visits with respect to operative time, operative and postoperative complications. The mean age of groups A and B were 6.57+2.8 and 7+2.8 ranging from 3 to12 years. There was a statistically significant difference between groups as regard intraoperative blood loss, trauma, postoperative complications as neck stiffness and bad odor plus postoperative endoscopic and radiological grading after the operation. Conclusions Suction coagulation diathermy adenoidectomy is alternative to cold adenoidectomy with significantly fewer intraoperative complications such as blood loss and trauma of prevertebral muscle plus post-operative complications such as primary or secondary bleeding and rhinolalia aperta.

Low flow alarms represent a management challenge in patients with left ventricular assist devices because they are often a consequence of complex patient-device interactions. We present a case of intermittent suction of the postero-medial papillary muscle into the left ventricular assist device inflow cannula during diastole, causing low flows. This case highlights the importance of a systematic approach and use of multiple investigation modalities in making an accurate diagnosis. (Level of Difficulty: Advanced.), Central Illustration

Objective The purpose of this study was to obtain a quantitative and qualitative assessment of the SUPEVAC unit (German Malaysian Medical Industries, Selangor, Malaysia), a novel field suction unit powered by a positive pressure gas source and capable of hospital-grade suction levels and rates. Methods This was a randomized crossover trial in a simulated clinical setting to compare the SUPEVAC unit with standard hospital wall suction. Twenty-two fellows of the Australasian College for Emergency Medicine, the Australian and New Zealand College of Anaesthetists, or the College of Intensive Care Medicine were recruited. Outcomes were assessed via a structured survey and measuring the time to view the glottis. Results This study found there was no significant difference between the SUPEVAC unit and wall suction with regard to suction time (P = .762; 95% confidence interval, −0.683 to 0.338) or qualitative assessment via the survey. Conclusions The SUPEVAC unit is comparable with wall suction in a clinical setting. Further research is warranted.

Background/objective Endotracheal suction is one of the most common and harmful procuedres performed on mechanically ventilated children. The aim of the study was to establish the feasibility of a randomised controlled trial (RCT) examining the effectiveness of normal saline instillation (NSI) and a positive end-expiratory pressure recruitment manoeuvre (RM) with endotracheal suction in the paediatric intensive care unit. Methods Pilot 2 × 2 factorial RCT. The study was conducted at a 36-bed tertiary paediatric intensive care unit in Australia. Fifty-eight children aged less than 16 years undergoing tracheal intubation and invasive mechanical ventilation. (i) NSI or no NSI and (ii) RM or no RM with endotracheal suction . The primary outcome was feasibility; secondary outcomes were ventilator-associated pneumonia (VAP), change in end-expiratory lung volume assessed by electrical impedance tomography, dynamic compliance, and oxygen saturation-to-fraction of inspired oxygen (SpO2/FiO2) ratio. Results/Findings Recruitment, retention, and missing data feasibility criteria were achieved. Eligibility and protocol adherence criteria were not achieved, with 818 patients eligible and 58 enrolled; cardiac surgery was the primary reason for exclusion. Approximately 30% of patients had at least one episode of nonadherence. Children who received NSI had a reduced incidence of VAP; however, this did not reach statistical significance (incidence rate ratio = 0.12, 95% confidence interval = 0.01–1.10; p = 0.06). NSI was associated with a significantly reduced SpO2/FiO2 ratio up to 10 min after suction. RMs were not associated with a reduced VAP incidence (incidence rate ratio = 0.31, 95% confidence interval = 0.05–1.88), but did significantly improve end-expiratory lung volume at 2 and 5 min after suction, dynamic compliance, and SpO2/FiO2 ratio. Conclusion RMs provided short-term improvements in end-expiratory lung volume and oxygenation. NSI with suction led to a reduced incidence of VAP; however, a definitive RCT is needed to test statistical differences. A RCT of study interventions is worthwhile and may be feasible with protocol modifications including the widening of participant eligibility.

OBJECTIVE To assess feasibility and acceptability of a novel, low-cost "Suction Tube Uterine Tamponade" (STUT) treatment for refractory postpartum hemorrhage (PPH). METHODS We allocated patients with refractory PPH by randomly ordered envelopes to STUT or routine uterine balloon tamponade (UBT, Ellavi free-flow system) in 10 hospitals in South Africa. In the STUT group, a 24FG Levin stomach tube was inserted into the uterine cavity and vacuum created with a vacuum pump or manual vacuum aspiration syringe. RESULTS For this internal pilot study, 12 participants were allocated to STUT and 12 to UBT. Insertion failed in one of each group and was recorded as difficult in 3/10 STUT and 4/9 UBT insertions respectively (five missing data). There were two laparotomies and one intensive care unit admission in the UBT group. Pain during STUT insertion was graded as none/mild in 9/10 and severe in 1/10. The experience of the STUT procedure was graded as fine in 4/11 and "uncomfortable but acceptable" in 7/11. CONCLUSION STUT is feasible and acceptable, justifying continuation of our trial. These data will also inform a large World Health Organization trial to test effectiveness of uterine tamponade methods. The numbers are too small to support any clinical recommendation.

We have developed a novel instrument which is a drill burr protection sheath with an inbuilt suction-irrigation system for endoscopic ear surgery. It allows simultaneous suction and irrigation. It is a metallic attachment onto the mastoid drill handpiece. It provides protection for the endoscope as well as the external auditory skin during transcanal drilling procedures. It is cost effective. 5

The unprecedented pandemic has been causing devastating damage to the human life and livelihood. The SARS CoV-2 viral strains are currently responsible for the serious of infection waves and high mortality rate. The management of disease requires well developed medical infrastructure such as central oxygen suction, ventilator facility to support the patients with severe complications. Therefore, early diagnosis and monitoring are mandatory in order to control the disease progression and its clinical complications. Current study, we retrospectively analyzed the clinical parameters of the COVID-19 positive patients, and found that the body mass index ratio, oxygen saturation level and the neutrophil, lymphocyte ratio were continuously monitored. Any significant increase in the above said parameters may be correlated with adverse disease progression and patient mortality rate. In this way, developing countries could cut down the necessity for medical infrastructure.

Background Non-intubated video-assisted thoracic surgery is a therapeutic option for intractable secondary spontaneous pneumothorax in patients who are poor candidates for surgery with endotracheal intubation under general anesthesia. However, intraoperative respiratory management in this surgery is often challenging because of hypoxia caused by surgical pneumothorax. Case presentation A 75-year-old man with idiopathic pulmonary fibrosis who had been on home oxygen therapy underwent non-intubated uniportal video-assisted thoracic surgery for intractable spontaneous pneumothorax. During the operation, oxygen was administered using a high-flow nasal cannula at a high flow rate. An air-locking port for single-incision surgery was used to minimize the inflow of air into the pleural cavity. The intrapleural air was continuously suctioned through the chest tube. The air-leak point was easily identified and closed using ligation. Oxygenation was satisfactory throughout the operation. Conclusions Non-intubated uniportal video-assisted thoracic surgery for secondary spontaneous pneumothorax with an air-locking port, continuous pleural suction, and high-flow nasal cannula may achieve satisfactory intraoperative oxygenation in patients with respiratory dysfunction. The intrapleural space can be feasible for surgical manipulation without surgical pneumothorax in non-intubated video-assisted thoracic surgery even when supplied with oxygen at a high flow rate using a high-flow nasal cannula.

Objective To evaluate the necessity and effectiveness of a preplanned technique for drilling during transcanal endoscopic ear surgery. Methods Study design: Retrospective case series study from June 2011 to June 2015. Setting: Private tertiary care hospital. Patients: Eighty-five ears of 78 patients, age ranging from 9 to 57 years underwent transcanal endoscopic drilling for various types of pathology in their middle and external ear. Interventions: Application of a preplanned technique for transcanal drilling in endoscopic ear surgery that involved short timed drilling with use of intermittent irrigation and suction. Every events of the procedure were done one after another with the single hand of the surgeon. An attachment providing protecting sheath around rotating burr was used during each time of drilling. Main outcomes measure: Efficacy of such drilling technique in single handed endoscopic ear surgery. Presence of any postoperative thermal injury of facial nerve and any lacerated injury of skin of external ear. Results This preplanned technique was found suitable for transcanal endoscopic drilling with the single hand of the surgeon. Postoperative facial nerve palsy or laceration of skin of external ear was not noted in any patient. Conclusion After using the present technique, transcanal endoscopic drilling could be done easily and safely with single hand of the surgeon.

Antecedentes: Tanto la sobreinfección bacteriana como la neumonía asociada a la ventilación (NAV) son eventos frecuentes en los cuidados críticos. Durante la pandemia de COVID-19, las prácticas diagnósticas habituales, como el lavado broncoalveolar y el aspirado traqueal, están limitadas debido al alto riesgo de exposición que conllevan para el operador. Con el fin de poner el foco principal en la protección del personal sanitario, se desarrolla y utiliza una técnica de aspiración traqueal modificada (M-TA) para la adquisición de muestras microbiológicas del tracto respiratorio inferior con un dispositivo de aspiración cerrado. Métodos: Se realiza un estudio observacional retrospectivo para evaluar la eficacia de la M-TA. Resultados: Se analizaron un total de 33 muestras de M-TA. En el 66,6% de los casos, los resultados condujeron a un cambio en la toma de decisiones médicas. Se alcanzó una precisión del 100% en el diagnóstico de COVID-19 y una tasa de crecimiento bacteriano del 56% en las cultivas en las que se sospechó de VAP. Ningún personal sanitario desarrolló síntomas ni dio positivo a COVID-19 durante o después de la recogida de muestras. Conclusiones: La técnica de M-TA presentada podría considerarse como un procedimiento seguro y eficaz con bajo porcentaje de complicaciones.

Alba Ramírez-Sarmiento,1– 3 Orlando Aya,3,4 Diana Cáceres-Rivera,1,2 Carlos F Reyes,2– 4 Angela Espitia,1,2 Camilo Pizarro,3,4 Joaquim Gea,5,6 Victor R Castillo,7,8 Mauricio Orozco-Levi1– 3,6 1Respiratory Department, Instituto Cardiovascular y Hospital Internacional de Colombia, Fundación Cardiovascular de Colombia, Floridablanca, Santander, Colombia; 2EMICON Research Group MINCIENCIAS, Bogotá, Cundinamarca, Colombia; 3Universidad de Santander (UDES), Bucaramanga, Santander, Colombia; 4Department of Critical Care, Fundación Cardiovascular de Colombia, Floridablanca, Santander, Colombia; 5Respiratory Department, Parc de Salut Mar, Barcelona, Catalonia, Spain; 6CEXS-Universidad Pompeu Fabra, Barcelona, Catalonia, Spain; 7Department of Cardiovascular Surgery, Fundación Cardiovascular de Colombia, Floridablanca, Santander, Colombia; 8Biomedical and Translational Research Group, Fundación Cardiovascular de Colombia, Floridablanca, Santander, ColombiaCorrespondence: Mauricio Orozco-LeviRespiratory Department, ICV-HIC, Fundación Cardiovascular de Colombia, Calle 155a no. 23-58, El Bosque, Floridablanca, Santander, ColombiaTel +57 3175741421Email mauricioorozco@fcv.orgBackground: Bronchoaspiration of content that accumulates in the supraglottic area (eg, saliva, gastroesophageal reflux) is a risk factor for ventilator-associated pneumonia. A continuous supraglottic suction system may decrease the risk of bronchoaspiration in these patients.Objective: (1) Constructing a conceptual model and functional prototype of a continuous supraglottic suction device for use in humans; (2) defining functional characteristics in ex vivo swine head models; and (3) evaluating its efficacy and safety in mechanically ventilated patients.Methods: Study conducted in three phases. First phase: definition of distances and diameters of the triangle determined by dental arch, posterior oropharynx and vallecula, and diameter of the oropharynx in axial projection; and identification of the declining area of supraglottic suction. Second phase: design engineering and functional prototype evaluated in ex vivo models. Third phase: evaluation of device use in terms of safety and efficacy in ventilated patients.Results: We obtained a final functional model of the SUPRAtube device injected into PVC for medical use. Device effectiveness in in vitro simulation showed a high and fast suction capacity of liquid and thick volumes. Study of swine heads allowed to validate the shape, size and functional fenestration of the device. Study in intubated and mechanically ventilated patients showed a high supraglottic suction capacity and the absence of local adverse events during 72 (7– 240) hours of continuous operation.Conclusion: Our study describes the process of conceptualization, design and production of a practical, safe, low-cost continuous supraglottic suction device without representing antibiotic pressure, which appears to be a new complementary preventive strategy for the standard management of intubated and mechanically ventilated patients.Keywords: mechanical ventilation, bronchoaspiration, supraglottic suction, SUPRAtube, endotracheal tube, gastroesophageal reflux

Background\ud The risk of transmission of SARS-CoV-2 from aerosols generated by medical procedures is a cause for concern.\ud \ud Aim\ud To evaluate the evidence for aerosol production and transmission of respiratory infection associated with procedures that involve airway suctioning or induce coughing/sneezing.\ud \ud Methods\ud The review was informed by PRISMA guidelines. Searches were conducted in PubMed for studies published between January 1st, 2003 and October 6th, 2020. Included studies examined whether nasogastric tube insertion, lung function tests, nasendoscopy, dysphagia assessment, or suctioning for airway clearance result in aerosol generation or transmission of SARS-CoV-2, SARS-CoV, MERS, or influenza. Risk of bias assessment focused on robustness of measurement, control for confounding, and applicability to clinical practice.\ud \ud Findings\ud Eighteen primary studies and two systematic reviews were included. Three epidemiological studies found no association between nasogastric tube insertion and acquisition of respiratory infections. One simulation study found low/very low production of aerosols associated with pulmonary lung function tests. Seven simulation studies of endoscopic sinus surgery suggested significant increases in aerosols but findings were inconsistent; two clinical studies found airborne particles associated with the use of microdebriders/drills. Some simulation studies did not use robust measures to detect particles and are difficult to equate to clinical conditions.\ud \ud Conclusion\ud There was an absence of evidence to suggest that the procedures included in the review were associated with an increased risk of transmission of respiratory infection. In order to better target precautions to mitigate risk, more research is required to determine the characteristics of medical procedures and patients that increase the risk of transmission of SARS-CoV-2.

Selective endoscopic coagulation of a nasal bleeding vessel is an effective means of treating epistaxis. Precisely locating the bleeding site(s) is critical.To investigate the utility of combining a negative pressure suction device and endoscope in locating bleeding sites of refractory epistaxis.A total of 116 patients with refractory epistaxis, who underwent systematic endoscopic exploration under local anesthesia in the absence of identifiable sites of bleeding were randomizely divided into two groupsCompared with the CG, there were statistically significant differences in length of hospital stay, rebleeding, and postoperative pain and complications (allCombining a negative pressure suction device and endoscope was a safe and effective technique for accurately locating bleeding sites in patients with refractory epistaxis.

Surgical plume (SP) carries biological risks such as virus transmission. An evacuation system can remove SP from the surgical field, but is it safe to release evacuated gas into the operating room (OR) atmosphere? We examined this using a commercially available evacuator equipped with a filter under a laparoscopic porcine surgery model. SP was generated by activating an electrocautery or ultrasonic scalpel on the surface of the liver, and we evaluated whether DNA fragments derived from porcine tissue were present in the exhausted gas from the evacuation system into the atmosphere. DNA fragments were detected in the inlet gas of the evacuation system, while it was not detected in the outlet gas. As far as pathogen transmission via SP in the abdominal cavity is concerned, if the smoke evacuator ensures filter adsorption, it seems that there is little risk in releasing the suction gas into the atmosphere in the OR.

A potentially life-threatening emergency in ENT practice is the aspiration of tracheobronchial foreign body. This commonly affects young children and requires early extraction. Successful removal provides immediate relief. However procedural complications can cause devastating morbidity like anoxic encephalopathy or instant death. The aim of this study is to describe the experience in our institution with two surgeons approach for removal of tracheobronchial foreign bodies by telescope and optical forceps. This is an observational study from the period of March 2010 to April 2021 in which 96 patients (59 males, 37 females; age range 3 months to 15 years) were diagnosed with foreign body aspiration. In all cases rigid bronchoscopy and FB removal under general anaesthesia was performed using the two surgeons technique. This technique was instituted once Storz make paediatric telescope (2.9 mm diameter 36 cm length), optical grasping forceps and optical suction were procured in March 2010. Aspirated material was inorganic or organic with varying location in right main bronchus, left main bronchus or the trachea. We highlight the OT setup, surgical algorithm and the advantages of this technique. Visual and tactile coordination between the two surgeons being the crux of this procedure; allows hands on mentoring of the next generation of budding surgeons in a real-life scenario without compromising patient safety. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-021-02847-8.

Laparoscopic sleeve gastrectomy (SG) continues to grow in popularity as a primary bariatric procedure. The purpose of this study is to determine if leak rates and need for subsequent interventions are changed by the standardized use of a closed suction calibration system (CSCS) at a high-volume urban hospital. A retrospective review was conducted between January 1, 2016, and December 31, 2018, on SG patients. All cases performed in 2018 were completed with a closed suction calibration system. Patient demographics, comorbidities, operative variables, and outcomes were collected. Descriptive statistics and chi-squared test were used to compare the two groups. Logistic regression models were adjusted for patient- and procedure-specific factors. Four hundred ninety cases were performed before and 195 after institution of the CSCS. Groups were similar in most characteristics, including median body mass index (BMI) (46.4 vs 45.8 kg/m2, p = 0.79). Those in the closed suction cohort were more likely to have OSA requiring therapy (32.4% vs 46.6%, p

Background Commercial large-bore suction catheters and makeshift large-bore suction catheters with an endotracheal tube (ETT) attached to a meconium aspirator have been shown to have superior suction rates compared with a standard Yankauer. Objectives To compare suction rates between a commercial large-bore suction catheter and a makeshift endotracheal tube—meconium aspirator (ETTMA) combination. Methods We measured suction rates between a standard bulb-tip Yankauer catheter (Model: K86; Cardinal Health, Waukegan, IL), a commercial large-bore catheter (Part: 43200; The Big Stick®, SSCOR, Inc., Sun Valley, CA), and an 8.0-mm standard ETT connected to a meconium aspirator (NeotechTM Products, Inc., Valencia, CA; Ref: N0101 Clear) with high-, medium-, and low-viscosity fluids. Median suction rates were calculated with interquartile ranges. The relative differences with 95% confidence intervals (CI) between the Yankauer and both the large-bore catheter and the ETTMA combination were calculated using a linear mixed-effects model. Results Each device was trialed five times with each of the three different viscosity fluids for a total of 45 trials. Overall, suction rates were faster for the large-bore suction catheter compared with the Yankauer (relative difference 22 mL/s; 95% CI 17–28) and ETTMA (8 mL/s; 95% CI 5–10). The large-bore catheter had consistently faster suction rates compared with the Yankauer and ETTMA combination across all fluid viscosities. Conclusions The commercial large-bore suction catheter had faster suction rates than the makeshift ETTMA combination when compared with the standard Yankauer.

Aim To compare the effects and safety of open and closed endotracheal suction in children with severe brain injury. Design A single‐blinding, single‐centre randomized controlled trial (RCT). Methods The children with severe brain injury admitted to the intensive care unit (ICU) from 1 September 2020–31 August 2022 will be included. And a total of 172 children with severe brain injury are expected to be included. The intracranial pressure, SpO2 and heart rate before suctioning, at the end of suction, and at 5 and 10 min after suction, the estimated sputum volume for each suction, the incidence of ventilator‐associated pneumonia, the duration of mechanical ventilation and the length of ICU stay will be analysed. Results This present RCT has been prospectively registered in China Clinical Trial Registry (http://www.chictr.org.cn, ChiCTR2000030963). This present study is expected to provide reliable evidence to the airway management in children with severe brain injury.

Horizontal canal fistulas are not uncommon in patients with cholesteatoma. Patients with canal wall down cavities and exposed horizontal canal fistulas develop significant dizziness with wind or suction exposure. Obliteration of mastoid cavities in patients with exposed fistulas can be challenging. We describe a patient with horizontal canal fistula and chronic dizziness from wind exposure who underwent successful mastoid cavity obliteration with preservation of hearing. Patients with horizontal canal fistulas in a canal wall down cavity can be managed with mastoid obliteration for relief of dizziness.

Application of negative-pressure wound therapy dressings to the web spaces and small, often moist, areas of the hand can be technically demanding and time consuming. The researchers present a case report and technique for managing a devastating hand infection and soft-tissue defects by creating a self-fabricated sponge-glove that is easily reproducible. Vacuum-assisted therapy for combined volar dorsal soft-tissue defects of the hand, or "Hand Vac," is a novel approach for treating extensive hand wounds. This technique was used in a patient with diabetes with a deep space infection of the hand following serial debridements and antibiotic bead therapy. A single, medium size sponge was cut using a knife and scissors to create an easily applied glove that was then sealed with adhesive dressing and a single suction port. The patient avoided complete amputation of the hand and deep infection was eradicated. The wounds had progressive granulation and healing and were eventually covered with split-thickness skin grafts. The authors conclude that severe soft-tissue defects involving both the volar and dorsal aspects of the hand can be effectively managed with a single glove-like sponge and suction port.

Ilaj bi’l tadbeer (regimenal therapy) is one of the preferred treatment methods used in Unani system of medicine since ancient times. Ḥijāma is one of the effective modalities of treatment in Ilaj bi’l tadbeer. It is a unique therapeutic procedure in which cup like vessels are placed on the body surface by creating a vacuum to either let out blood from below the skin surface or just plain suction without bloodletting. The objective of this comprehensive review paper is to address the claims of Unāni physicians and clinical studies conducted on the efficacy of Ḥijāma. Various published clinical trials showed the efficacy of Ḥijāma in the management of a number of diseases. Though, the effect showed by some clinical trials was short term. Hence, it is suggested that rigorous, well-designed, controlled, randomized and long duration follow up clinical trials on large sample size are to be conducted by trained clinicians or researchers to establish the efficacy of Ḥijāma in the management of various diseases. Keywords: Ilaj bi’l tadbeer, Ḥijāma, Therapeutic Benefits

Background Troubleshooting intraoperative complications requires careful management, and the safest technique should be chosen. We recently experienced a unique intraoperative bronchial complication during pulmonary lobectomy in robot-assisted thoracic surgery (RATS). There is no consensus on whether to continue RATS or convert to a more familiar technique, such as video-assisted thoracic surgery (VATS) or thoracotomy, for intraoperative complications that occur during RATS, and the decision should be determined individually. Case presentation A 74-year-old woman with primary lung adenocarcinoma (clinical stage IA2) underwent robot-assisted right lower lobectomy under one-lung ventilation and CO2 insufflation. Intraoperatively, the anesthesiologist placed the endobronchial suction tube in the right bronchus with intention of maintaining the right lung collapse, which was simultaneously stapled with the right lower bronchus during the right lower lobe bronchial closure using a robotic stapler. During robot-assisted manipulation, we removed the staples involved with the suction tube, one by one, using robotic-arm forceps and sutured the partially opened stump. Subsequently, the bronchial stump was covered with a pedicled pericardial fat pad. The postoperative course was uneventful, and the patient developed no complications when followed up 8 months after discharge. Hence, we could rectify this intraoperative bronchial complication using a robot-assisted technique and avoid conversion to VATS or thoracotomy. Conclusion The precise manipulation techniques in RATS contributed to facilitate the successful execution of surgical procedures, such as staple removal and re-suturing of the bronchial stump and may be a useful as a method for such troubleshooting such intraoperative complications.

As of May 2021, COVID-19 has not yet converged globally. SARS-CoV-2 virus is found in saliva. Dental treatment often involves procedures in which virus particles in saliva are likely to spread outside. So, more advanced infection control is required in dentistry, and the frequency of using dental aerosol suction devices in dental clinics in Japan has increased dramatically compared before COVID-19 pandemic. In this study, sound pressure levels were measured in outpatient clinical treatment areas. A survey of the sound environment was also conducted to the dentists and dental hygienists working there. As a result, the respondents answered that their clinical office was noisier than before COVID-19, and they felt distressed by the sound of dental aerosol suction devices. The average value of LAeq measured in the clinic was 59.2 dB during consultation hours (8:30 -16:30). The LAeq value when using the extraoral suction device was 69.4 dB, which was about 10 decibels higher than without the device. Our findings suggest that the improvement of the sound of an extraoral vacuum device is needed to provide a better and healthier environment in the dental clinic. © INTER-NOISE 2021 .All right reserved.

Measuring and controlling the force required to grip a nerve is required to avoid any undesired neurological damage caused by an excessive suction force applied to the tissue. We aimed to develop a suction-based nerve gripper that can measure the suction force applied to the gripped peripheral nerve. A tiny force sensor can be incorporated by casting a soft material on a barometric pressure sensor chip and embedding it in the suction tip. In this study, a suction tip was designed based on a parametric analysis. The sensing characteristics and performance were evaluated experimentally. The experimental results demonstrate that a suction tip exhibits a force measurement capacity of approximately 2.8 N with a controlled suction force at 0.1 N intervals. The practical applicability of the proposed gripper was assessed based on an in vivo experiment performed on small animal subjects.

The clinical manifestations of foreign body (FB) aspiration can range from an asymptomatic presentation to a life-threatening emergency. Patients may present with acute onset cough, chest pain, breathlessness or sub-acutely with unexplained hemoptysis, non-resolving pneumonia and at times, as an incidental finding on imaging. Patients with iatrogenic FB such as an aspirated broken tooth during difficult intubation or a broken instrument are more common scenarios in the intensive care unit (ICU). Patients with post-obstructive pneumonia with or without sepsis, or variable degree of hemoptysis often require ICU level of care and bronchoscopic interventions. Rigid bronchoscopy has traditionally been the modality of choice; however, with the innovation in instrumentation and wider availability of flexible bronchoscopes, most of the FB removal is now successfully performed using flexible bronchoscopy. Proceduralists choose instruments in accordance with their training and expertise. We describe the use of most common instruments including forceps, balloon catheters, and baskets. Role of cryoprobe and LASER in FB removal is reviewed as well. In general, larger working channel bronchoscopes are preferred; however, smaller working channel bronchoscopes may be used in situations when the patients are intubated with a smaller diameter endotracheal or tracheostomy tubes. Large size FB are removed en bloc with the grasping tool, bronchoscope, and endotracheal or tracheostomy tube, requiring preparation to safely re-establish the airway. After FB removal, bronchoscopy is re-performed to identify any residual FB, assess any injury to the airway, suction post-obstructive secretions or pus, control any active bleeding and remove granulation tissue that may be obstructing the airway. Additional interventions like balloon dilatation may be required to dislodge an impacted FB or to maintain patency of bronchial lumen. If bronchoscopic methods fail, surgery may be required for retrieval of FB in symptomatic patients or to resect suppurative or necrotizing lung process. Multidisciplinary approach involving intensivists, surgeons, and anesthesiologists is the key to optimal patient outcomes.

The hip suction seal plays a key role in distractive stability and maintenance of intra-articular fluid pressure of the hip. Preservation of the suction seal relies on the acetabular labrum and the congruence between the labrum and the femoral head−neck junction. During the treatment of cam-type impingement, iatrogenic over-resection in the femoral head−neck junction or labrum deficiency can cause loss of this suction seal. In this technical note, we describe a remplissage procedure performed in addition to labral reconstruction in a patient with loss of the suction seal due to a dysfunctional labrum and previous over-resection of a cam deformity., Technique Video Video 1 This video describes the key aspects of a labral reconstruction and remplissage technique correlated with dynamic hip examination to restore suction seal in revision hip arthroscopy of a left hip. According to preoperative examination and imaging of a patient with previous hip arthroscopy, over-resection in the anterior part of femoral head−neck junction and a dysfunctional labrum are detected. After these findings are confirmed with diagnostic arthroscopy and an intraoperative dynamic hip examination, labral reconstruction and the remplissage procedure are planned. Both procedures are performed using the kite technique, with the graft prepared from the same semitendinosus allograft in accordance with the defect size. In the labral reconstruction procedure with the defect between 11 and 2 o’clock, the anchors at the 11 and 12 o’clock positions are placed through the anterolateral portal, whereas the anchors at the 1 and 2 o’clock positions are placed through the distal anterolateral accessory (DALA) portal. A proximal modified mid-anterior portal is created to prevent suture tangling during labral reconstruction. During the remplissage procedure, anchors are placed through the DALA portal while viewing from modified mid-anterior portal (mMAP). A mid-body anchor is placed in line with the convexity of the femoral head and acetabulum by using same portal configuration. After remplissage and labral reconstruction, dynamic hip examination is performed to evaluate the reestablished suction seal in the joint while viewing through the mMAP. Finally, the capsule is closed.

Suctioning of the endotracheal tube in ventilated patients is one of the ways to maintain the airway open. There arevarious risks associated with this procedure. Suctioning methods that are appropriate for the situation can help to avoid acute problems. The purpose of this study was to compare the effects of open vs closed suction on cardiorespiratory parameters in patients on mechanical ventilations. Patients hospitalized to Neuro-ICU and Medical ICU with ventilator support was studied in a non-randomized clinical trial with a time series study design. Sixty samples were chosen using a convenient sampling procedure, including 30 for open suction and 30 for closed suction. Before and during suction, data such as demographic factors and cardio-respiratory parameters such as respiratory rate, heart rate, mean arterial pressure, and SpO2 were measured. In this study, statistically significant changes (p=0.001) in Mean Arterial Pressure (MAP) and SpO2 were identified when open and closed suction systems were compared. According to the findings, closed suction has a significant favourable impact on cardiopulmonary parameters. Keywords: Cardio Respiratory parameters, mechanical ventilation, SpO2, Mean Arterial Pressure (MAP), opensuction, closed suction

Background There have been no detailed reports on tracheal puncture after thyroid fine‐needle aspiration (FNA). This study aimed to discuss the cytological differential diagnoses of tracheal puncture after thyroid FNA and clarify its clinical significance. Methods Tracheal puncture was defined as aspiration of tracheal components, including ciliated cells, chondrocytes, and goblet cells. A history of air suction or cough during aspiration was also considered tracheal puncture. Among the 18,480 nodules from 13,813 patients that underwent thyroid FNA, 70 (0.38%) nodules with tracheal puncture were retrospectively examined. Eleven thyroglossal duct cysts (TGDCs) and seven bronchial cysts that could exhibit ciliated cells were included in the study to compare the cytological findings. Results Sixty‐six (94.3%) nodules had no clinical evidence of complications during and after FNA. Of the nodules with tracheal puncture, 64.3%, 48.6%, and 51.4% nodules were

Background Incisional negative-pressure wound therapy (iNPWT) is widely adopted by different disciplines for multiple indications. Questions about the most appropriate uses and value of iNPWT have been raised. Methods An open-label within-patient RCT was conducted in transgender men undergoing gender-affirming mastectomies. The objective was to determine the effect of iNPWT as a substitute for standard dressing and suction drains on wound healing complications. One chest side was randomized to receive the iNPWT intervention, and the other to standard dressing with suction drain. The primary endpoints were wound healing complications (haematoma, seroma, infection, and dehiscence) after three months. Additional outcomes were pain according to a numerical rating scale and patient satisfaction one week after surgery. Results Eighty-five patients were included, of whom 81 received both the iNPWT and standard treatment. Drain removal criteria were met within 24 h in 95 per cent of the patients. No significant decrease in wound healing complications was registered on the iNPWT side, but the seroma rate was significantly increased. In contrast, patients experienced both significantly less pain and increased comfort on the iNPWT side. No medical device-related adverse events were registered. Conclusion Substituting short-term suction drains with iNPWT in gender-affirming mastectomies increased the seroma rates and did not decrease the amount of wound healing complications. Registration number: NTR7412 (Netherlands Trial Register).

Auricular pseudocysts (APs) are benign intercartilaginous cysts at the auricle. Various therapeutic options have been used to treat APs, but they frequently recur in usual clinical practice. Here, we report a case of AP successfully treated using a silicon cast. A 65-year-old male presented with a cyst on his right auricle. Although a local injection of steroid was administered, the cyst had recurred. A dental silicon cast was applied after removal of the contents of the cyst by suction. There was no recurrence of the cyst 6 years after that treatment. Dental silicon casts are a novel technique for an appropriate fixation over auricles in the treatment of APs and had an effective therapeutic result in our case.

Objective: To evaluate rates of postoperative infection in patients with acute purulent appendicitis or gangrenous perforated appendicitis after laparoscopic appendectomy (LA). Methods: In this ret...

BACKGROUND To characterize the workflow during transcanal totally endoscopic tympanoplasty by recording the time and instrumentation used for different steps in the procedure. This analysis aims to identify aspects of instrumentation and surgical technique that could be modified to improve surgical efficiency. METHODS Thirty-one endoscopic tympanoplasty procedures were observed at a single academic center. Patient age ranged from 2.7 to 17.8 years. The procedure was separated into distinct steps. The duration in minutes and the instruments used were recorded by an independent observer. RESULTS Raising the tympanomeatal flap (median 9.82 minutes) and positioning the graft and replacing the flap (median 9.13 minutes) took significantly longer than all other steps (P < .05, Wilcoxon method). Teaching a trainee significantly increased step duration by a total of 32.8 minutes (P < .05, Wilcoxon method). There was no correlation between age of the patient, side of the ear, surgical technique, or graft type, and duration of surgery. Suction instruments with a functional tip (dissector or knife tip) were most commonly used to dissect and maneuver soft tissue while maintaining the surgical field clear of blood. CONCLUSION As elevation of the tympanomeatal flap and graft placement are the most time-consuming steps in endoscopic tympanoplasty, especially for surgical trainees, surgical efficiency could most dramatically be enhanced by modification of instrumentation or technique to facilitate these steps. Modification of simpler steps such as hair trimming and ear canal packing have less potential for shortening surgical duration.

Background: Post traumatic raw area is a very troublesome condition to treat which requires long term regular dressings, higher antibiotics and close monitoring of patient vitals. This study evaluates the efficacy of modified Vacuum-assisted closure (VAC) combined with a closed suction irrigation system for treating an post-traumatic wound and infection. Methods: We conducted a retrospective study of 20 patients with post-traumatic raw areas from 2020 to 2021 at a single tertiary center. All patients included in the study received modified VAC treatment (VAC combined with a closed suction irrigation system, CSIS) until the wound can be closed secondarily. Detailed information was obtained from the medical records. Results: Reduction in wound size was significant after 1 week of VAC with CSIS treatment. The patients had excellent wound beds after an average of 3 -6 days(1 or 2 cycles of VAC with CSIS) All wounds healed completely and were infection free after an average of 15 days, and the average hospital stay was 22 days. Wounds remained infection free after coverage. Conclusions: This study shows that VAC combined with a CSIS is a superior method to treat raw areas compared to conventional VAC. This improved VAC procedure provides an excellent granulation to facilitate wound healing, hasten closure and shorten the hospital stay.

Lactational breast abscess results from inadequate or partially treated mastitis. Recently, needle aspiration or catheter suction drainage is being adopted in place of incision and drainage. We planned to evaluate the effectiveness of needle aspiration versus vacuum suction drainage in resolution of puerperal breast abscess. One-hundred-twelve mothers with lactational breast abscess were randomized to either ultrasound-guided needle aspiration or vacuum suction drainage. These patients were followed up on alternate days and assessed for complete resolution of breast abscess, pain in the breast on Visual Analog Scale (VAS) of 0–10, day of return to normal breast feeding, number of aspirations needed, recurrence of abscess and total cost of care. In the suction drain group, 98% of mothers enjoyed complete resolution within 10 days as compared to 87% of mothers treated with needle aspiration. Mean VAS at first follow-up was 2.89 in aspiration group and 2.62 in suction group. The VAS reduced to 0.74 in aspiration group and 0.53 in suction drainage group, at the last follow-up. The mean day of recovery was 7 days for aspiration and 5.73 days for suction. Most patients required 3 aspirations. The mean drainage time was 4.5 days. Vacuum suction drainage is the more effective method for achieving resolution of lactational breast abscess and offers greater patient satisfaction compared to needle aspiration.

Hysterectomy the most commonly performed gynaecological surgery world over is mostly a planned surgery commonly done for benign uterine conditions, though relatively high rates of complications have been reported. Blood loss during surgery seems to be a major complication. Anaemia being prevalent in Indian women, adds to the risk of prolong recovery time and postoperative morbidity with excessive blood loss intra operatively. Tranexamic acid (TXA) being an anti fibrinolytic agent have been found to decrease blood loss and requirement of blood transfusion in various surgical procedures and aids in better recovery. To find the effectiveness of tranexamic acid in decreasing blood loss in patients undergoing hysterectomy for benign indications and the need for blood transfusion. Type of study- Retrospective observational study over a period of 1 year in 200 patients.Study was conducted in Obstetrics and Gynaecology department of L.N. medical college, J.K hospital and research centre Bhopal. Approval for conducting study from ethical committee of hospital was taken. A retrospective analysis of all patients record was done who underwent hysterectomy for benign indications over the study period of one year and patient were sorted out in two groups, one (group 1) who received tranexamic acid (TXA) during surgery and other one (group 2) who did not receive TXA during surgery. Outcome of the study was assessed on following parameters - amount of blood lost (measurement of blood loss was done by the amount of blood collected in suction bottle and soiled mops), postoperative haemoglobin level after 24 hours of surgery, blood transfusion requirement, duration of hospital stay. Significantly less intraoperative loss of blood and need for blood transfusion was found in group 1 as compared to group 2. (P=0.0001). In the present study we concluded that a single dose of tranexamic acid given during surgery significantly reduces the blood loss, operating time and need for blood transfusion in patients undergoing hysterectomy for benign indications. Tranexamic acid being an anti fibrinolytic agent can be safely recommended as prophylactic measure for reducing blood loss in hysterectomies specially in low resource setting.

Purpose Inguinal hernia is a common male surgical disease. Intervention carries a wide range of complications such as scrotal haematoma and seroma which may require surgical re-intervention or predispose patients to developing infections, pains or feeling of mass. This could lead to long hospital stay. Scrotal tamponade by bandaging or wearing of tight pants and elevation are practiced to reduce bleeding and haematoma formation. These methods require prolong use. Closed suction drains are scarcely used in resource-deprived communities due to high cost and non-availability. Aim This study was to determine the effectiveness of a closed non-suction drain in preventing scrotal collection requiring further surgical intervention and the predisposition to developing surgical site infection following nylon darn repair of inguinoscrotal hernia. Methods Forty (40) participants were recruited for a preliminary study and assigned into control and interventional groups (CG, IG) for purposes of inserting flexible feeding tube (FFT) wound drain after nylon darn (ND) repair. Daily measurement of drained scrotal collection was carried out in the IG till the day drainage was zero. Residual volumes in IG and wound collection in the CG who were not candidates for re-intervention were determined at 14th and 28th post-operative days using ultrasound scan. Data were analyzed using SPSS version 25. Results Three (3) patients (15.8%) in the CG required re-intervention. Surgical site infection rates for the CG and IG were, respectively, 2/19 versus 0/21 (ρ = 0.134).There was a numerical significant difference in the mean volumes of scrotal collections between the control (0.95 ± 0.42 ml) and the intervention group (0.44 ± 0.33 ml) [p value of 0.041] but with no clinical impact. Conclusion Simple inexpensive flexible feeding tube placement significantly reduced scrotal collection which forms a base for larger sample size in subsequent studies. This could reduce the feared risk of re-intervention, wound infection and long hospital stay post-operative.

BACKGROUND Suction and capillary pull are 2 biopsy techniques used in endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). Although these techniques have been shown to perform comparably in terms of overall diagnostic yield, we hypothesized that the capillary pull technique would be associated with improved rapid on-site evaluation (ROSE) adequacy rates thus allowing for a shorter procedure time. METHODS One hundred eighteen patients undergoing EBUS-TBNA for any indication were randomized to suction or capillary pull techniques for the first biopsy pass; the technique used for all subsequent passes was based on operator preference and was not recorded. The first pass was subjected to ROSE and an adequacy assessment was given. ROSE slides were also scored for cellularity of diagnostic/lesional cells and blood contamination. The overall procedure time was also recorded. RESULTS There were no significant differences between suction and capillary pull techniques in terms of ROSE adequacy rates. Cellularity of diagnostic/lesional cells and blood contamination scores were also comparable. There was no significant difference in procedure time for the 2 techniques. CONCLUSION This study suggests no differences in ROSE outcomes between suction and capillary pull techniques in EBUS-TBNA. The technique used should therefore be left to the discretion of the operator.

Objective: This observational study was done to know the factors responsible and management of suction pneumothorax after trans-hiatal esophagogastrectomy. Materials and Methods: Progressive observational study of 415 patients who underwent trans-hiatal esophagogastrectomy and 35 patients who underwent trans-abdominal esophago-gastrectomy in last five years, for carcinoma esophagus and followed in immediate post-operative period for suction pneumothorax. Results: Ten patients from trans-hiatal group and two patients from trans-abdominal group complicated with suction pneumothorax in immediate post-operative period. It is the corrugated rubber drain site behind the neck incision close to esophago-gastric anastomosis which is responsible for maximum number of cases of suction pneumothorax. Withdrawal of corrugated rubber drain is the first and effective treatment, if diagnosis is made at an earliest point of occurrence of suction pneumothorax. If pneumothorax and air leak is not diagnosed and treated, then other fatal pulmonary complications can occur. Conclusion: Trans-hiatal esophageal dissection is usually associated with mediastinal pleural breach, so bilateral intercostal tube thoracostomy is a rational part of this surgery. Also close observation in immediate post-operative period is necessary to pick-up suction pneumothorax at an earliest point of suspicion. Keywords: Trans- hiatal suction pneumothorax, Esophagogastrectomy suction pneumothorax.

Inappropriate preparation of respiratory gases is associated with serious complications during mechanical ventilation. To develop a temperature monitoring system of respiratory gases within the endotracheal tube, four newborn piglets were studied using an ultra-rapid-response thermometer attached to the closed endotracheal tube suction system. Respiratory gas temperatures were monitored at the mouth-corner level of the endotracheal tube using three thermocouples (Tairway, inserted into the endotracheal tube via the closed suction system; Ttube_centre and Ttube_wall, embedded within the endotracheal tube 0.5 mm and 1.6 mm from the tube wall, respectively). Univariate analysis showed that inspiratory Ttube_centre and inspiratory Ttube_wall were positively correlated with inspiratory Tairway (both p airway on inspiratory Ttube_centre and Ttube_wall and deflation of endotracheal tube cuff (p

Purpose of Review Subcutaneous emphysema is often observed by clinicians in the context of pneumothorax. It is usually clinically insignificant, but in a few cases can progress to threaten the patient’s vision or airway. A variety of approaches to management of such cases are described in the literature. There no controlled trials and no guidelines on management, other than that the cause should be identified and treated wherever possible. The goal of this article is to review the described approaches to subcutaneous emphysema in pneumothorax and provide a reference to the clinician. Summary Treatment can be directed primarily towards treating an underlying pneumothorax and / or towards the subcutaneous emphysema. These are not mutually exclusive approaches. Management of the underlying pneumothorax includes conservative management; use of negative suction; siting of wider bore intercostal drains and definitive surgical management. Management of subcutaneous emphysema may include decompression techniques such as: ‘blow hole’ incisions or subcutaneous angio-catheters or tunnelled drains. In the current absence of controlled trials is not possible to comment on the efficacy of these techniques: no recommendations on management of subcutaneous emphysema in pneumothorax can be made. Management will be significantly influenced by local technical expertise and patient factors for the foreseeable future.

A closed suction system is used to remove endotracheal secretions without interrupting the patient’s ventilation. Closed suctioning may reduce adverse effects associated with suctioning with, for example, decreased clinical signs of hypoxemia and limited environmental, personnel, and patient contamination. However, it is not clear whether ventilation is maintained during the procedure. We aimed to determine the effects of endotracheal tube (ETT) size, suction catheter (SC) size, and SC length in the ETT on ventilation parameters measured during suction. Suction was performed on a test lung, ventilated with either volume-controlled continuous mandatory ventilation (VC-CMV) or pressure-controlled continuous mandatory ventilation (PC-CMV) using ETT sizes of 6.0–8.5 mm paired with SC sizes of 8–16 French gauge (Fr = 0.33 mm). Airway resistance ( Raw), peak inspiratory pressure (PIP), positive end-expiratory pressure (PEEP), and expiratory minute volume ( Vexp) were recorded for each ventilation episode by a HAMILTON-G5 ventilator. Here, Raw was considerably increased by insertion of the SC into the ETT. This Raw effect altered the PIP and Vexp. PIP was increased in VC-CMV because the ventilation area of the ETT was reduced, and Vexp was decreased in PC-CMV in relation to the size of the SC. PEEP decreased with application of the 16 Fr SC and 30 L/min flow rate in VC-CMV. We conclude that airway pressure and minute volume are not maintained during closed endotracheal suctioning with VC-CMV and PC-CMV, respectively. The degree of interference to ventilation is affected through selection of appropriate SC size and ventilation settings.

Objectives Boerhaave’s syndrome is a life-threatening disease with high mortality and morbidity. Endoscopic negative pressure therapy (ENPT) can be used to treat oesophageal perforations. Case presentation We report on a case of oesophageal rupture with peritonitis in a 35-year-old male patient. The start of treatment was 11 h after the perforation event. The treatment of the perforation defect was performed exclusively by intraluminal ENPT, the treatment of peritonitis was performed by laparotomy with abdominal lavage. For ENPT we used two different types of open-pore drains. The first treatment cycle of four days was performed with an open-pored polyurethane foam drainage (OPD), which was placed intraluminal to cover the perforation defect and to empty the stomach permanently. The second treatment cycle of nine days was performed with a thin nasogastric tube like double-lumen open-pored film drainage (OFD). For suction OPD and OFD were connected with an electronic vacuum pump (−125 mmHg). OFD enables active gastric emptying with simultaneous intestinal feeding via an integrated feeding tube. Intraluminal ENPT with a total treatment duration of 13 days was able to achieve the complete healing of the defect. Surgical treatment of the perforation defect was not necessary. The patient was discharged 20 days after initial treatment with a non-irritating abdominal wound and a closed perforation. Conclusions In suitable cases, endoscopic negative pressure therapy is a minimally invasive, organ-preserving procedure for the treatment of spontaneous oesophageal rupture.