Introduction: Organ dysfunction may lead to critical disease. The critical disease has put many patients to be monitored intensively during medical treatment to restore their body function. Most ...ventilator usage is to support recovery from respiratory system problems. A ventilator is connected to an Endo Tracheal Tube inserted into the patient’s mouth. This study aims to explore in depth the meaning of patient experience dealing with endotracheal tube insertion during hospitalization in intensive care unit.
Methods: This study used a qualitative research design with an interpretative phenomenological approach. This study used purposive sampling, with total 10 participants with inclusion criteria: patient that has endotracheal tube experience more than 2 x 24 hours, 30-70 years of age, conscious, has good memory while in intensive care unit, able to communicate well and are willing to become participants by signing the participant’s informed consent form. The data collection strategy used in-depth interview techniques with semi-structured interview guidelines. Researchers conducted data analysis using NVivo.
Results: There are five themes in this study, namely: pain, feeling thirsty, disoriented, feeling anxiety, and hard to communicate verbally.
Conclusion: Discomfort experienced in patients while utilizing endotracheal tubes and ventilators affects both physically, psychologically, socially, and spiritually. It takes a lot of courage to survive during those hard times. Patients adapt by praying, showing an obedient attitude, keeping calm, and trying to find out their self-comfort position.
Background: Confirmation of the position of the endotracheal tube (ETT) is an essential step for verification of intubation. Failure to diagnose esophageal intubation may lead to fatal consequences. ...Capnography is the gold standard for confirmation of ETT position, but it is practically impossible to be performed in all situations. Ultrasonography (USG) or “visual stethoscope” can be used as an effective alternative for all intubators in all situations. Aims and Objectives: The study was conducted to evaluate the ultrasonography (USG) technique with respect to its efficacy to detect the proper endotracheal position of ETT compared to end-tidal capnography among patients undergoing general anesthesia; to compare the time taken by the USG technique with that of capnography for detection of proper placement of ETT; to assess the feasibility of USG to detect accidental esophageal intubation. Materials and Methods: This prospective comparative cross-sectional observational study was conducted on 68 patients. Both capnography and upper airway USG were performed immediately after intubation to confirm the ETT placement. Sensitivity, specificity, and positive and negative predictive values of upper airway USG were determined against capnography as the reference method. The time required to determine ETT placement by the two methods was found out and compared. Agreement between the methods was assessed with kappa statistics. Results: USG detected all three cases of esophageal intubation but could not detect two patients with correct tracheal intubation. Upper airway USG had a sensitivity of 96.92% (95% confidence interval CI: 93.54–100%), specificity of 100%, positive predictive value of 100%, and negative predictive value of 60% (95% CI: 50.4–69.6%). The Kappa value was found to be 0.735, indicating a good agreement between upper airway USG and capnography for confirmation of ETT placement. Time taken for confirmation of ETT by capnography was 21.68±2.63 s versus 11.44±1.38 s for upper airway USG (P<0.001). USG demonstrated bilateral lung sliding in 60 (88.2%) patients, unilateral lung sliding in 3 (4.4%) patients, and lung sliding was absent in 5 (7.4%) patients. Conclusion: Real-time upper airway USG is an alternative method of confirmation of ETT that is not only sensitive and accurate but is faster than the current gold standard method, capnography.
Introduction: Accurate placement of an endotracheal tube (ETT) is critical for patient safety during medical procedures. The research explores the potential of ultrasound technology to provide a ...reliable alternative for ETT confirmation, offering insights into its diagnostic performance and the implications for enhancing patient care in surgical settings.
Aims & Objectives: To determine the diagnostic accuracy of ultrasound for the confirmation of endotracheal tube keeping Capnography as a Gold standard.
Place and Duration of Study: It is a Cross Sectional study and the study was carried out in Operation Theater Shaikh Zayed Hospital Lahore, within 6 months after approval of synopsis i.e. from 5th May, 2020 till 4th November, 2021.
Material & Methods:Total 219 patients who fulfilled the inclusion criteria were enrolled. After standardization of anesthetic measures all patients were intubated by direct laryngoscopy. ETT placement was assessed by capnometry and by ultrasonography. Endotracheal tube placement was labeled (as per operational definition) on both the techniques.The analysis of the data was conducted using SPSS version 21.0, a p-value of ?0.05 was considered significant.
Results: The mean age, BMI, neck circumference and thyromental distance of the patients was 39±8.15 years, 27±3.42 Kg/m 2, 29.5±4.63cm and 6.9±0.50cm. There were 58% males and 42% females in the study. Ultrasonography exhibited sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy rates of 98.5%, 90.6%, 98.9%, 86.1%, and 97.7%, respectively, in its ability to detect the accurate placement of endotracheal tubes (ETT).
Conclusion: The sensitivity, specificity, diagnostic accuracy and promptness of recognition for confirmation of tracheal placement of ETT is higher withultrasonography compared to the gold standardcapnography in patients undergoing elective surgery under general anesthesia.
We aimed to examine the associations between use of cuffed or uncuffed endotracheal tubes (ETTs) and complications during and after short-term intubation of post-palatoplasty patients without ...intrinsic lung disease.
Retrospective cohort study.
Operating room and PICU.
Children without intrinsic lung disease who had undergone palatoplasty at a single institution. Inclusion criteria: intubation using ETTs with an internal diameter of 3.5 mm and postoperative management in the PICU. Exclusion criteria: 1) patients for whom ETTs with internal diameters other than 3.5 mm were used, 2) patients who had already been extubated in the operating room, and 3) patients who had a tracheostomy.
None.
Eighty-seven patients were screened for eligibility; 71 met the inclusion criteria. Of the 71 patients, 41 (58%) with polyurethane-cuffed ETTs (PUC-ETTs) and 30 (42%) with uncuffed ETTs were enrolled. We failed to identify an association between type of PUC-ETT and the development of atelectasis (odds ratio OR, 1.06; 95% CI, 0.35-3.20;
= 1.00). Similarly, we failed to identify an association between type of PUC-ETT and development of stridor (OR, 1.58; 95% CI, 0.43-5.81;
= 0.715) or hoarseness after extubation (OR, 7.03; 95% CI, 0.83-59.6;
= 0.10). At extubation, air leak pressure was higher in the PUC-ETT group than in the uncuffed ETT group (
< 0.001), a finding which was not evident at intubation. The number of patients who received IV dexamethasone and the cases of inhaled racemic epinephrine were not statistically significant.
In this select population of post-palatoplasty infants without intrinsic lung disease, we failed to identify any association between type of ETT (cuffed or uncuffed) and greater odds of developing respiratory complications. Taken together with the 95% CI of the effect size, our data indicate continued uncertainty about type of ETT that should be used for short-term intubation.
Over-inflation of an endotracheal tube (ETT) cuff may lead to tracheal mucosal irritation, tracheal wall ischemia or necrosis, whereas under-inflation increases the risk of pulmonary aspiration as ...well as leaking anesthetic gas and polluting the environment. The objectives of this two-phase study were to (1) identify the incidence of improper ETT cuff inflation (both over- and under-inflation) using the minimum occlusive volume (MOV) technique coupled with a regular injectable syringe in the anesthetized dogs, and (2) evaluate the performance of two commercially available inflation syringe devices (Tru-Cuff and AG Cuffill®) with the regular injectable syringe in inflating the ETT cuff to a recommended safe cuff pressure range (20-30 cmH
O). Dogs undergoing general anesthesia at Purdue Veterinary Medicine Teaching Hospital were included. The ETT cuff pressure was assessed with an aneroid manometer after the syringe inflation. The results of the first objective showed that a total of 80 dogs enrolled and that 50 of these 80 dogs required ETT cuff inflation. Among the 50 dogs, only 14% had proper ETT cuff inflation; 76% of the ETT cuffs were over-inflated and 10% were under-inflated. Ninety dogs were enrolled for the second objective study and they were randomly and equally assigned to the three syringe device treatment groups. The results showed that 80% of the ETT cuffs were over-inflated in the regular injectable syringe treatment group, whereas only 6.7% and 3.3% ETT cuffs were over-inflated in the Tru-Cuff and AG Cuffill® syringe treatment groups, respectively. The AG Cuffill® syringe treatment group had a significantly (
< 0.05) higher percentage of properly inflated ETT cuffs (86.7%) compared to the other two groups (regular injectable syringe 3.3%; Tru-Cuff syringe 50%. We concluded that there was a high incidence of improper ETT cuff inflation when using MOV technique coupled with a regular injectable syringe. The use of an AG Cuffill® syringe significantly reduced improper ETT cuff inflation.
: We evaluated a new device designed to clean the endotracheal tube in mechanically ventilated patients, the Mucus Shaver.
: Prospective, randomized trial.
: University hospital intensive care unit.
...: We enrolled 24 patients expected to remain ventilated for >72 hrs.
: The Mucus Shaver is a concentric inflatable catheter for the removal of mucus and secretions from the interior surface of the endotracheal tube. The Mucus Shaver is advanced to the distal endotracheal tube tip, inflated, and subsequently withdrawn over a period of 3-5 secs. Patients were prospectively randomized within 2 hrs of intubation to receive standard endotracheal tube suctioning treatment or standard suctioning plus Mucus Shaver use until extubation.
: During the study period, demographic data, recent medical history, adverse events, and staff evaluation of the Mucus Shaver were recorded. At extubation, each endotracheal tube was removed, cultured, and analyzed by scanning electron microscopy. Twelve patients were assigned to the study group and 12 were assigned to the control group. No adverse events related to the use of the Mucus Shaver were observed. At extubation, only one endotracheal tube from the Mucus Shaver group was colonized, whereas in the control group ten endotracheal tubes were colonized (8% vs. 83%; p < .001). Scanning electron microscopy showed little secretions on the endotracheal tubes from the study group, whereas thick bacterial deposits were present on all the endotracheal tubes from the control group (p < .001 by Fisher exact test, using a maximum biofilm thickness of 30 μm as cut-off). The nursing staff was satisfied by the overall safety, feasibility, and efficacy of the Mucus Shaver.
: The Mucus Shaver is a safe, feasible, and efficient device for endotracheal tube cleaning in the clinical setting. The Mucus Shaver is helpful in preventing endotracheal tube colonization by potentially harmful microorganisms.
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