Endotracheale Intubation

Ventilator-associated pneumonia diagnosis remains a debatable topic. New definitions of ventilator-associated conditions involving worsening oxygenation have been recently proposed to make surveillance of events possibly linked to ventilator-associated pneumonia as objective as possible. The objective of the study was to confirm the effect of subglottic secretion suctioning on ventilator-associated pneumonia prevalence and to assess its concomitant impact on ventilator-associated conditions and antibiotic use.

The GlideScope Video Laryngoscope may improve the view seen at laryngoscopy in adults who have a difficult airway. Manikin studies and case reports suggest it may also be useful in children, although prospective studies are limited in number. We hypothesised that the paediatric GlideScope will result in an improved view seen at laryngoscopy in children with a known difficult airway, compared to direct laryngoscopy. Eighteen children with a history of difficult or failed intubation were prospectively recruited. After inhalational induction, each patient had laryngoscopy performed using a standard blade followed by GlideScope videolaryngoscopy. The GlideScope yielded a significantly improved laryngoscopic view, both with (p = 0.003) and without (p = 0.004) laryngeal pressure. The mean (SD) time taken to achieve the optimal view was 20 (8)s using conventional laryngoscopy and 26 (22)s using the GlideScope (p = 0.5). The GlideScope significantly improves the laryngoscopic view obtained in children with a difficult airway.

To examine the in vivo relationship between peak inflation pressure and the minimum occlusive pressure of a "high-volume, low-pressure" endotracheal tube cuff that may in some circumstances promote tracheal ischemic complications. Prospective, clinical study. Surgical suite in a university hospital. Fifteen patients undergoing mechanical ventilation and general anesthesia for surgery. After the regularly assigned anesthesia personnel established adequate general anesthesia, the investigator deflated and then reinflated the endotracheal tube cuff until tracheal seal was reestablished by auscultation. Peak inflation pressure and minimum occlusive pressure were determined using fluid-filled transducers to simultaneously record airway pressure just proximal to the endotracheal tube and cuff pressure via the pilot tube. Peak inflation pressure ranged from 12.1 to 43.7 mm Hg, and was associated with a minimum occlusive pressure of 2.2 to 39.7 mm Hg. Minimum occlusive pressure increased linearly over the range of measured peak inflation pressure values (r2 = .85, p < .001). Knowledge of the linear relationship between peak inflation pressure and minimum occlusive pressure can help the clinician identify patients who may be at risk for cuff-induced tracheal ischemic complications, such as tracheoesophageal fistula and tracheal stenosis. In our series, a cuff pressure of 25 mm Hg corresponded to a peak inflation pressure of 35.3 mm Hg (48 cm H2O). Patients with higher peak inflation pressures may be at risk for ischemic tracheal injury, despite proper cuff inflation techniques.