Thesis (M.S.)--University of Wisconsin - Madison. / Typescript. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 61-63).

La sonde d’intubation est le facteur de risque principal des microinhalations. Sa présence empêche la fermeture des cordes vocales, favorisant ainsi la progression des sécrétions oropharyngées vers les voies respiratoires inférieures. Le ballonnet de la sonde trachéale prévient en partie cette microinhalation, mais la présence de microsillons sur les ballonnets en polyvinyl chloride (PVC) et la souspression du ballonnet (<20 cmH2O) favorisent les microinhalations autour du ballonnet. Alors que lésions ischémiques trachéales sévères liées à l’intubation ne sont pas fréquentes, elles sont associées à une morbidité et une mortalité élevées. Leurs principaux facteurs de risque sont la surpression du ballonnet trachéal (>30 cmH2O) et la durée de l’intubation. Hypothèse Malgré les précautions habituelles consistant à réguler la Pbal 3 fois par jour avec un manomètre manuel, les souspressions et surpressions du ballonnet trachéal sont probablement fréquentes. Si tel est le cas la régulation continue de la Pbal avec un régulateur de pression pneumatique permettrait de prévenir les microinhalations et l’ischémie trachéale liées à l’intubation. 1.Déterminer l’incidence et les facteurs de risque de souspression et de surpression du ballonnet trachéal chez les patients de réanimation. 2.Déterminer l’impact du matériau et de la forme du ballonnet sur les variations de la Pbal. 3.Déterminer l’impact de la régulation continue de la Pbal sur la survenue de complications liées à l’intubation sur un modèle animal d’abord puis chez le patient de réanimation. Incidence et facteurs de risque Tout d’abord nous avons réalisé une étude prospective observationnelle sur une cohorte de 101 patients intubés et ventilés afin de déterminer l’incidence des souspressions et surpressions du ballonnet et de déterminer leurs facteurs de risque. La Pbal a été ajustée manuellement toutes les 8h. Les Pbal et pressions des voies aériennes ont été enregistrées en continu sur 8h. Seuls 18% des patients avaient une Pbal constamment normale (20-30 cmH2O). 54% des patients ont présenté des souspressions, 73% des surpressions. De plus, 33% des patients ont présenté une souspression ou une surpression >30 minutes. Les facteurs de risque indépendamment associés à la survenue de souspressions étaient la durée d’intubation (OR=1,1(ICà95 %)1-1,2, p=0,039) et l’absence de sédation (2,5(1-6), p<0,01). Nous n’avons pas pu identifier de facteurs de risques de surpressions. 2.Impact du matériau et de la forme du ballonnet Nous avons réalisé ensuite une autre étude prospective observationnelle afin de déterminer l’impact du polyuréthane (PU) et de la forme du ballonnet sur les variations de la Pbal. 76 patients intubés et ventilés (26 ballonnets en PVC, 22 ballonnets en PU de forme cylindrique [Cy] et 28 ballonnets en PU de forme conique [Co]) ont été inclus. La Pbal a été ajustée manuellement toutes les 8h. Les Pbal et pressions des voies aériennes ont été enregistrées en continu sur 24h. Aucune différence significative n’a été retrouvée entre les 3 groupes quant au pourcentage du temps passé avec une souspression du ballonnet (moy±SD 26±22, 28±12, 30±13% dans les groupes PVC, PUCy et PUCo; respectivement) ou au pourcentage du temps passé avec une surpression (med[25è-75è centiles] 7[2-14], 6[3-14], 11%[5-20]). 3.Impact de la régulation continue de la Pbal sur la survenue de complications •Etude animale Il s’agit d’une étude randomisée contrôlée portant sur 12 porcs intubés et ventilés pendant 48h. L’objectif principal était de déterminer l’impact de la régulation continue de la Pbal sur les lésions ischémiques trachéales. / Microaspiration of contaminated oropharyngeal secretions and gastric contents represents the main pathophysiologic mechanism responsible for VAP. Tracheal tube prevents normal closure of vocal cords resulting in microaspiration of secretions towards lower respiratory tract. The cuff of tracheal tube protects, at least in part, the lower airway from microaspiration. However, folds in polyvinyl-chloride (PVC) cuffs and underinflation of tracheal cuff (<20 cmH2O) favour microaspiration around the cuff. Although, severe tracheal ischemic lesions are not common, they are associated with substantial morbidity and mortality. Their major risk factors include overinflation of tracheal cuff (>30 cmH2O), and prolonged intubation. Hypothesis In spite of routine care of cuff pressure (Pcuff) including manual regulation thrice a day using a manometer, underinflation and overinflation of tracheal cuff are probably common in critically ill patients. In that case, continuous regulation of Pcuff using a pneumatic device would allow preventing intubation-related complications such as microaspiration and tracheal ischemia. To determine incidence of and risk factors for underinflation and overinflation of tracheal cuff in critically ill patients. 2. To determine the impact of polyurethane (PU) and shape of tracheal cuff on variations of Pcuff. To determine the impact of continuous control of Pcuff on the incidence of intubation-related complications first in an animal model, and then in critically ill patients. Methods and results 1.Incidence and risk factors We performed a prospective observational cohort study on 101 intubated patients in order to determine incidence of and risk factors for underinflation and overinflation of tracheal cuff. After manual adjustment of Pcuff at 25 cmH2O, continuous recording of Pcuff and airway pressure was performed for 8 h. Only 18% of study patients spent 100% of recording time with normal (20-30 cmH2O) Pcuff. 54% of study patients developed cuff underinflation, 73% developed cuff overinflation. 33% of study patients developed underinflation or overinflation for >30 min. Absence of sedation [odds ratio (95% confidence interval)=2.5 (1-6), P=0.03] and duration of prior intubation [1.1(1-1.2), P<0.01] were independently associated with cuff underinflation. No risk factor for overinflation could be determined. 2.Impact of polyurethane and tracheal cuff shape We performed another prospective observational before-after study to determine the impact of PU, and tracheal cuff shape on variations in Pcuff in intubated critically ill patients. Pcuff was continuously recorded for 24 h in 76 intubated patients, including 26 with PVC, 22 with cylindrical (C) PU, and 28 with tapered (T) PU-cuffed tracheal tubes. Pcuff was manually adjusted every 8 h by nurses and was maintained around 25 cmH2O. Time spent with cuff underinflation and overinflation was continuously recorded. No significant difference was found in percentage of time spent with underinflation (mean±SD, 26±22, 28±12, 30±13% in PVC, CPU, and TPU groups, respectively) and overinflation [median (IQR), 7(2-14), 6(3-14), 11%(5-20)] among the three groups. 3.Impact of continuous regulation of Pcuff on intubation-related complications. •Animal study This was a prospective randomized controlled study aiming to determine the impact of continuous control of Pcuff on tracheal ischemic lesions. Twelve piglets were intubated and mechanically ventilated for 48 hours.

Background and objective Dexmedetomidine is characterized with effects of sedation, analgesia, amnesia and lack of respiratory depression. Hence, it should be suitable for awake fibreoptic intubation (AFOI). Methods We enrolled 30 oral cancer patients with limited mouth openings who were undergoing AFOI for elective surgery. Patients were randomly allocated into two groups; the Dex group (nU16) that received dexmedetomidine (1.0mgkg-1) infusion and the Control group (nU14) that received fentanyl (1.0mgkg-1) infusion. Main outcomes were evaluated by grading scores presenting conditions for nasal intubation and postintubation. Other analysed parameters included airway obstruction, haemodynamic changes, consumption time for intubation, amnesia level and satisfaction. Results Intubation score (1-5) representing condition for nasal intubation was significantly better in the Dex group [2(1-3)] than in the Control group [3(2-5)] (PU0.001). Postintubation score (1-3) representing tolerance to intubation also showed more favourable results in the Dex group[1(1-3)] than intheControl group[2(2-3)] (PU0.002). The Dex group showed significantly reduced haemodynamic response to intubation than the Control group. Incidence requiring temporary haemodynamic support was higher in the Dex group but not of significance. Both levels of amnesia and satisfaction score were significant in the Dex group. Other analysed parameters such as consumption time for intubation, airway obstruction score and postoperative adverse events did not differ significantly. Conclusion Combination of dexmedetomidine loading with topical anaesthesia provides significant benefit for AFOI in intubation condition, patient tolerance, haemodynamic response, amnesia and satisfaction. Dexmedetomidine is effective for AFOI in anticipated difficult airway with only minor and temporary haemodynamic adverse effects.

No description available.

UA Open Access Publishing Fund / Background: Noninvasive positive-pressure ventilation (NIPPV) use has increased in the treatment of patients with respiratory failure. However, despite decreasing the need for intubation in some patients, there are no data regarding the risk of intubation-related complications associated with delayed intubation in adult patients who fail NIPPV. The objective of this study is to evaluate the odds of a composite complication of intubation following failed NIPPV compared to patients intubated primarily in the medical intensive care unit (ICU). Methods: This is a single-center retrospective cohort study of 235 patients intubated between 1 January 2012 and 30 June 2013 in a medical ICU of a university medical center. A total of 125 patients were intubated after failing NIPPV, 110 patients were intubated without a trial of NIPPV. Intubation-related data were collected prospectively through a continuous quality improvement (CQI) program and retrospectively extracted from the medical record on all patients intubated on the medical ICU. A propensity adjustment for the factors expected to affect the decision to initially use NIPPV was used, and the adjusted multivariate regression analysis was performed to evaluate the odds of a composite complication (desaturation, hypotension, or aspiration) with intubation following failed NIPPV versus primary intubation. Results: A propensity-adjusted multivariate regression analysis revealed that the odds of a composite complication of intubation in patients who fail NIPPV was 2.20 (CI 1.14 to 4.25), when corrected for the presence of pneumonia or acute respiratory distress syndrome (ARDS), and adjusted for factors known to increase complications of intubation (total attempts and operator experience). When a composite complication occurred, the unadjusted odds of death in the ICU were 1.79 (95% CI 1.03 to 3.12). Conclusions: After controlling for potential confounders, this propensity-adjusted analysis demonstrates an increased odds of a composite complication with intubation following failed NIPPV. Further, the presence of a composite complication during intubation is associated with an increased odds of death in the ICU.

<p><strong>Bakgrund:</strong> Nya tekniska lösningar för att intubera patienter börjar bli tillgängliga för operationsavdelningar. Glidescope är ett videolaryngoskop som visar lovande resultat när det gäller underlättande av intubationer för personal framförallt vid svåra luftvägar och intubationer. Forskningen pekar på att Glidescope reducerar antalet intubationsförsök och ökar andelen lyckade förstagångsintubationer. Studier pekar på att det för patienten är fördelaktigt med så få intubationsförsök som möjligt.</p><p><strong>Syfte: </strong>Att undersöka anestesipersonals erfarenheter av att arbeta med Glidescope.</p><p><strong>Metod: </strong>Semistrukturerade individuella intervjuer genomfördes med nio anestesisjuksköterskor och två läkare. En kvalitativ beskrivande ansats med en kvalitativ innehållsanalys som analysmetod har använts. Intervjuerna genomfördes våren 2010 på ett sjukhus i södra norrland.</p><p><strong>Resultat: </strong>Glidescope är ett enkelt och lättanvänt redskap för intubation och detta gäller även för personer med begränsad erfarenhet av Glidescope. Det underlättar intubationer men kan förlänga tiden för att placera tuben. Det reducerar patienttraumat som förknippas med en intubation och ökar patientsäkerheten. Ur ett hygienperspektiv behövs bättre rutiner för användning av Glidescopet. En begränsning för Glidescopet är pågående blödning i svalget.</p><p><strong>Slutsats: </strong>Glidescope är i de flesta fall ett enkelt och lättanvänt redskap för intubation som underlättar främst vid svåra intubationer. Glidescope förbättrar patientsäkerheten. Glidescope är användbart vid studenthandledning. Glidescope begränsas av pågående blödning i svalget och är sämre ur ett hygienperspektiv jämfört med Macintoshlaryngoskopet.</p> / <p><strong>Background:</strong> New technical solutions for patient intubation are becoming available for surgical wards. Glidescope is a video laryngoscope which shows promising results for easy intubation for staff, especially in difficult airways and intubations. Research shows that Glidescope reduces the number of tries and increases the proportion of successful first try intubations. Studies show that the patient benefits from a reduced number of tried intubations.</p><p><strong>Purpose: </strong>To examine anaesthesia staffs experience of working with Glidescope.</p><p><strong>Method: </strong>Semi structured personal interviews were conducted with nine anaesthetic nurses and two anaesthesiologists. A qualitative descriptive approach with a qualitative content analysis as an analysis method was used. The interviews were conducted at a hospital in the middle part of Sweden during the spring of 2010.</p><p><strong>Results: </strong>Glidescope is an easy to use tool for intubation and this is also true for staff with limited experience with Glidescope. It makes intubation easier but may prolong the time to place the tube. Glidescope reduces the trauma for the patient associated with intubation and increases patient safety. From a hygiene perspective better routines are needed for the use of the Glidescope. Glidescope is limited by ongoing bleeding in the throat area.</p><p><strong>Conclusion: </strong>Glidescope is for the most part an easy to use tool which eases difficult intubations. Glidescope improves patient safety. Glidescope is useful in student instruction. Glidescope is limited by on going bleeding in the throat area and is less hygienic than the Macintoshlaryngscope.</p>

No description available.

Bakgrund: Nya tekniska lösningar för att intubera patienter börjar bli tillgängliga för operationsavdelningar. Glidescope är ett videolaryngoskop som visar lovande resultat när det gäller underlättande av intubationer för personal framförallt vid svåra luftvägar och intubationer. Forskningen pekar på att Glidescope reducerar antalet intubationsförsök och ökar andelen lyckade förstagångsintubationer. Studier pekar på att det för patienten är fördelaktigt med så få intubationsförsök som möjligt. Syfte: Att undersöka anestesipersonals erfarenheter av att arbeta med Glidescope. Metod: Semistrukturerade individuella intervjuer genomfördes med nio anestesisjuksköterskor och två läkare. En kvalitativ beskrivande ansats med en kvalitativ innehållsanalys som analysmetod har använts. Intervjuerna genomfördes våren 2010 på ett sjukhus i södra norrland. Resultat: Glidescope är ett enkelt och lättanvänt redskap för intubation och detta gäller även för personer med begränsad erfarenhet av Glidescope. Det underlättar intubationer men kan förlänga tiden för att placera tuben. Det reducerar patienttraumat som förknippas med en intubation och ökar patientsäkerheten. Ur ett hygienperspektiv behövs bättre rutiner för användning av Glidescopet. En begränsning för Glidescopet är pågående blödning i svalget. Slutsats: Glidescope är i de flesta fall ett enkelt och lättanvänt redskap för intubation som underlättar främst vid svåra intubationer. Glidescope förbättrar patientsäkerheten. Glidescope är användbart vid studenthandledning. Glidescope begränsas av pågående blödning i svalget och är sämre ur ett hygienperspektiv jämfört med Macintoshlaryngoskopet. / Background: New technical solutions for patient intubation are becoming available for surgical wards. Glidescope is a video laryngoscope which shows promising results for easy intubation for staff, especially in difficult airways and intubations. Research shows that Glidescope reduces the number of tries and increases the proportion of successful first try intubations. Studies show that the patient benefits from a reduced number of tried intubations. Purpose: To examine anaesthesia staffs experience of working with Glidescope. Method: Semi structured personal interviews were conducted with nine anaesthetic nurses and two anaesthesiologists. A qualitative descriptive approach with a qualitative content analysis as an analysis method was used. The interviews were conducted at a hospital in the middle part of Sweden during the spring of 2010. Results: Glidescope is an easy to use tool for intubation and this is also true for staff with limited experience with Glidescope. It makes intubation easier but may prolong the time to place the tube. Glidescope reduces the trauma for the patient associated with intubation and increases patient safety. From a hygiene perspective better routines are needed for the use of the Glidescope. Glidescope is limited by ongoing bleeding in the throat area. Conclusion: Glidescope is for the most part an easy to use tool which eases difficult intubations. Glidescope improves patient safety. Glidescope is useful in student instruction. Glidescope is limited by on going bleeding in the throat area and is less hygienic than the Macintoshlaryngscope.

No description available.

Bakgrund: På intensivvårdsavdelningar finns olika rutiner kring huruvida endotrakealtubens position hos intuberade skall skiftas eller bibehållas i samma mungipa, då sidbyten kan leda till allvarliga komplikationer. Rutinen vid CIVA har varit att byta endotrakealtubens position på alla intuberade patienter en gång per dygn. Varken rutinen med skifte samt bibehållen position har utvärderats. Syftet med studien är att undersöka oralt intuberade patienters munhälsa vid bibehållen position av endotrakealtub under vårdtiden. Metod: Studien är en kvantitativ deskriptiv tvärsnittsstudie. Ett protokoll utformades för att undersöka hur stor andel av patienterna som får tryckskador i munnen med bibehållen tublägesposition. Resultat: Av totalt 85 oralt intuberade patienter utvecklade 10 rodnad och 7 sår medan 68 hade helt intakt slemhinna. Flest nyupptäckta sår uppkom efter 3-4 dagars intubering medan rodnader var jämnt fördelat. Slutsats: Endast ett fåtal patienter utvecklade tryckskador. Rutinen att bibehålla endotrakealtuben i samma position lämpar sig på patientkategorin på CIVA eftersom medelvårdtiden för intuberade är 3,2 dagar och flertalet extuberas under de 3 första dagarna. Klinisk betydelse: Studien ligger till grund för CIVA:s ändrade rutin att bibehålla endotrakealtubspositionen i samma mungipa och skulle på sikt kunna bidra till att minska samhällskostnaderna genom att reducera förekomsten av VAP och därmed patientvårdtiden / Background: Intensive care units have different routines whether the endotracheal tube position should be shifted or maintained in the same corner of the mouth. Repositioning of the tube can lead to serious complications. The routine at CIVA has been to change the endotracheal tube position in all intubated patients once per day. None of the routines have been evaluated. The objective of this study is to examine the oral health of intubated patients with maintained tube position. Method: The study is a quantitative descriptive cross-sectional study. A protocol was designed to examine the proportion of patients receiving pressure sores in the mouth. Results: Of a total of 85 orally intubated patients, 10 developed redness and 7 wounds while 68 had intact mucosa. The majority of the newly discovered sores occurred after 3-4 days of intubation. Conclusion: Only a few patients developed pressure sores. The routine to maintain the endotracheal tube in the same position is suitable for the patient category at CIVA since the average length of stay for intubated is 3.2 days and the majority were extubated during the first 3 days . Clinical significance: This study is the basis for CIVA's changed routine to maintain the endotracheal tube position in the same corner of the mouth and could eventually help to reduce the costs for society by reducing the incidence of VAP and thus patient care period.