No description available.

Endotracheal suctioning is a procedure performed on a daily basis in hospitals, and is mostly take place in intensive care units (ICUs). (Annapoorna, 2005; Day et al, 2009). It helps removing sputum or secretion out from patients’ trachea. For patients who are under mechanical ventilation, this procedure is vital to maintain their airway patency when they are intubated with endotracheal tube or tracheostomized (Finucane & Santora, 2003). However, the procedure has its own risk and complications such as hypoxaemia, atelectasis, cardiovascular instability and more (Thomson, 2000). There are in general two types of endotracheal suctioning: open and closed system. As disconnection of mechanical ventilation from patients is needed for open endotracheal suctioning (OES), it has a higher risk of complications. However, the cost for OES is much cheaper compared to the closed system. Although OES is widely used in Hong Kong, there is no evidence-based guideline for nurses to follow. The guideline developed by American Association of Respiratory Care (2010) is lack of specificity on the target population and its recommendations were based on mixed literatures targeting on adult and infant patients. Therefore, the aim of this dissertation is to develop an evidence-based guideline for OES in adult patients under mechanical ventilation in ICU. To develop a guideline for OES, search was performed in multiple electronic databases (British Nursing Index, CINAHL, Cochrane Library, Ovid MEDLINE, and PubMed) with keywords related to OES and its complications. A total of 457 studies fulfilled the inclusion criteria and 11 of them were selected. The selected studies were evaluated by quality appraisal checklists, which are developed by Scottish Intercollegiate Guidelines Network (SIGN). Data were extracted for developing the guideline. Evidence have shown that the incidence of post-OES hypoxemia can be reduced by performing hyperoxygenation with 100% oxygen for 4-6 breaths prior and after each open endotracheal suction, accompanying with hyperinflation with 150% of patient’s tidal volume at most 8 breaths/40 seconds delivered by ventilator and prohibiting normal saline instillation into trachea for diluting the sputum. The grades of the recommendations in the guideline were rated with using of the SIGN grading system. The implementation potential was analyzed by the patients’ characteristics, transferability of the findings, feasibility of implementation and cost-benefit ratio. A 12-month implementation program was developed including communication with stakeholders, 4-week pilot testing, and training of ICU staffs, and implementation of OES guideline. The effectiveness of the guideline will be evaluated based on the primary outcome (i.e. oxygen level in blood) for detecting the incidence of hypoxemia. Also, the acceptability of the guideline, compliance of the guideline, financial cost reduction and better quality of service will be used as other evaluation indicators. / published_or_final_version / Nursing Studies / Master / Master of Nursing

No description available.

Purpose: The of this study was to explore the knowledge, level of practice, and the frequency of problems met during the use of CTSS amongst intensive care unit (ICU) nurses and suggest ways to improve the use of the system. Design: A non experimental exploratory design using a descriptive survey approach was employed. Sample: The sample of participants were taken from three governmental hospitals in Abu Dhabi chosen randomly. It included all nurses in the ICUs of three hospitals who happened to be working at the time of the study. The response was Eighty three staff nurses, three charge nurses, and one respiratory therapist. Instrument: A questionnaire consisting of twenty one questions was used to explore the ICU nurses' knowledge, experience, practice, and difficulties met by nurses. Averages, tables, figures, and correlation coefficient were used to analyze the data. Results: Results showed a positive correlation (+0.0433) between the level of knowledge and length of use of the system but the effect is minimal. Again the knowledge and the frequency of use on ventilated patients were minimally positive (+0.0898). On the other hand, the relation between the frequency of use and the years of experience was more positively related than the frequency of use and the knowledge. Conclusion: There is a need to set a plan aiming at making the system more frequently used. Not only that , but it should be used safely and appropriately and supported by policy and procedure guidelines. / Thesis (M.Cur.)-University of Natal, Durban, 2001.

Thesis (M.Tech.: Emergency Medical Care)-Dept. of Emergency Medical Care and Rescue, Durban University of Technology, 2008. xii, 301 leaves, Annexures A-0 to A-7 / Paramedic clinical decision making (CDM) surrounding emergency airway management of the critically ill or injured patient in the pre-hospital environment is poorly understood. In order to deliver pre-hospital care effectively it is necessary to understand how paramedics make clinical decisions in this area and determine what influences clinical practice. This study primarily investigated the factors influencing paramedic CDM in the context of advanced emergency airway management with specific focus on the newly introduced skill of rapid sequence intubation (RSI). An evaluation of the correct application of RSI guidelines, the determination of the need for their review and the identification of measures to enhance CDM around RSI were secondary research questions.

Orientador: Norma Sueli Pinheiro Módolo / Banca: Lais Helena Navarro e Lima / Banca: Eliana Marisa Ganem / Banca: Leopoldo Muniz da Silva / Banca: Angélica de Fátima de Assunção Baga / Resumo: A intubação traqueal de pacientes pediátricos, especialmente de crianças com idade inferior a oito anos, foi por muito tempo realizada exclusivamente com uso de tubos traqueais sem balonete devido ao risco do mesmo causar lesão na mucosa traqueal. Diversos estudos demonstraram a possibilidade do uso de cânulas traqueais com balonete de alta complacência e baixa pressão em crianças sem ter ocorrido aumento do risco de lesões de via aérea. O emprego da lidocaína alcalinizada no preenchimento do balonete apresentou diminuição na incidência de morbidade laringotraqueal no pós-operatório em adultos. Contudo, não há estudos comparando o uso de balonete preenchido com lidocaína alcalinizada e seus benefícios na população pediátrica. Comparar a utilização de cânulas traqueais com balonetes preenchidos com solução fisiológica, ar ou lidocaína alcalinizada a 1% e a 0,5% na prevenção de morbidades laringotraqueais, da agitação e da alteração hemodinâmica, no período pós-operatório, em pacientes com idade de três a 13 anos submetidos à anestesia geral. Cento e sessenta e quatro pacientes pediátricos submetidos à anestesia geral balanceada foram distribuídos em quatro grupos, de acordo com o preenchimento do balonete do tubo traqueal: grupo SF (n 41) preenchido com solução fisiológica 0,9%; grupo AR (n= 41) preenchido com ar ambiente; grupo L1% (n=41) preenchido com lidocaína alcalinizada a 1%; grupo L 0,5% (n=41) preenchido com lidocaína alcalinizada a 0,5%. Os balonetes foram lubrificados com gel hidrossolúvel antes da intubação traqueal e, após a intubação traqueal, preenchidos com ar ou a solução de acordo com o grupo até ser obtida a pressão de selo. A pressão do balonete foi mantida abaixo ou igual a 20 cm H2O. Os dados relativos aos atributos hemodinâmicos... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Tracheal intubation in pediatric patients, especially children under 8 years old, was for long performed exclusively with uncuffed tracheal tubes due to the risk of tracheal mucosal damage. Several studies have demonstrated the possibility of the use of cuffed tracheal tube with high compliance and low pressure in children. Its use has occurred without increasing risk of airway injury. The use of alkalized lidocaine filling the cuff showed a decrease in the incidence of laryngotracheal morbidity in adults postoperatively. However, there are no studies comparing the use of cuff filled with alkalinized lidocaine and its benefits in the pediatric population. compare the use of cuffed tracheal tubes filled with saline, air or alkalized 1% and 0.5% lidocaine in preventing laryngotracheal morbidity, and hemodynamic changes in the postoperative period in patients aged between 3 and 13 years undergoing general anesthesia. one hundred sixty four pediatric patients undergoing balanced general anesthesia were divided into four groups, according to the filling of the tracheal tube cuff: saline group (n=41) filled with 0.9% saline; AR group (n=41) filled with ambient air; L1% group (n=14) filled with alkalinized 1% lidocaine; group L 0.5% (n=41) filled with alkalinized 0.5% lidocaine. All cuffs were lubricated with water-soluble gel before tracheal intubation. After tracheal intubation, they were filled until reaching sealing pressure. The cuff pressure was kept below or equal to 20 cm H2O. Data on respiratory and hemodynamic parameters were obtained before intubation and after 30, 60, 90 and 120 minutes of anesthesia and at the end of surgery, immediately before and after extubation. After 30 minutes of intubation, a sample of peripheral venous blood was collected from patients who had the cuffs filled with lidocaine for determination of its plasma concentration... (Complete abstract click electronic access below) / Doutor

Thesis (M.Tech.: Emergency Medical Care)-Dept. of Emergency Medical Care and Rescue, Durban University of Technology, 2008. xii, 301 leaves, Annexures A-0 to A-7 / Paramedic clinical decision making (CDM) surrounding emergency airway management of the critically ill or injured patient in the pre-hospital environment is poorly understood. In order to deliver pre-hospital care effectively it is necessary to understand how paramedics make clinical decisions in this area and determine what influences clinical practice. This study primarily investigated the factors influencing paramedic CDM in the context of advanced emergency airway management with specific focus on the newly introduced skill of rapid sequence intubation (RSI). An evaluation of the correct application of RSI guidelines, the determination of the need for their review and the identification of measures to enhance CDM around RSI were secondary research questions.

Made available in DSpace on 2014-06-11T19:30:29Z (GMT). No. of bitstreams: 0 Previous issue date: 2013-04-17Bitstream added on 2014-06-13T21:01:12Z : No. of bitstreams: 1 soares_smf_dr_botfm.pdf: 880552 bytes, checksum: 62410b338ee94ef382aa18f6ceb2dce9 (MD5) / A intubação traqueal de pacientes pediátricos, especialmente de crianças com idade inferior a oito anos, foi por muito tempo realizada exclusivamente com uso de tubos traqueais sem balonete devido ao risco do mesmo causar lesão na mucosa traqueal. Diversos estudos demonstraram a possibilidade do uso de cânulas traqueais com balonete de alta complacência e baixa pressão em crianças sem ter ocorrido aumento do risco de lesões de via aérea. O emprego da lidocaína alcalinizada no preenchimento do balonete apresentou diminuição na incidência de morbidade laringotraqueal no pós-operatório em adultos. Contudo, não há estudos comparando o uso de balonete preenchido com lidocaína alcalinizada e seus benefícios na população pediátrica. Comparar a utilização de cânulas traqueais com balonetes preenchidos com solução fisiológica, ar ou lidocaína alcalinizada a 1% e a 0,5% na prevenção de morbidades laringotraqueais, da agitação e da alteração hemodinâmica, no período pós-operatório, em pacientes com idade de três a 13 anos submetidos à anestesia geral. Cento e sessenta e quatro pacientes pediátricos submetidos à anestesia geral balanceada foram distribuídos em quatro grupos, de acordo com o preenchimento do balonete do tubo traqueal: grupo SF (n 41) preenchido com solução fisiológica 0,9%; grupo AR (n= 41) preenchido com ar ambiente; grupo L1% (n=41) preenchido com lidocaína alcalinizada a 1%; grupo L 0,5% (n=41) preenchido com lidocaína alcalinizada a 0,5%. Os balonetes foram lubrificados com gel hidrossolúvel antes da intubação traqueal e, após a intubação traqueal, preenchidos com ar ou a solução de acordo com o grupo até ser obtida a pressão de selo. A pressão do balonete foi mantida abaixo ou igual a 20 cm H2O. Os dados relativos aos atributos hemodinâmicos... / Tracheal intubation in pediatric patients, especially children under 8 years old, was for long performed exclusively with uncuffed tracheal tubes due to the risk of tracheal mucosal damage. Several studies have demonstrated the possibility of the use of cuffed tracheal tube with high compliance and low pressure in children. Its use has occurred without increasing risk of airway injury. The use of alkalized lidocaine filling the cuff showed a decrease in the incidence of laryngotracheal morbidity in adults postoperatively. However, there are no studies comparing the use of cuff filled with alkalinized lidocaine and its benefits in the pediatric population. compare the use of cuffed tracheal tubes filled with saline, air or alkalized 1% and 0.5% lidocaine in preventing laryngotracheal morbidity, and hemodynamic changes in the postoperative period in patients aged between 3 and 13 years undergoing general anesthesia. one hundred sixty four pediatric patients undergoing balanced general anesthesia were divided into four groups, according to the filling of the tracheal tube cuff: saline group (n=41) filled with 0.9% saline; AR group (n=41) filled with ambient air; L1% group (n=14) filled with alkalinized 1% lidocaine; group L 0.5% (n=41) filled with alkalinized 0.5% lidocaine. All cuffs were lubricated with water-soluble gel before tracheal intubation. After tracheal intubation, they were filled until reaching sealing pressure. The cuff pressure was kept below or equal to 20 cm H2O. Data on respiratory and hemodynamic parameters were obtained before intubation and after 30, 60, 90 and 120 minutes of anesthesia and at the end of surgery, immediately before and after extubation. After 30 minutes of intubation, a sample of peripheral venous blood was collected from patients who had the cuffs filled with lidocaine for determination of its plasma concentration... (Complete abstract click electronic access below)

Orientador: Alfio Jose Tincani / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Mèdicas / Made available in DSpace on 2018-08-17T20:11:17Z (GMT). No. of bitstreams: 1 Servin_SilvioOscarNoguera_D.pdf: 954922 bytes, checksum: 98d734a92e137d605954e5dfefe3a20a (MD5) Previous issue date: 2011 / Resumo: Introdução: Pacientes que necessitam permanecer sob intubação endotraqueal por longos períodos ou que são submetidos à anestesia geral, poderão ter lesão na luz da traquéia devido a pressões exercidas pelo balonete terminal do tubo endotraqueal (TET). Em alguns casos, estas lesões no epitélio poderão evoluir para estenose ou ocasionalmente necrose. Objetivo: Apresentar um modelo de tubo endotraqueal modificado (TETM) em que a pressão do balonete é variável com o ciclo da ventilação mecânica, sendo o mesmo avaliado em simulador pulmonar e animal. Método: Em simulador pulmonar acoplado a ventilador mecânico (VM) ajustado para dois volumes correntes (VC) de 10 e 15 mL/Kg e complacência de 60 mL/cmH²0, foram utilizados dois modelos de tubos endotraqueais para avaliar a eficiência da ventilação do TETM. O primeiro, identificado como modificado (TETM), e o segundo como convencional (TETC) ambos de número 7,5 mm e 8,0 mm. Foi ainda realizado comparação entre os dois modelos de tubos em suinos da raça Large White sob anestesia geral e VM por período de 48 horas contínuas, sendo os animais posteriormente eutanasiados para análise histopatológica das traquéias. Resultados: Ambos TETM (7,5 e 8,0 mm) apresentaram escape de ar no simulador pulmonar. O menor escape (13%) foi observado no TETM de 7,5 mm com VC = 15 mL/Kg e o maior escape (32%) no TETM de 8,0 mm com VC = 10 mL/Kg. Apesar disto, ambos TETM apresentaram boa eficiência no simulador pulmonar. Na avaliação do uso dos TET em porcos, a análise histopatológica dos cortes seriados de suas traquéias foi observado que o TETM causou menos áreas traumáticas em seu epitélio tanto macro como microscopicamente, quando comparado com o TETC. Conclusão: O uso de novo modelo de TET poderá diminuir o risco da ocorrência de lesão traqueal sem prejuízo relevante para a mecânica respiratória / Abstract: Introduction: Patients who need to undergo endotracheal intubation for a long periods or who are under general anesthesia, may have damage in the trachea light due to pressure from the cuff end. In some cases, the lesions in the tracheal epithelium may progress to stenosis or occasionally necrosis. Objective: Show a modified endotracheal tube (TETM) in both a lung simulator and animals in which the cuff pressure is variable according to the mechanical ventilation cycle. Method: In a lung simulator coupled to a mechanical ventilator (MV) fitted with two tidal volumes (Vt) (10 and 15mL/Kg) and compliance of 60mL/cmH20, two types of endotracheal tubes were used: modified (TETM) and conventional (TETC) with numbers 7.5 and 8.0 in order to evaluate the efficiency of TETM ventilation. There was also a comparison between two pipe models in MV anesthetized pigs for a period of 48 hours after which the animals were put down and a histopathology of the tracheas was carried out. Results: Both TETMs (7.5 and 8.0) had air leaks in the lung simulator. The smallest air leak (13%) was observed at 7.5 with TETM VC = 15 mL / kg and the highest (32%) at 8.0 with TETM VC = 10 mL / kg. In spite of that, both TETM showed good efficiency at lung simulator. From histopathological evaluation, in serial sections of the animals' trachea, we observed that TETM caused less traumatic areas in their epithelium, both macro and microscopically, when compared to TETC. Conclusion: The use of this new TETM may decrease the risk of occurrence of tracheal injury without relevant damage in respiratory mechanics / Doutorado / Fisiopatologia Cirúrgica / Doutor em Ciências da Cirurgia

Submitted in fulfilment of the Master's Degree in Clinical Technology, Durban University of Technology, 2010. / Introduction: The aim of this study was to establish the most reliable standard method for monitoring endotracheal tube cuff pressure in an intensive care unit. Methodology: The study was conducted at King Edward VIII Hospital ICU on adult patients undergoing prolonged intubation of more than 24 hours. Consent was obtained from the patient’s next of kin. The patient’s Pcuff for this study was recorded in two ways simultaneously for a period of 12 hours during the day. The principal investigator recorded the Pcuff thrice during the study period using the Posey cufflator®. Continuous recording was done using a pressure transducer connected to the Nihon Kohden BSM®. Factors causing changes in Pcuff were also documented. Results: Thirty-five critically ill adult patients were enrolled into the study. Nineteen (54.3%) of the subjects were male. Seventeen out of 35 subjects were studied for the entire 720 minute period. The mean time of study of the group was 667 minutes with the lowest period being 135 minutes for one patient. The group mean ± Standard deviation (SD) was 26.6 8.7 with a 95% confidence index of 9.2 – 44.0 and the median value was 25 for continuous readings. For the entire group, 13% of the time was spent in the low pressure range (< 20 cmH2O), while 23% was spent in the high pressure (> 30 cmH2O). A mean of 64% of the time was spent in the normal pressure range. Overall, the most frequently encountered events that caused pressure changes were body movement, coughing, head movement and suctioning accounting for 26.2%, 20.1%, 19.2% and 9.4% respectively. For intermittent readings, the mean ± SD of all patients for T0 was 25.3 ± 6.9; for T6 25.9 ± 8.7 and for T12 24.8 ± 3.8. The overall mean ± SD for all readings was 25.6 ± 7.1. For the entire group, 12% of the time was spent in the low pressure range (< 20 cmH2O), while 5% was spent in the high pressure (> 30 cmH2O). A mean of 83% of the time was spent in the normal pressure range. The correlation between intermittent pressure and the continuous reading at the same time was r = 0.87. iii Discussion: Continuous monitoring of Pcuff indicated that the endotracheal cuff pressure varies extensively during mechanical ventilation in critically ill patients, such variation being noted both between patients and within an individual patient. In an attempt to compare intermittent and continuous monitoring of endotracheal cuff pressures, a good correlation between the two measurements was demonstrated. However, the variations in pressures noted for an individual patient would not have been detected if endotracheal cuff pressures were monitored intermittently. Hence, with continuous monitoring the pressure changes may be detected early. Conclusion: Continuous monitoring of cuff pressure during mechanical ventilation in intensive care units is thus recommended for all patients. If intermittent monitoring is performed, it should be more frequently than eight-hourly. It is recommended that a pressure range of 20-30 cmH2O still be used as the normal range. The role of self adjusting pressure devices, although needing further exploration, holds much promise. / DUT Postgraduate Development Services.