No description available.

<p>Over-inflation of an endotracheal tube (ETT) cuff may lead to tracheal necrosis, whereas under- inflation increases the risk of pulmonary aspiration. The objectives of this 2-phase study were to 1) identify the frequency of abnormal ETT cuff inflation in anesthetized dogs, 2) evaluate ETT cuff inflation with 3 devices (regular syringe, Tru-CuffTM syringe, AG Cuffill syringe) in achieving proper cuff pressure (20-30 cmH2O). Dogs undergoing general anesthesia at Purdue Veterinary Medicine Teaching Hospital (PVMTH) were included. The standard operating procedure (SOP) of PVMTH was used for ETT size selection and cuff inflation. The results of objective 1 showed that 50 of the 80 dogs required ETT cuff inflation. Among these 50 dogs, only 14% had proper cuff inflation; 76% of the cuffs were over-inflated and 10% were under-inflated. For objective 2, 90 dogs were equally assigned to the 3 devices for ETT cuff inflation and cuff pressure was assessed with an aneroid manometer. The results showed that 80% of the ETT cuffs were over-inflated with the regular syringe, whereas only 6.7% and 3.3% ETT cuffs were over-inflated with the Tru-CuffTM and AG Cuffill syringes, respectively. The AG Cuffill syringe treatment group had a significantly higher percentage of proper inflated ETT cuffs (86.7%; both p < 0.05) compared to the other two groups (regular [3.3%]; Tru-CuffTM [50%]). We concluded that there was a high frequency of improper ETT cuff inflation when using SOP coupled with a regular syringe. The use of an AG Cuffill syringe significantly reduced improper ETT cuff inflation.</p>

The aspiration of oral and gastric substances is a well-known risk for ventilator associated pneumonia (VAP) in the intubated, mechanically ventilated (MV), patient of the intensive care unit (ICU) population. The gastric biomarker pepsin and the oral biomarker salivary amylase have been identified as evidence of aspiration prior to the manifestation of acute pulmonary illness. In an effort to decrease the risk for aspiration, several evidence based nursing practices are in place. Actions include 30 degree head of the bed positioning, oral care, suctioning, and circuit change interval protocols, as well as the administration of medication with the objective of reducing acid reflux. Additional recommendations concern the type of endotracheal tube (ETT) used to ventilate the intubated patient. The continuous subglottic suctioning endotracheal tube (CSS-ETT) features an additional port which continually suctions secretions that accumulate above the inflated endotracheal cuff. Patients with standard endotracheal tubes (S-ETT) receive manual, as needed suctioning of accumulated secretions in the mouth and the oropharynx per agency protocol. Research of the critical care population has demonstrated a decreased instance of VAP using CSS-ETT as compared to S-ETT utilization. This study sought to compare the incidence of the biomarkers pepsin and salivary amylase in the suctioned oral and tracheal secretions of patients with S-ETT compared to patients with CSS-ETT. Part of the protocol of a descriptive, comparative study of the clinical indicators for suctioning established the collection of the paired suctioned oral and tracheal aspirates. Those collected aspirates were analyzed for a pilot study of pepsin and amylase analysis. This study compares the incidence of aspirates in oral and tracheal secretions by endotracheal tube type.; The intention of this study was that it would assist in demonstrating beneficial aspects of the selection of the CSS-ETT. It is considered that further investigation with a larger population group could add statistical significance.; Tracheal aspirates were obtained with a closed tracheal suction device while oral secretions were obtained with a suction catheter designed to reach the oropharynx. Biomarkers assayed were the gastric marker pepsin and the oropharyngeal marker salivary amylase. Assays of pepsin and salivary amylase were performed using standard procedures in a specialty diagnostic laboratory. Specimens were obtained from 11 subjects: 8 male and 3 female. The majority were Caucasian (n=9), had a CSS-ETT (n=8), were on mechanical ventilation in the synchronized intermittent mandatory ventilation mode, and on tube feedings (n=9) located in the stomach (n=7). The mean age was 56 years. Feeding tubes were placed in 9 patients, and the majority of the tubes were Dobbhoff. Pepsin was found in the oral secretions of 62.5% (n = 5) of the CSS-ETT subjects, while 50.0% (n = 4) had pepsin in the tracheal aspirate. Pepsin was found in the oral secretions of 66.7% (n = 2) of the S-ETT subjects, and 66.7% (n = 2) had pepsin in their tracheal aspirate. All subjects of both groups (n = 11) had oral salivary amylase detected. Salivary amylase was detected in the tracheal aspirate of 100% (n = 3) of the S-ETT subjects versus 62.5% (n = 5) in CSS-ETT group. Based on the results of this study, there was a reduction in the number of subjects who had oral compared to tracheal aspirate pepsin in the CSS-ETT group (n = 5 oral versus n = 4 tracheal) tube type. The S-ETT group had equal number of subjects with oral (n = 2) and tracheal pepsin detected (n = 2). However, the results when comparing the S-ETT and the CSS-ETT groups were not statistically significant (p = 0.898 pepsin oral and 0.621 tracheal pepsin). There may be clinical significance. It appears that the CSS-ETT was beneficial in that group; two fewer subjects had pepsin in their tracheal aspirate (n = 5 oral versus n = 4 tracheal aspirate pepsin).

Critically ill patients who require MV are at risk for a number of complications, including the development of ventilator-associated events (VAE) and agitation that may require the use of sedation. Patients experience anxiety and discomfort during mechanical ventilation from a variety of sources including unfamiliar breathing assistance and an inability to communicate anxiety and pain verbally, but a primary cause of discomfort identified by these patients is the simply the presence of the endotracheal tube (ETT). Discomfort often leads to agitation and may be exacerbated by ETT movement. Management of agitation typically involves the use of sedative therapy and has been shown to increase the length of stay in the hospital. Additionally, when ETT cuff pressure is not adequately maintained, risk of microaspiration increases and these microaspirations increase the risk of ventilator-associated events. ETT movement may adversely affect the cuff seal against the tracheal mucosa, increasing leakage around the cuff and microaspiration. To date, no studies have described the effect of ETT movement on patient comfort and agitation. Noting the frequency of ETT movement during the provision of nursing care and plausible inadvertent consequences on discomfort and agitation, a research model was created and specific instruments selected in order to study this topic. This dissertation will provide a review of the literature regarding the role of the ETT in microaspiration, as well as detail a study that explores the frequency and amount of ETT movement and its potential effect on agitation.

Orientador: José Reinaldo Cerqueira Braz / Resumo: Justificativa: a hiperinsuflação do balonete do tubo traqueal, causada pela rápida difusão do óxido nitroso (N2O), pode determinar lesões traqueais. Objetivos: comparar as pressões de balonetes de tubos traqueais, contendo ou não válvula reguladora de pressão, durante anestesia com N2O e estudar as eventuais lesões da mucosa do segmento traqueal em contato com o balonete do tubo traqueal. Método: dezesseis cães foram submetidos à anestesia venosa com pentobarbital sódico e anestesia inalatória com N2O (1,5 L.min-1) e O2 (1,0 L.min -1). Os cães foram distribuídos aleatoriamente em dois grupos de acordo com o tubo traqueal utilizado: G1 (n=8) tubo traqueal convencional com balonete de baixa pressão (Portex Blue-Line, Inglaterra); G2 (n=8) tubo traqueal dotado de válvula reguladora de pressão de Lanz (Mallincrodt, EUA). Em ambos os grupos, a insuflação do balonete foi feita com ar até a pressão de 30 cm H2O. A medida da pressão do balonete foi realizada através de manômetro (Mallincrodt, EUA), antes e após 60, 120 e 180 minutos do início da... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Background: High endotracheal tube intracuff pressure caused by fast diffusion of nitrous oxide (N2O) may cause mucosal tracheal lesions. Objectives: We have studied the effects of endotracheal tubes intracuff pressures with or without pressure regulating valve on tracheal mucosa during anesthesia with N2O. Methods: Sixteen dogs were submitted to intravenous anesthesia with pentobarbital and inhalational anesthesia with N2O (1.5 L.min-¹) and O2 (1.0 L.min-¹). The dogs were randomly allocated to two groups according to the endotracheal tube: G1 (n=8) conventional endotracheal tube with low-pressure cuff (Portex Blue-line, England); G2 (n=8) endotracheal tube with pressure regulating valve of Lanz from Mallincrodt (USA). In both groups the cuff insufflation was done with air to adjust cuff pressure to 30 cm H2O. Intracuff pressure was measured using a manometer at zero (control) and 60, 120 and 180 minutes after inhation of the N2O. The animals were sacrificed and biopsy specimens from areas of the trachea in contact with the endotracheal cuff were... (Complete abstract, click electronic address below) / Doutor

Postoperativ halssmärta (POST) är en mycket vanlig komplikation hos patienter som genomgått generell anestesi med intubation.  POST anses av anestesipersonal vara en relativt lindrig komplikation. Patienter upplever det dock som ett stort problem och därför bör det undvikas. Syftet med denna litteraturstudie var att undersöka vad anestesisjuksköterskor kan göra för att förebygga POST som komplikation hos patienter som genomgått generell anestesi med intubation. Examensarbetet är en integrativ litteraturstudie som innefattar tolv globala studier. Litteraturstudiens resultat visar att det finns flera farmakologiska och icke farmakologiska metoder som kan förebygga POST. Lokal behandling med kortikosteroider och NSAID-preparat har förebyggande effekt på POST. Icke farmakologiska interventioner som konformad kuff, substanser som lakritslösning, magnesium och zink lindrar. Vissa studier finner att kortikosteroider och lidokain kan öka förekomsten av POST. I nuläget kan resultatet inte tillämpas av anestesisjuksköterskor då resultaten är tvetydiga och inte kan utföras utan ordination av anestesiolog. Vidare forskning inom området med inriktning på omvårdnad är av yttersta vikt.

Background: Laryngospasm is a common and often serious adverse respiratory event encountered during anesthetic care of children. We examined, in a case control design, the risk factors for laryngospasm in children. Material and Methods: The records of 130 children identified as having experienced laryngospasm under general anesthesia were examined. Cases were identified from those prospectively entered into the Mayo Clinic performance improvement database between January 1, 1996 and December 31, 2005. Potential demographic, patient, surgical and anesthetic related risk factors were determined in a 1 : 2 case-control study. Results: No individual demographic factors were found to be significantly associated with risk for laryngospasm. However, multivariate analysis demonstrated significant associations between laryngospasm and intercurrent upper respiratory infection (OR 2.03 P = 0.022) and the presence of an airway anomaly (OR = 3.35, P = 0.030). Among those experiencing laryngospasm during maintenance or emergence, the use of a laryngeal mask airway was strongly associated even when adjusted for the presence of upper respiratory infection and airway anomaly (P = 0.019). Ten patients experienced postoperatively one or more complications whereas only three complications were observed among controls (P = 0.008). No child required cardiopulmonary resuscitation and there were no deaths in either study cohort. Conclusions: In our pediatric population, the risk of laryngospasm was increased in children with upper respiratory tract infection or an airway anomaly. The use of laryngeal mask airway was found to be associated with laryngospasm even when adjusted for the presence of upper respiratory tract infection and airway anomaly.

No description available.

Bakgrund: I anestesisjuksköterskans ansvar ingår att extubera patienten på ett säkert sätt. I anestesisjuksköterskans arbete fodras ett tvärprofessionellt omhändertagande av patienten inom ett team. Det är ett varierande arbetstempo i en komplex och högteknologisk miljö. Extuberingsprocessen kan medföra många komplikationer som kan ge obehag för patienten som har varit sövd i generell anestesi med endotrachealtub. Extubation ställer därmed höga krav på anestesisjuksköterskan som skall ha fördjupande medicinska och omvårdnadskunskaper vid omhändertagandet av patient. Det saknas forskning kring extubationsprocessen ur en anestesisjuksköterskas perspektiv även om det är ett riskfyllt moment. Syfte: Syftet var att beskriva anestesisjuksköterskors upplevelser och erfarenheter av svårigheter i samband med extubation av patient. Metod: Studien innefattade semistrukturerade intervjuer med nio anestesisjuksköterskor från två sjukhus i Västra Götalandsregionen i Sverige. Datamaterialet analyserades med hjälp av en kvalitativ innehållsanalys. Resultat: Resultatet visade betydande trygghet i att ha utbildning, erfarenhet och kunskap om extubationsprocessen då arbetssättet bygger på erfarenhet. Förmåga att förhålla sig till utmaningar bygger på att anestesisjuksköterskorna upplever en stor respekt för extubationsprocessen eftersom det kan innefatta många risker. Trygghet av att se patientens individuella behov var en betydande faktor för ett komplikationsfritt omhändertagande av patienter. För att främja ett systematiskt och patientsäkert sätt kring patienten, beskrev anestesisjuksköterskorna vikten av utbildning inom extubationsprocessen. Diskussion: I diskussionen jämförs det aktuella resultatet med tidigare forskning. Vidare diskuteras kunskapsbristen och forskning kring fenomenet. Slutsats: Anestesisjuksköterskornas arbete kring extubationsprocessen kräver god kunskap och erfarenhet inom anestesisjukvård. Förmåga till kommunikation och teamarbete är viktiga faktorer för en lyckad extubation.

Made available in DSpace on 2014-06-11T19:30:29Z (GMT). No. of bitstreams: 0 Previous issue date: 2001Bitstream added on 2014-06-13T18:40:40Z : No. of bitstreams: 1 abud_tmv_dr_botfm.pdf: 265309 bytes, checksum: e3b637e472f866c08307b35491fa04cb (MD5) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Justificativa: a hiperinsuflação do balonete do tubo traqueal, causada pela rápida difusão do óxido nitroso (N2O), pode determinar lesões traqueais. Objetivos: comparar as pressões de balonetes de tubos traqueais, contendo ou não válvula reguladora de pressão, durante anestesia com N2O e estudar as eventuais lesões da mucosa do segmento traqueal em contato com o balonete do tubo traqueal. Método: dezesseis cães foram submetidos à anestesia venosa com pentobarbital sódico e anestesia inalatória com N2O (1,5 L.min-1) e O2 (1,0 L.min -1). Os cães foram distribuídos aleatoriamente em dois grupos de acordo com o tubo traqueal utilizado: G1 (n=8) tubo traqueal convencional com balonete de baixa pressão (Portex Blue-Line, Inglaterra); G2 (n=8) tubo traqueal dotado de válvula reguladora de pressão de Lanz (Mallincrodt, EUA). Em ambos os grupos, a insuflação do balonete foi feita com ar até a pressão de 30 cm H2O. A medida da pressão do balonete foi realizada através de manômetro (Mallincrodt, EUA), antes e após 60, 120 e 180 minutos do início da... / Background: High endotracheal tube intracuff pressure caused by fast diffusion of nitrous oxide (N2O) may cause mucosal tracheal lesions. Objectives: We have studied the effects of endotracheal tubes intracuff pressures with or without pressure regulating valve on tracheal mucosa during anesthesia with N2O. Methods: Sixteen dogs were submitted to intravenous anesthesia with pentobarbital and inhalational anesthesia with N2O (1.5 L.min-¹) and O2 (1.0 L.min-¹). The dogs were randomly allocated to two groups according to the endotracheal tube: G1 (n=8) conventional endotracheal tube with low-pressure cuff (Portex Blue-line, England); G2 (n=8) endotracheal tube with pressure regulating valve of Lanz from Mallincrodt (USA). In both groups the cuff insufflation was done with air to adjust cuff pressure to 30 cm H2O. Intracuff pressure was measured using a manometer at zero (control) and 60, 120 and 180 minutes after inhation of the N2O. The animals were sacrificed and biopsy specimens from areas of the trachea in contact with the endotracheal cuff were... (Complete abstract, click electronic address below)