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      Analysis of the incidence of postintubation injuries in patients intubated in the prehospital or early hospital conditions of the hospital emergency department and the intensive care unit

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          Abstract

          Background

          Intubation is still one of the best methods to secure the airway. In the case of prehospital or early hospital conditions when factors such as urgency, stress, or inaccuracy of the undertaken activities are involved, the risk of causing complications, for instance, edema or postintubation injuries, increases, especially while dealing with a difficult intubation. The risk of improper inflation of the endotracheal tube cuff also increases, which is considered in this study.

          Objective

          The aim of this study was to evaluate the prevalence of postintubation complications, such as postintubation injuries or edema, in a research sample, and to examine whether such complications occur more often, for example, while using a guidewire. In this study, we also evaluated the injuries associated with the inflation of the endotracheal tube cuff.

          Materials and methods

          This study was performed on a group of 153 patients intubated in prehospital conditions. The tests were carried out in three clinical sites that received patients from prehospital care. Postintubation injuries were revealed and photographed using videolar-yngoscope, such as the C-MAC and the McGrath series 5. The endotracheal tube cuff pressure was measured using a pressure gage manual (VBM Medizintechnik GmbH). The quantitative analyses of differences between incidence of variables were assessed using χ 2 test for P<0.05. Analyses have been carried out using the Statistica software.

          Results

          In the group of 153 patients, postintubation injuries occurred in 17% of cases. The dependency between using the guidewire and the occurrence of the hematomas and loss of mucosa was statistically significant ( P<0.01). In nearly half (42%) of the patients the endotracheal tube cuff pressure was excessively inflated over 30 cm H 2O, and in two cases, endotracheal tube displacement was observed on account of poor cuff inflation (<20 cm H 2O).

          Conclusion

          The highest percentage of overfilled cuffs were observed in the admission room. In the other wards, it was observed in 25% of cases. Even though only six cases of poor cuff inflation were noticed, the relationship between the leakage and the clinical conditions of patients is worth examining. The results would help in taking additional measures to reduce the risk of complications.

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          Most cited references 34

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          Can an airway assessment score predict difficulty at intubation in the emergency department?

          To assess whether an airway assessment score based on the LEMON method is able to predict difficulty at intubation in the emergency department. Patients requiring endotracheal intubation in the resuscitation room of a UK teaching hospital between June 2002 and September 2003 were assessed on criteria based on the LEMON method. At laryngoscopy, the Cormack and Lehane grade was recorded. An airway assessment score was devised and assessed. 156 patients were intubated during the study period. There were 114 Cormack and Lehane grade 1 intubations, 29 grade 2 intubations, 11 grade 3 intubations, and 2 grade 4 intubations. Patients with large incisors (p<0.001), a reduced inter-incisor distance (p<0.05), or a reduced thyroid to floor of mouth distance (p<0.05) were all more likely to have a poor laryngoscopic view (grade 2, 3, or 4). Patients with a high airway assessment score were more likely to have a poor laryngoscopic view compared with those patients with a low airway assessment score (p<0.05). An airway assessment score based on criteria of the LEMON method is able to successfully stratify the risk of intubation difficulty in the emergency department. Patients with a poor laryngoscopic view (grades 2, 3, or 4) were more likely to have large incisors, a reduced inter-incisor distance, and a reduced thyroid to floor of mouth distance. They were also more likely to have a higher airway assessment score than those patients with a good laryngoscopic view.
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            Endotracheal tube cuff pressure in three hospitals, and the volume required to produce an appropriate cuff pressure

            Background Cuff pressure in endotracheal (ET) tubes should be in the range of 20–30 cm H2O. We tested the hypothesis that the tube cuff is inadequately inflated when manometers are not used. Methods With IRB approval, we studied 93 patients under general anesthesia with an ET tube in place in one teaching and two private hospitals. Anesthetists were blinded to study purpose. Cuff pressure in tube sizes 7.0 to 8.5 mm was evaluated 60 min after induction of general anesthesia using a manometer connected to the cuff pilot balloon. Nitrous oxide was disallowed. After deflating the cuff, we reinflated it in 0.5-ml increments until pressure was 20 cmH2O. Results Neither patient morphometrics, institution, experience of anesthesia provider, nor tube size influenced measured cuff pressure (35.3 ± 21.6 cmH2O). Only 27% of pressures were within 20–30 cmH2O; 27% exceeded 40 cmH2O. Although it varied considerably, the amount of air required to achieve a cuff pressure of 20 cmH2O was similar with each tube size. Conclusion We recommend that ET cuff pressure be set and monitored with a manometer.
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              Effect of prehospital advanced life support on outcomes of major trauma patients.

              Determine whether prehospital advanced life support (ALS) improves the survival of major trauma patients and whether it is associated with longer on-scene times. A 36-month retrospective study of all major trauma patients who received either prehospital bag-valve-mask (BVM) or endotracheal intubation (ETI) and were transported by paramedics to our Level I trauma center. Logistic regression analysis determined the association of prehospital ALS with patient survival. Of 9,451 major trauma patients, 496 (5.3%) had either BVM or ETI. Eighty-one percent received BVM, with a mean Injury Severity Score of 29 and a mortality rate of 67%; 93 patients (19%) underwent successful ETI, with a mean Injury Severity Score of 35 and a mortality rate of 93%. Adjusted survival for patients who had BVM was 5.3 times more likely than for patients who had ETI (95% confidence interval, 2.3-14.2, p = 0.00). Survival among patients who received intravenous fluids was 3.9 times more likely than those who did not (p = not significant). Average on-scene times for patients who had ETI or intravenous fluids were not significantly longer than those who had BVM or no intravenous fluids. ALS procedures can be performed by paramedics on major trauma patients without prolonging on-scene time, but they do not seem to improve survival.
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                Author and article information

                Journal
                Ther Clin Risk Manag
                Ther Clin Risk Manag
                Therapeutics and Clinical Risk Management
                Therapeutics and Clinical Risk Management
                Dove Medical Press
                1176-6336
                1178-203X
                2015
                01 October 2015
                : 11
                : 1489-1496
                Affiliations
                [1 ]Department of Emergency Medicine and Disaster Medicine, Barlicki University Hospital, Lodz, Poland
                [2 ]Department of Anesthesiology and Intensive Therapy, Medical University of Lodz, Lodz, Poland
                [3 ]Department of Microelectronics and Computer Science, IT Centre, Lodz University of Technology, Lodz, Poland
                Author notes
                Correspondence: Tomasz Gaszynski, Department of Emergency Medicine and Disaster Medicine, Barlicki University Hospital, Medical University of Lodz, Ul Kopcinskiego 22, 90-153 Lodz, Poland, Tel/fax +48 42 678 3748, Email tomasz.gaszynski@ 123456umed.lodz.pl
                Article
                tcrm-11-1489
                10.2147/TCRM.S90181
                4599039
                26491335
                © 2015 Cierniak et al. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License

                The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                Categories
                Original Research

                Medicine

                postintubation injuries, postintubation edema, endotracheal tube cuff pressure

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