Pub Date : 2022-12-05DOI: 10.5005/jp-journals-11010-02111
Rao Vasudha, G. J. Gijoe, P. K. Chakravarthy, Sen Nagamani
{"title":"Time to tracheostomy: Is seven the magic number? A retrospective analysis in a surgical intensive care unit","authors":"Rao Vasudha, G. J. Gijoe, P. K. Chakravarthy, Sen Nagamani","doi":"10.5005/jp-journals-11010-02111","DOIUrl":"https://doi.org/10.5005/jp-journals-11010-02111","url":null,"abstract":"","PeriodicalId":53846,"journal":{"name":"Indian Journal of Respiratory Care","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2022-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48828683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-05DOI: 10.5005/jp-journals-11010-02210
R. B, U. K. Shenoy
Introduction: The success of awake fibreoptic assisted intubation often depends on the adequacy of anaesthesia of the airway and patient comfort for the procedure. Aim: To compare the standard technique (nerve block) of airway anaesthesia with simple aspiration of lignocaine. Methods: Thirty patients in whom difficult airway was anticipated were randomly allocated into either Group A (Aspiration) and Group B (Nerve block). In Group A, 0.2 mL/kg of 1.5% lignocaine was trickled on to the dorsum of the tongue while the patient was encouraged to breathe through the mouth. In Group B, superior laryngeal nerve block and intratracheal injection of lignocaine was used. Fibreoptic bronchoscopy was then carried out by a consultant anaesthesiologist, who was blinded to the local anaesthetic technique used. The patient responses to instrumentation of pharynx, glottis and trachea, and tolerance of the endotracheal tube were noted. Results: Two cases were excluded from the study because of bleeding resulting in subsequent loss of visualisation of glottis through bronchoscope. There was no statistical or clinical difference in the patient responses between the two groups (P > 0.05) due to fibreoptic bronchoscope in the pharynx, larynx and endotracheal tube in the trachea or with regard to the use of rescue medications. Conclusions: Aspiration of 1.5% lignocaine (0.2 mL/kg) provides clinically comparable conditions for intubation as the nerve block technique for awake fibreoptic nasotracheal intubation in patients with anticipated difficult airway.
{"title":"Comparison of two techniques of airway anaesthesia for awake fibreoptic nasotracheal intubation in patients with anticipated difficult airway","authors":"R. B, U. K. Shenoy","doi":"10.5005/jp-journals-11010-02210","DOIUrl":"https://doi.org/10.5005/jp-journals-11010-02210","url":null,"abstract":"Introduction: The success of awake fibreoptic assisted intubation often depends on the adequacy of anaesthesia of the airway and patient comfort for the procedure. Aim: To compare the standard technique (nerve block) of airway anaesthesia with simple aspiration of lignocaine. Methods: Thirty patients in whom difficult airway was anticipated were randomly allocated into either Group A (Aspiration) and Group B (Nerve block). In Group A, 0.2 mL/kg of 1.5% lignocaine was trickled on to the dorsum of the tongue while the patient was encouraged to breathe through the mouth. In Group B, superior laryngeal nerve block and intratracheal injection of lignocaine was used. Fibreoptic bronchoscopy was then carried out by a consultant anaesthesiologist, who was blinded to the local anaesthetic technique used. The patient responses to instrumentation of pharynx, glottis and trachea, and tolerance of the endotracheal tube were noted. Results: Two cases were excluded from the study because of bleeding resulting in subsequent loss of visualisation of glottis through bronchoscope. There was no statistical or clinical difference in the patient responses between the two groups (P > 0.05) due to fibreoptic bronchoscope in the pharynx, larynx and endotracheal tube in the trachea or with regard to the use of rescue medications. Conclusions: Aspiration of 1.5% lignocaine (0.2 mL/kg) provides clinically comparable conditions for intubation as the nerve block technique for awake fibreoptic nasotracheal intubation in patients with anticipated difficult airway.","PeriodicalId":53846,"journal":{"name":"Indian Journal of Respiratory Care","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2022-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45737847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-05DOI: 10.5005/jp-journals-11010-02207
Sanjay Sasikumar, V. Shanbhag, A. Shenoy
Background: Pressure support ventilation (PSV) is a widely used weaning mode that provides varying amount of support with changing lung characteristics. Proportional-assist ventilation plus (PAV+) is a new mode that automatically adjusts to changes in the respiratory system. Aim: This study compared PSV and PAV+ for weaning from mechanical ventilation. Methods: This was a prospective, randomised, control study enrolling 23 adult patients, mechanically ventilated for at least 48 h after passing SBT criteria and a PSV trial of 30 min. They were randomised to receive either PAV+ (Group 1) or PSV (Group 2). A washout time of 30 min was given for patients in either of the group in order to nullify the effect of the previous PSV mode. Two arterial blood gas samples were taken, during the assessment of SBT readiness, and after 60 min on the randomised weaning mode. Clinical signs of respiratory distress and objective weaning criteria were noted. Success and duration of weaning, rapid shallow breathing index (RSBI), rapid shallow breathing index rate (RSBI rate), haemodynamic and respiratory parameters were noted. Results: 13 patients were randomised to PAV+ group; 10 patients to PSV group. Demographic data were similar in both groups. RSBI, RSBI rate, arterial blood gas analysis, peak and mean inspiratory pressure were not different in either group. The average length of ICU stay, duration to wean and days to extubate were almost similar in both groups. Conclusion: Both PAV+ mode and PSV can be used with equal efficiency in patients ready for weaning.
{"title":"Comparison of pressure support ventilation and proportional assist ventilation plus for weaning from mechanical ventilation in critically ill patients","authors":"Sanjay Sasikumar, V. Shanbhag, A. Shenoy","doi":"10.5005/jp-journals-11010-02207","DOIUrl":"https://doi.org/10.5005/jp-journals-11010-02207","url":null,"abstract":"Background: Pressure support ventilation (PSV) is a widely used weaning mode that provides varying amount of support with changing lung characteristics. Proportional-assist ventilation plus (PAV+) is a new mode that automatically adjusts to changes in the respiratory system. Aim: This study compared PSV and PAV+ for weaning from mechanical ventilation. Methods: This was a prospective, randomised, control study enrolling 23 adult patients, mechanically ventilated for at least 48 h after passing SBT criteria and a PSV trial of 30 min. They were randomised to receive either PAV+ (Group 1) or PSV (Group 2). A washout time of 30 min was given for patients in either of the group in order to nullify the effect of the previous PSV mode. Two arterial blood gas samples were taken, during the assessment of SBT readiness, and after 60 min on the randomised weaning mode. Clinical signs of respiratory distress and objective weaning criteria were noted. Success and duration of weaning, rapid shallow breathing index (RSBI), rapid shallow breathing index rate (RSBI rate), haemodynamic and respiratory parameters were noted. Results: 13 patients were randomised to PAV+ group; 10 patients to PSV group. Demographic data were similar in both groups. RSBI, RSBI rate, arterial blood gas analysis, peak and mean inspiratory pressure were not different in either group. The average length of ICU stay, duration to wean and days to extubate were almost similar in both groups. Conclusion: Both PAV+ mode and PSV can be used with equal efficiency in patients ready for weaning.","PeriodicalId":53846,"journal":{"name":"Indian Journal of Respiratory Care","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2022-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45929252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-05DOI: 10.5005/jp-journals-11010-02202
G. Umesh
Plagiarism is a serious form of scientific misconduct that may bring significant disrepute not only for the author in question but also to the concerned institution. Lack of appropriate knowledge on the part of the authors is the major contributor to plagiarism. Educational institutions should take lead role to educate their students and faculty members regarding scientific misconduct and its repercussions
{"title":"Plagiarism - The dark art of scientific writing","authors":"G. Umesh","doi":"10.5005/jp-journals-11010-02202","DOIUrl":"https://doi.org/10.5005/jp-journals-11010-02202","url":null,"abstract":"Plagiarism is a serious form of scientific misconduct that may bring significant disrepute not only for the author in question but also to the concerned institution. Lack of appropriate knowledge on the part of the authors is the major contributor to plagiarism. Educational institutions should take lead role to educate their students and faculty members regarding scientific misconduct and its repercussions","PeriodicalId":53846,"journal":{"name":"Indian Journal of Respiratory Care","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2022-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49098048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-05DOI: 10.5005/jp-journals-11010-02209
Thajunnisa P, U. K. Shenoy
Introduction: Conventionally either partial rebreathing mask or nonrebreathing mask can be used to deliver oxygen concentrations of up to 60%. A simple modification of the partial rebreathing mask using two pieces of respiratory tubing, or ‘tusks’ has been shown to deliver a high FIO2. Aim: This study aimed to evaluate the efficiency of the ‘tuskmask’. Methods: This was a prospective study. Twenty patients of either gender, 18-70 years, ASA PS I or II and scheduled for elective surgery requiring arterial blood pressure monitoring intraoperatively were studied. On the day of surgery, in the operating room, after establishing standard monitoring, an intravenous access was secured. The radial artery was cannulated using a 20 G cannula and hep-locked. A baseline arterial blood gas (ABG) sample was drawn on room air and three more samples taken after breathing oxygen through a 60% Venturi mask, polymask (10 L/min) or tuskmask (10 L/min) for ten minutes each with a ten minutewashout period in between. The ABG samples were analysed at the end of study. Results: The mean age (SD) in years was 53.65 (17.10). There were 15 female and five male patients. The PaO2 obtained with tuskmask was significantly higher with tuskmask compared to polymask and 60% Venturi mask but PaCO2 was similar with all three masks. The mean (95% confidence interval) derived FIO2 of tuskmask was 0.924 (0.872 to 0.97). Conclusion: The tuskmask when used with oxygen flow of 10 L/min, consistently delivers a very high concentration (FIO2 ≥ 0.85) without causing rebreathing.
{"title":"Evaluation of ‘tuskmask’ as an oxygen delivery system","authors":"Thajunnisa P, U. K. Shenoy","doi":"10.5005/jp-journals-11010-02209","DOIUrl":"https://doi.org/10.5005/jp-journals-11010-02209","url":null,"abstract":"Introduction: Conventionally either partial rebreathing mask or nonrebreathing mask can be used to deliver oxygen concentrations of up to 60%. A simple modification of the partial rebreathing mask using two pieces of respiratory tubing, or ‘tusks’ has been shown to deliver a high FIO2. Aim: This study aimed to evaluate the efficiency of the ‘tuskmask’. Methods: This was a prospective study. Twenty patients of either gender, 18-70 years, ASA PS I or II and scheduled for elective surgery requiring arterial blood pressure monitoring intraoperatively were studied. On the day of surgery, in the operating room, after establishing standard monitoring, an intravenous access was secured. The radial artery was cannulated using a 20 G cannula and hep-locked. A baseline arterial blood gas (ABG) sample was drawn on room air and three more samples taken after breathing oxygen through a 60% Venturi mask, polymask (10 L/min) or tuskmask (10 L/min) for ten minutes each with a ten minutewashout period in between. The ABG samples were analysed at the end of study. Results: The mean age (SD) in years was 53.65 (17.10). There were 15 female and five male patients. The PaO2 obtained with tuskmask was significantly higher with tuskmask compared to polymask and 60% Venturi mask but PaCO2 was similar with all three masks. The mean (95% confidence interval) derived FIO2 of tuskmask was 0.924 (0.872 to 0.97). Conclusion: The tuskmask when used with oxygen flow of 10 L/min, consistently delivers a very high concentration (FIO2 ≥ 0.85) without causing rebreathing.","PeriodicalId":53846,"journal":{"name":"Indian Journal of Respiratory Care","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2022-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48342789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-05DOI: 10.5005/jp-journals-11010-02104
J. Sreedharan, Joel D Vazhakat, S. Nair
Tracheostomy is a commonly performed procedure in the intensive care unit. Selection of patients for this procedure should be done carefully after understanding the individual risks and benefits. Optimal care begins with the selection of an appropriate tube for the patient from the wide range of tubes available today. Care of the cuff, proper patient positioning, humidification of inspired gases and a well secured tube would avoid undue complications. Adequate support needs to be given to facilitate communication and swallowing. Emergency equipment for tube change should be readily available. A good tracheostomy care plan also includes oral hygiene, infection control practices, wound care and provision of adequate nutrition. Decannulation may fail, if performed without proper assessment of functional and anatomical changes in the airway. A good understanding of the basic principles of respiratory care will provide better outcome in patients with a tracheostomy
{"title":"Basic principles of respiratory care for patients with tracheostomy","authors":"J. Sreedharan, Joel D Vazhakat, S. Nair","doi":"10.5005/jp-journals-11010-02104","DOIUrl":"https://doi.org/10.5005/jp-journals-11010-02104","url":null,"abstract":"Tracheostomy is a commonly performed procedure in the intensive care unit. Selection of patients for this procedure should be done carefully after understanding the individual risks and benefits. Optimal care begins with the selection of an appropriate tube for the patient from the wide range of tubes available today. Care of the cuff, proper patient positioning, humidification of inspired gases and a well secured tube would avoid undue complications. Adequate support needs to be given to facilitate communication and swallowing. Emergency equipment for tube change should be readily available. A good tracheostomy care plan also includes oral hygiene, infection control practices, wound care and provision of adequate nutrition. Decannulation may fail, if performed without proper assessment of functional and anatomical changes in the airway. A good understanding of the basic principles of respiratory care will provide better outcome in patients with a tracheostomy","PeriodicalId":53846,"journal":{"name":"Indian Journal of Respiratory Care","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2022-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43473852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-05DOI: 10.5005/jp-journals-11010-02213
M. Yadav, Gopinath R, S. Uppin, Sundaram C
Diffuse pulmonary calcification can be (1) metastatic, in which the calcium deposits occur in normal tissues, or (2) dystrophic, in which calcification occurs on injured lung tissue. The pathogenesis of these abnormalities is not fully understood, but hypercalcemia, hyperphosphatemia, alkalosis, and lung damage predispose to calcification and ossification. Standard digital radiography and high resolution computed tomography (HRCT) offer excellent diagnostic sensitivity in the detection of small calcifications inside the lung. We describe the case of a 35 year old male admitted with acute respiratory failure due to acute on chronic lung pathology. His blood culture and bronchial wash cultures were sterile throughout the illness. Bronchial wash culture was negative for acid fast bacilli (AFB), on Gram staining and for any fungal growth. Smears were negative for malignancy. CT scan of the chest showed multiple nodules bilaterally. As all the cultures were sterile, in view of history of unexplained fever, weight loss and unexplained finding of pulmonary nodular lesions, the patient was further investigated on the lines of vasculitic syndromes and the possibility of these syndromes was also ruled out. Postmortem biopsy revealed a diagnosis of diffuse pulmonary calcification syndrome. Diffuse pulmonary calcification is a progressive, normally asymptomatic disease but can lead to critical and fulminant respiratory failure.
{"title":"Diffuse pulmonary calcification syndrome - a case report","authors":"M. Yadav, Gopinath R, S. Uppin, Sundaram C","doi":"10.5005/jp-journals-11010-02213","DOIUrl":"https://doi.org/10.5005/jp-journals-11010-02213","url":null,"abstract":"Diffuse pulmonary calcification can be (1) metastatic, in which the calcium deposits occur in normal tissues, or (2) dystrophic, in which calcification occurs on injured lung tissue. The pathogenesis of these abnormalities is not fully understood, but hypercalcemia, hyperphosphatemia, alkalosis, and lung damage predispose to calcification and ossification. Standard digital radiography and high resolution computed tomography (HRCT) offer excellent diagnostic sensitivity in the detection of small calcifications inside the lung. We describe the case of a 35 year old male admitted with acute respiratory failure due to acute on chronic lung pathology. His blood culture and bronchial wash cultures were sterile throughout the illness. Bronchial wash culture was negative for acid fast bacilli (AFB), on Gram staining and for any fungal growth. Smears were negative for malignancy. CT scan of the chest showed multiple nodules bilaterally. As all the cultures were sterile, in view of history of unexplained fever, weight loss and unexplained finding of pulmonary nodular lesions, the patient was further investigated on the lines of vasculitic syndromes and the possibility of these syndromes was also ruled out. Postmortem biopsy revealed a diagnosis of diffuse pulmonary calcification syndrome. Diffuse pulmonary calcification is a progressive, normally asymptomatic disease but can lead to critical and fulminant respiratory failure.","PeriodicalId":53846,"journal":{"name":"Indian Journal of Respiratory Care","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2022-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46842500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-05DOI: 10.5005/jp-journals-11010-02201
Ramkumar V. Venkateswaran
Patients in ICUs constitute a higher risk group as they are sicker and are subjected to more invasive interventions. It was estimated in one medicalsurgical ICU that around 1.7 errors occur per patient per day.2 Around 29% of these errors had a potential to cause significant harm or death. Given an average length of stay of 3 days in the ICU, this data suggests that nearly all patients who are admitted to an ICU will suffer a potentially life-threatening medical error at some time during their ICU stay. When this data is further extrapolated to cover all ICUs in the United States, it suggests that approximately 85,000 errors can occur every day (of which 24,650 can be potentially life-threatening). And this data applies to an advanced country. Though we have no data to highlight the enormity of the problem in Indian ICUs, we can be sure that safety is a factor that should be causing concern to patients, health care providers and administrators alike.
{"title":"Are intensive care units safe?","authors":"Ramkumar V. Venkateswaran","doi":"10.5005/jp-journals-11010-02201","DOIUrl":"https://doi.org/10.5005/jp-journals-11010-02201","url":null,"abstract":"Patients in ICUs constitute a higher risk group as they are sicker and are subjected to more invasive interventions. It was estimated in one medicalsurgical ICU that around 1.7 errors occur per patient per day.2 Around 29% of these errors had a potential to cause significant harm or death. Given an average length of stay of 3 days in the ICU, this data suggests that nearly all patients who are admitted to an ICU will suffer a potentially life-threatening medical error at some time during their ICU stay. When this data is further extrapolated to cover all ICUs in the United States, it suggests that approximately 85,000 errors can occur every day (of which 24,650 can be potentially life-threatening). And this data applies to an advanced country. Though we have no data to highlight the enormity of the problem in Indian ICUs, we can be sure that safety is a factor that should be causing concern to patients, health care providers and administrators alike.","PeriodicalId":53846,"journal":{"name":"Indian Journal of Respiratory Care","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2022-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42376777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-05DOI: 10.5005/jp-journals-11010-02109
J. Sreedharan, S. Nair, Rakhi B, Rakhi K R, Joel D Vazhakat, Jomson John
Background: Paediatric patients undergoing cardiac surgery are likely to be prone to developing postextubation stridor (PES) due to their airway anatomy and several factors related to surgery, Aim: To examine the incidence and risk factors for PES in paediatric patients undergoing cardiac surgery. Methods: The study was prospectively conducted in the paediatric cardiac postsurgical ICU (PICU) at a tertiary referral hospital from November 2010 to January 2012. All paediatric patients presenting with immediate stridor or its developing within 24 hours after extubation were included. Only those patients who were ventilated for at least 6 hours after surgery, but not more than 7 days and deemed fit for elective extubation were considered. Results: Of the 1328 patients admitted to the PICU, 29 patients (2.18%) met the criteria for PES. Of these, 22 (75.6%) were < 1 year old. Ten patients (34%) did not respond to conservative approach or Noninvasive Ventilation (NIV) and had to be reintubated. Six patients were reintubated within an hour, three in < 6 hours and one after 12 hours of extubation. Conclusion: PES is common in paediatric postcardiac surgical patients. Infants are more prone to develop PES. Majority of them can be successfully managed with conservative measures and noninvasive ventilation. The onset of PES varies from immediately after extubation to 3 hours after extubation. Up to one-third of the patients with PES may require reintubation and is common in the first hour after extubation. Patients who develop PES need close observation in the first few hours after extubation.
{"title":"Postextubation stridor in paediatric cardiac surgery patients","authors":"J. Sreedharan, S. Nair, Rakhi B, Rakhi K R, Joel D Vazhakat, Jomson John","doi":"10.5005/jp-journals-11010-02109","DOIUrl":"https://doi.org/10.5005/jp-journals-11010-02109","url":null,"abstract":"Background: Paediatric patients undergoing cardiac surgery are likely to be prone to developing postextubation stridor (PES) due to their airway anatomy and several factors related to surgery, Aim: To examine the incidence and risk factors for PES in paediatric patients undergoing cardiac surgery. Methods: The study was prospectively conducted in the paediatric cardiac postsurgical ICU (PICU) at a tertiary referral hospital from November 2010 to January 2012. All paediatric patients presenting with immediate stridor or its developing within 24 hours after extubation were included. Only those patients who were ventilated for at least 6 hours after surgery, but not more than 7 days and deemed fit for elective extubation were considered. Results: Of the 1328 patients admitted to the PICU, 29 patients (2.18%) met the criteria for PES. Of these, 22 (75.6%) were < 1 year old. Ten patients (34%) did not respond to conservative approach or Noninvasive Ventilation (NIV) and had to be reintubated. Six patients were reintubated within an hour, three in < 6 hours and one after 12 hours of extubation. Conclusion: PES is common in paediatric postcardiac surgical patients. Infants are more prone to develop PES. Majority of them can be successfully managed with conservative measures and noninvasive ventilation. The onset of PES varies from immediately after extubation to 3 hours after extubation. Up to one-third of the patients with PES may require reintubation and is common in the first hour after extubation. Patients who develop PES need close observation in the first few hours after extubation.","PeriodicalId":53846,"journal":{"name":"Indian Journal of Respiratory Care","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2022-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47087067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-05DOI: 10.5005/jp-journals-11010-02114
N. Shetty, R. Krishna, Tajammul Sayeed
Inability to secure an airway in a hypoxic patient is a nightmare for every anaesthesiologist. The challenge doubles when such situations occur outside the operating room. Many new airway devices have been designed to overcome this difficulty. Airtraq is a videolaryngoscope which has been successfully used in the operating room as a rescue device during difficult laryngoscopy. We describe two such scenarios where Airtraq was used successfully to secure the airway in patients with poor or no glottic view on direct laryngoscopy
{"title":"Use of Airtraq as a rescue device in intensive care unit","authors":"N. Shetty, R. Krishna, Tajammul Sayeed","doi":"10.5005/jp-journals-11010-02114","DOIUrl":"https://doi.org/10.5005/jp-journals-11010-02114","url":null,"abstract":"Inability to secure an airway in a hypoxic patient is a nightmare for every anaesthesiologist. The challenge doubles when such situations occur outside the operating room. Many new airway devices have been designed to overcome this difficulty. Airtraq is a videolaryngoscope which has been successfully used in the operating room as a rescue device during difficult laryngoscopy. We describe two such scenarios where Airtraq was used successfully to secure the airway in patients with poor or no glottic view on direct laryngoscopy","PeriodicalId":53846,"journal":{"name":"Indian Journal of Respiratory Care","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2022-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49011025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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