Pub Date : 2022-12-13DOI: 10.5005/jp-journals-11010-05208
S. Prasad, Yogesh K. Gaude
Heat and moisture exchange filters (HMEFs) have been a controversial yet widely used adjunct to breathing circuit. Here we discuss a case scenario where clogging of HMEF with moisture presented as elevated peak airway pressures. Apart from stressing the importance of monitoring airway pressure, we discuss about the judicious use of HMEFs, problems associated with their use and measures to overcome the same. Being a ubiquitous adjunct, a thorough knowledge of its functioning and constant vigilance during its use is of paramount importance
{"title":"HME filters: a boon or bane?","authors":"S. Prasad, Yogesh K. Gaude","doi":"10.5005/jp-journals-11010-05208","DOIUrl":"https://doi.org/10.5005/jp-journals-11010-05208","url":null,"abstract":"Heat and moisture exchange filters (HMEFs) have been a controversial yet widely used adjunct to breathing circuit. Here we discuss a case scenario where clogging of HMEF with moisture presented as elevated peak airway pressures. Apart from stressing the importance of monitoring airway pressure, we discuss about the judicious use of HMEFs, problems associated with their use and measures to overcome the same. Being a ubiquitous adjunct, a thorough knowledge of its functioning and constant vigilance during its use is of paramount importance","PeriodicalId":53846,"journal":{"name":"Indian Journal of Respiratory Care","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42109384","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-11010-02102
I. McLellan
{"title":"End-of-life issues in the ICU","authors":"I. McLellan","doi":"10.5005/jp-journals-11010-02102","DOIUrl":"https://doi.org/10.5005/jp-journals-11010-02102","url":null,"abstract":"","PeriodicalId":53846,"journal":{"name":"Indian Journal of Respiratory Care","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43864782","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-11010-02106
Prasad K. N, Jyothsna M, Shenoy U. K
Background: Rapid sequence intubation with application of cricoid pressure is widely practiced in all emergency situations to prevent aspiration of gastric contents. Stylet or gum elastic bougie is used as intubation aid for rapidly securing the airway. Aim: To compare gum elastic bougie and malleable stylet as aids for endotracheal intubation during application of cricoid pressure. Results: Endotracheal intubation was successful in the first attempt in all of the 60 patients enrolled in the study. Time taken for laryngoscopy and intubation was clinically similar in both the groups of patients. However, in the stylet group, successful ET intubation was achieved in about 7 sec less when compared to the bougie group (p< 0.05). Ease of intubation as compared using the Visual Analogue Scale (VAS) Score was similar in both groups. Laryngeal view improved in 22 patients of 60 patients (36.66%) after application of cricoid pressure, while it remained the same as before in 22. Overall, the grade remained the same or improved after cricoid pressure in 73.3% of patients. The laryngeal view worsened in 16 patients (27.7%). Conclusion: Gum elastic bougie and stylet are equally effective intubation aids during rapid sequence intubation. Intubation aided by bougie takes more time than that of a stylet, even though it is clinically trivial. Cricoid pressure does not affect the laryngoscopic visualisation of glottis in majority of patients
{"title":"Comparison between gum elastic bougie and malleable stylet as aids to intubation during application of cricoid pressure: a prospective randomised controlled study","authors":"Prasad K. N, Jyothsna M, Shenoy U. K","doi":"10.5005/jp-journals-11010-02106","DOIUrl":"https://doi.org/10.5005/jp-journals-11010-02106","url":null,"abstract":"Background: Rapid sequence intubation with application of cricoid pressure is widely practiced in all emergency situations to prevent aspiration of gastric contents. Stylet or gum elastic bougie is used as intubation aid for rapidly securing the airway. Aim: To compare gum elastic bougie and malleable stylet as aids for endotracheal intubation during application of cricoid pressure. Results: Endotracheal intubation was successful in the first attempt in all of the 60 patients enrolled in the study. Time taken for laryngoscopy and intubation was clinically similar in both the groups of patients. However, in the stylet group, successful ET intubation was achieved in about 7 sec less when compared to the bougie group (p< 0.05). Ease of intubation as compared using the Visual Analogue Scale (VAS) Score was similar in both groups. Laryngeal view improved in 22 patients of 60 patients (36.66%) after application of cricoid pressure, while it remained the same as before in 22. Overall, the grade remained the same or improved after cricoid pressure in 73.3% of patients. The laryngeal view worsened in 16 patients (27.7%). Conclusion: Gum elastic bougie and stylet are equally effective intubation aids during rapid sequence intubation. Intubation aided by bougie takes more time than that of a stylet, even though it is clinically trivial. Cricoid pressure does not affect the laryngoscopic visualisation of glottis in majority of patients","PeriodicalId":53846,"journal":{"name":"Indian Journal of Respiratory Care","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42790421","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-11010-02203
I. McLellan
{"title":"The end of life issues - Part 2","authors":"I. McLellan","doi":"10.5005/jp-journals-11010-02203","DOIUrl":"https://doi.org/10.5005/jp-journals-11010-02203","url":null,"abstract":"","PeriodicalId":53846,"journal":{"name":"Indian Journal of Respiratory Care","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49098993","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-11010-02211
Tajammul Sayeed, A. Shenoy, U. Goneppanavar
Introduction: Several drugs have been used to enhance patient comfort during awake nasal fibreoptic intubation (AFOI) process. Most of these can cause dangerous airway or haemodynamic compromise. This study compared combination of midazolam and fentanyl against dexmedetomidine. Methods: Thirty two adults undergoing AFOI were randomly allocated into group MF (1mg midazolam and 1 µg/kg fentanyl) or group D (dexmedetomidine 1µg/kg over 10 minutes). Following standard airway topicalisation technique, the study drugs were administered and AFOI was performed. Results: The demographic data, patient comfort score, post intubation score, endoscopy and intubation times were comparable. The endoscopy was observed to be easy in all patients except 2 in MF group while intubation was easy in all (group D) versus 12 patients in group MF (P value 0.03). Significant haemodynamic response was observed in group MF while patients were more stable in group D. Postoperatively, 10 and two patients in groups D and MF respectively felt sedation was excellent (P value 0.02) while increased need for sedation was felt by one and three patients in groups D and MF respectively (P value 0.028). AFOI was remembered by six and one patients in groups D and MF respectively (P value 0.003). Two in group D and three in group MF had moderate discomfort. None experienced severe discomfort. The overall satisfaction score was comparable. There were no serious adverse events during the study. Conclusions: Dexmedetomidine provides better intubating conditions and patient satisfaction without adversely affecting the airway or haemodynamic stability during AFOI
{"title":"Comparison of the safety and effectiveness of dexmedetomidine with a combination of midazolam and fentanyl for sedation during awake fibreoptic nasotracheal intubation","authors":"Tajammul Sayeed, A. Shenoy, U. Goneppanavar","doi":"10.5005/jp-journals-11010-02211","DOIUrl":"https://doi.org/10.5005/jp-journals-11010-02211","url":null,"abstract":"Introduction: Several drugs have been used to enhance patient comfort during awake nasal fibreoptic intubation (AFOI) process. Most of these can cause dangerous airway or haemodynamic compromise. This study compared combination of midazolam and fentanyl against dexmedetomidine. Methods: Thirty two adults undergoing AFOI were randomly allocated into group MF (1mg midazolam and 1 µg/kg fentanyl) or group D (dexmedetomidine 1µg/kg over 10 minutes). Following standard airway topicalisation technique, the study drugs were administered and AFOI was performed. Results: The demographic data, patient comfort score, post intubation score, endoscopy and intubation times were comparable. The endoscopy was observed to be easy in all patients except 2 in MF group while intubation was easy in all (group D) versus 12 patients in group MF (P value 0.03). Significant haemodynamic response was observed in group MF while patients were more stable in group D. Postoperatively, 10 and two patients in groups D and MF respectively felt sedation was excellent (P value 0.02) while increased need for sedation was felt by one and three patients in groups D and MF respectively (P value 0.028). AFOI was remembered by six and one patients in groups D and MF respectively (P value 0.003). Two in group D and three in group MF had moderate discomfort. None experienced severe discomfort. The overall satisfaction score was comparable. There were no serious adverse events during the study. Conclusions: Dexmedetomidine provides better intubating conditions and patient satisfaction without adversely affecting the airway or haemodynamic stability during AFOI","PeriodicalId":53846,"journal":{"name":"Indian Journal of Respiratory Care","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43591921","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-11010-02212
A. Shenoy, Shyamsunder Kamath
A 20 year old man diagnosed to have multiple neurofibromatosis presented with 2 months history of orthopnoea and cough with moderate expectoration since 1 month. Chest Xray and CT scan showed a huge mediastinal mass with compression of the trachea and superior vena cava. In view of the anticipated airway problems, an awake intubation in the sitting position was achieved. Cardiopulmonary bypass was not considered because of the possibility of excessive bleeding after heparinization. Despite this, the patient bled about 4,500 mL. Tracheomalacia was suspected intraoperatively. A larger endotracheal tube was inserted at the end of the procedure and the patient ventilated electively overnight. He was successfully extubated 24 hours later.
{"title":"Anaesthetic management of a huge mediastinal tumour with tracheobronchial compression","authors":"A. Shenoy, Shyamsunder Kamath","doi":"10.5005/jp-journals-11010-02212","DOIUrl":"https://doi.org/10.5005/jp-journals-11010-02212","url":null,"abstract":"A 20 year old man diagnosed to have multiple neurofibromatosis presented with 2 months history of orthopnoea and cough with moderate expectoration since 1 month. Chest Xray and CT scan showed a huge mediastinal mass with compression of the trachea and superior vena cava. In view of the anticipated airway problems, an awake intubation in the sitting position was achieved. Cardiopulmonary bypass was not considered because of the possibility of excessive bleeding after heparinization. Despite this, the patient bled about 4,500 mL. Tracheomalacia was suspected intraoperatively. A larger endotracheal tube was inserted at the end of the procedure and the patient ventilated electively overnight. He was successfully extubated 24 hours later.","PeriodicalId":53846,"journal":{"name":"Indian Journal of Respiratory Care","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45527177","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-11010-02110
Prathibha Todur, S. Johnson, A. Shenoy
Introduction: Quantification of physiological dead space (VDphys) provides important insight into the efficiency of ventilation and its relation to pulmonary perfusion. Arterial to end-tidal carbon dioxide difference [P(a-ET)CO2] may provide a valuable surrogate measure of VDphys and may be useful as an index of weaning success. Aim: To evaluate the utility of [P(a-ET)CO2] as a weaning index. Methods: This prospective study enrolled 52 invasively mechanically ventilated adult patients treated in Medical Intensive Care Unit (MICU) between December 2010 and December 2011. The end-tidal carbon dioxide concentration was measured using a side stream capnograph at each attempt at decreasing ventilatory support and when they were ready to be weaned. A receiver operating characteristic (ROC) curve was constructed for weaning success, progressive weaning and extubation success. A cut-off point was obtained from these curves from which the sensitivity, specificity, positive and negative predictive values were obtained. Results: The ability of [P(a-ET)CO2] as a predictor of progressive reduction in ventilator support (n = 118), predictor of weaning from mechanical ventilation (n = 40) and for extubation success (n = 39) was evaluated. The area under the curve (AUC) for progressive weaning, spontaneous breathing trial and extubation success were 0.852, 0.905 and 0.702 and a threshold of 10.5 mm Hg, 9.4 mm Hg and 9.5 mm Hg respectively were obtained. Conclusion: P(a-ET)CO2 of ≤ 10 mm Hg may be used as an index of weaning during progressive weaning from mechanical ventilation, spontaneous breathing trial and to predict success of extubation.
{"title":"Utility of arterial to end-tidal carbon dioxide difference [P(a – ET)CO2] as a weaning index","authors":"Prathibha Todur, S. Johnson, A. Shenoy","doi":"10.5005/jp-journals-11010-02110","DOIUrl":"https://doi.org/10.5005/jp-journals-11010-02110","url":null,"abstract":"Introduction: Quantification of physiological dead space (VDphys) provides important insight into the efficiency of ventilation and its relation to pulmonary perfusion. Arterial to end-tidal carbon dioxide difference [P(a-ET)CO2] may provide a valuable surrogate measure of VDphys and may be useful as an index of weaning success. Aim: To evaluate the utility of [P(a-ET)CO2] as a weaning index. Methods: This prospective study enrolled 52 invasively mechanically ventilated adult patients treated in Medical Intensive Care Unit (MICU) between December 2010 and December 2011. The end-tidal carbon dioxide concentration was measured using a side stream capnograph at each attempt at decreasing ventilatory support and when they were ready to be weaned. A receiver operating characteristic (ROC) curve was constructed for weaning success, progressive weaning and extubation success. A cut-off point was obtained from these curves from which the sensitivity, specificity, positive and negative predictive values were obtained. Results: The ability of [P(a-ET)CO2] as a predictor of progressive reduction in ventilator support (n = 118), predictor of weaning from mechanical ventilation (n = 40) and for extubation success (n = 39) was evaluated. The area under the curve (AUC) for progressive weaning, spontaneous breathing trial and extubation success were 0.852, 0.905 and 0.702 and a threshold of 10.5 mm Hg, 9.4 mm Hg and 9.5 mm Hg respectively were obtained. Conclusion: P(a-ET)CO2 of ≤ 10 mm Hg may be used as an index of weaning during progressive weaning from mechanical ventilation, spontaneous breathing trial and to predict success of extubation.","PeriodicalId":53846,"journal":{"name":"Indian Journal of Respiratory Care","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47870318","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-11010-02101
J. V. Divatia
How to cite this article: Divatia JV. Challenges in critical care medicine in India. Ind J Resp Care 2013; 2:169-173. Over the last few decades, there has been a tremendous increase in the knowledge, technology and skills required to treat critically ill patients. This has led to the development of intensive care units (ICUs), which are essentially areas where severely ill patients can be cared for and provided with the infrastructure and expertise necessary to treat critical illness. The ICU is highly specified and sophisticated area of a hospital which is designed, staffed, located, furnished and equipped, dedicated to management of critically ill patients, injuries or complications. It is a department with dedicated medical, nursing and allied staff. It operates with defined policies, protocols and procedures, having its own quality control, education, training and research programmes.1
如何引用这篇文章：Divatia JV。印度重症医学面临的挑战。Ind J Resp Care 2013；2:169-173.在过去的几十年里，治疗危重患者所需的知识、技术和技能有了巨大的增长。这导致了重症监护室（ICU）的发展，重症监护室基本上是重症患者可以得到护理的地方，并为他们提供治疗危重症所需的基础设施和专业知识。重症监护室是医院的一个高度指定和复杂的区域，其设计、人员配备、位置、家具和设备专门用于管理危重患者、受伤或并发症。这是一个拥有专职医疗、护理和专职工作人员的部门。它按照既定的政策、规程和程序运作，有自己的质量控制、教育、培训和研究方案。1
{"title":"Challenges in critical care medicine in India","authors":"J. V. Divatia","doi":"10.5005/jp-journals-11010-02101","DOIUrl":"https://doi.org/10.5005/jp-journals-11010-02101","url":null,"abstract":"How to cite this article: Divatia JV. Challenges in critical care medicine in India. Ind J Resp Care 2013; 2:169-173. Over the last few decades, there has been a tremendous increase in the knowledge, technology and skills required to treat critically ill patients. This has led to the development of intensive care units (ICUs), which are essentially areas where severely ill patients can be cared for and provided with the infrastructure and expertise necessary to treat critical illness. The ICU is highly specified and sophisticated area of a hospital which is designed, staffed, located, furnished and equipped, dedicated to management of critically ill patients, injuries or complications. It is a department with dedicated medical, nursing and allied staff. It operates with defined policies, protocols and procedures, having its own quality control, education, training and research programmes.1","PeriodicalId":53846,"journal":{"name":"Indian Journal of Respiratory Care","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48239804","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-11010-02205
Anup Bansal, A. S. Ponnish, N. Ramakrishnan
It is not uncommon to have occasional difficulty in falling asleep or have fatigue and day time sleepiness. However, when sleep disturbances persist for over a month and are associated with significant daytime dysfunction for at least two weeks, it may be a warning of an underlying sleep disorder requiring further evaluation and treatment. The combination of snoring, nonrefreshing sleep and daytime sleepiness is usually a hallmark of Obstructive Sleep Apnea (OSA) which is the most common sleep related breathing disorder. This review article aims to provide a practical and comprehensive approach to the diagnosis and management of sleep related breathing disorders with a focus on OSA.
{"title":"Practical approach to sleep disordered breathing","authors":"Anup Bansal, A. S. Ponnish, N. Ramakrishnan","doi":"10.5005/jp-journals-11010-02205","DOIUrl":"https://doi.org/10.5005/jp-journals-11010-02205","url":null,"abstract":"It is not uncommon to have occasional difficulty in falling asleep or have fatigue and day time sleepiness. However, when sleep disturbances persist for over a month and are associated with significant daytime dysfunction for at least two weeks, it may be a warning of an underlying sleep disorder requiring further evaluation and treatment. The combination of snoring, nonrefreshing sleep and daytime sleepiness is usually a hallmark of Obstructive Sleep Apnea (OSA) which is the most common sleep related breathing disorder. This review article aims to provide a practical and comprehensive approach to the diagnosis and management of sleep related breathing disorders with a focus on OSA.","PeriodicalId":53846,"journal":{"name":"Indian Journal of Respiratory Care","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48438954","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-11010-02105
N. Jasmine, A. Shenoy, Daniel Thomas Anjilivelil
Background: LTS II and PLMA are supraglottic devices that may be used for ventilation in patients with normal as well as difficult airways at risk of aspiration. Aim: Comparison of LTS II with PLMA during controlled ventilation in paralysed patients with respect to time to successful insertion, success rate of insertion, attempts at repositioning, airway leak pressure, ease of ventilation and Ryle’s tube insertion, fibreoptic laryngeal view and complications. Methods: Thirty patients were studied using a prospective, randomised cross-over design. Ethical committee clearance and informed consent were obtained from all patients. Anaesthesia was induced with propofol and fentanyl and neuromuscular blockade achieved with vecuronium. Patients were divided into two groups: Group LTS and Group PLMA. In each group, the first airway device was inserted, various parameters observed and then removed. The second airway device was then inserted and the same parameters noted. Anaesthesia was continued with the second device in position. Results: Success with insertion at first attempt and time to insertion were comparable with both devices [LTS II 27/30 (17.5 s) and PLMA 29/30 (15.5 s) respectively]. PLMA required repositioning in fewer patients and provided better fibreoptic view than LTS II. Ryle’s tube insertion failed in four patients with PLMA but in none with LTS II. No significant difference was found in the airway seal pressure [mean, PLMA (27 cm H2 O) and LTS II (26.4 cm H2 O)], ease of ventilation or overall complications. Conclusion: Insertion and ventilation are comparable with PLMA and LTS II. Ryle’s tube insertion is easier with LTS II but requires more repositioning attempts and does not provide a good view of the larynx
背景：TTSII和PLMA是声门上设备，可用于气道正常和困难的有误吸风险的患者的通气。目的：在瘫痪患者控制通气期间，比较TTS-II和PLMA在成功插入时间、插入成功率、重新定位尝试、气道渗漏压力、通气和Ryle管插入的容易程度、喉纤维视图和并发症方面的效果。方法：采用前瞻性随机交叉设计对30例患者进行研究。所有患者都获得了伦理委员会的批准和知情同意。丙泊酚和芬太尼诱导麻醉，维库溴铵实现神经肌肉阻滞。将患者分为两组：LTS组和PLMA组。在每组中，插入第一个气道装置，观察各种参数，然后取出。然后插入第二个气道装置，并记录相同的参数。在第二个装置就位的情况下继续进行麻醉。结果：第一次尝试插入的成功率和插入时间与两种装置相当[TTS II 27/30（17.5 s）和PLMA 29/30（15.5 s）]。PLMA需要在更少的患者中重新定位，并且提供了比TTSII更好的光纤视图。Ryle导管插入在4名PLMA患者中失败，但在LTSII患者中没有一例失败。气道密封压力[平均PLMA（27 cm H2 O）和LTS II（26.4 cm H2 O。结论：插入和通气与PLMA和TTSII相当。Ryle的插管在TTSII中更容易，但需要更多的重新定位尝试，并且不能很好地观察喉部
{"title":"Comparison of Laryngeal tube suction II (LTS II) and Proseal laryngeal mask airway (PLMA) for controlled ventilation in anaesthetised and paralysed adult patients","authors":"N. Jasmine, A. Shenoy, Daniel Thomas Anjilivelil","doi":"10.5005/jp-journals-11010-02105","DOIUrl":"https://doi.org/10.5005/jp-journals-11010-02105","url":null,"abstract":"Background: LTS II and PLMA are supraglottic devices that may be used for ventilation in patients with normal as well as difficult airways at risk of aspiration. Aim: Comparison of LTS II with PLMA during controlled ventilation in paralysed patients with respect to time to successful insertion, success rate of insertion, attempts at repositioning, airway leak pressure, ease of ventilation and Ryle’s tube insertion, fibreoptic laryngeal view and complications. Methods: Thirty patients were studied using a prospective, randomised cross-over design. Ethical committee clearance and informed consent were obtained from all patients. Anaesthesia was induced with propofol and fentanyl and neuromuscular blockade achieved with vecuronium. Patients were divided into two groups: Group LTS and Group PLMA. In each group, the first airway device was inserted, various parameters observed and then removed. The second airway device was then inserted and the same parameters noted. Anaesthesia was continued with the second device in position. Results: Success with insertion at first attempt and time to insertion were comparable with both devices [LTS II 27/30 (17.5 s) and PLMA 29/30 (15.5 s) respectively]. PLMA required repositioning in fewer patients and provided better fibreoptic view than LTS II. Ryle’s tube insertion failed in four patients with PLMA but in none with LTS II. No significant difference was found in the airway seal pressure [mean, PLMA (27 cm H2 O) and LTS II (26.4 cm H2 O)], ease of ventilation or overall complications. Conclusion: Insertion and ventilation are comparable with PLMA and LTS II. Ryle’s tube insertion is easier with LTS II but requires more repositioning attempts and does not provide a good view of the larynx","PeriodicalId":53846,"journal":{"name":"Indian Journal of Respiratory Care","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48867160","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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