[Combitube--a new instrument for emergency intubation].
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Emergencies↗
Biomedical subjects
M Frass
Publications and source records attributed to M Frass.
Massive upper airway bleeding after thrombolytic therapy: successful airway management with the Combitube.
We present the case of a patient who required immediate intubation because of increasing upper airway bleeding. Endotracheal intubation failed because the glottis could not be visualized. An airway control device designed for cases of difficult emergency intubations was used successfully. This device can be inserted without the use of a laryngoscope.
Airway Obstruction↗
Airway management in a case of neck impalement: use of the oesophageal tracheal combitube airway.
A patient presented with neck impalement after a traffic accident. Respiratory arrest demanded immediate tracheal intubation, which was impossible as a wooden splinter had partially obstructed the pharynx and prevented laryngoscopy. An oesophageal tracheal Combitube airway was inserted successfully and the patient's lungs were ventilated adequately until tracheotomy was performed.
Adult↗
Influence of age on outcome of mechanically ventilated patients in an intensive care unit.
OBJECTIVE: To assess the influence of age on the outcome of patients receiving prolonged mechanical ventilation. DESIGN: Retrospective study. SETTING: Intensive care unit. PATIENTS: A total of 1,141 patients in our ICU during a 32-month period. A total of 536 patients required mechanical ventilation. After exclusion of 171 patients ventilated for less than 24 hrs after surgery, 365 patients were investigated. MEASUREMENTS AND MAIN RESULTS: Two hundred sixty-six (73%) patients were aged less than 70 yrs; 99 (27%) patients were greater than or equal to 70 yrs. There was no significant difference in mortality rate between the younger and the older age groups. There was no significant influence of other important factors, such as severity of illness, duration of mechanical ventilation, or length of ICU stay. The only factor showing a significant influence on patient outcome was the reason for mechanical ventilation. There were more survivors in the group being ventilated because of ventilatory insufficiency than in the group with oxygenation impairment (57.8% vs. 23.9%, p less than .001). CONCLUSION: An influence of age on the outcome of mechanically ventilated patients in the ICU could not be ascertained in this study.
Adolescent↗
Emergency ventilation using the Combitube in cases of difficult intubation.
The esophageal-tracheal Combitube (Sheridan, Argyle, NY) is a new device for emergency intubation, which can be inserted blindly without the use of a laryngoscope. Ventilation is independent of the position of the Combitube in either the esophagus or the trachea, since ventilation is always provided by the tube's double channel. The "tracheal" channel acts as a conventional endotracheal airway and has an open distal end. The "esophageal" channel has a blocked distal end, so that together with the inflated distal cuff it acts as an esophageal obturator in cases of esophageal intubation. Perforations at the pharyngeal section direct the airflow to the trachea. At the oropharyngeal section a large elastic balloon is positioned in order to obturate the oral cavity and the nasopharynx. Two patients are described to exemplify the Combitube's clinical use. Both had rapidly enlarging cervical hematomas causing upper airway obstruction and thus requiring immediate intubation. Endotracheal intubation failed because the glottis could not be visualized with a laryngoscope. In both cases the Combitube was applied successfully and adequate ventilation was provided via the Combitube placed esophageally. To better secure each patient's airway, tracheotomy was performed during ventilation without any complications.
Aged↗
[Evaluating the efficacy of lay first aid classes. An analysis of 222 ambulance interventions in Vienna].
In spite of the well known necessity of correct first aid, only a small part of all emergency patients in Vienna receive proper first aid support by lay people. Analysis of 222 cases of the Vienna emergency ambulance service shows, that patients receive correct first aid far more often after an accident that in an internal emergency. Only few patients receive psychical support in a medical emergency. The necessity of a change in the first aid course contents is discussed in this article.
Adult↗
[Comparison of netilmicin administration once or three times daily in intensive care patients].
In a retrospective study once-daily dosage of netilmicin was compared with the thrice-daily regimen in critically ill patients. Netilmicin given once daily for 5 days appeared to be as effective as the multiple dose regimen, with no increase in the incidence of nephrotoxicity.
Adolescent↗
[Acute upper airway obstruction caused by cervical hematoma as a complication of an internal jugular vein catheter].
4 cases of inadvertent puncture of the common carotid artery following unsuccessful puncture of the internal jugular vein leading to a massive cervical hematoma are described. In all cases, acute upper airway obstruction required immediate intubation.
Aged↗
Esophageal tracheal combitube (ETC) for emergency intubation: anatomical evaluation of ETC placement by radiography.
The esophageal tracheal combitube (ETC) is designed for emergency intubation. The ETC is inserted blindly allowing ventilation after either esophageal or endotracheal placement. A special pharyngeal balloon serves to seal the upper airways. In 10 cardiac arrest patients, emergency intubation with the ETC was performed. Blood gas analyses showed adequate ventilation. Radiography proved correct placement of the proximal and distal balloons in accordance with design theory. Hyperinflation experiments documented expansion of the proximal balloon into the oral cavity rather than towards the epiglottis.
Emergencies↗
Relationship between neopterin and granulocyte elastase plasma levels and the severity of multiple organ failure.
In a series of 56 patients (24 uncomplicated postoperative and 32 septic patients), neopterin and elastase alpha 1 protease inhibitor complex (E-alpha 1 PI) plasma levels were measured daily. The clinical course of each patient was evaluated with the Multiple Organ Failure (MOF) score according to Goris. Neopterin could differentiate between septic and nonseptic patients (p less than .001), and E-alpha 1 PI between septic nonsurvivors and nonseptic patients only (p less than .01). In septic patients, acute pulmonary insufficiency was indicated by elevated E-alpha 1 PI values (greater than or equal to 400 micrograms/L) 1 day before mechanical ventilation was performed with a sensitivity of 81% and a specificity of 82%. Defining a patient with MOF whose score was greater than or equal to 5 as a high-risk septic patient, a comparison neopterin greater than or equal to 40 nmol/L and E-alpha 1 PI greater than or equal to 400 micrograms/L, measured 1 day before the evaluation of an MOF score of greater than or equal to 5 yielded a sensitivity of 91% and a specificity of 99% when patients fulfilled both criteria. We conclude that neopterin and E-alpha 1 PI might be useful parameters for the diagnosis of septicemia and monitoring of the clinical course in septic patients. Moreover, they might indicate the possible central role of macrophage and PMN activation in the development of MOF.
Adult↗
Esophageal tracheal combitube, endotracheal airway, and mask: comparison of ventilatory pressure curves.
The esophageal tracheal Combitube (ETC) is a new airway especially designed for airway maintenance and ventilation in unconscious patients such as those requiring CPR. The ETC may be used as an esophageal obturator or an endotracheal airway. Previous studies yielded a significantly higher mean arterial oxygen tension (PaO2) during ventilation using an ETC in the esophageal position compared to a conventional endotracheal airway (ETA). To investigate this phenomenon, endotracheal and airway opening pressures were examined in 12 patients in randomized order during ventilation with an ETC in the esophageal position, with an ETA, and with a mask, respectively. In this study again the PaO2 was higher with ETC compared to ETA. The following differences in intratracheal pressure and flow could be found for ETC when compared to ETA: smaller rising pressure during inspiration, prolonged expiratory flow time, and formation of a small positive end expiratory pressure (PEEP). These factors may be responsible for the improved oxygen tension with ETC. Comparing mask to ETC ventilation, PaO2 did not differ; however, mean arterial carbon dioxide tension was higher during mask ventilation.
Adult↗
Atrial natriuretic peptide decrease during spontaneous breathing with continuous positive airway pressure in volume-expanded healthy volunteers.
We examined the effect of spontaneous breathing with continuous positive airway pressure (CPAP) on the plasma concentrations of immunoreactive (ir) alpha-atrial natriuretic peptide (ANP). In three experiments, each of 11 healthy male volunteers performed CPAP at 20, 10 and 0 cm H2O for 2 h during continuous volume loading. Samples were drawn from a peripheral vein. Plasma concentrations of irANP were determined by a sensitive radioimmunoassay. Significantly lower concentrations of irANP were observed during 20 cm H2O CPAP than at 10 and 0 cm H2O. The concentrations of irANP did not differ significantly when individuals breathing with CPAP at 10 and at 0 cm H2O were compared. Our data suggest that CPAP at 20 cm H2O lowers the release of ANP in volume-expanded subjects. We hypothesize that this phenomenon may contribute to the fluid retention and renal dysfunction observed frequently during high CPAP levels. The decline in plasma concentrations of irANP may be the result of atrial compression by the distended lungs and of reduced venous return to the heart during CPAP.
Adult↗
Ventilation with the esophageal tracheal combitube in cardiopulmonary resuscitation. Promptness and effectiveness.
The success of cardiopulmonary resuscitation after cardiac arrest depends not only on the duration of the arrest, but also on the prompt establishment of a patent airway. In this study, we tested the safety and promptness of intubation with esophageal tracheal combitube (ETC) when compared to conventional endotracheal airway. Effectiveness of ventilation via the ETC as shown by blood gas analyses appeared to be comparable to endotracheal airway. Data suggest that the ETC might serve as a useful device during cardiopulmonary resuscitation.
Blood Gas Analysis↗
R-wave amplitude changes during exercise stress testing: patients with dilative cardiomyopathy compared to patients with coronary artery disease.
R-wave amplitude (RWA) depends to a large extent on the left ventricular filling volume. Changes of RWA are attributed to the Brody-effect. Exercise has been shown to induce a decrease of RWA in a healthy population and an increase in patients with coronary artery disease (CAD). No clear data exist for cardiomyopathy (CMP). Controls (n = 12), patients with CMP (n = 32) and CAD (n = 58) were compared. Alterations of RWA (Wilson lead V5) were correlated with parameters of a bicycle exercise test including resting and exercise hemodynamics and parameters of LV-function including EF, LVEDV and LVEDP. CMP compared to CAD had smaller RWA at rest (0.78 +/- 0.47 vs 1.32 +/- 0.72 mV, P less than 0.01). During comparable levels of exercise CMP (EF 35 +/- 14%) showed no significant changes of RWA. CAD (EF 57 +/- 16%) presented an increase of RWA by +0.11 +/- 0.23 mV (P less than 0.01), while controls showed a straight decline of RWA (-0.31 +/- 0.24 mV). In patients with CAD delta RWA (RWA max exercise - RWA rest) was a more sensitive parameter for detection of disease (assuming delta RWA greater than or equal to +0.1 mV, 36/58 patients) than maximal ST-segment changes (ST-segment-depression in lead V5 greater than or equal to 0.2 mV at 0.08 sec after J-point, 22/58 patients). Precordial leads V2, V4, V5 and V6 showed similar changes. This paper supports the theory that changes of wall thickness or changes in the amount of air respective to the amount of fluid in the lungs are responsible for RWA changes. These changes are clearly dependent on the severity of the disease and on left ventricular function. Therefore measurement of RWA changes during exercise may offer additional information in patients with CAD as well as in patients with CMP.
Adult↗
The esophageal tracheal combitube: preliminary results with a new airway for CPR.
We developed the esophageal tracheal combitube (ETC), a plastic twin-lumen tube, one lumen resembling an esophageal obturator airway (EOA), the other resembling an endotracheal airway (ETA). Ventilation is possible after either esophageal or tracheal placement of the ETC. A specially designed pharyngeal balloon replaces the mask of the EOA and provides sufficient seal, preventing the escape of air through the mouth and nose. The effectiveness of ventilation with the ETC in esophageal position was tested in a crossover study comparing ETC and ETA during routine operations in 31 patients. Blood gas measurements showed a significantly higher (P less than .001) mean arterial oxygen tension during ventilation with the ETC. The reason for this is not yet clear. Preliminary investigations during CPR in 21 arrest patients indicate that the ETC is as effective as the ETA.
Adult↗
Mechanical ventilation with positive end-expiratory pressure decreases release of alpha-atrial natriuretic peptide.
The influence of PEEP during controlled mechanical ventilation (CMV) on plasma levels of alpha-atrial natriuretic peptide (alpha-ANP) was examined in seven patients suffering from acute respiratory failure. The majority of patients were volume-expanded. Samples were drawn from the superior vena cava, right atrium, pulmonary artery, and radial artery. All alpha-ANP levels were significantly depressed by 15 cm H2O PEEP for one hour, when compared to CMV without PEEP. During the PEEP period, cardiac index, creatinine clearance, urinary flow and urinary sodium excretion were decreased. CMV with PEEP of 20 cm H2O depressed peripheral venous plasma levels of alpha-ANP in six volume-expanded healthy volunteers, too. The decreased release of alpha-ANP could be a consequence of atrial compression by the distended lungs and of reduced venous return. We suggest that the decline in plasma alpha-ANP levels contributes to fluid retention and renal dysfunction, which occur frequently during CMV with PEEP. More detailed studies are necessary to confirm our hypothesis.
Adult↗
Evaluation of esophageal tracheal combitube in cardiopulmonary resuscitation.
Prompt establishment of an airway is a primary goal in CPR of nonbreathing and unconscious patients. The esophageal tracheal combitube (ETC) is a new airway, designed for emergency intubation providing sufficient ventilation whether the airway is placed into the trachea or into the esophagus. We evaluated the effectiveness of the ETC in 31 patients during CPR. Blood gas analyses obtained during esophageal placement of the ETC showed results comparable to those of ventilation with a conventional endotracheal airway (ETA). The ETC appeared to oxygenate and ventilate patients adequately without complications. The efficacy, safety, and ease of insertion ensure rapid airway control. It is concluded that the ETC provides a sufficient alternative to the ETA whenever ideal conditions or trained staff for endotracheal intubation are not immediately available.
Aged↗
Mechanical ventilation with the esophageal tracheal combitube (ETC) in the intensive care unit.
Mechanical ventilation in critically ill patients is usually performed with the conventional endotracheal airway. The esophageal tracheal combitube (ETC) is a new device for cardiopulmonary resuscitation, conceived to bridge the gap between hospital and prehospital phases. The ETC may be used in esophageal and endotracheal positions. The authors report six patients who were ventilated with the ETC in the esophageal obturator position for 2-8 h after emergency ventilation. Blood gas data showed adequate ventilation with the ETC during the observation period. Data suggest that mechanical ventilation with the ETC is possible for several hours after cardiopulmonary resuscitation. This might be helpful during the initial post-arrest period, when replacement of the ETC by a conventional endotracheal airway might destabilize a vulnerable patient.
Aged↗