PubMed · 3486275
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A Allen. 1986. Transitions.. https://pubmed.ncbi.nlm.nih.gov/3486275/
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CONTEXT: Surgical site infection (SSI) in the general surgical population is a significant public health issue. The use of a high fractional inspired concentration of oxygen (FIO2) during the perioperative period has been reported to be of benefit in selected patients, but its role as a routine intervention has not been investigated. OBJECTIVE: To determine whether the routine use of high FIO2 during the perioperative period alters the incidence of SSI in a general surgical population. DESIGN, SETTING, AND PATIENTS: Double-blind, randomized controlled trial conducted between September 2001 and May 2003 at a large university hospital in metropolitan New York City of 165 patients undergoing major intra-abdominal surgical procedures under general anesthesia. INTERVENTIONS: Patients were randomly assigned to receive either 80% oxygen (FIO2 of 0.80) or 35% oxygen (FIO2 of 0.35) during surgery and for the first 2 hours after surgery. MAIN OUTCOME MEASURES: Presence of clinically significant SSI in the first 14 days after surgery, as determined by clinical assessment, a management change, and at least 3 prospectively defined objective criteria. RESULTS: The study groups were closely matched in a large number of clinical variables. The overall incidence of SSI was 18.1%. In an intention-to-treat analysis, the incidence of infection was significantly higher in the group receiving FIO2 of 0.80 than in the group with FIO2 of 0.35 (25.0% vs 11.3%; P =.02). FIO2 remained a significant predictor of SSI (P =.03) in multivariate regression analysis. Patients who developed SSI had a significantly longer length of hospitalization after surgery (mean [SD], 13.3 [9.9] vs 6.0 [4.2] days; P<.001). CONCLUSIONS: The routine use of high perioperative FIO2 in a general surgical population does not reduce the overall incidence of SSI and may have predominantly deleterious effects. General surgical patients should continue to receive oxygen with cardiorespiratory physiology as the principal determinant.
PURPOSE: To present a case of laryngeal damage in an infant caused by a too large and inappropriately designed cuffed tracheal tube. CLINICAL FEATURES: A 13-month-old child undergoing cardiac surgery was intubated with an uncuffed endotracheal tube with an internal diameter (ID) of 4.0 mm. Because of an important air leak around the tracheal tube during mechanical ventilation, a cuffed endotracheal tube ID 4.0 mm was inserted. The air leak with the tube cuff not inflated was acceptable at 25 cm H2O airway pressure. After extubation on the third postoperative day, the patient showed increasing stridor and respiratory deterioration. Fibreoptic laryngoscopy of the spontaneously breathing patient showed a large intra-laryngeal web. After surgical removal of the web, the child rapidly recovered and was discharged from the hospital on the 12th postoperative day. Inspection of the 4.0 mm (ID) cuffed tracheal tube revealed a cuff positioned inappropriately high and an increase of 0.7 mm in outer tube diameter compared to the 4.0 mm (ID) uncuffed tracheal tube from the same manufacturer. The tube cuff is likely to be situated within the larynx when placed in accordance to insertion depth formulas or radiological criteria, as used for uncuffed tracheal tubes in children. CONCLUSION: The larger than expected tracheal tube with its intra-laryngeal cuff position in a 13-month-old child likely caused mucosal damage and an inflammatory reaction within the larynx resulting in granulation tissue formation and fibrous healing around the tracheal tube.
BACKGROUND: Principles and characteristics of the recently introduced Microcuff paediatric tracheal tube (Microcuff, GmbH, Weinheim, Germany) with anatomically based depth markings, cuff-free subglottic tube shaft and short high volume-low pressure cuff with ultrathin cuff membrane are presented. First available tubes (ID 4.0 mm) were evaluated regarding cuff pressures required to seal the trachea and regarding the distance from the tube tip to the carina. METHODS: After obtaining approval of the local ethical committee, 20 children aged 2-4 years, receiving tracheal intubation under general anaesthesia with muscle paralysis, were included. The tubes were placed during direct laryngoscopy and the glottic depth marking placed between the vocal cords. Cuff pressure to prevent audible air leakage at standardised ventilator settings (PIP 20 cm H(2)O/PEEP 5 cm H(2)O/RR20 x min(-1)) was assessed by means of a cuff pressure manometer within 5 min after intubation. Subsequently, the distance from the tube tip to the tracheal carina was measured by means of fibre bronchoscopy. Data are presented as the median (range). RESULTS: Patient age was 3.0 years (2.0-3.9 years), weight 13.5 kg (9.1-19.2 kg) and body length 95 cm (79-105 cm). The lowest cuff pressure required to seal the trachea ranged from 4-14 cmH(2)O (median 10 cm H(2)O), the distance from tube tip to tracheal carina was to 2.9 cm (2.0-4.5 cm). CONCLUSIONS: The new Microcuff paediatric tracheal tube with ultrathin high volume-low pressure cuff required tracheal sealing pressures below tracheal wall pressures usually required with uncuffed tracheal tubes for efficient sealing and ventilation at 20 cm H(2)O peak inspiratory pressure. The distance from the tube tip to carina was in the safe range in all patients.