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The results of surgical intervention with the use of laparostomy in 29 patients with diffuse purulent peritonitis at the terminal stage are presented. In 11 cases, laparostomy was performed during the first operation, in 18--for postoperative peritonitis. At the time of operations, laser radiation, gastrointestinal intubation were widely used.
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The pre- and intra-operative care of patients with acute intestinal obstruction is reviewed. The most important pre-operative problems are hypovolaemia, sepsis, electrolyte and acid-base imbalances. The evaulation and treatment of these disorders are discussed. The importance of preventing regurgitation and inhalation of stomach contents is emphasised and the methods which are used are described. The safest techniques of induction and maintenance of anaesthesia as well as muscle relaxation and intra-operative fluid therapy are indicated.
Chest radiography is essential to evaluate the placement and position of tubes and lines in patients treated in intensive care units, such as central venous and arterial catheters, endotracheal and nasogastric tubes, thorax drains, cardiac pacemakers and defibrillators. Radiologic findings with respect to normal positioning, wrong positioning, and complications are described and illustrated.
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Emergency and unexpected difficult airway management can rapidly deteriorate into a critical airway event such as "cannot ventilate, cannot intubate" (CVCI). A critical airway event (i.e., inadequate mask ventilation, failed intubation, and CVCI) can be resolved by rescue ventilation, thus avoiding potential neurological disability or death. Recommended options include use of the larygeal mask airway, the esophageal-tracheal Combitube (ETC; Tyco-Healthcare-Nellcor, Pleasanton, Calif), transtracheal jet ventilation, or a surgical airway. This article reviews proper use of the ETC in combination with the self-inflating bulb (SIB) and/or portable carbon dioxide detector to resolve critical airway situations. The combined use of these 3 devices provides on ideal integrated system for airway control and ventilation. In addition, critical airway events and rescue ventilation options; ETC design, technical aspects, training, insertion, and ventilation; determining ETC location (i.e., esophagus vs trachea); and monitoring ETC lung ventilation are reviewed. The SIB primarily assesses ETC location within the esophagus or the trachea; the carbon dioxide detector also permits monitoring lung ventilation. Use of the ETC in prehospital, emergency medicine, and anesthesia settings, including ETC advantages, contraindications, and reported complications will be reviewed in Part 2. How to safely exchange the ETC for a definitive airway also will be reviewed.
Emergency and unexpected difficult airway management can rapidly deteriorate into a critical airway event (e.g., inadequate mask ventilation, failed tracheal intubation, or cannot ventilate-cannot intubate). Recommended options to resolve a critical airway event include the laryngeal mask airway, the esophageal tracheal Combitube (ETC; Tyco-Healthcare-Nellcor, Pleasanton, Calif), transtracheal jet ventilation, or a surgical airway to avoid potential neurological disability or death. Part 1, which was published in the February 2004 AANA Journal, reviewed use of the ETC in combination with the self-inflating bulb and/or portable carbon dioxide detector as an effective rescue airway system. Important aspects of rescue ventilation, ETC training methods, how to use the ETC, and determining ETC location also were reviewed. Part 2 reviews ETC advantages, contraindications, and reported complications in prehospital, emergency medicine, and anesthesia settings. Safe methods to exchange the ETC for a definitive airway also are described. Major ETC advantages include the following: (1) easy to learn, (2) can be inserted rapidly, (3) effectively secures the airway, (4) provides adequate lung ventilation, (5) minimizes aspiration risks, (6) facilitates application of high ventilatory pressures, and (7) can be exchanged safely for a definitive airway without compromising airway control or protection.
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BACKGROUND: Insertion of a nasogastric tube in anesthetized and intubated patients is sometimes difficult. We studied the movement of a gastric tube in order to find a way for successful insertion of a nasogastric tube. METHODS: We used the method of Ozer's; bronchofiber examination of nasogastric tube placement in an anethetized patient, with changing heights of a pillow [0 cm, 5 cm, 10 cm], rotating head [45 degree each side] and jaw lifting. RESULTS: The height of the pillow is an important factor regardless of other maneuvers. CONCLUSIONS: Our study showed that using a 5 cm height pillow was a best way to insert a nasogastric tube, but ipsilateral head rotation did not contribute to the procedure.
BACKGROUND: In the medical intensive care unit at the University of Virginia Health System, capnography is used to detect end-tidal carbon dioxide to protect patients from inadvertent airway cannulation during placement of gastric tubes. OBJECTIVES: To compare the method in which capnography is used with a method in which a colorimetric carbon dioxide detector is used and to determine what variables affect accurate placement of gastric tubes. METHODS: A prospective convenience sample of 195 gastric tube insertions was studied in 130 adult patients in a medical intensive care unit. Standard insertions of gastric tubes (done with capnography) were simultaneously monitored by using a disposable colorimetric device, with a color change indicating the presence of carbon dioxide. RESULTS: Insertion variables included tube type (60% Salem sump tubes, 40% soft-bore feeding tubes), route of insertion (71% oral, 29% nasal), mechanical ventilation (81%), and decreased mental status (72%). Carbon dioxide was successfully detected with the colorimetric indicator (within seconds) in all insertions in which carbon dioxide was detected by capnography. When carbon dioxide was detected (27% of insertions), the tubes were withdrawn and reinserted. Carbon dioxide detection during tube placement was significantly associated with nasal insertions (P = .03) and spontaneously breathing/nonintubated status (P = .01) but not with mental status or tube type. CONCLUSIONS: A colorimetric device is as accurate as capnography for detecting carbon dioxide during placement of gastric tubes.
67 prolongely intubated patients from intensive care unit were under our observation. Were performed ultrasound examination and CT scan of paranasal sinuses in prolongely intubated patients. In the same patients it was performed the examination of tympanic cavity by acoustic impendansometry. Also was performed bacteriologic examination of nasal discharge in prolongely intubated patients. Our investigations showed, that in prolongely intubated patients there is a high risk of development of polysinusitis and evstachitis, which can lead to so called fever of unknown origin and even to chronic sepsis. According to the authors, sanitation of nasal cavity must be performed every day at least 1 time, and if there is the shade--at least 2 times every day. To create the negative pressure, it is rational to use iamic--catheter and, through which activation of mucocilliary transport is performed. Changing of nasogastral probe is rational after one day by turns in each nasal pass. It is rational to cleanse places of pressing of these probes with the antiseptic solutions.
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BACKGROUND: Sinus disease in the intubated patient remains a frequent reason behind otolaryngological consultation to the Intensive Care Unit. Previous prospective studies often have been limited to only one computed tomography (CT) scan of the sinuses. The purpose of this study was to verify the development of sinus disease in the orotracheally intubated patient and determine a radiographic pattern of its progression if present. METHODS: The charts of all patients admitted to the hospital with a diagnosis of aneurysm or subarachnoid hemorrhage over a 2-year period were evaluated. Patients who were orotracheally intubated with at least one postintubation CT scan of the head were included. CT scans obtained after the initiation of antibiotics or tracheostomy were excluded. The Lund-Mackay staging system was used to evaluate the scans. RESULTS: A total of 50 patients with 172 scans were evaluated. Analysis revealed a significant trend toward increasing severity of radiological sinus disease over the first 7 days of intubation (p < 0.001). The presence of a nasogastric tube (NGT) resulted in an increased Lund-Mackay score, but the trend remained significant for patients without an NGT as well. CONCLUSION: This study shows that the presence and progression of sinus findings is fairly common in the intubated patient and that although the placement of an NGT increased the rate of development of sinus findings, the lack of one did not preclude sinus disease. Clinical exam remains a more important indicator of disease when evaluating the Intensive Care Unit patient for rhinosinusitis.
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The authors describe 12 patients in whom feeding tubes were inadvertently placed in the bronchial tree a total of 14 times. All but four of the misplacements were complicated by pneumothorax. No deaths were directly attributable to the misplacements, although one cardiac arrest occurred as a late complication of intrapleural feeding. Careful, controlled insertion of feeding tubes and radiographic confirmation of their placement are essential to reduce morbidity and mortality.