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At least 109 records · Page 6Linked to original sources
PubMed2002

Nasotracheal intubation: a simple and effective technique to reduce nasopharyngeal trauma and tube contamination.

UNLABELLED: Our hypothesis was that nasopharyngeal passage of an endotracheal tube can be facilitated by a nasopharyngeal airway (Wendl tube) acting as a "pathfinder." Accordingly, we performed a randomized, controlled trial with blinded assessment of nasopharyngeal bleeding and contamination of the tip of the endotracheal tube. After the induction of anesthesia, a Wendl tube (28 Ch) was inserted into the more patent nostril. In the control group (n = 30), the Wendl tube was retrieved before nasopharyngeal passage was attempted with an endotracheal tube (inner diameter, 7.0 mm). In the intervention group (n = 30), the Wendl tube was kept in position and only its adjustable flange was removed. Then, we inserted the tip of the endotracheal tube into the trailing end of the Wendl tube. Subsequently, the endotracheal tube was advanced under visual control to the oropharynx guided by the Wendl tube. After the endotracheal tube was positioned in the oropharynx, the Wendl tube was removed and intubation completed. Six hours after surgery, we determined the patients' nasal pain. The "pathfinder" technique reduced the incidence (P < 0.001) and severity (P = 0.001) of bleeding, decreased tube contamination with blood and mucus (P < 0.001), and diminished postoperative nasal pain (P = 0.036). IMPLICATIONS: Nasopharyngeal passage of an endotracheal tube can be facilitated by a flexible Wendl tube (nasopharyngeal airway) covering and guiding the rigid tube tip. This technique is helpful in reducing the incidence and severity of nosebleeds and in minimizing contamination of the tip of the endotracheal tube with blood and mucus.

Adult↗
PubMed1994

Efficacy of the self-inflating bulb in detecting esophageal intubation. Does the presence of a nasogastric tube or cuff deflation make a difference?

BACKGROUND: The principle underlying the use of the self-inflating bulb in differentiating esophageal from tracheal intubation is that the trachea is held open by rigid cartilaginous rings, whereas the esophagus collapses when a negative pressure is applied to its lumen. This investigation was designed to test the efficacy of the bulb in detecting esophageal intubation in the presence of a nasogastric tube and after tracheal tube cuff deflation. METHODS: In anesthetized patients, the trachea and esophagus were intubated with identical tubes. The efficacy of the bulb was tested after a nasogastric tube was placed (group 1, n = 70) and after cuff deflation (group 2, n = 60) by a second anesthesiologist. RESULTS: In patients with nasogastric tubes (group 1), the anesthesiologists reported no reinflation of the compressed bulbs connected to tubes placed in the esophagus and immediate reinflation when connected to tracheally placed tubes in every case. In group 2, the determination of tube placement was correct in every case after cuff deflation. Mean (+/- SEM) negative pressures generated when compressed bulbs were connected to esophageally placed tubes were 57.8 +/- 0.48 mmHg (group 1) and 55.3 +/- 0.52 mmHg (group 2) and remained unchanged after the introduction of nasogastric tubes or after cuff deflation. CONCLUSIONS: These results confirm that a nasogastric tube or cuff deflation does not interfere with the reliability of the self-inflating bulb in detecting esophageal intubation and thus does not contribute to false positive results. Confirmation of tracheal tube placement by this simple method makes it ideal for use with other recognized methods both in and outside the operating rooms and enables physicians and emergency personnel to proceed with other resuscitative measures.

Adolescent↗
PubMed2002

The influence of cuff volume and anatomic location on pharyngeal, esophageal, and tracheal mucosal pressures with the esophageal tracheal combitube.

BACKGROUND: The authors determined the influence of cuff volume and anatomic location on pharyngeal, esophageal, and tracheal mucosal pressures for the esophageal tracheal combitube. METHODS: Twenty fresh cadavers were studied. Microchip sensors were attached to the anterior, lateral, and posterior surfaces of the distal and proximal cuffs of the small adult esophageal tracheal combitube. Mucosal pressure for the proximal cuff in the pharynx was measured at 0- to 100-ml cuff volume in 10-ml increments, and for the distal cuff in the esophagus and trachea were measured at 0- to 20-ml cuff volume in 2-ml increments. The proximal cuff volume to form an oropharyngeal seal of 30 cm H2O was determined. In addition, mucosal pressures for the proximal cuff in the pharynx were measured in four awake volunteers with topical anesthesia. RESULTS: There was an increase in mucosal pressure in the trachea, esophagus, and pharynx at all cuff locations with increasing volume (all: P < 0.001). Pharyngeal mucosal pressures were highest posteriorly (50-ml cuff volume: 99 +/- 62 cm H2O; 100-ml cuff volume: 255 +/- 161 cm H2O). Esophageal mucosal pressures were highest posteriorly (10-ml cuff volume: 108 +/- 55 cm H2O; 20-ml cuff volume: 269 +/- 133 cm H2O). Tracheal mucosal pressures were highest anteriorly (10-ml cuff volume: 98 +/- 53 cm H2O; 20-ml cuff volume: 236 +/- 139 cm H2O). The proximal cuff volume to obtain an oropharyngeal seal of 30 cm H2O was 47 +/- 12 ml. Pharyngeal mucosal pressures were similar for cadavers and awake volunteers. CONCLUSION: We conclude that mucosal pressures for the esophageal tracheal combitube increase with cuff volume, are highest where the cuff is adjacent to rigid anatomic structures, and potentially exceed mucosal perfusion pressure even when cuff volumes are limited to achieving an oropharyngeal seal of 30 cm H2O.

Adult↗
PubMed1984

Appliance for stabilizing orogastric and orotracheal tubes in infants.

The long-term use of orotracheal tubes in infants has been associated with airway damage, palatal groove formation, acquired cleft palate, and defective primary dentition. Nasotracheal intubation is associated with trauma to the nasal septum and deformities of the nares. Because the infant is an obligatory nose-breather, nasogastric feeding tubes obstruct the nares and cause mucosal edema. We have developed an intraoral appliance designed to stabilize orogastric feeding and orotracheal tubes, and prevent obstruction to the nares and trauma to the palate and alveolar ridge.

Enteral Nutrition↗
PubMed1985

Forward displacement of the larynx for nasogastric tube insertion in intubated patients.

Simple insertion of a nasogastric (NG) tube was successful in only 52 of 100 anesthetized intubated patients. After the larynx was manually pulled forward, the NG tube was successfully inserted in 33 patients. In the remaining 15 patients, the NG tube was inserted only with the aid of a finger or a laryngoscope used with Magill forceps. The difficulty of NG tube insertion was not correlated with sex, age, weight, or type of endotracheal intubation. Forward displacement of the larynx by manually gripping and lifting the thyroid cartilage is a useful and safe maneuver that facilitates NG tube insertion in anesthetized intubated patients.

Adolescent↗
PubMed2000

Accidental removal of endotracheal and nasogastric tubes and intravascular catheters.

OBJECTIVES: To characterize the rates of accidental removal of endotracheal tubes, nasogastric tubes, central venous catheters, and arterial catheters. To assess the efficacy of corrective measures aimed at reducing the accidental removal of these devices. DESIGN: Prospective, observational, and interventional study. SETTING: Eighteen-bed medical-surgical intensive care unit of a 650-bed tertiary care hospital. PATIENTS: Patients admitted to the intensive care unit who had any of the following devices in place for more than 24 hrs: endotracheal tube, nasogastric tube, central venous catheter, arterial catheter. MEASUREMENTS AND INTERVENTIONS: Data were collected on the date of placement of tubes and catheters, position of vascular catheters, date of removal, and reason for removal. The study involved three consecutive 6-month periods. At the end of the first and the second periods, information about rates of accidental removal was provided to the physicians and nurses. In addition, the personnel were instructed to be more vigilant and specific measures aimed at reducing the accidental removal were introduced. MAIN RESULTS: In the first period, 289 endotracheal tubes were placed and 13.1% (24.7 per 1000 days) were removed accidentally. In the second and third periods, 17.1% (25.5 per 1000 days) and 11.4% (15.1 per 1000 days) were removed accidentally, respectively. In the first period, 368 nasogastric tubes were placed and 41% (73.9 per 1000 days) were removed accidentally. In both the second and the third period, a significant reduction in the rate of accidental removal was observed (32.4% or 41.2 per 1000 days and 25.8% or 29.8 per 1000 days, respectively). A significant decrease was observed in the rates of accidental removal of central venous catheters from 7.5% (12.4 per 1000 days) in the first period to 3.6% (5.4 per 1000 days) in the second period. The rate of arterial catheters accidentally removed expressed according to the time at risk significantly decreased from 46.5 per 1000 days in the first period to 19.1 per 1000 days in the second period and 25.3 per 1000 days in the third period. CONCLUSIONS: The information provided by the rates of accidental removal expressed by patient-days is helpful to compare results obtained in populations with different times of follow-up. Education of medical personnel and limiting upper-extremity access to within 20 cm from any catheter or tube resulted in a significant reduction of patient-related removal of tubes and catheters.

Catheterization, Central Venous↗
PubMedDate not supplied

A modified technique for securing oro-nasal tubes.

Secure positioning of orally or nasally placed endotracheal and gastric tubes is a necessity for the patient with burns. This article describes a technique for securing these tubes with a simple modification to avoid compression on the ear that may lead to subsequent necrosis and infection.

Burns↗
PubMed1991

Otitis media in adult trauma patients: incidence and clinical significance.

To determine the incidence and clinical significance of otitis media in traumatized adults requiring intubation, 67 adult trauma patients admitted to a level-I trauma center over a 6-month period who required three or more days of intubation were examined otoscopically for the presence of otitis media. Eleven of these intubated brain-injured patients had otitis and upon examination all were found to have purulent paranasal sinusitis as well. In conclusion, all intubated patients with severe head injuries should be evaluated otoscopically for the presence of otitis and those patients with otitis should be examined for the presence of sinusitis.

Acute Disease↗
PubMed1994

Advanced trauma life support program increases emergency room application of trauma resuscitative procedures in a developing country.

Over a 9-year period (July 1981-December 1985--pre-ATLS period; January 1986-June 1990--post-ATLS period), the hospital charts of 813 trauma patients with ISS > or = 16 were reviewed (n = 413, pre-ATLS and n = 400, post-ATLS) in order to assess the impact of the ATLS program. The frequency of endotracheal intubation (ET), nasogastric tube insertion (NG), intravenous access (i.v.), Foley catheterization of the bladder (Foley) and chest tube insertion (CT) were compared by Pearson Chi-square analysis. Overall, pre-ATLS vs. post-ATLS frequencies (%) were 83.5 vs. 65.3 for ET, 97.3 vs. 98.0 for i.v., 74.6 vs. 96.3 for Foley, 68.3 vs. 91.3 for NG, and 18.4 vs. 47.0 for CT. In the emergency room these frequencies (%) were 26.1 vs. 36.4 for ET, 98.8 vs. 98.7 for i.v., 11.0 vs. 97.1 for Foley, 3.2 vs. 95.9 for NG, and 3.9 vs. 95.2 for CT. The differences in the application of these life saving procedures between the pre-ATLS and post-ATLS periods were statistically significant (p < 0.05) except i.v. access, which showed no difference between the pre-ATLS and post-ATLS groups. Of the patients with severe chest injuries (AIS > or = 3) 87.7% had chest tubes post ATLS (94.4% in ER) compared with 48.1% pre ATLS (3.2% in ER). These differences were associated with significant improvement in trauma patient outcome post ATLS. We conclude that the frequency of lifesaving interventions, particularly in the ER, was increased post ATLS.(ABSTRACT TRUNCATED AT 250 WORDS)

Catheterization, Peripheral↗