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Secure Airway (secure + airway)
Selected AbstractsIs the LMA Classic a secure airway?ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 9 2009S. K. Barnung No abstract is available for this article. [source] Characteristics and outcome of unplanned extubation in ventilated preterm and term newborns on a neonatal intensive care unitPEDIATRIC ANESTHESIA, Issue 9 2006ALEX VELDMAN MD Summary Background :,Unplanned extubation events (UEE) are a serious hazard to patient safety, especially on a neonatal intensive care unit (NICU), where reestablishing a secure airway can be difficult. The following study was undertaken to analyze characteristics of UEE and develop prevention strategies. Methods :,A retrospective cohort study on a level III single center NICU was undertaken. Patient records of a 12-month period from December 2003 to December 2004 were analyzed using a standardized evaluation form. Fischer's exact t -test and the Mann,Whitney U -Ranked Sum test were used for statistical analysis. Results :,One hundred and four neonates with a total ventilation time of 14 495 h were included in this study. Of these patients 12 UEE were observed (1 UEE/1208 h of ventilation time). Neither median birth weight [1445 g (range 460,4650) vs 1755 g (range 460,3570 g)] nor median gestational age [31.5 weeks (range 25.6,39.6 weeks) vs 32.7 weeks (range 23.9,41.5 weeks)] differed significantly between neonates with UEE compared with the total group. When the UEE occurred, the neonates were cared for by experienced nursing staff with a median of 10 years nursing experience. The workload for the individual nurse was high: during shifts when UEE happened, each nurse had to take care of 3.85 patients (range 1.8,5 patients). This workload was higher than the average of 3 (range 1.6,6) patients/nurse during the study period. The most frequently reported reason for UEE was difficult fixation of the tracheal tube (TT) (four patients), followed by handling of the infant by nursing staff or physiotherapy (two patients) or an active infant in whom dislocation of the TT occurred without external manipulations (three patients). In three instances, the reason for the UEE was not documented. Of the 12 UEE observed in 10 patients, three required immediate reintubation, five were managed with nasal continuous positive airway pressure and four did not require further respiratory support. Of those who required support, FiO2 increased by 14% over baseline compared with the FiO2 prior to UEE. Conclusions :,Inadequate TT fixation could be identified as the main contributor to UEE and should be targeted in prevention strategies. The reintubation rate after UEE was only 25%. Overall, UEE did not result in an adverse outcome in terms of mortality. Length of stay on NICU was significantly longer in UEE patients. [source] Percutaneous dilational tracheostomy: a safer technique of airway management using a microlaryngeal tubeANAESTHESIA, Issue 3 2002L. Fisher Summary Management of the airway in an intubated patient during formation of a tracheostomy can be hazardous. The usual method involves withdrawal of the tracheal tube, which has been providing a secure airway, prior to inserting the tracheostomy tube. A method of airway management, using a microlaryngeal tube, has been devised with the aim of maintaining full tracheal intubation and ventilation until the correct position of the tracheostomy tube can be verified. An audit of 250 successive cases of percutaneous tracheostomy demonstrated this method to be safe and effective. [source] Difficult intubation of a child through laryngeal mask airway with two tracheal tubesACTA PAEDIATRICA, Issue 12 2006TANIL KENDIIRLI Abstract Difficult tracheal intubation occurs infrequently. It is estimated that difficult laryngoscopy occurs in 1,2% of patients. Tracheal intubation of especially small infants can be challenging. When faced with a difficult airway, intubation through a laryngeal mask airway is one method of obtaining a secure airway. Here, we report a 23-mo-old girl with chronic lung disease and severe pneumonia, who was admitted to our paediatric intensive care unit. Since the patient could not be intubated by the standard method, because her larynx was up and forward, she was intubated successfully with a laryngeal mask airway through which two consecutive tracheal tubes were inserted. Conclusion: Laryngeal mask airway has an important role as a back-up device in case direct visualization of the larynx is not possible. [source] | ||||||||||