BACKGROUND:Tracheal intubation(TI)is a fundamental procedure for securing the airway or assisting ventilation in emergency medicine.Tracheal intubation in the lateral position(TILP)has been utilized in clinical practi...BACKGROUND:Tracheal intubation(TI)is a fundamental procedure for securing the airway or assisting ventilation in emergency medicine.Tracheal intubation in the lateral position(TILP)has been utilized in clinical practice,demonstrating potential advantages in specific scenarios,including emergency settings.However,there is a lack of comprehensive reviews and practical protocols on TILP application.To address this gap,we performed a narrative review,and provided evidence-based recommendations to formulate a practice protocol,to assist clinicians to effectively apply TILP.METHODS:We conducted a narrative review of TILP applications and developed recommendations based on clinical research evidence and clinical experience.Delphi method was used among the TILP consortium to grade the strength of the recommendations and to help reach consensus.The practice protocols were formulated as warranted by advancements in medical knowledge,technology,and practice.RESULTS:This narrative review summarized the current evidence on TILP application,highlighting its safety,efficacy,challenges,and potential complications.In total,24 recommendations and a clinical protocol for TILP application in emergency patients were established.CONCLUSION:TILP is a valuable technique in emergency medicine.We reviewed its application in emergency settings and formulated recommendations along with a clinical practice protocol.Future studies are needed to evaluate the safety and efficacy of TILP,broaden its scope of application,and explore effective training protocols.展开更多
Endotracheal intubation-related complications are common in clinical,and there are currently no effective strategies to address these matters.Inspired by the biological characteristics of human airway mucus(HAM),an ar...Endotracheal intubation-related complications are common in clinical,and there are currently no effective strategies to address these matters.Inspired by the biological characteristics of human airway mucus(HAM),an artificial airway mucus(ARM)coating is straightforwardly constructed by combining carboxymethyl chitosan with methyl cellulose.The ARM coating exhibited excellent lubricity(coefficient of friction(Co F)=0.05)and hydrophilicity(water contact angle(WCA)=21.3°),and was capable of coating both the internal and external surfaces of the endotracheal tube(ETT).In vitro experiments demonstrated that the ARM coating not only showed good broad-spectrum antibacterial activity,but also significantly reduced nonspecific protein adhesion.Through an in vivo intubation cynomolgus monkey model,ARM-coated ETT potently mitigated airway injury and inflammation,and was highly potential to prevent bacterial infection and catheter blockage.This work offers a promising avenue for the development of airway-friendly invasive devices.展开更多
Endotracheal intubation has broad application prospects in the biomedical field.At present,visual intubation tools are mainly used to judge the catheter position.However,when patients suffer from pains in the neck,thr...Endotracheal intubation has broad application prospects in the biomedical field.At present,visual intubation tools are mainly used to judge the catheter position.However,when patients suffer from pains in the neck,throat,and trachea and other diseases or other conditions,if the exposure of the glottic area is not ideal,there are difficult airways.For difficult airways,this visual intubation tool has great limitations.Studying the new guidance method of endotracheal intubation and providing a reference or solution for difficult airway intubation is a crucial problem in the biomedical clinical field.In this paper,an endotracheal intubation method is proposed based on end-tidal carbon dioxide(ETCO_(2))perception.The simulation model verifies the feasibility of this method for endotracheal intubation guidance.Then,four micro-cavity tubes are used as a gas collection tube,and a set of endotracheal tube guidance systems based on ETCO_(2) perception is designed and developed to collect and process the CO_(2) concentration information in the pharyngeal cavity.The experimental results show that this guidance system can be used for intubation guidance in the simulated pharyngeal cavity without vision.展开更多
目的探讨颏下气管插管用于复杂颌面骨折患者气道管理的安全性。方法回顾性分析我院2024年1月~2025年8月12例复杂颌面骨折行颏下气管插管的临床资料,插管由麻醉医生与颌面外科医生协作完成,经颏下旁正中线切口建立口底通道,将经口插入的...目的探讨颏下气管插管用于复杂颌面骨折患者气道管理的安全性。方法回顾性分析我院2024年1月~2025年8月12例复杂颌面骨折行颏下气管插管的临床资料,插管由麻醉医生与颌面外科医生协作完成,经颏下旁正中线切口建立口底通道,将经口插入的气管导管引出并固定,术毕再将导管回纳口腔后经口拔除。结果12例均成功实施颏下气管插管,插管操作时间(8.2±1.8)min。呼吸回路断开时间均不超过1 min,断开前基线呼气末二氧化碳分压(pressure of end-tidal CO_(2),P_(ET)CO_(2))(37.4±1.6)mm Hg,重连后P_(ET)CO_(2)(37.6±1.4)mm Hg,无明显数值波动。2例术后转入重症监护室(合并肋骨骨折、肺挫伤预计早期拔管困难,均于术后48 h内拔除气管导管);其余10例术后拔管时间(9.1±5.4)min,术后麻醉后恢复室(postanesthesia care unit,PACU)时间(31.5±18.5)min,出PACU时Aldrete评分均≥9分。术后住院期间无切口感染、血肿、涎瘘、舌神经感觉异常及唾液腺功能异常。术后1个月门诊复查所有患者无增生性瘢痕形成,无主诉舌神经感觉异常或唾液渗漏。结论颏下气管插管是颌面创伤患者安全、有效、微创的气道管理技术,美容效果良好,可作为颌面创伤患者气管切开术的替代方案。展开更多
目的基于最佳证据构建重症患者气管插管拔管后吞咽障碍早期康复方案,为降低重症监护病房(intensive care unit,ICU)患者气管插管后并发症、提高患者生活质量提供理论依据。方法基于文献回顾法系统检索分析拔管后吞咽障碍患者的最佳证据...目的基于最佳证据构建重症患者气管插管拔管后吞咽障碍早期康复方案,为降低重症监护病房(intensive care unit,ICU)患者气管插管后并发症、提高患者生活质量提供理论依据。方法基于文献回顾法系统检索分析拔管后吞咽障碍患者的最佳证据,在此基础上使用德尔菲法进行两轮专家函询构建最终的早期康复方案。结果本研究共邀请15名专家,通过两轮函询,每轮专家函询问卷有效回收率均为100%,专家积极性较高,方案整体问卷权威系数为0.86,两轮专家函询的肯德尔和谐系数分别为0.311和0.342(P<0.01),最终形成4项一级条目、20项二级条目、40项三级条目的ICU患者气管插管拔管后吞咽障碍早期康复方案,包含团队建设、康复评估、护理及康复措施、护理评价4部分。结论该方案具备实用性、科学性与系统性,适用于拔管后吞咽障碍患者,可助力其尽快恢复吞咽功能。展开更多
基金National Natural Science Foundation of China(U24A20714 to XMF and 82102238 to PC)。
文摘BACKGROUND:Tracheal intubation(TI)is a fundamental procedure for securing the airway or assisting ventilation in emergency medicine.Tracheal intubation in the lateral position(TILP)has been utilized in clinical practice,demonstrating potential advantages in specific scenarios,including emergency settings.However,there is a lack of comprehensive reviews and practical protocols on TILP application.To address this gap,we performed a narrative review,and provided evidence-based recommendations to formulate a practice protocol,to assist clinicians to effectively apply TILP.METHODS:We conducted a narrative review of TILP applications and developed recommendations based on clinical research evidence and clinical experience.Delphi method was used among the TILP consortium to grade the strength of the recommendations and to help reach consensus.The practice protocols were formulated as warranted by advancements in medical knowledge,technology,and practice.RESULTS:This narrative review summarized the current evidence on TILP application,highlighting its safety,efficacy,challenges,and potential complications.In total,24 recommendations and a clinical protocol for TILP application in emergency patients were established.CONCLUSION:TILP is a valuable technique in emergency medicine.We reviewed its application in emergency settings and formulated recommendations along with a clinical practice protocol.Future studies are needed to evaluate the safety and efficacy of TILP,broaden its scope of application,and explore effective training protocols.
基金supported by the National Natural Science Foundation of China(Nos.52203046 and 82171219)Sichuan Science and Technology Program(No.2023NSFSC1944)+3 种基金West China Nursing Discipline Development Special Fund ProjectSichuan University(No.HXHL21007)the China Postdoctoral Science Foundation(No.2023M742483)the National Natural Science Foundation of Guangdong(No.2024A1515012881)。
文摘Endotracheal intubation-related complications are common in clinical,and there are currently no effective strategies to address these matters.Inspired by the biological characteristics of human airway mucus(HAM),an artificial airway mucus(ARM)coating is straightforwardly constructed by combining carboxymethyl chitosan with methyl cellulose.The ARM coating exhibited excellent lubricity(coefficient of friction(Co F)=0.05)and hydrophilicity(water contact angle(WCA)=21.3°),and was capable of coating both the internal and external surfaces of the endotracheal tube(ETT).In vitro experiments demonstrated that the ARM coating not only showed good broad-spectrum antibacterial activity,but also significantly reduced nonspecific protein adhesion.Through an in vivo intubation cynomolgus monkey model,ARM-coated ETT potently mitigated airway injury and inflammation,and was highly potential to prevent bacterial infection and catheter blockage.This work offers a promising avenue for the development of airway-friendly invasive devices.
基金the Science and Technology Commission of Shanghai Municipality(No.18441904600)the Cross Research Fund for Translational Medicine of Shanghai Jiao Tong University(No.ZH2018ZDA14)。
文摘Endotracheal intubation has broad application prospects in the biomedical field.At present,visual intubation tools are mainly used to judge the catheter position.However,when patients suffer from pains in the neck,throat,and trachea and other diseases or other conditions,if the exposure of the glottic area is not ideal,there are difficult airways.For difficult airways,this visual intubation tool has great limitations.Studying the new guidance method of endotracheal intubation and providing a reference or solution for difficult airway intubation is a crucial problem in the biomedical clinical field.In this paper,an endotracheal intubation method is proposed based on end-tidal carbon dioxide(ETCO_(2))perception.The simulation model verifies the feasibility of this method for endotracheal intubation guidance.Then,four micro-cavity tubes are used as a gas collection tube,and a set of endotracheal tube guidance systems based on ETCO_(2) perception is designed and developed to collect and process the CO_(2) concentration information in the pharyngeal cavity.The experimental results show that this guidance system can be used for intubation guidance in the simulated pharyngeal cavity without vision.
文摘目的探讨颏下气管插管用于复杂颌面骨折患者气道管理的安全性。方法回顾性分析我院2024年1月~2025年8月12例复杂颌面骨折行颏下气管插管的临床资料,插管由麻醉医生与颌面外科医生协作完成,经颏下旁正中线切口建立口底通道,将经口插入的气管导管引出并固定,术毕再将导管回纳口腔后经口拔除。结果12例均成功实施颏下气管插管,插管操作时间(8.2±1.8)min。呼吸回路断开时间均不超过1 min,断开前基线呼气末二氧化碳分压(pressure of end-tidal CO_(2),P_(ET)CO_(2))(37.4±1.6)mm Hg,重连后P_(ET)CO_(2)(37.6±1.4)mm Hg,无明显数值波动。2例术后转入重症监护室(合并肋骨骨折、肺挫伤预计早期拔管困难,均于术后48 h内拔除气管导管);其余10例术后拔管时间(9.1±5.4)min,术后麻醉后恢复室(postanesthesia care unit,PACU)时间(31.5±18.5)min,出PACU时Aldrete评分均≥9分。术后住院期间无切口感染、血肿、涎瘘、舌神经感觉异常及唾液腺功能异常。术后1个月门诊复查所有患者无增生性瘢痕形成,无主诉舌神经感觉异常或唾液渗漏。结论颏下气管插管是颌面创伤患者安全、有效、微创的气道管理技术,美容效果良好,可作为颌面创伤患者气管切开术的替代方案。
文摘目的基于最佳证据构建重症患者气管插管拔管后吞咽障碍早期康复方案,为降低重症监护病房(intensive care unit,ICU)患者气管插管后并发症、提高患者生活质量提供理论依据。方法基于文献回顾法系统检索分析拔管后吞咽障碍患者的最佳证据,在此基础上使用德尔菲法进行两轮专家函询构建最终的早期康复方案。结果本研究共邀请15名专家,通过两轮函询,每轮专家函询问卷有效回收率均为100%,专家积极性较高,方案整体问卷权威系数为0.86,两轮专家函询的肯德尔和谐系数分别为0.311和0.342(P<0.01),最终形成4项一级条目、20项二级条目、40项三级条目的ICU患者气管插管拔管后吞咽障碍早期康复方案,包含团队建设、康复评估、护理及康复措施、护理评价4部分。结论该方案具备实用性、科学性与系统性,适用于拔管后吞咽障碍患者,可助力其尽快恢复吞咽功能。
