BACKGROUND Several techniques of nasogastric tube(NGT)insertion have been described in the literature with different success rates.AIM To systematically search the literature and conduct a meta-analysis comparing the ...BACKGROUND Several techniques of nasogastric tube(NGT)insertion have been described in the literature with different success rates.AIM To systematically search the literature and conduct a meta-analysis comparing the success rates,insertion time and complications associated with different techniques of NGT insertion in anesthetized and intubated patients.METHODS An electronic search of the PubMed,Scopus,CENTRAL(Cochrane Central Register of Controlled Trials),and Google Scholar databases were performed up to October 31,2019.We included 17 randomized controlled trials with 2500 participants in the meta-analysis.RESULTS As compared to the conventional method,successful insertion of the NGT on first attempt was higher with modified techniques such as the reverse Sellick’s maneuver[relative risk(RR)1.94;95%confidence interval(CI):1.62-2.31],use of a frozen NGT(RR 1.55;95%CI:1.13-2.13),inserting the NGT with neck flexion and lateral neck pressure(RR 1.64;95%CI:1.10-2.45),endotracheal tube-assisted(RR 1.88;95%CI:1.52-2.32)and video-assisted placements(RR 1.60;95%CI:1.31-1.95).All the modified techniques also led to comparatively higher insertion success rates than the conventional technique.CONCLUSION The use of modified techniques of NGT insertion such as the reverse Sellick’s maneuver,neck flexion with lateral neck pressure,frozen NGT,endotracheal tube-guided or video-assisted methods result in a significantly better chance of successful tube insertion at first attempt as compared to the conventional technique.All modified techniques also significantly improve the overall chance of successful NGT placement as compared to the conventional method.展开更多
BACKGROUND A“cannot intubate,cannot oxygenate(CICO)”situation is a life-threatening condition that requires emergent management to establish a route for oxygenation to prevent oxygen desaturation.In this paper,we de...BACKGROUND A“cannot intubate,cannot oxygenate(CICO)”situation is a life-threatening condition that requires emergent management to establish a route for oxygenation to prevent oxygen desaturation.In this paper,we describe airway management in a patient with an extended parotid tumor that invaded the airways during CICO using the endotracheal tube tip in the pharynx(TTIP)technique.CASE SUMMARY A 43-year-old man was diagnosed with parotid tumor for>10 years.Computed tomography and nasopharyngeal fiberoptic examination revealed a substantial mass from the right parotid region with a deep extension through the lateral pharyngeal region to the retropharyngeal region and obliteration of the nasopharynx to the oropharynx.Tumor excision was arranged.However,we encountered CICO during anesthesia induction.An endotracheal tube was used as an emergency supraglottic airway device(TTIP)to ventilate the patient in a CICO situation where other tools such as laryngeal mask airway or mask ventilation were not suitable for this complicated and difficult airway.The patient did not experience desaturation despite sudden loss of definite airway.During tracheostomy,the pulse oximetry remained 100%with our technique of ventilating the patient.The arterial blood gas analysis revealed PaCO_(2)35.7 mmHg and PaO2242.5 mmHg upon 50%oxygenation afterward.CONCLUSION Using an endotracheal tube as a supraglottic airway device,patients may have increased survival without experiencing life-threatening desaturation.展开更多
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
Airway management plays a crucial role in providing adequate oxygenation and ventilation to patients during various medical procedures and emergencies.When patients have a limited mouth opening due to factors such as ...Airway management plays a crucial role in providing adequate oxygenation and ventilation to patients during various medical procedures and emergencies.When patients have a limited mouth opening due to factors such as trauma,inflammation,or anatomical abnormalities airway management becomes challenging.A commonly utilized method to overcome this challenge is the use of video laryngoscopy(VL),which employs a specialized device equipped with a camera and a light source to allow a clear view of the larynx and vocal cords.VL overcomes the limitations of direct laryngoscopy in patients with limited mouth opening,enabling better visualization and successful intubation.Various types of VL blades are available.We devised a novel flangeless video laryngoscope for use in patients with a limited mouth opening and then tested it on a manikin.展开更多
BACKGROUND MURCS association,an acronym for Müllerian duct aplasia/hypoplasia,congenital renal agenesis/ectopia,and cervical somite dysplasia,presents unique anaesthetic challenges,particularly for airway control...BACKGROUND MURCS association,an acronym for Müllerian duct aplasia/hypoplasia,congenital renal agenesis/ectopia,and cervical somite dysplasia,presents unique anaesthetic challenges,particularly for airway control due to cervical spine anomalies.This case report adds to the limited literature by detailing airway management strategies in a paediatric patient with MURCS,emphasising the need for thorough preoperative evaluation and curated planning.CASE SUMMARY This report describes the successful anaesthetic and airway management of a 6-year-old girl with MURCS undergoing dental extraction.To address the complexities of the patient’s condition,a multidisciplinary approach involving comprehensive preoperative assessment,meticulous planning,and advanced airway management techniques was adopted.CONCLUSION This report emphasizes individualized anesthetic strategies and interprofessional collaboration for managing rare congenital syndromes.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
BACKGROUND In critical care practice,difficult airway management poses a substantial challenge,necessitating urgent intervention to ensure patient safety and optimize outcomes.Extracorporeal membrane oxygenation(ECMO)...BACKGROUND In critical care practice,difficult airway management poses a substantial challenge,necessitating urgent intervention to ensure patient safety and optimize outcomes.Extracorporeal membrane oxygenation(ECMO)is a potential rescue tool in patients with severe airway compromise,although evidence of its efficacy and safety remains limited.AIM To review the local experience of using ECMO support in patients with difficult airway management.METHODS This retrospective case series study includes patients with difficult airway management who required ECMO support at a tertiary hospital in a Middle Eastern country.RESULTS Between 2016 and 2023,a total of 13 patients required ECMO support due to challenging airway patency in the operating room.Indications for ECMO encompassed various diagnoses,including tracheal stenosis,external tracheal compression,and subglottic stenosis.Surgical interventions such as tracheal resection and anastomosis often necessitated ECMO support to maintain adequate oxygenation and hemodynamic stability.The duration of ECMO support ranged from standby mode(ECMO implantation is readily available)to several days,with relatively infrequent complications observed.Despite the challenges encountered,most patients survived hospital discharge,highlighting the effectiveness of ECMO in managing difficult airways.CONCLUSION This study underscores the crucial role of ECMO as a life-saving intervention in selected cases of difficult airway management.Further research is warranted to refine the understanding of optimal management strategies and improve outcomes in this challenging patient population.展开更多
Existing literature indicates that prolonged insertion time is associated with procedural complexity and may influence adenoma detection.Xu et al recently reported that longer insertion time correlates with lower aden...Existing literature indicates that prolonged insertion time is associated with procedural complexity and may influence adenoma detection.Xu et al recently reported that longer insertion time correlates with lower adenoma detection,but this effect can be mitigated by sufficient withdrawal duration.Insertion time should not be regarded merely as a numeric variable but rather as a multidimensional marker of technical difficulty.Integrating the insertion-to-withdrawal ratio with composite indicators such as looping or bowel preparation quality may enhance predictive models of colonoscopy performance.Conceptualizing insertion time in this way provides a more nuanced understanding of its role in adenoma detection and highlights the need for improved frameworks that link procedural complexity with quality outcomes.展开更多
BACKGROUND Peripherally inserted central catheter(PICC)is the preferred intravenous route for chemotherapy in patients with cancer,but its complications,especially deep vein thrombosis(DVT),are becoming increasingly p...BACKGROUND Peripherally inserted central catheter(PICC)is the preferred intravenous route for chemotherapy in patients with cancer,but its complications,especially deep vein thrombosis(DVT),are becoming increasingly prevalent.Medical staff proficient in intubation and maintenance techniques can reduce complications.The multivariate integration teaching model applies the integration of“teaching learning application”to medical training,which helps shift the prevention of complications from“passive management of complications”to“active construction of risk immunity”,thereby ensuring foundational competency for PICC in patients with cancer.AIM To investigate the efficacy of the multivariate integration teaching model in patients with gastric cancer and concurrent DVT after PICC intubation and analyze its effect on patients’quality of life index(QLI)and satisfaction.METHODS A retrospective analysis of medical records of 100 patients with gastric cancer and PICC treated at Zhejiang Provincial People’s Hospital from May 2019 to November 2020 was conducted.According to the different treatment methods and teaching modes received by medical staff,they were divided into a control group and an experimental group,with 50 cases in each group.The routine clinical teaching model and the multivariate integration teaching model were administered to the medical staff for the control group and the experimental group,respectively,to compare the incidence rates of DVT and other adverse reactions,QLI scores,Karnofsky Performance Scale scores,Mental Status Scale in Non-Psychiatric Settings scores,patient satisfaction,medical staff’s test marks,and satisfaction evaluation of the teaching model.RESULTS Compared with the control group,the experimental group exhibited significantly lower incidence rates of DVT and other adverse reactions and MSSNS scores but significantly higher QLI scores,KPS scores,patient satisfaction,medical staff’s test marks,and their satisfaction evaluations of the teaching model(P<0.05).CONCLUSION In a single-center practice,performing the multivariate integration teaching model for medical staff may effectively improve the patients’QLI and satisfaction and may have certain application value in preventing DVT in patients with gastric cancer and PICC.展开更多
Lung ischemia-reperfusion injury(LIRI),an acute lung injury syndrome triggered by lung transplantation or distal organ ischemia,has long been a difficult and hot issue in clinical research.In this study,we proposed a ...Lung ischemia-reperfusion injury(LIRI),an acute lung injury syndrome triggered by lung transplantation or distal organ ischemia,has long been a difficult and hot issue in clinical research.In this study,we proposed a simple and less invasive reversible LIRI surgical protocol,achieved by improving the mouse left hilar entrapment model,which significantly improved the operability of the experiment and the reproducibility of the results.The protocol achieves precise control of the ischemic and reperfusion processes by visualizing transoral intubation,using reversible ligation of live knots to clamp the left hilar,and temporary closure of the thoracic cavity during ischemia.The reversible survival model we constructed not only provides a reliable tool to study the cellular and molecular mechanisms of LIRI but also can be used to assess the stage of injury regression,experimental pneumonia,and survival in mice.In addition,it simplifies the lung portal separation clamping operation for reversible clamping and provides an easy-to-learn visual tracheal intubation method that can be quickly mastered and replicated by beginners for consistent and reliable results.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
Background: Emergency front-of-neck airway(eFONA) is a life-saving procedure in “cannot intubate, cannot oxygenate”(CICO). The fastest and most reliable method of eFONA has not been determined. We compared two of th...Background: Emergency front-of-neck airway(eFONA) is a life-saving procedure in “cannot intubate, cannot oxygenate”(CICO). The fastest and most reliable method of eFONA has not been determined. We compared two of the most advocated approaches: surgical cricothyroidotomy and percutaneous cricothyroidotomy, in an obese, in vivo porcine hemorrhage model, designed to introduce real-time physiological feedback, relevant and high provider stress. The primary aim was to determine the fastest method to secure airway. Secondary aims were arterial saturation and partial pressure of oxygen, proxy survival and influence of experience.Methods: Twelve pigs [(60.3±4.1) kg] were anesthetized and exposed to 25%–35% total blood volume hemorrhage before extubation and randomization to Seldinger technique “percutaneous cricothyroidotomy”(n=6) or scalpelbougie-tube technique “surgical cricothyroidotomy”(n=6). Specialists in anesthesia and intensive care in a tertiary referral hospital performed the eFONA, simulating an actual CICO-situation.Results: In surgical cricothyroidotomy vs. percutaneous cricothyroidotomy, the median(interquartile range, IQR) times to secure airway were 109(IQR 71–130) s and 298(IQR 128–360) s(P=0.0152), arterial blood saturation(SaO2) were 74.7(IQR 46.6–84.2)% and 7.9(IQR 4.1–15.6)%(P=0.0167), PaO_(2) were 7.0(IQR 4.7–7.7) kPa and 2.0(IQR 1.1–2.9) kPa(P=0.0667), and times of cardiac arrest(proxy survival) were 137–233 s, 190(IQR 143–229) s, from CICO. All six animals survived surgical cricothyroidotomy, and two of six(33%) animals survived percutaneous cricothyroidotomy. Years in anesthesia, 13.5(IQR 7.5–21.3), did not influence time to secure airway.Conclusions: eFONA by surgical cricothyroidotomy was faster and had increased oxygenation and survival, when performed under stress by board certified anesthesiologists, and may be an indication of preferred method in situations with hemorrhage and CICO, in obese patients.展开更多
AIM:To investigate a limited water infusion method in colonoscopy.METHODS:Consecutive patients undergoing minimally sedated colonoscopy were randomized to receive air insufflation(n = 89) or water infusion limited to ...AIM:To investigate a limited water infusion method in colonoscopy.METHODS:Consecutive patients undergoing minimally sedated colonoscopy were randomized to receive air insufflation(n = 89) or water infusion limited to the rectum,sigmoid colon and descending colon(n = 90).Completion rates,cecal intubation times,procedure times,need for abdominal compression,turning of patients and levels of discomfort were evaluated.RESULTS:Completion rates,total procedure times,need for abdominal compression,and turning of patients were similar between groups.Less pain was experienced in the water group than in the air group(2.5 ± 2.5 vs 3.4 ± 2.8,mean ± SD,P = 0.021).The cecal intubation time was significantly longer in the water group than in the air group(6.4 ± 3.1 min vs 4.5 ± 2.4 min,P < 0.001).More water was infused in the water group(322 ± 80.9 mL vs 26.2 ± 39.4 mL,P < 0.001).CONCLUSION:Limited airless water infusion in the distal colon reduces patients' pain during colonoscopy.展开更多
AIM:To study the therapeutic efficacy of a new transnasal ileus tube advanced endoscopically for adhesive small bowel obstruction.METHODS:A total of 186 patients with adhesive small bowel obstruction treated from Sept...AIM:To study the therapeutic efficacy of a new transnasal ileus tube advanced endoscopically for adhesive small bowel obstruction.METHODS:A total of 186 patients with adhesive small bowel obstruction treated from September 2007 to February 2011 were enrolled into this prospective randomized controlled study.The endoscopically advanced new ileus tube was used for gastrointestinal decompression in 96 patients and ordinary nasogastric tube(NGT) was used in 90 patients.The therapeutic efficacy was compared between the two groups.RESULTS:Compared with the NGT group,the ileus tube group experienced significantly shorter time for relief of clinical symptoms and improvement in the findings of abdominal radiograph(4.1 ± 2.3 d vs 8.5 ± 5.0 d) and laboratory tests(P < 0.01).The overall effectiveness rate was up to 89.6% in the ileus tube group and 46.7% in the NGT group(P < 0.01).And 10.4% of the patients in the ileus tube group and 53.3% of the NGT group underwent surgery.For recurrent adhesive bowel obstruction,ileus tube was also significantly more effective than NGT(95.8% vs 31.6%).In the ileus tube group,the drainage output on the first day and the length of hospital stay were significantly different depending on the treatment success or failure(P < 0.05).The abdominal radiographic improvement was correlated with whether or not the patient underwent surgery.CONCLUSION:Ileus tube can be used for adhesive small bowel obstruction.Endoscopic placement of the ileus tube is convenient and worthy to be promoted despite the potential risks.展开更多
BACKGROUND:We sought to evaluate the risk factors for developing ventilator-associated pneumonia(VAP)and whether the location of intubation posed a risk in trauma patients.METHODS:Data were retrospectively reviewed fo...BACKGROUND:We sought to evaluate the risk factors for developing ventilator-associated pneumonia(VAP)and whether the location of intubation posed a risk in trauma patients.METHODS:Data were retrospectively reviewed for adult trauma patients requiring intubation for>48 hours,admitted between 2010 and 2013.Patients’demographics,clinical presentations and outcomes were compared according to intubation location(prehospital intubation[PHI]vs.trauma room[TRI])and presence vs.absence of VAP.Multivariate regression analysis was performed to identify predictors of VAP.RESULTS:Of 471 intubated patients,332 patients met the inclusion criteria(124 had PHI and208 had TRI)with a mean age of 30.7±14.8 years.PHI group had lower GCS(P=0.001),respiratory rate(P=0.001),and higher frequency of head(P=0.02)and chest injuries(P=0.04).The rate of VAP in PHI group was comparable to the TRI group(P=0.60).Patients who developed VAP were 6 years older,had significantly lower GCS and higher ISS,head AIS,and higher rates of polytrauma.The overall mortality was 7.5%,and was not associated with intubation location or pneumonia rates.In the early-VAP group,gram-positive pathogens were more common,while gram-negative microorganisms were more frequently encountered in the late VAP group.Logistic regression analysis and modeling showed that the impact of the location of intubation in predicting the risk of VAP appeared only when chest injury was included in the models.CONCLUSION:In trauma,the risk of developing VAP is multifactorial.However,the location of intubation and presence of chest injury could play an important role.展开更多
AIM:To optimize the preoperative diagnosis and surgical management of adult intussusception (AI).METHODS:A retrospective review of the clinical features,diagnosis,management and pathology 41 adult patients with postop...AIM:To optimize the preoperative diagnosis and surgical management of adult intussusception (AI).METHODS:A retrospective review of the clinical features,diagnosis,management and pathology 41 adult patients with postoperative diagnoses of intussusception was conducted.RESULTS:Forty-one patients with 44 intussusceptions were operated on,24.4% had acute symptoms,24.4% had subacute symptoms,and 51.2% had chronic symptoms.70.7% of the patients presented with intestinal obstruction.There were 20 enteric,15 ileocolic,eight colocolonic and one sigmoidorectal intussusceptions.65.9% of intussusceptions were diagnosed preoperatively using a computed tomography (CT) scan (90.5% accurate) and ultrasonography (60.0% accurate,rising to 91.7% for patients who had a palpable abdominal mass).Coloscopy located the occupying lesions of the lead point of ileocolic,colocolonic and sigmoidorectal intussusceptions.Four intussusceptions in three patients were simply reduced.Twenty-one patients underwent resection after primary reduction.There was no mortality and anastomosis leakage perioperatively.Except for one patient with multiple small bowel adenomas,which recurred 5 mo after surgery,no patients were recurrent within 6 mo.Pathologically,54.5% of the intussusceptions had a tumor,of which 27.3% were malignant.9.1% comprised nontumorous polyps.Four intussusceptions had a gastrojejunostomy with intestinal intubation,and four intussusceptions had no organic lesion.CONCLUSION:CT is the most effective and accurate diagnostic technique.Colonoscopy can detect most lead point lesions of non-enteric intussusceptions.Intestinal intubation should be avoided.展开更多
AIM: To study the significance of cap-fitted colonoscopy in improving cecal intubation time and polyp detection rate. METHODS: This study was a prospective randomized controlled trial conducted from March 2008 to Febr...AIM: To study the significance of cap-fitted colonoscopy in improving cecal intubation time and polyp detection rate. METHODS: This study was a prospective randomized controlled trial conducted from March 2008 to February 2009 in a tertiary referral hospital at Sydney. The primary end point was cecal intubation time and the secondary endpoint was polyp detection rate. Consecutive cases of total colonoscopy over a 1-year period were recruited. Randomization into either standard colonoscopy (SC) or cap-assisted colonoscopy (CAC) was performed after consent was obtained. For cases randomized to CAC, one of the three sizes of cap was used: D-201-15004 (with a diameter of 15.3 mm), D-201-14304 (14.6 mm) and D-201-12704 (13.0 mm). All of these caps were produced by Olympus Medical Systems, Japan. Independent predictors for faster cecal time and better polyp detection rate were also determined from this study. RESULTS: There were 200 cases in each group. There was no signif icant difference in terms of demographic characteristics between the two groups. CAC, when compared to the SC group, had no signif icant difference in terms of cecal intubation rate (96.0% vs 97.0%, P = 0.40) and time (9.94 ± 7.05 min vs 10.34 ± 6.82 min, P = 0.21), or polyp detection rate (32.8% vs 31.3%, P = 0.75). On the subgroup analysis, there was no significant difference in terms of cecal intubation time by trainees (88.1% vs 84.8%, P = 0.40), ileal intubation rate (82.5% vs 79.0%, P = 0.38) or total colonoscopy time (23.24 ± 13.95 min vs 22.56 ± 9.94 min, P = 0.88). On multivariate analysis, the independent determinants of faster cecal time were consultant-performed procedures (P < 0.001), male patients (P < 0.001), non-usage of hyoscine (P < 0.001) and better bowel preparation (P = 0.01). The determinants of better polyp detection rate were older age (P < 0.001), no history of previous abdominal surgery (P = 0.04), patients not having esophagogastroduodenoscopy in the same setting (P = 0.003), trainee-performed procedures (P = 0.01), usage of hyoscine (P = 0.01) and procedures performed for polyp follow-up (P = 0.01). The limitations of the study were that it was a single-center experience, no blinding was possible, and there were a large number of endoscopists. CONCLUSION: CAC did not signif icantly different from SC in term of cecal intubation time and polyp detection rate.展开更多
文摘BACKGROUND Several techniques of nasogastric tube(NGT)insertion have been described in the literature with different success rates.AIM To systematically search the literature and conduct a meta-analysis comparing the success rates,insertion time and complications associated with different techniques of NGT insertion in anesthetized and intubated patients.METHODS An electronic search of the PubMed,Scopus,CENTRAL(Cochrane Central Register of Controlled Trials),and Google Scholar databases were performed up to October 31,2019.We included 17 randomized controlled trials with 2500 participants in the meta-analysis.RESULTS As compared to the conventional method,successful insertion of the NGT on first attempt was higher with modified techniques such as the reverse Sellick’s maneuver[relative risk(RR)1.94;95%confidence interval(CI):1.62-2.31],use of a frozen NGT(RR 1.55;95%CI:1.13-2.13),inserting the NGT with neck flexion and lateral neck pressure(RR 1.64;95%CI:1.10-2.45),endotracheal tube-assisted(RR 1.88;95%CI:1.52-2.32)and video-assisted placements(RR 1.60;95%CI:1.31-1.95).All the modified techniques also led to comparatively higher insertion success rates than the conventional technique.CONCLUSION The use of modified techniques of NGT insertion such as the reverse Sellick’s maneuver,neck flexion with lateral neck pressure,frozen NGT,endotracheal tube-guided or video-assisted methods result in a significantly better chance of successful tube insertion at first attempt as compared to the conventional technique.All modified techniques also significantly improve the overall chance of successful NGT placement as compared to the conventional method.
文摘BACKGROUND A“cannot intubate,cannot oxygenate(CICO)”situation is a life-threatening condition that requires emergent management to establish a route for oxygenation to prevent oxygen desaturation.In this paper,we describe airway management in a patient with an extended parotid tumor that invaded the airways during CICO using the endotracheal tube tip in the pharynx(TTIP)technique.CASE SUMMARY A 43-year-old man was diagnosed with parotid tumor for>10 years.Computed tomography and nasopharyngeal fiberoptic examination revealed a substantial mass from the right parotid region with a deep extension through the lateral pharyngeal region to the retropharyngeal region and obliteration of the nasopharynx to the oropharynx.Tumor excision was arranged.However,we encountered CICO during anesthesia induction.An endotracheal tube was used as an emergency supraglottic airway device(TTIP)to ventilate the patient in a CICO situation where other tools such as laryngeal mask airway or mask ventilation were not suitable for this complicated and difficult airway.The patient did not experience desaturation despite sudden loss of definite airway.During tracheostomy,the pulse oximetry remained 100%with our technique of ventilating the patient.The arterial blood gas analysis revealed PaCO_(2)35.7 mmHg and PaO2242.5 mmHg upon 50%oxygenation afterward.CONCLUSION Using an endotracheal tube as a supraglottic airway device,patients may have increased survival without experiencing life-threatening desaturation.
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.
文摘Airway management plays a crucial role in providing adequate oxygenation and ventilation to patients during various medical procedures and emergencies.When patients have a limited mouth opening due to factors such as trauma,inflammation,or anatomical abnormalities airway management becomes challenging.A commonly utilized method to overcome this challenge is the use of video laryngoscopy(VL),which employs a specialized device equipped with a camera and a light source to allow a clear view of the larynx and vocal cords.VL overcomes the limitations of direct laryngoscopy in patients with limited mouth opening,enabling better visualization and successful intubation.Various types of VL blades are available.We devised a novel flangeless video laryngoscope for use in patients with a limited mouth opening and then tested it on a manikin.
基金Supported by Far-Eastern Memorial Hospital,No.FEMH-2025-C-016.
文摘BACKGROUND MURCS association,an acronym for Müllerian duct aplasia/hypoplasia,congenital renal agenesis/ectopia,and cervical somite dysplasia,presents unique anaesthetic challenges,particularly for airway control due to cervical spine anomalies.This case report adds to the limited literature by detailing airway management strategies in a paediatric patient with MURCS,emphasising the need for thorough preoperative evaluation and curated planning.CASE SUMMARY This report describes the successful anaesthetic and airway management of a 6-year-old girl with MURCS undergoing dental extraction.To address the complexities of the patient’s condition,a multidisciplinary approach involving comprehensive preoperative assessment,meticulous planning,and advanced airway management techniques was adopted.CONCLUSION This report emphasizes individualized anesthetic strategies and interprofessional collaboration for managing rare congenital syndromes.
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.
文摘BACKGROUND In critical care practice,difficult airway management poses a substantial challenge,necessitating urgent intervention to ensure patient safety and optimize outcomes.Extracorporeal membrane oxygenation(ECMO)is a potential rescue tool in patients with severe airway compromise,although evidence of its efficacy and safety remains limited.AIM To review the local experience of using ECMO support in patients with difficult airway management.METHODS This retrospective case series study includes patients with difficult airway management who required ECMO support at a tertiary hospital in a Middle Eastern country.RESULTS Between 2016 and 2023,a total of 13 patients required ECMO support due to challenging airway patency in the operating room.Indications for ECMO encompassed various diagnoses,including tracheal stenosis,external tracheal compression,and subglottic stenosis.Surgical interventions such as tracheal resection and anastomosis often necessitated ECMO support to maintain adequate oxygenation and hemodynamic stability.The duration of ECMO support ranged from standby mode(ECMO implantation is readily available)to several days,with relatively infrequent complications observed.Despite the challenges encountered,most patients survived hospital discharge,highlighting the effectiveness of ECMO in managing difficult airways.CONCLUSION This study underscores the crucial role of ECMO as a life-saving intervention in selected cases of difficult airway management.Further research is warranted to refine the understanding of optimal management strategies and improve outcomes in this challenging patient population.
文摘Existing literature indicates that prolonged insertion time is associated with procedural complexity and may influence adenoma detection.Xu et al recently reported that longer insertion time correlates with lower adenoma detection,but this effect can be mitigated by sufficient withdrawal duration.Insertion time should not be regarded merely as a numeric variable but rather as a multidimensional marker of technical difficulty.Integrating the insertion-to-withdrawal ratio with composite indicators such as looping or bowel preparation quality may enhance predictive models of colonoscopy performance.Conceptualizing insertion time in this way provides a more nuanced understanding of its role in adenoma detection and highlights the need for improved frameworks that link procedural complexity with quality outcomes.
文摘BACKGROUND Peripherally inserted central catheter(PICC)is the preferred intravenous route for chemotherapy in patients with cancer,but its complications,especially deep vein thrombosis(DVT),are becoming increasingly prevalent.Medical staff proficient in intubation and maintenance techniques can reduce complications.The multivariate integration teaching model applies the integration of“teaching learning application”to medical training,which helps shift the prevention of complications from“passive management of complications”to“active construction of risk immunity”,thereby ensuring foundational competency for PICC in patients with cancer.AIM To investigate the efficacy of the multivariate integration teaching model in patients with gastric cancer and concurrent DVT after PICC intubation and analyze its effect on patients’quality of life index(QLI)and satisfaction.METHODS A retrospective analysis of medical records of 100 patients with gastric cancer and PICC treated at Zhejiang Provincial People’s Hospital from May 2019 to November 2020 was conducted.According to the different treatment methods and teaching modes received by medical staff,they were divided into a control group and an experimental group,with 50 cases in each group.The routine clinical teaching model and the multivariate integration teaching model were administered to the medical staff for the control group and the experimental group,respectively,to compare the incidence rates of DVT and other adverse reactions,QLI scores,Karnofsky Performance Scale scores,Mental Status Scale in Non-Psychiatric Settings scores,patient satisfaction,medical staff’s test marks,and satisfaction evaluation of the teaching model.RESULTS Compared with the control group,the experimental group exhibited significantly lower incidence rates of DVT and other adverse reactions and MSSNS scores but significantly higher QLI scores,KPS scores,patient satisfaction,medical staff’s test marks,and their satisfaction evaluations of the teaching model(P<0.05).CONCLUSION In a single-center practice,performing the multivariate integration teaching model for medical staff may effectively improve the patients’QLI and satisfaction and may have certain application value in preventing DVT in patients with gastric cancer and PICC.
基金Natural Science Foundation of Anhui ProvinceGrant/Award Number:1908085MH241。
文摘Lung ischemia-reperfusion injury(LIRI),an acute lung injury syndrome triggered by lung transplantation or distal organ ischemia,has long been a difficult and hot issue in clinical research.In this study,we proposed a simple and less invasive reversible LIRI surgical protocol,achieved by improving the mouse left hilar entrapment model,which significantly improved the operability of the experiment and the reproducibility of the results.The protocol achieves precise control of the ischemic and reperfusion processes by visualizing transoral intubation,using reversible ligation of live knots to clamp the left hilar,and temporary closure of the thoracic cavity during ischemia.The reversible survival model we constructed not only provides a reliable tool to study the cellular and molecular mechanisms of LIRI but also can be used to assess the stage of injury regression,experimental pneumonia,and survival in mice.In addition,it simplifies the lung portal separation clamping operation for reversible clamping and provides an easy-to-learn visual tracheal intubation method that can be quickly mastered and replicated by beginners for consistent and reliable results.
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Background: Emergency front-of-neck airway(eFONA) is a life-saving procedure in “cannot intubate, cannot oxygenate”(CICO). The fastest and most reliable method of eFONA has not been determined. We compared two of the most advocated approaches: surgical cricothyroidotomy and percutaneous cricothyroidotomy, in an obese, in vivo porcine hemorrhage model, designed to introduce real-time physiological feedback, relevant and high provider stress. The primary aim was to determine the fastest method to secure airway. Secondary aims were arterial saturation and partial pressure of oxygen, proxy survival and influence of experience.Methods: Twelve pigs [(60.3±4.1) kg] were anesthetized and exposed to 25%–35% total blood volume hemorrhage before extubation and randomization to Seldinger technique “percutaneous cricothyroidotomy”(n=6) or scalpelbougie-tube technique “surgical cricothyroidotomy”(n=6). Specialists in anesthesia and intensive care in a tertiary referral hospital performed the eFONA, simulating an actual CICO-situation.Results: In surgical cricothyroidotomy vs. percutaneous cricothyroidotomy, the median(interquartile range, IQR) times to secure airway were 109(IQR 71–130) s and 298(IQR 128–360) s(P=0.0152), arterial blood saturation(SaO2) were 74.7(IQR 46.6–84.2)% and 7.9(IQR 4.1–15.6)%(P=0.0167), PaO_(2) were 7.0(IQR 4.7–7.7) kPa and 2.0(IQR 1.1–2.9) kPa(P=0.0667), and times of cardiac arrest(proxy survival) were 137–233 s, 190(IQR 143–229) s, from CICO. All six animals survived surgical cricothyroidotomy, and two of six(33%) animals survived percutaneous cricothyroidotomy. Years in anesthesia, 13.5(IQR 7.5–21.3), did not influence time to secure airway.Conclusions: eFONA by surgical cricothyroidotomy was faster and had increased oxygenation and survival, when performed under stress by board certified anesthesiologists, and may be an indication of preferred method in situations with hemorrhage and CICO, in obese patients.
基金Supported by Research funds from Buddhist Dalin Tzu Chi General Hospital
文摘AIM:To investigate a limited water infusion method in colonoscopy.METHODS:Consecutive patients undergoing minimally sedated colonoscopy were randomized to receive air insufflation(n = 89) or water infusion limited to the rectum,sigmoid colon and descending colon(n = 90).Completion rates,cecal intubation times,procedure times,need for abdominal compression,turning of patients and levels of discomfort were evaluated.RESULTS:Completion rates,total procedure times,need for abdominal compression,and turning of patients were similar between groups.Less pain was experienced in the water group than in the air group(2.5 ± 2.5 vs 3.4 ± 2.8,mean ± SD,P = 0.021).The cecal intubation time was significantly longer in the water group than in the air group(6.4 ± 3.1 min vs 4.5 ± 2.4 min,P < 0.001).More water was infused in the water group(322 ± 80.9 mL vs 26.2 ± 39.4 mL,P < 0.001).CONCLUSION:Limited airless water infusion in the distal colon reduces patients' pain during colonoscopy.
文摘AIM:To study the therapeutic efficacy of a new transnasal ileus tube advanced endoscopically for adhesive small bowel obstruction.METHODS:A total of 186 patients with adhesive small bowel obstruction treated from September 2007 to February 2011 were enrolled into this prospective randomized controlled study.The endoscopically advanced new ileus tube was used for gastrointestinal decompression in 96 patients and ordinary nasogastric tube(NGT) was used in 90 patients.The therapeutic efficacy was compared between the two groups.RESULTS:Compared with the NGT group,the ileus tube group experienced significantly shorter time for relief of clinical symptoms and improvement in the findings of abdominal radiograph(4.1 ± 2.3 d vs 8.5 ± 5.0 d) and laboratory tests(P < 0.01).The overall effectiveness rate was up to 89.6% in the ileus tube group and 46.7% in the NGT group(P < 0.01).And 10.4% of the patients in the ileus tube group and 53.3% of the NGT group underwent surgery.For recurrent adhesive bowel obstruction,ileus tube was also significantly more effective than NGT(95.8% vs 31.6%).In the ileus tube group,the drainage output on the first day and the length of hospital stay were significantly different depending on the treatment success or failure(P < 0.05).The abdominal radiographic improvement was correlated with whether or not the patient underwent surgery.CONCLUSION:Ileus tube can be used for adhesive small bowel obstruction.Endoscopic placement of the ileus tube is convenient and worthy to be promoted despite the potential risks.
文摘BACKGROUND:We sought to evaluate the risk factors for developing ventilator-associated pneumonia(VAP)and whether the location of intubation posed a risk in trauma patients.METHODS:Data were retrospectively reviewed for adult trauma patients requiring intubation for>48 hours,admitted between 2010 and 2013.Patients’demographics,clinical presentations and outcomes were compared according to intubation location(prehospital intubation[PHI]vs.trauma room[TRI])and presence vs.absence of VAP.Multivariate regression analysis was performed to identify predictors of VAP.RESULTS:Of 471 intubated patients,332 patients met the inclusion criteria(124 had PHI and208 had TRI)with a mean age of 30.7±14.8 years.PHI group had lower GCS(P=0.001),respiratory rate(P=0.001),and higher frequency of head(P=0.02)and chest injuries(P=0.04).The rate of VAP in PHI group was comparable to the TRI group(P=0.60).Patients who developed VAP were 6 years older,had significantly lower GCS and higher ISS,head AIS,and higher rates of polytrauma.The overall mortality was 7.5%,and was not associated with intubation location or pneumonia rates.In the early-VAP group,gram-positive pathogens were more common,while gram-negative microorganisms were more frequently encountered in the late VAP group.Logistic regression analysis and modeling showed that the impact of the location of intubation in predicting the risk of VAP appeared only when chest injury was included in the models.CONCLUSION:In trauma,the risk of developing VAP is multifactorial.However,the location of intubation and presence of chest injury could play an important role.
文摘AIM:To optimize the preoperative diagnosis and surgical management of adult intussusception (AI).METHODS:A retrospective review of the clinical features,diagnosis,management and pathology 41 adult patients with postoperative diagnoses of intussusception was conducted.RESULTS:Forty-one patients with 44 intussusceptions were operated on,24.4% had acute symptoms,24.4% had subacute symptoms,and 51.2% had chronic symptoms.70.7% of the patients presented with intestinal obstruction.There were 20 enteric,15 ileocolic,eight colocolonic and one sigmoidorectal intussusceptions.65.9% of intussusceptions were diagnosed preoperatively using a computed tomography (CT) scan (90.5% accurate) and ultrasonography (60.0% accurate,rising to 91.7% for patients who had a palpable abdominal mass).Coloscopy located the occupying lesions of the lead point of ileocolic,colocolonic and sigmoidorectal intussusceptions.Four intussusceptions in three patients were simply reduced.Twenty-one patients underwent resection after primary reduction.There was no mortality and anastomosis leakage perioperatively.Except for one patient with multiple small bowel adenomas,which recurred 5 mo after surgery,no patients were recurrent within 6 mo.Pathologically,54.5% of the intussusceptions had a tumor,of which 27.3% were malignant.9.1% comprised nontumorous polyps.Four intussusceptions had a gastrojejunostomy with intestinal intubation,and four intussusceptions had no organic lesion.CONCLUSION:CT is the most effective and accurate diagnostic technique.Colonoscopy can detect most lead point lesions of non-enteric intussusceptions.Intestinal intubation should be avoided.
文摘AIM: To study the significance of cap-fitted colonoscopy in improving cecal intubation time and polyp detection rate. METHODS: This study was a prospective randomized controlled trial conducted from March 2008 to February 2009 in a tertiary referral hospital at Sydney. The primary end point was cecal intubation time and the secondary endpoint was polyp detection rate. Consecutive cases of total colonoscopy over a 1-year period were recruited. Randomization into either standard colonoscopy (SC) or cap-assisted colonoscopy (CAC) was performed after consent was obtained. For cases randomized to CAC, one of the three sizes of cap was used: D-201-15004 (with a diameter of 15.3 mm), D-201-14304 (14.6 mm) and D-201-12704 (13.0 mm). All of these caps were produced by Olympus Medical Systems, Japan. Independent predictors for faster cecal time and better polyp detection rate were also determined from this study. RESULTS: There were 200 cases in each group. There was no signif icant difference in terms of demographic characteristics between the two groups. CAC, when compared to the SC group, had no signif icant difference in terms of cecal intubation rate (96.0% vs 97.0%, P = 0.40) and time (9.94 ± 7.05 min vs 10.34 ± 6.82 min, P = 0.21), or polyp detection rate (32.8% vs 31.3%, P = 0.75). On the subgroup analysis, there was no significant difference in terms of cecal intubation time by trainees (88.1% vs 84.8%, P = 0.40), ileal intubation rate (82.5% vs 79.0%, P = 0.38) or total colonoscopy time (23.24 ± 13.95 min vs 22.56 ± 9.94 min, P = 0.88). On multivariate analysis, the independent determinants of faster cecal time were consultant-performed procedures (P < 0.001), male patients (P < 0.001), non-usage of hyoscine (P < 0.001) and better bowel preparation (P = 0.01). The determinants of better polyp detection rate were older age (P < 0.001), no history of previous abdominal surgery (P = 0.04), patients not having esophagogastroduodenoscopy in the same setting (P = 0.003), trainee-performed procedures (P = 0.01), usage of hyoscine (P = 0.01) and procedures performed for polyp follow-up (P = 0.01). The limitations of the study were that it was a single-center experience, no blinding was possible, and there were a large number of endoscopists. CONCLUSION: CAC did not signif icantly different from SC in term of cecal intubation time and polyp detection rate.
