scholarly journals Impact of a Low-Pressure Polyurethane Adult Endotracheal Tube on the Incidence of Ventilator-Associated Pneumonia: A before and after Concurrence Study

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
John Schweiger ◽  
Rachel Karlnoski ◽  
Devanand Mangar ◽  
Jaya Kolla ◽  
Gerardo Munoz ◽  
...  
Keyword(s):  
Endotracheal Tube ◽  
Length Of Hospital Stay ◽  
Retrospective Chart Review ◽  
High Volume ◽  
Low Pressure ◽  
Ventilator Associated Pneumonia ◽  
Cuffed Endotracheal Tube ◽  
Number Of Patients ◽  
Before And After ◽  
Control And Prevention

Background. Ventilator-associated pneumonia (VAP) is a leading cause of morbidity and mortality in intensive care unit (ICU) patients, encompassing up to 15% of all hospital acquired infections. Our hospital implemented a facility-wide conversion from a low-volume high-pressure polyvinyl cuffed endotracheal tube (PV-cuffed ETT) to a high-volume low-pressure (HVLP) polyurethane-cuffed endotracheal tube (PU-cuffed ETT) in an effort to reduce the incidence of VAP. Methods. We completed an IRB approved, retrospective chart review comparing the number of episodes of VAP 12 months preceding and following the introduction of a new ETT. A diagnosis of VAP was made based upon the guidelines of our institution, consistent with the Center of Disease Control and Prevention definition. Results. The number of patients developing VAP the year after the ETT conversion reduced to 32 (16.3%) from 68 (24.7%) the year before the conversion (). The rate of VAP was reduced by 56% per ventilator day after the implementation of the PU-cuffed ETT (). No significant differences were observed in length of hospital stay, length of mechanical ventilation, or mortality before or after the conversion. Conclusions. We found that HVLP PU-cuffed ETTs were associated with a statistically significant reduction of VAP in the adult ICUs.

An in-vitro study to evaluate high-volume low-pressure endotracheal tube cuff deflation dynamics

2019 ◽  
Vol 85 (8) ◽  
Author(s):  
Joan D. Marti ◽  
Gianluigi Li Bassi ◽  
Valentina Isetta ◽  
Miguel R. Lazaro ◽  
Eli Aguilera-Xiol ◽  
...  
Keyword(s):  
Endotracheal Tube ◽  
In Vitro Study ◽  
High Volume ◽  
Low Pressure ◽  
Vitro Study ◽  
Endotracheal Tube Cuff ◽  
Tube Cuff ◽  
Cuff Deflation

Initial Experience of an Anesthesiology-based Service for Perioperative Management of Pacemakers and Implantable Cardioverter Defibrillators

2015 ◽  
Vol 123 (5) ◽  
pp. 1024-1032 ◽  
Author(s):  
G. Alec Rooke ◽  
Stefan A. Lombaard ◽  
Gail A. Van Norman ◽  
Jörg Dziersk ◽  
Krishna M. Natrajan ◽  
...  
Keyword(s):  
Medical Center ◽  
Strong Support ◽  
Retrospective Chart Review ◽  
High Volume ◽  
Management Plan ◽  
Implantable Cardioverter Defibrillators ◽  
Device Management ◽  
Number Of Patients ◽  
Cardioverter Defibrillators ◽  
Over Time

Abstract Background Management of cardiovascular implantable electronic devices (CIEDs), including pacemakers and implantable cardioverter defibrillators, for surgical procedures is challenging due to the increasing number of patients with CIEDs and limited availability of trained providers. At the authors’ institution, a small group of anesthesiologists were trained to interrogate CIEDs, devise a management plan, and perform preoperative and postoperative programming and device testing whenever necessary. Methods Patients undergoing surgery between October 1, 2009 and June 30, 2013 at the University of Washington Medical Center were included in a retrospective chart review to determine the number of devices actively managed by the Electrophysiology/Cardiology Service (EPCS) versus the Anesthesiology Device Service (ADS), changes in workload over time, surgical case delays due to device management, and errors and problems encountered in device programming. Results The EPCS managed 254 CIEDs, the ADS managed 548, and 227 by neither service. Over time, the ADS providers managed an increasing percentage of devices with decreasing supervision from the EPCS. Only two CIEDs managed by the ADS required immediate assistance from the EPCS. Patients who were unstable postoperatively were referred to the EPCS. Although numerous issues in programming were encountered, primarily when restoring demand pacing after programming asynchronous pacing for surgery, no patient harm resulted from ADS or EPCS management of CIEDs. Conclusions An ADS can provide safe CIED management for surgery, but it requires specialized provider training and strong support from the EPCS. Due to the complexity of CIED management, an ADS will likely only be feasible in high-volume settings.

Performance characteristics of a novel reusable intermediate-volume low-pressure cuffed endotracheal tube

1994 ◽  
Vol 38 (4) ◽  
pp. 363-367 ◽  
Author(s):  
J. HÄHNEL ◽  
H. TREIBER ◽  
F. KONRAD ◽  
T. MUTZBAUER ◽  
P. STEFFEN ◽  
...  
Keyword(s):  
Endotracheal Tube ◽  
Low Pressure ◽  
Performance Characteristics ◽  
Cuffed Endotracheal Tube

An In-Vitro Safety Assessment Of Endotracheal Tube High-Volume Low-Pressure Cuffs

2012 ◽  
Author(s):  
Gianluigi Li Bassi ◽  
Otavio Tavares Ranzani ◽  
Joan D. Marti ◽  
Valeria Giunta ◽  
Nestor Luque ◽  
...  
Keyword(s):  
Endotracheal Tube ◽  
Safety Assessment ◽  
High Volume ◽  
Low Pressure

Tracheal stenosis associated with a low pressure cuffed endotracheal tube

Anaesthesia ◽  
1976 ◽  
Vol 31 (4) ◽  
pp. 504-507 ◽  
Author(s):  
T. L. BRADBEER ◽  
M. L. JAMES ◽  
J. W. SEAR ◽  
J. F. SEARLE ◽  
R. Stacey
Keyword(s):  
Endotracheal Tube ◽  
Tracheal Stenosis ◽  
Low Pressure ◽  
Cuffed Endotracheal Tube

scholarly journals Timelines of Oral Care and Early-Onset Ventilator Associated Pneumonia Prevention

2014 ◽  
Author(s):  
Kristen Francoeur
Keyword(s):  
Endotracheal Tube ◽  
Early Onset ◽  
Local Level ◽  
Quality Care ◽  
Oral Care ◽  
Retrospective Chart Review ◽  
Trauma Patients ◽  
Ventilator Associated Pneumonia ◽  
Prevention Measures ◽  
Early Application

<p>Hospital-acquired infections, including ventilator associated pneumonia (VAP), are a significant cause of morbidity and mortality and associated with increased costs and length of stay (Chastre & Fagon, 2002; NNIS, 2004). Ventilator associated pneumonia is believed to primarily result from aspiration of oropharyngeal secretions around the endotracheal tube cuff into the lungs (Grap, Munro, Unoki, Hamilton, & Ward, 2012). A randomized control trial tested early application of oral chlorhexidine (CHG) on oral microbial flora and VAP in trauma patients and suggested that early (within 12 hours of intubation) application may reduce VAP rates in trauma patients (Grap, Munro, Hamilton, Elswick, Sessler & Ward, 2011). The VAP rate in a local Level 1 trauma center, 11-bed trauma intensive care unit (TICU) was 8.7 per 1000 device days, above the national average (NHSN, 2011). The purpose of this research was to explore the relationship between the time of insertion of an endotracheal tube and first CHG application and early onset (within 72 hours of intubation) VAP. A retrospective chart review of the records of randomly selected adult intubated trauma patients hospitalized on the TICU was conducted. Collected data included: time of intubation; timing of CHG application; VAP occurrences; and length of intubation. Less than half (45.8%) of patients received early CHG application, and most (79.2%) were intubated in the emergency department (ED), suggesting that VAP prevention measures begin in the ED. Of the patients reviewed, five developed VAP; three occurred in patients who had received oral CHG within 12 hours of intubation. A CNS-driven collaboration with other disciplines and departments is essential to implement VAP prevention measures and provide comprehensive, quality care.</p>

scholarly journals Robotic-assisted pancreatic surgery in the elderly patient: experiences from a high-volume centre

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Karl H. Hillebrandt ◽  
Sebastian Knitter ◽  
Lea Timmermann ◽  
Matthäus Felsenstein ◽  
Christian Benzing ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Pancreatic Surgery ◽  
Length Of Hospital Stay ◽  
High Volume ◽  
The Elderly ◽  
Robotic Assisted ◽  
Conversion To Open Surgery ◽  
Number Of Patients ◽  
Group 2

Abstract Background Robotic-assisted pancreatic surgery (RPS) has fundamentally developed over the past few years. For subgroups, e.g. elderly patients, applicability and safety of RPS still needs to be defined. Given prognosticated demographic developments, we aim to assess the role of RPS based on preoperative, operative and postoperative parameters. Methods We included 129 patients undergoing RPS at our institution between 2017 and 2020. Eleven patients required conversion to open surgery and were excluded from further analysis. We divided patients into two groups; ≥ 70 years old (Group 1; n = 32) and < 70 years old (Group 2; n = 86) at time of resection. Results Most preoperative characteristics were similar in both groups. However, number of patients with previous abdominal surgery was significantly higher in patients ≥ 70 years old (78% vs 37%, p < 0.0001). Operative characteristics did not significantly differ between both groups. Although patients ≥ 70 years old stayed significantly longer at ICU (1.8 vs 0.9 days; p = 0.037), length of hospital stay and postoperative morbidity were equivalent between the groups. Conclusion RPS is safe and feasible in elderly patients and shows non-inferiority when compared with younger patients. However, prospectively collected data is needed to define the role of RPS in elderly patients accurately. Trial registration Clinical Trial Register: Deutschen Register Klinischer Studien (DRKS; German Clinical Trials Register). Clinical Registration Number: DRKS00017229 (retrospectively registered, Date of Registration: 2019/07/19, Date of First Enrollment: 2017/10/18).

scholarly journals A polyurethane cuffed endotracheal tube is associated with decreased rates of ventilator-associated pneumonia

2011 ◽  
Vol 26 (3) ◽  
pp. 280-286 ◽  
Author(s):  
Melissa A. Miller ◽  
Jennifer L. Arndt ◽  
Mark A. Konkle ◽  
Carol E. Chenoweth ◽  
Theodore J. Iwashyna ◽  
...  
Keyword(s):  
Endotracheal Tube ◽  
Ventilator Associated Pneumonia ◽  
Cuffed Endotracheal Tube

scholarly journals Preoperative Plasmapheresis for Elective Thymectomy in Myasthenia Patient: Is It Necessary?

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Somcharoen Saeteng ◽  
Apichat Tantraworasin ◽  
Sophon Siwachat ◽  
Nirush Lertprasertsuke ◽  
Juntima Euathrongchit ◽  
...  
Keyword(s):  
Muscle Power ◽  
Length Of Hospital Stay ◽  
Retrospective Chart Review ◽  
University Hospital ◽  
Secondary Outcome ◽  
Myasthenic Crisis ◽  
Number Of Patients ◽  
History Of ◽  
Review Study

Background. Role of plasmapheresis before thymectomy remains controversial. The aim of this study is to determine the peri-operative and post-operative outcome of a thymectomy between performing and not performing a pre-operative plasmaphreresis. Patients and Methods. A retrospective chart review study was conducted in Chiang Mai University Hospital between January 2006 and December 2011. There were 86 myasthenia patients divided into two groups; Preoperative plasmapheresis group (PPG) and no preoperative plasmapheresis group (NPPG). The primary outcome involved post-operative extubation and the secondary outcome included post-operative complications, 28 day mortality and length of hospital stay. Results. Eighty-six patients were enrolled in this study. The number of patients who had a history of myasthenic crisis at any time or within one month in the PPG was significantly more than those in the NPPG. Muscle power and forced expiratory vital capacity in the NPPG was higher than that in the PPG. The postoperative extubation rate was similar in both groups. After controlling for the propensity score, there were no statistically significant differences in both of primary and secondary outcomes. Conclusion. The results of this study shows no significant differences between both groups in all outcomes, therefore the pre-operative plasmaphresis is not necessary for elective thymectomy.

scholarly journals Electroconvulsive therapy (ECT) and schizophrenia

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S332-S332
Author(s):  
Rhys Masin ◽  
George Kirov
Keyword(s):  
Hospital Stay ◽  
Rating Scales ◽  
Average Length ◽  
Length Of Hospital Stay ◽  
Retrospective Chart Review ◽  
Future Research ◽  
List Type ◽  
Before And After ◽  
Clinically Significant ◽  
The Uk

AimsAn evaluation of the benefits of ECT in patients with schizophrenia who received ECT in Cardiff & Vale UHB, in order to: ⋅Investigate the effectiveness of ECT as a treatment for schizophrenia⋅Inform future clinical practice⋅Identify clear outcome measures for use in future researchBackgroundSchizophrenia is a severe and debilitating mental illness, for which pharmacological treatment is often ineffective. ECT is seldom used for schizophrenia, despite encouraging evidence for its efficacy. Current guidance in the UK is inconsistent, as RCPsych contemplates the use of ECT in schizophrenia in certain cases, while NICE does not. This confusion warrants the need for further evaluation of ECT as a treatment for schizophrenia.MethodEight suitable patients were identified, and a retrospective chart review was conducted in relation to the following outcomes: •What was the main indication for ECT, and was the issue resolved•Change in clinical rating scales•Concordance with medication before and after treatment•Length of hospital stay before and after treatment, over one year•Mental Health Act status after treatment for those treated on section•Was the level of observation reduced following treatmentResultInitial indication for treatment was completely resolved in seven out of eight cases. All patients improved in overall symptomatic score (mean improvement = 59.5%). Five patients (62.5%) improved above the threshold of clinically significant response. At the commencement of treatment, three (37.5%) patients were refusing all medication, three (37.5%) had poor concordance and two (25%) were fully concordant. At treatment endpoint, all were fully concordant. Average length of hospital stay remained unchanged: 30 weeks during the year before ECT, and 33 weeks during the year after ECT. Of six patients treated under Section 3, four (66.7%) had their section lifted within six months. Observation level was reduced in all cases that had been placed under continuous observation.ConclusionECT improved all outcomes except admission duration. These results provide support for the consideration of ECT as a meaningful treatment option for schizophrenia.

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