Zbrinjavanje dišnog puta u jedinici intenzivnog liječenja

Airway management in the intensive care unit (ICU) is a challenging procedure and is frequently associated with life threatening complications. The incidence of difficult intubations ranges from 10% to 22%, depending on the setting and the patients in need of endotracheal intubation. Multiple attempts are often needed to secure the airway. Despite the high risk for patients in the ICU setting, the equipment for airway management such as capnometry or alternative devices is not always available. The novel technique of video laryngoscopy has been recently introduced into clinical practice in the operating room. First results from larger studies are very promising, suggesting these new devices to be helpful for successful intubation with fewer attempts in difficult intubation scenarios. At the same time, several reports show that successful use of video laryngoscopes in emergency situations need substantial practical training and expertise in airway management. The use of a protocol for airway management has been shown to decrease complications. Parts of this protocol are appropriate staffing, pre-oxygenation and strategies to avoid cardiovascular complications. In conclusion, high practical skill of airway management is needed in critically ill patients. Monitoring such as capnography and alternative equipment for securing the airway is not just mandatory in the operating room but also in the ICU.Zbrinjavanje dišnog puta u jedinici intenzivnog liječenja (JIL) je izazovan postupak i često se povezuje sa životno opasnim komplikacijama. Incidencija otežane intubacije varira od 10% do 22%, ovisno o uvjetima i bolesnicima kojima je potrebna endotrahealna intubacija. Obično je potrebno više pokušaja kako bi se osigurao dišni put. Unatoč visokom riziku za bolesnika u okruženju JIL oprema za osiguravanje dišnih putova kao što su kapnometrija i alternativna pomagala često nije dostupna. Nova tehnika video laringoskopije je nedavno uvedena u kliničku praksu u operacijskoj dvorani. Prvi rezultati većih studija su vrlo obećavajući, jer pokazuju da su ti novi uređaji korisni za uspješnu intubaciju s manje pokušaja kod otežane inubacije. Istodobno je nekoliko izvješća pokazalo da uspješna uporaba video laringoskopa u hitnim situacijama zahtijeva stalnu praktičnu uvježbanost i stručnost u osiguranju dišnog puta. Primjena protokola za zbrinjavanje dišnih putova je smanjila komplikacije. Dio ovoga protokola čine odgovorajuće osoblje, pred-oksigenacija i strategije za izbjegavanje kardiovaskularnih komplikacija. Ukratko, kod bolesnika u JIL potrebna je visoka praktična vještina zbrinjavanja dišnog puta. Praćenje kao što je kapnografija i alternativna pomagala za osiguravanje dišnog puta nisu obvezna samo u operacijskoj dvorani, nego i u JIL

Rigid fibrescope Bonfils: use in simulated difficult airway by novices

<p>Abstract</p> <p>Background</p> <p>The Bonfils intubation fibrescope is a promising alternative device for securing the airway. We examined the success rate of intubation and the ease of use in standardized simulated difficult airway scenarios by physicians. We compared the Bonfils to a classical laryngoscope with Macintosh blade.</p> <p>Methods</p> <p>30 physicians untrained in the use of rigid fibrescopes but experienced in airway management performed endotracheal intubation in an airway manikin (SimMan, Laerdal, Kent, UK) with three different airway conditions. We evaluated the success rate using the Bonfils (Karl Storz, Tuttlingen, Germany) or the Macintosh laryngoscope, the time needed for securing the airway, and subjective rating of both techniques.</p> <p>Results</p> <p>In normal airway all intubations were successful using laryngoscope (100%) vs. 82% using the Bonfils (p < 0.05). In the scenario "tongue oedema" success rate using the Macintosh laryngoscope was 67% and 83% using the Bonfils. In the scenario "decreased cervical range of motion with jaw trismus", success rate using the Macintosh laryngoscope was 84% vs. 76%. In difficult airway scenarios time until airway was secured did not differ between the two devices. Use of Bonfils was rated "easier" in both difficult airway scenarios.</p> <p>Conclusion</p> <p>The Bonfils can be successfully used by physicians unfamiliar with this technique in an airway manikin. The airway could be secured with at least the same success rate as using a Macintosh laryngoscope in difficult airway scenarios. Use of the Bonfils did not delay intubation in the presence of a difficult airway. These results indicate that intensive special training is advised to use the Bonfils effectively in airway management.</p

Comparison of the McGrath® Series 5 and GlideScope® Ranger with the Macintosh laryngoscope by paramedics

<p>Abstract</p> <p>Background</p> <p>Out-of-hospital endotracheal intubation performed by paramedics using the Macintosh blade for direct laryngoscopy is associated with a high incidence of complications. The novel technique of video laryngoscopy has been shown to improve glottic view and intubation success in the operating room. The aim of this study was to compare glottic view, time of intubation and success rate of the McGrath^®Series 5 and GlideScope^®Ranger video laryngoscopes with the Macintosh laryngoscope by paramedics.</p> <p>Methods</p> <p>Thirty paramedics performed six intubations in a randomised order with all three laryngoscopes in an airway simulator with a normal airway. Subsequently, every participant performed one intubation attempt with each device in the same manikin with simulated cervical spine rigidity using a cervical collar. Glottic view, time until visualisation of the glottis and time until first ventilation were evaluated.</p> <p>Results</p> <p>Time until first ventilation was equivalent after three intubations in the first scenario. In the scenario with decreased cervical motion, the time until first ventilation was longer using the McGrath^®compared to the GlideScope^®and AMacintosh (p < 0.01). The success rate for endotracheal intubation was similar for all three devices. Glottic view was only improved using the McGrath^®device (p < 0.001) compared to using the Macintosh blade.</p> <p>Conclusions</p> <p>The learning curve for video laryngoscopy in paramedics was steep in this study. However, these data do not support prehospital use of the McGrath^®and GlideScope^®devices by paramedics.</p

Neuroprotective Actions of Estradiol and Novel Estrogen Analogs in Ischemia: Translational Implications

This review highlights our investigations into the neuroprotective efficacy of estradiol and other estrogenic agents in a clinically relevant animal model of transient global ischemia, which causes selective, delayed death of hippocampal CA1 neurons and associated cognitive deficits. We find that estradiol rescues a significant number of CA1 pyramidal neurons that would otherwise die in response to global ischemia, and this is true when hormone is provided as a long-term pretreatment at physiological doses or as an acute treatment at the time of reperfusion. In addition to enhancing neuronal survival, both forms of estradiol treatment induce measurable cognitive benefit in young animals. Moreover, estradiol and estrogen analogs that do not bind classical nuclear estrogen receptors retain their neuroprotective efficacy in middle-aged females deprived of ovarian hormones for a prolonged duration (8 weeks). Thus, non-feminizing estrogens may represent a new therapeutic approach for treating the neuronal damage associated with global ischemia