A Enyedi

A Roscoe

B Fülesdi

HE Mungroop

I Takács

J Kollár

JL Benumof

T Végh

Critical Care

English

PubMed

Crossref

Clinical experiences with a new endobronchial blocking device: the EZ-Blocker

Végh, Tamás

Enyedi, Attila

Takács, István

Kollár, József

Fülesdi, Béla

DEA University of Debrecen Electronic Archive

induction agents for out-of-theatre intubations was compared against historical controls.Methods Data were collected prospectively on all out-of-theatre tracheal intubations occurring within the region during a 1-month period. We included all intubations performed outside areas normally used for elective or emergency surgery. Neonates and cardiac arrests were excluded from analysis. Data were collected locally using a standardised proforma and centrally collated. All intubations were performed according to the preference of the treating team.Results Hypnotics were used for 164 out-of-theatre intubations. Seventy-six per cent of intubations were accomplished by the use of propofol. Propofol was more likely to cause hypotension than other hypnotics (27.4% vs. 14.3%). Use of alternatives increased with seniority of the intubator. Consultants and senior trainees were less likely to use propofol than junior trainees (73% vs. 93%). Etomidate was not used at all. Previous studies from North American and European centres demonstrate greater use of alternative induction agents, particularly etomidate and ketamine [1-4]. UK practice has also changed over time, comparing our study with historical controls [5,6].Conclusions There is signifi cant geographical variation in choice of induction agent for critically ill patients. There has been an increase in the use of propofol amongst UK physicians over the past 7 years. Choice of hypnotic agent has a signifi cant impact on physiological stability and out-of-theatre intubations are commonly performed in emergent circumstances on unstable patients. This study raises concerns that UK physicians choose induction agents based on familiarity rather than the pharmacodynamic profi le.References1. Jaber S, et al.: Crit Care Med 2006, 34:2355-2361.2. Griesdale DEG, et al.: Intensive Care Med 2008, 34:1835-1842.3. Jabre P, et al.: Lancet 2009, 374:293-300.4. Jaber S, et al.: Intensive Care Med 2010, 36:248-255.5. Graham CA, et al.: Emerg Med J 2003, 20:3-5.6. Reid C, et al.: Emerg Med J 2004, 21:296-301.P154Frequency and signifi cance of post-intubation hypotension during emergency airway managementA Heff ner, D Swords, J Kline, A JonesCarolinas Medical Center, Charlotte, NC, USACritical Care 2011, 15(Suppl 1):P154 (doi: 10.1186/cc9574)Introduction Arterial hypotension is known to follow emergency intubation but the signifi cance of this event is poorly described. We aimed to measure the incidence of post-intubation hypotension (PIH) following emergency intubation and determine its association with in-hospital mortality.Methods A retrospective cohort study of endotracheal intubations performed in a large, urban emergency department over a 1-year period. Patients were included if they were >17 years old and had systolic blood pressure (SBP) >90 mmHg for 30 consecutive minutes prior to intubation. Patients were analyzed in two groups: those with PIH defi ned by SBP <90 mmHg within 60 minutes of intubation, and those with no PIH. The primary outcome was hospital mortality.Results Emergency intubation was performed on 465 patients, of which 336 met inclusion criteria and were analyzed. The median patient age was 49 years, 59% of patients presented with nontraumatic illness and 92% underwent induction with etomidate. PIH occurred in 76/336 (23%) of patients. The median time to fi rst PIH was 11 minutes (IQR 2 to 27). Intubation for acute respiratory failure was the only independent predictor of PIH (OR  =  2.1, 95% CI  =  1.1 to 4.0). Patients with PIH had signifi cantly higher in-hospital mortality (33% vs. 21%; 95% CI for 12% diff erence = 1 to 23%) and longer mean ICU length of stay (9.7 vs. 5.9 days, P <0.01) and hospital length of stay (17.0 vs. 11.4 days, P <0.01). Multivariate logistic regression analysis confi rmed PIH as an independent predictor of hospital mortality (OR = 1.9, 95% CI = 1.1 to 3.6).Conclusions PIH occurs in nearly one-quarter of normotensive patients undergoing emergency intubation. Intubation for acute respiratory failure is an independent predictor of PIH. PIH is associated with a signifi cantly higher in-hospital mortality and longer ICU and hospital lengths of stay.P155Clinical experiences with a new endobronchial blocking device: the EZ-BlockerT Végh, A Enyedi, I Takács, J Kollár, B FülesdiUniversity of Debrecen, HungaryCritical Care 2011, 15(Suppl 1):P155 (doi: 10.1186/cc9575)Introduction Both elective and emergency thoracic surgical procedures may require one-lung ventilation (OLV) for lung isolation [1]. Although in the majority of the cases a double lumen endotracheal tube (DLT) is the fi rst choice, there are situations when insertion of DLT is not feasible [2]. We therefore intended to test the applicability of a recently developed endobronchial blocker (BB), the EZ-Blocker, in clinical practice.Methods Data were obtained from 10 patients undergoing thoracic surgery necessitating OLV. For lung isolation, a single lumen tube (SLT) and EZ-Blocker as BB were used. The time of insertion and positioning of BB, the lung defl ation time with the BB cuff  infl ated and defl ated, the minimal occlusion volume (MOV) of the BB cuff  with 25 cmH2O positive airway pressure (PAP) and intracuff  pressure (ICP) at MOV were registered. Based on the CT scan the diameter of the right (RMB) and left main bronchus (LMB) at 1 cm distal apart from the bifurcation was measured offl  ine. Lung defl ation was defi ned as 5.5 cm distance of the upper lobe from the rib cage at open chest.Results The insertion time was 76 ± 15 seconds. The lung defl ation time through the lumen with the BB cuff  infl ated was 700 ± 83 seconds, and with a defl ated cuff  through the lumen of SLT was 9.4 ± 0.7 seconds. The MOV was 6.7 ± 1 ml in LMB versus 8 ± 1 ml in RMB (P = 0.03). The ICP was 40 ± 4 mmHg in LMB versus 85 ± 5 mmHg in RMB (P <0.001). With linear regression there were strong positive relationships between the diameter of MB and MOV/ICP.Conclusions The use of EZ-Blocker is easy and safe for infrequent users, too. The short insertion time and short lung defl ation time allows use in an emergency situation or in case of a diffi  cult airway. Only a small fraction of ICP (10 to 20%) is transmitted to the bronchial wall and it does not cause mucosal ischemia. The diameter of the MB has great impact on the MOV and ICP. The MOV is similar but ICP is smaller than published in previous reports with other BBs [3].References1. Mungroop HE, et al.: Br J Anaesth 2010, 104:119-120.2. Benumof JL: J Cardiothor Vasc Anesth 1998, 12:131-132.3. Roscoe A, et al.: Anesth Analg 2007, 104:655-658.P156Rohrer’s constant, k2, as a factor for determining endotracheal tube obstructionAG Flevari, N Maniatis, E Dimitriadou, M Theodorakopoulou, E Paramythiotou, N Christoforidis, A Kaziani, D Koukios, F Drakopanagiotakis, A ArmaganidisAttikon University Hospital, Athens, GreeceCritical Care 2011, 15(Suppl 1):P156 (doi: 10.1186/cc9576)Introduction The purpose of the study was to apply a method by which to measure Rohrer’s constant, k2, in order to estimate endotracheal tube (ETT) resistance (RETT). The resistance drop across the ETT is expressed by the equation RETT = k1 + k2V’, as Rohrer described, where k1 is the constant of laminar fl ow (V’) and k2 is the constant of turbulent fl ow. In our past study we graphed RETT over inspiratory V’ for ETTs with inner diameters of 6.5 to 9.0 mm [1]. This graph provided us with k1 and k2 constant values, for each ETT size.Methods Ten intubated patients with ETTs with diffi  culty in patency were included in the study. Patients were all fully sedated and mechanically ventilated, by a Siemens Servo 300 ventilator, under constant fl ow. Pressure data were obtained: at the proximal end of the ETT (Pproximal), refl ecting the impedance distally to the proximal end of the ETT; and at the distal end of the ETT (Pdistal), refl ecting the resistance distally to the distal end of the ETT. Pdistal was recorded by an intratracheal catheter, placed 2 cm above the carinal end of the ETT. Each resistance was calculated by dividing ΔP (Ppeak – Pplateau) by V’, at every point of interest (either proximal or distal sites), using the rapid end-inspiratory occlusion method. RETT resulted from the diff erence: Critical Care 2011, Volume 15 Suppl 1 http://ccforum.com/supplements/15/S1S55

Clinical experiences with a new endobronchial blocking device: the EZ-Blocker (P-155)

Crit Care Med

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3061785

Clinical experiences with a new endobronchial blocking device: the EZ-Blocker

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