Acute and Critical Care

Original Articles

Pulmonary
Evaluating diaphragmatic dysfunction and predicting non-invasive ventilation failure in acute exacerbation of chronic obstructive pulmonary disease in India: Nupur B Patel, Gaurav Jain, Udit Chauhan, Ajeet Singh Bhadoria, Saurabh Chandrakar, Haritha Indulekha; Acute Crit Care. 2023;38(2):200-208. Published online May 25, 2023; DOI: https://doi.org/10.4266/acc.2022.01060

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Background
Baseline diaphragmatic dysfunction (DD) at the initiation of non-invasive ventilation (NIV) correlates positively with subsequent intubation. We investigated the utility of DD detected 2 hours after NIV initiation in estimating NIV failure in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients. Methods: In a prospective-cohort design, we enrolled 60 consecutive patients with AECOPD initiated on NIV at intensive care unit admission, and NIV failure events were noted. The DD was assessed at baseline (T1 timepoint) and 2 hours after initiating NIV (T2 timepoint). We defined DD as ultrasound-assessed change in diaphragmatic thickness (ΔTDI) <20% (predefined criteria [PC]) or its cut-off that predicts NIV failure (calculated criteria [CC]) at both timepoints. A predictive-regression analysis was reported. Results: In total, 32 patients developed NIV failure, nine within 2 hours of NIV and remaining in next 6 days. The ∆TDI cut-off that predicted NIV failure (DD-CC) at T1 was ≤19.04% (area under the curve [AUC], 0.73; sensitivity, 50%; specificity, 85.71%; accuracy; 66.67%), while that at T2 was ≤35.3% (AUC, 0.75; sensitivity, 95.65%; specificity, 57.14%; accuracy, 74.51%; hazard ratio, 19.55). The NIV failure rate was 35.1% in those with normal diaphragmatic function by PC (T2) versus 5.9% by CC (T2). The odds ratio for NIV failure with DD criteria ≤35.3 and <20 at T2 was 29.33 and 4.61, while that for ≤19.04 and <20 at T1 was 6, respectively. Conclusions: The DD criterion of ≤35.3 (T2) had a better diagnostic profile compared to baseline and PC in prediction of NIV failure.

Citations

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Advancing healthcare through thoracic ultrasound research in older patients
Simone Scarlata, Chukwuma Okoye, Sonia Zotti, Fulvio Lauretani, Antonio Nouvenne, Nicoletta Cerundolo, Adriana Antonella Bruni, Monica Torrini, Alberto Finazzi, Tessa Mazzarone, Marco Lunian, Irene Zucchini, Lorenzo Maccioni, Daniela Guarino, Silvia Fabbr
Aging Clinical and Experimental Research.2023; 35(12): 2887. CrossRef

Pulmonary
The role of ROX index–based intubation in COVID-19 pneumonia: a cross-sectional comparison and retrospective survival analysis: Sara Vergis, Sam Philip, Vergis Paul, Manjit George, Nevil C Philip, Mithu Tomy; Acute Crit Care. 2023;38(2):182-189. Published online May 25, 2023; DOI: https://doi.org/10.4266/acc.2022.00206

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Abstract PDF: Background
Coronavirus disease 2019 (COVID-19) patients with acute respiratory failure who experience delayed initiation of invasive mechanical ventilation have poor outcomes. The lack of objective measures to define the timing of intubation is an area of concern. We investigated the effect of timing of intubation based on respiratory rate-oxygenation (ROX) index on the outcomes of COVID-19 pneumonia. Methods: This was a retrospective cross-sectional study performed in a tertiary care teaching hospital in Kerala, India. Patients with COVID-19 pneumonia who were intubated were grouped into early intubation (within 12 hours of ROX index <4.88) or delayed intubation (12 hours or more hours after ROX <4.88). Results: A total of 58 patients was included in the study after exclusions. Among them, 20 patients were intubated early, and 38 patients were intubated 12 hours after ROX index <4.88. The mean age of the study population was 57±14 years, and 55.0% of the patients were male; diabetes mellitus (48.3%) and hypertension (50.0%) were the most common comorbidities. The early intubation group had 88.2% successful extubation, while only 11.8% of the delayed group had successful extubation (P<0.001). Survival was also significantly more frequent in the early intubation group. Conclusions: Early intubation within 12 hours of ROX index <4.88 was associated with improved extubation and survival in patients with COVID-19 pneumonia.

Trauma
Association of Glasgow coma scale and endotracheal intubation in predicting mortality among patients admitted to the intensive care unit: Nader Markazi Moghaddam, Mohammad Fathi, Sanaz Zargar Balaye Jame, Mohammad Darvishi, Morteza Mortazavi; Acute Crit Care. 2023;38(1):113-121. Published online February 22, 2023; DOI: https://doi.org/10.4266/acc.2022.00927

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Abstract PDF: Background
We assessed predictors of mortality in the intensive care unit (ICU) and investigated if Glasgow coma scale (GCS) is associated with mortality in patients undergoing endotracheal intubation (EI). Methods: From February 2020, we performed a 1-year study on 2,055 adult patients admitted to the ICU of two teaching hospitals. The outcome was mortality during ICU stay and the predictors were patients’ demographic, clinical, and laboratory features. Results: EI was associated with a decreased risk for mortality compared with similar patients (adjusted odds ratio [AOR], 0.32; P=0.030). This shows that EI had been performed correctly with proper indications. Increasing age (AOR, 1.04; P<0.001) or blood pressure (AOR, 1.01; P<0.001), respiratory problems (AOR, 3.24; P<0.001), nosocomial infection (AOR, 1.64; P=0.014), diabetes (AOR, 5.69; P<0.001), history of myocardial infarction (AOR, 2.52; P<0.001), chronic obstructive pulmonary disease (AOR, 3.93; P<0.001), immunosuppression (AOR, 3.15; P<0.001), and the use of anesthetics/sedatives/hypnotics for reasons other than EI (AOR, 4.60; P<0.001) were directly; and GCS (AOR, 0.84; P<0.001) was inversely related to mortality. In patients with trauma surgeries (AOR, 0.62; P=0.014) or other surgical categories (AOR, 0.61; P=0.024) undergoing EI, GCS had an inverse relation with mortality (accuracy=82.6%, area under the receiver operator characteristic curve=0.81). Conclusions: A variety of features affected the risk for mortality in patients admitted to the ICU. Considering GCS score for EI had the potential of affecting prognosis in subgroups of patients such as those with trauma surgeries or other surgical categories.

Pulmonary
Association between timing of intubation and mortality in patients with idiopathic pulmonary fibrosis: Eunhye Bae, Jimyung Park, Sun Mi Choi, Jinwoo Lee, Sang-Min Lee, Hong Yeul Lee; Acute Crit Care. 2022;37(4):561-570. Published online October 28, 2022; DOI: https://doi.org/10.4266/acc.2022.00444

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Abstract PDF Supplementary Material: Background
Delayed intubation is associated with poor prognosis in patients with respiratory failure. However, the effect of delayed intubation in patients with idiopathic pulmonary fibrosis (IPF) remains unknown. This study aimed to analyze whether timing of intubation after high-concentration oxygen therapy was associated with worse clinical outcomes in IPF patients. Methods: This retrospective propensity score-matched study enrolled adult patients with IPF who underwent mechanical ventilation between January 2011 and July 2021. Patients were divided into early and delayed intubation groups. Delayed intubation was defined as use of high-concentration oxygen therapy for at least 48 hours before tracheal intubation. The primary outcome was intensive care unit (ICU) mortality, and a conditional logistic regression model was used to evaluate the association between timing of intubation and clinical outcomes. Results: The median duration of high-concentration oxygen therapy before intubation was 0.5 days in the early intubation group (n=60) and 5.1 days in the delayed intubation group (n=36). The ICU mortality rate was 56.7% and 75% in the early and delayed intubation groups, respectively, before propensity matching (P=0.075). After matching for demographic and clinical covariates, 33 matched pairs were selected. In the propensity-matched cohort, delayed intubation significantly increased the risk of ICU mortality (adjusted odds ratio, 3.99; 95% confidence interval, 1.02–15.63; P=0.046). However, in-hospital mortality did not differ significantly between the groups. Conclusions: In patients with IPF, delayed intubation after initiation of high-concentration oxygen therapy was significantly associated with increased risk of ICU mortality compared to early intubation.

Liver
Early mechanical ventilation for grade IV hepatic encephalopathy is associated with increased mortality among patients with cirrhosis: an exploratory study: Saad Saffo, Guadalupe Garcia-Tsao; Acute Crit Care. 2022;37(3):355-362. Published online August 18, 2022; DOI: https://doi.org/10.4266/acc.2022.00528

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Abstract PDF

Background
Unresponsive patients with toxic-metabolic encephalopathies often undergo endotracheal intubation for the primary purpose of preventing aspiration events. However, among patients with pre-existing systemic comorbidities, mechanical ventilation itself may be associated with numerous risks such as hypotension, aspiration, delirium, and infection. Our primary aim was to determine whether early mechanical ventilation for airway protection was associated with increased mortality in patients with cirrhosis and grade IV hepatic encephalopathy.
Methods
The National Inpatient Sample was queried for hospital stays due to grade IV hepatic encephalopathy among patients with cirrhosis between 2016 and 2019. After applying our exclusion criteria, including cardiopulmonary failure, data from 1,975 inpatient stays were analyzed. Patients who received mechanical ventilation within 2 days of admission were compared to those who did not. Univariable and multivariable logistic regression analyses were performed to identify clinical factors associated with in-hospital mortality.
Results
Of 162 patients who received endotracheal intubation during the first 2 hospital days, 64 (40%) died during their hospitalization, in comparison to 336 (19%) of 1,813 patients in the comparator group. In multivariable logistic regression analysis, mechanical ventilation was the strongest predictor of in-hospital mortality in our primary analysis (adjusted odds ratio, 3.00; 95% confidence interval, 2.14–4.20; P<0.001) and in all sensitivity analyses.
Conclusions
Mechanical ventilation for the sole purpose of airway protection among patients with cirrhosis and grade IV hepatic encephalopathy may be associated with increased in-hospital mortality. Future studies are necessary to confirm and further characterize our findings.

Citations

Citations to this article as recorded by

Development and validation of a nomogram for predicting in-hospital mortality of intensive care unit patients with liver cirrhosis
Xiao-Wei Tang, Wen-Sen Ren, Shu Huang, Kang Zou, Huan Xu, Xiao-Min Shi, Wei Zhang, Lei Shi, Mu-Han Lü
World Journal of Hepatology.2024; 16(4): 625. CrossRef
Using machine learning methods to predict 28-day mortality in patients with hepatic encephalopathy
Zhe Zhang, Jian Wang, Wei Han, Li Zhao
BMC Gastroenterology.2023;[Epub] CrossRef
Experience in Non-invasive Ventilation in Grade 3 Hepatic Encephalopathy
İlhan Ocak, Mustafa Çolak, Erdem Kınacı
Istanbul Medical Journal.2023; 24(3): 295. CrossRef

CPR/Resuscitation
Risk factors associated with inpatient cardiac arrest during emergency endotracheal intubation at general wards: Chul Park; Acute Crit Care. 2019;34(3):212-218. Published online August 31, 2019; DOI: https://doi.org/10.4266/acc.2019.00598; Correction in: Acute Crit Care 2020;35(3):228

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Abstract PDF

Background
Peri-intubation cardiac arrest (PICA) following emergent endotracheal intubation (ETI) is a rare, however, potentially preventable type of cardiac arrest. Limited published data have described factors associated with inpatient PICA and patient outcomes. The aim of this study was to identify risk factors associated with PICA among hospitalized patients emergently intubated at a general ward as compared to non-PICA inpatients. In addition, we identified a difference of clinical outcomes in patients between PICA and other types of inpatient cardiac arrest (OTICA).
Methods
We conducted a retrospective observational study of patients at two institutions between January 2016 to December 2017. PICA was defined in patients emergently intubated who experienced cardiac arrest within 20 minutes after ETI. The non-PICA group consisted of inpatients emergently intubated without cardiac arrest. Risk factors for PICA were identified through univariate and multivariate logistic regression analysis. Clinical outcomes were compared between PICA and OTICA.
Results
Fifteen episodes of PICA occurred during the study period, accounting for 3.6% of all inpatient arrests. Intubation-related shock index, number of intubation attempts, pre-ETI vasopressor use, and neuromuscular blocking agent (NMBA) use, especially succinylcholine, were independently associated with PICA. Clinical outcomes of intensive care unit and hospital length of stay, survival to discharge, and neurologic outcome at hospital discharge were not significantly different between PICA and OTICA.
Conclusions
We identified four independent risk factors for PICA, and preintubation hemodynamic stabilization and avoidance of NMBA were possibly correlated with a decreased PICA risk. Clinical outcomes of PICA were similar to those of OTICA.

Citations

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Risk factors for peri-intubation cardiac arrest: A systematic review and meta-analysis
Ting-Hao Yang, Shih-Chieh Shao, Yi-Chih Lee, Chien-Han Hsiao, Chieh-Ching Yen
Biomedical Journal.2023; : 100656. CrossRef
Reverse shock index (RSI) as a predictor of post-intubation cardiac arrest (PICA)
Mehdi Torabi, Ghazal Soleimani Mahani, Moghaddameh Mirzaee
International Journal of Emergency Medicine.2023;[Epub] CrossRef
Incidence and factors associated with out-of-hospital peri-intubation cardiac arrest: a secondary analysis of the CURASMUR trial
Cédric Gil-Jardiné, Patricia Jabre, Frederic Adnet, Thomas Nicol, Patrick Ecollan, Bertrand Guihard, Cyril Ferdynus, Valery Bocquet, Xavier Combes
Internal and Emergency Medicine.2022; 17(2): 611. CrossRef
Risk factors associated with peri-intubation cardiac arrest in the emergency department
Ting-Hao Yang, Kuan-Fu Chen, Shi-Ying Gao, Chih-Chuan Lin
The American Journal of Emergency Medicine.2022; 58: 229. CrossRef
Comparison of video-stylet and conventional laryngoscope for endotracheal intubation in adults with cervical spine immobilization: A PRISMA-compliant meta-analysis
I-Wen Chen, Yu-Yu Li, Kuo-Chuan Hung, Ying-Jen Chang, Jen-Yin Chen, Ming-Chung Lin, Kuei-Fen Wang, Chien-Ming Lin, Ping-Wen Huang, Cheuk-Kwan Sun
Medicine.2022; 101(33): e30032. CrossRef
Peri-Intubation Cardiorespiratory Arrest Risk in Pediatric Patients: A Systematic Review
Rohit S. Loomba, Riddhi Patel, Elizabeth Kunnel, Enrique G. Villarreal, Juan S. Farias, Saul Flores
Journal of Pediatric Intensive Care.2022;[Epub] CrossRef
Comparison of Suction Rates Between a Standard Yankauer, a Commercial Large-Bore Suction Device, and a Makeshift Large-Bore Suction Device
Dhimitri A. Nikolla, Briana King, Andrew Heslin, Jestin N. Carlson
The Journal of Emergency Medicine.2021; 61(3): 265. CrossRef
Emergency Airway Management Outside the Operating Room: Current Evidence and Management Strategies
Kunal Karamchandani, Jonathan Wheelwright, Ae Lim Yang, Nathaniel D. Westphal, Ashish K. Khanna, Sheila N. Myatra
Anesthesia & Analgesia.2021; 133(3): 648. CrossRef
Further Validation of a Novel Acute Myocardial Infarction Risk Stratification (nARS) System for Patients with Acute Myocardial Infarction
Shinnosuke Sawano, Kenichi Sakakura, Kei Yamamoto, Yousuke Taniguchi, Takunori Tsukui, Masaru Seguchi, Hiroshi Wada, Shin-ichi Momomura, Hideo Fujita
International Heart Journal.2020; 61(3): 463. CrossRef
Corrigendum to: Risk factors associated with inpatient cardiac arrest during emergency endotracheal intubation at general wards
Chul Park
Acute and Critical Care.2020; 35(3): 228. CrossRef

Pulmonary
Clinical Application of Modified Burns Wean Assessment Program Scores at First Spontaneous Breathing Trial in Weaning Patients from Mechanical Ventilation: Eun Suk Jeong, Kwangha Lee; Acute Crit Care. 2018;33(4):260-268. Published online November 30, 2018; DOI: https://doi.org/10.4266/acc.2018.00276

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Abstract PDF

Background
The purpose of this study was to evaluate the clinical application of modified Burns Wean Assessment Program (m-BWAP) scoring at first spontaneous breathing trial (SBT) as a predictor of successful liberation from mechanical ventilation (MV) in patients with endotracheal intubation.
Methods
Patients requiring MV for more than 72 hours and undergoing more than one SBT in a medical intensive care unit (ICU) were prospectively enrolled over a 3-year period. The m-BWAP score at first SBT was obtained by a critical care nursing practitioner.
Results
A total of 103 subjects were included in this study. Their median age was 69 years (range, 22 to 87 years) and 72 subjects (69.9%) were male. The median duration from admission to first SBT was 5 days (range, 3 to 26 days), and the rate of final successful liberation from MV was 84.5% (n=87). In the total group of patients, the successful liberation from MV group at first SBT (n=65) had significantly higher m-BWAP scores than did the unsuccessful group (median, 60; range, 43 to 80 vs. median, 53; range, 33 to 70; P<0.001). Also, the area under the m-BWAP curve for predicting successful liberation of MV was 0.748 (95% confidence interval, 0.650 to 0.847), while the cutoff value based on Youden’s index was 53 (sensitivity, 76%; specificity, 64%).
Conclusions
The present data show that the m-BWAP score represents a good predictor of weaning success in patients with an endotracheal tube in place at first SBT.

Citations

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What do we know about experiencing end-of-life in burn intensive care units? A scoping review
André Filipe Ribeiro, Sandra Martins Pereira, Rui Nunes, Pablo Hernández-Marrero
Palliative and Supportive Care.2023; 21(4): 741. CrossRef
Effect of a Japanese Version of the Burns Wean Assessment Program e-Learning Materials on Ventilator Withdrawal for Intensive Care Unit Nurses
Rika KIMURA, Naoko HAYASHI, Akemi UTSUNOMIYA
Journal of Nursing Research.2023; 31(4): e287. CrossRef
Value of modified Burns Wean Assessment Program scores in the respiratory intensive care unit: An Egyptian study
Nermeen A. Abdelaleem, Sherif A.A. Mohamed, Azza S. Abd ElHafeez, Hassan A. Bayoumi
Multidisciplinary Respiratory Medicine.2020;[Epub] CrossRef
Protecting Postextubation Respiratory Failure and Reintubation by High-Flow Nasal Cannula Compared to Low-Flow Oxygen System: Single Center Retrospective Study and Literature Review
Minhyeok Lee, Ji Hye Kim, In Beom Jeong, Ji Woong Son, Moon Jun Na, Sun Jung Kwon
Acute and Critical Care.2019; 34(1): 60. CrossRef

Case Report

Pulmonary
A Reinforced Endotracheal Tube Completely Severed by a Patient Bite and Lodged in the Right Main Bronchus: Susie Yoon, Hyunjung Choo, Se Eun Kim, Heeyeon Kwon, Hannah Lee; Korean J Crit Care Med. 2017;32(1):70-73. Published online November 14, 2016; DOI: https://doi.org/10.4266/kjccm.2016.00437

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Abstract PDF

Reinforced endotracheal tubes (ETTs) are designed to resist kinking or compression. However, these have a potential risk of being obstructed or severed by a patient’s bite. We report a case in which a reinforced ETT was severed by tube-bite while the patient was in the prone position during an intensive care unit stay. Bronchoscopic evaluation showed that the severed distal part of the tube had lodged in the patient’s right main bronchus, and it had to be surgically removed. The patency of reinforced ETTs should be carefully monitored in patients intubated in the prone position.

Citations

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Anaesthesia for reconstructive free flap surgery for head and neck cancer
Peter McCauley, Michael Moore, Edel Duggan
British Journal of Hospital Medicine.2022; 83(5): 1. CrossRef
Endotracheal Tube Obstruction Among Patients Mechanically Ventilated for ARDS Due to COVID-19: A Case Series
Samuel Wiles, Eduardo Mireles-Cabodevila, Scott Neuhofs, Sanjay Mukhopadhyay, Jordan P. Reynolds, Umur Hatipoğlu
Journal of Intensive Care Medicine.2021; 36(5): 604. CrossRef
Complete Endotracheal Tube Transection by Patient Bite: A Case Report and Algorithm for Fragment Identification and Extraction
Annette Ilg, Matthias Eikermann, Andrew J. Synn
A&A Practice.2021; 15(3): e01428. CrossRef
Importance of Capnography Monitoring in Critical Ill Patients
Young-Kown Ko
The Korean Journal of Critical Care Medicine.2017; 32(1): 79. CrossRef

Original Articles

Pulmonary/Anesthesiology
A Pilot Survey of Difficult Intubation and Cannot Intubate, Cannot Ventilate Situations in Korea: Jung Soo Kim, Hyun Kyoung Lim, Jeong Yun Song, Hyun Keun Lim, Kyungchul Song, Jae Hwa Cho; Korean J Crit Care Med. 2016;31(3):202-207. Published online August 30, 2016; DOI: https://doi.org/10.4266/kjccm.2016.00297

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Abstract PDF

Background
There have been no studies of airway management strategies for difficult intubation and cannot intubate, cannot ventilate (CICV) situations in Korea. This study was intended to survey devices or methods that Korean anesthesiologists and intensivists prefer in difficult intubation and CICV situations.
Methods
A face-to-face questionnaire that consisted of a doctor’s preference, experience and comfort level for alternative airway management devices was presented to anesthesiologists and intensivists at study meetings and conferences from October 2014 to December 2014.
Results
We received 218 completed questionnaires. In regards to difficult intubation, the order of preferred alternative airway devices was a videolaryngoscope (51.8%), an optical stylet (22.9%), an intubating laryngeal mask airway (11.5%), and a fiber-optic bronchoscope (10.6%). One hundred forty-two (65.1%) respondents had encountered CICV situations, and most of the cases were identified during elective surgery. In CICV situations, the order of preferred methods of infraglottic airway management was cricothyroidotomy (CT) by intravenous (IV) catheter (57.3%), tracheostomy by a surgeon (18.8%), wire-guided CT (18.8%), CT using a bougie (2.8%), and open surgery CT using a scalpel (2.3%). Ninety-eight (45%) of the 218 respondents were familiar with the American Society of Anesthesiologists’ difficult airway algorithm or Difficult Airway Society algorithm, and only 43 (19.7%) had participated in airway workshops within the past five years.
Conclusion
The videolaryngoscope was the most preferred device for difficult airways. In CICV situations, the method of CT via an IV catheter was the most frequently used, followed by wire-guided CT method and tracheostomy by the attending surgeon.

Citations

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Current practice pattern among anaesthesiologists for difficult airway management: A nationwide cross-sectional survey
Balasaheb T Govardhane, Apurva D Shinde, Raghubirsingh P. Gehdoo, Sanya Arora
Indian Journal of Anaesthesia.2023; 67(9): 809. CrossRef
Difficult Airway and Cannot Intubate, Cannot Ventilate Situations in Korea: What Can We Do in the Future?
Tak Kyu Oh
The Korean Journal of Critical Care Medicine.2017; 32(2): 225. CrossRef

Pulmonary
Factors Affecting Invasive Management after Unplanned Extubation in an Intensive Care Unit: A Lan Lee, Chi Ryang Chung, Jeong Hoon Yang, Kyeongman Jeon, Chi-Min Park, Gee Young Suh; Korean J Crit Care Med. 2015;30(3):164-170. Published online August 31, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.3.164

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Abstract PDF

Background
Unplanned extubation (UE) of patients requiring mechanical ventilation in an intensive care unit (ICU) is associated with poor outcomes for patients and organizations. This study was conducted to assess the clinical features of patients who experienced UE and to determine the risk factors affecting reintubation after UE in an ICU.
Methods
Among all adult patients admitted to the ICU in our institution who required mechanical ventilation between January 2011 and December 2013, those in whom UE was noted were included in the study. Data were categorized according to noninvasive or invasive management after UE.
Results
The rate of UE was 0.78% (the number of UEs per 100 days of mechanical ventilation). The incidence of self-extubation was 97.2%, while extubation was accidental in the remaining patients. Two cases of cardiac arrest combined with respiratory arrest after UE were noted. Of the 214 incidents, 54.7% required invasive management after UE. Long duration of mechanical ventilation (odds ratio [OR] 1.52; 95% confidence interval [CI] 1.32-1.75; p = 0.000) and high ICU mortality (OR 4.39; 95% CI 1.33-14.50; p = 0.015) showed the most significant association with invasive management after UE. In multivariate analysis, younger age (OR 0.96; 95% CI 0.93-0.99; p = 0.005), medical patients (OR 4.36; 95% CI 1.95-9.75; p = 0.000), use of sedative medication (OR 4.95; 95% CI 1.97-12.41; p = 0.001), large amount of secretion (OR 2.66; 95% CI 1.01-7.02; p = 0.049), and low PaO2/FiO2 ratio (OR 0.99; 95% CI 0.98-0.99; p = 0.000) were independent risk factors of invasive management after UE.
Conclusions
To prevent unfavorable clinical outcomes, close attention and proper ventilatory support are required for patients with risk factors who require invasive management after UE.

Citations

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Re-Intubation Among Critical Care Patients: A Scoping Review
Thandar Soe Sumaiyah Jamaludin, Mohd Said Nurumal, Nur Syila Syahida Syaziman, Syuhada Suhaimi, Muhammad Kamil Che Hasan
INTERNATIONAL JOURNAL OF CARE SCHOLARS.2021; 4(Supp1): 93. CrossRef

Case Report

Pulmonary
Obstructive Fibrinous Tracheal Pseudomembrane Presented with Atelectasis: Jick Hwan Ha, Hyewon Lee, Young Jae Park, Hyeon Hui Kang, Hwa Sik Moon, Sang Haak Lee; Korean J Crit Care Med. 2014;29(2):110-113. Published online May 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.2.110

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Abstract PDF

Obstructive fibrinous tracheal pseudomembrane (OFTP) is a rare condition usually associated with endotracheal intubation. Airway obstruction caused by OFTP may occur after endotracheal tube extubation and can lead to severe respiratory distress. It is a rare but potentially fatal complication. In this report, we present a case of OFTP presented with atelectasis that caused dyspnea after extubation and was successfully treated by mechanical removal using a rigid bronchoscope.

Citations

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Obstructive Fibrinous Tracheal Pseudomembrane
Yoann Ammar, Juliette Vella-Boucaud, Claire Launois, Hervé Vallerand, Sandra Dury, François Lebargy, Gaëtan Deslee, Jeanne-Marie Perotin
Anesthesia & Analgesia.2017; 125(1): 172. CrossRef
Obstructive Fibrinous Tracheal Pseudomembrane: An Update
Alberto Manassero, Matteo Bossolasco
Korean Journal of Critical Care Medicine.2014; 29(3): 241. CrossRef

Original Articles

Pulmonary
The Effect of Positive End-Expiratory Pressure on Air Leakage: Comparison of Cuff Designs: Junyong In, Gyung Serk Shim, Seunghyun Chung; Korean J Crit Care Med. 2014;29(1):3-6. Published online February 28, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.1.3

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Abstract PDF

Background
Recently developed taper-shaped cuffs (TG cuffs) of endotracheal tubes (ETTs) are known to have a more potent sealing effect than cylindrical high-volume low-pressure cuffs (HL cuffs) of conventional ETTs. The aim of this study was to compare TG cuffs with HL cuffs of ETTs in a bench-top model with regard to air leakage under various positive end-expiratory pressures (PEEP).
Methods
HL cuffs and TG cuffs made from PVC were included (HL group vs. TG group). A model trachea with an internal diameter (ID) of 22 mm was attached to a test lung. The test lung was ventilated using an anesthesia respirator with volume controlled mode and PEEPs of 0, 5, 10, or 15 cm H₂O. Using spirometry, percentages of expired to inspired tidal volumes (TVe/i) were calculated as a measure of air leakage.
Results
With regard to PEEPs, the HL group showed significantly higher air leakage compared to the TG group (p < 0.0001), and a higher PEEP resulted in greater air leakage (p < 0.0001). Air leakage with higher PEEP was greater in the HL group than in the TG group at ID 7.0 mm and 7.5 mm (p = 0.0467, p = 0.0045)
Conclusions
This study shows the superior sealing ability of the TG cuff during ventilation at various PEEPs.

Citations

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Impact of Low‐Volume, Low‐Pressure Tracheostomy Cuffs on Acute Mucosal Injury in Swine
Alexandra J. Berges, Ioan A. Lina, Rafael Ospino, Hsiu‐Wen Tsai, Dacheng Ding, Jessica M. Izzi, Alexander T. Hillel
Otolaryngology–Head and Neck Surgery.2022; 167(4): 716. CrossRef
Tidal Volume Delivery and Endotracheal Tube Leak during Cardiopulmonary Resuscitation in Intubated Newborn Piglets with Hypoxic Cardiac Arrest Exposed to Different Modes of Ventilatory Support
Marc R. Mendler, Claudia Weber, Mohammad A. Hassan, Li Huang, Benjamin Mayer, Helmut D. Hummler
Neonatology.2017; 111(2): 100. CrossRef

Comparison of Hemodynamic Changes by the Thoracic Electrical Bioimpedance Device during Endotracheal Intubation or Insertion of Laryngeal Mask Airway in General Anesthesia: Han Mok You, Jin Mo Kim, Jae Kyu Cheun; Korean J Crit Care Med. 1998;13(1):67-72.

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Abstract PDF: Introduction: we measured the hemodynamic changes by the thoracic electrical bioimpedance (TEB) device during induction of anesthesia, endotracheal intubation or insertion of layngeal mask airway (LMA). This TEB device is safe, reliable and estimate continuously and invasively hemodynamic variables.
METHODS
We measured the cardiovascular response of endotracheal intubation or that of LMA insertion in thirty ASA class I patients. General anesthesia was induced with injection of fentany 1 microgram/kg, thiopetal sodium 5 mg/kg and vecuronium 1 mg/kg intravenously. Controlled ventilation was for 3 minutes with inhalation of 50% nitrous oxide and 1.5 vol% of enflurane before tracheal intubation or LMA insertion in all patients. The patient was randomly assinged to either tracheal intubation group (ET group) or laryngeal mask airway group (LMA group). Heart rate (HR), mean arterial pressure (MAP), systemic vascular resistance (SVR), stroke index (SI) and cardic index (CI) were measured to pre-induction, pre-intubation, 1 minute after intubation, 2 minute, 3 minute, 5 minute, 7 minute.
RESULTS
MAP and SVR were decreased effectively LMA group than ET group during 1 minute after intubation, 2 minute, 3 minute, 5 minute, 7 minute (p<0.05). HR was decreased effectively LMA group than ET group between pre-induction and 1 minute after intubation, between 1 minute after intubation and 2 minute after intubation (p<0.05). But, SI and CI were no difference between ET group and LMA group during induction of anesthesia and intubation (p<0.05).
CONCLUSION
The insertion of LMA is beneficial for certain patients than endotracheal tube to avoid harmful cardiovascular response in the management of airway during anesthesia.

Randomized Controlled Trials

Guidewire-Assisted Nasogastric Tube Insertion in Intubated Patients in an Emergency Center: Jin Go, Hyunjong Kim, Seunghwan Kim, Je Sung You, Min Joung Kim, Hyun Soo Chung, Sung Phil Chung, Hahn Shick Lee; Korean J Crit Care Med. 2013;28(4):287-292.; DOI: https://doi.org/10.4266/kjccm.2013.28.4.287

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Abstract PDF: BACKGROUND
The purpose of this study is to identify the usefulness of guidewire-assisted nasogastric tube insertion in intubated patients with cervical spine immobilization or unstable vital signs in an emergency center.
METHODS
Thirty-four intubated patients in an emergency center were enrolled in the study. Patients were randomly allocated to the control group or the guidewire group. All patient necks were kept in neutral position during the procedure. In the control group, the nasogastric tube was inserted with the conventional method. A guidewire-supporting nasogastric tube was used in the guidewire group. The success rates of the first attempts and overall were recorded along with complications.
RESULTS
The first attempt success rate was 88.2% in the guidewire group compared with 35.2% in the control group (p < 0.001). The overall success rate was 94.2% in the guidewire group and 52.9% in the control group (p = 0.017). Five cases of self-limiting nasal bleeding were reported in the guidewire group, and two cases occurred in the control group. No statistical differences were identified between groups.
CONCLUSIONS
Guidewire-assisted nasogastric tube insertion is a simple and useful method in intubated patients with cervical spine immobilization or unstable vital signs.

Comparison of Intubation Success Rate and Times Required for Intubation by Glottic Exposure Methods with Glidescope(R): Hyung Seo Jang, Jun Bum Park, Jae Hoon Oh, Chang Sun Kim, Hyuk Joong Choi, Bo Seung Kang, Tae Ho Lim, Hyung Goo Kang; Korean J Crit Care Med. 2013;28(4):241-246.; DOI: https://doi.org/10.4266/kjccm.2013.28.4.241

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Abstract PDF: BACKGROUND
The glottis can be exposed by a Glidescope(R) during endotracheal intubation using either the epiglottis or valleculae elevation method. We compared the epiglottis and valleculae elevation methods for endotracheal intubations performed with a Glidescope(R) using differences in success rate, time spent for tracheal intubation and percent of glottic opening.
METHODS
Forty medical students without experience using a Glidescope(R) participated in this prospective, randomized study in which they intubated a tracheal tube into a manikin. All participants performed tracheal intubation using the 2 forementioned methods. Twenty students exposed the vocal cord by placing the blade tip in the valleculae (valleculae elevation method; VEM). The other 20 students directly elevated the epiglottis with the blade (epiglottis elevation method; EEM). We separated intubating time into 3 parts: turnaround time to exposing the vocal cord, tube passing time and first ventilating time.
RESULTS
The success rate of tracheal intubation using VEM (86.7%, 104/120) was higher than that using EEM (65.8%, 79/120) (p < 0.001). VEM resulted in a lower total intubation time (VEM vs. EEM, 23.5 +/- 5.3 vs. 29.0 +/- 8.7, p = 0.001). The key factor of this difference was the tube passing time (VEM vs. EEM, 7.4 +/- 2.5 vs. 12.8 +/- 7.4, p < 0.001).
CONCLUSIONS
Exposing the vocal cord by using VEM during tracheal intubation with a Glidescope(R) can increase the success rate of tracheal intubation and shorten the time of endotracheal intubation in novices.

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