BACKGROUND:Pulmonary aspiration of gastric contents during tracheal intubation is a lifethreatening complication in emergency patients.Rapid sequence intubation is commonly performed to prevent aspiration but is not a...BACKGROUND:Pulmonary aspiration of gastric contents during tracheal intubation is a lifethreatening complication in emergency patients.Rapid sequence intubation is commonly performed to prevent aspiration but is not associated with low risk of intubation related complications.Although it has been considered that aspiration can be prevented in the lateral position,few studies have evaluated the ability to prevent aspiration.Moreover,this position is not always a favorable position for tracheal intubation.If aspiration can be prevented in a clinically relevant semi-lateral position,it may be advantageous.We assessed the ability to prevent aspiration in the lateral position and various degrees of the semi-lateral position using a vomiting-regurgitation manikin model.METHODS:A manikin's head was placed in the neutral,simple extension,or sniffing position.The amount of aspirated saline into the bronchi during simulated vomiting was measured at semilateral position angles of 0°to 90° in 10° increments.The difference in the vertical height between the mouth corner and the inferior border of the vocal cord was measured radiologically at each semilateral position in the three head-neck positions.RESULTS:Pulmonary aspiration was prevented at the ≥70°,≥80°,and 90° semi-lateral positions in the neutral,simple extension,and sniffing positions,respectively.The mouth was lower than the vocal cord in the semi-lateral position in which aspiration was prevented.CONCLUSION:The lateral or excessive semi-lateral position was necessary to protect the lung from aspiration in the head-neck positions commonly used for tracheal intubation.Prevention of aspiration was difficult within clinically relevant semi-lateral positions.展开更多
AIM: To report our preliminary experience with a new generation aspiration catheter in the treatment of symptomatic pulmonary embolism(PE). METHODS: A retrospective database search for pulmonary artery embolectomy si... AIM: To report our preliminary experience with a new generation aspiration catheter in the treatment of symptomatic pulmonary embolism(PE). METHODS: A retrospective database search for pulmonary artery embolectomy since introduction of the Pronto.035' and XL extraction catheter(Vascular Solutions, Minneapolis, MN) at our institution in 10/2009 was performed. Ten consecutive patients were identified in which the Pronto.035' or XL catheter was used between 01/2010 and 03/2013. All patients were referred for catheter based embolectomy due to contraindications to systemic lysis, or for being in such a critical clinical condition that immediate percutaneous treatment deemed warranted. The computed tomography(CT) right to left heart ratio as predictor for the severity of the PE was retrospectively evaluated on standard axial views. The difference between pre- and post-procedure pulmonary pressure measures was taken to assess the procedural effect.RESULTS: Extensive PE was confirmed angiographically in all patients. Measured right- to left ventricle(RV/LV) ratios were elevated beyond one in seven of the eight available CTs. Acute procedural success defined as clinical removal of visible thrombus and improvement in mean pulmonary artery pressure was seen in all recorded patients(n = 8), the mean pulmonary pressures declined from a median(range) of 35.5(19-46) to 23(10-37, P = 0.008) mmHg. Neither death nor other complications occurred intra- or immediately periprocedural, yet short term mortality within 30 d was found in 6 out of 9 patients, one patient was lost in follow up. The cause of death within 30 d in the 6 patients was identified as: Circulatory failure in direct connection with the PE(n = 2), stroke, sepsis, or succumbing to malignancy in a hospice setting(n = 2). CONCLUSION: Success in thrombus removal with improved pulmonary hypertension and systemic hypotension suggests this aspiration technique to be effective. Aspiration catheters should be part of further trials.展开更多
Gastroesophageal reflux disease(GERD) has many protean manifestations.Some of the most vexing have to do with the airway.GERD affects the tracheobronchial tree directly,leading to aspiration pneumonia and asthma,or ex...Gastroesophageal reflux disease(GERD) has many protean manifestations.Some of the most vexing have to do with the airway.GERD affects the tracheobronchial tree directly,leading to aspiration pneumonia and asthma,or exacerbating existing pulmonary disease,such as asthma or chronic obstructive pulmonary disease.In addition to the respiratory manifestation of GERD,there are unique pharyngeal and laryngeal manifestations.These include voice hoarseness,throat-clearing,chronic cough,globus,and "post-nasal drip".Linking these symptoms to GERD is challenging and frequently the diagnosis is that of exclusion.Despite proton pump inhibitor therapy being the mainstay of treatment,with anti-reflux surgery being reserved for intractable cases,there is no definitive evidence of the superiority of either.展开更多
文摘BACKGROUND:Pulmonary aspiration of gastric contents during tracheal intubation is a lifethreatening complication in emergency patients.Rapid sequence intubation is commonly performed to prevent aspiration but is not associated with low risk of intubation related complications.Although it has been considered that aspiration can be prevented in the lateral position,few studies have evaluated the ability to prevent aspiration.Moreover,this position is not always a favorable position for tracheal intubation.If aspiration can be prevented in a clinically relevant semi-lateral position,it may be advantageous.We assessed the ability to prevent aspiration in the lateral position and various degrees of the semi-lateral position using a vomiting-regurgitation manikin model.METHODS:A manikin's head was placed in the neutral,simple extension,or sniffing position.The amount of aspirated saline into the bronchi during simulated vomiting was measured at semilateral position angles of 0°to 90° in 10° increments.The difference in the vertical height between the mouth corner and the inferior border of the vocal cord was measured radiologically at each semilateral position in the three head-neck positions.RESULTS:Pulmonary aspiration was prevented at the ≥70°,≥80°,and 90° semi-lateral positions in the neutral,simple extension,and sniffing positions,respectively.The mouth was lower than the vocal cord in the semi-lateral position in which aspiration was prevented.CONCLUSION:The lateral or excessive semi-lateral position was necessary to protect the lung from aspiration in the head-neck positions commonly used for tracheal intubation.Prevention of aspiration was difficult within clinically relevant semi-lateral positions.
文摘 AIM: To report our preliminary experience with a new generation aspiration catheter in the treatment of symptomatic pulmonary embolism(PE). METHODS: A retrospective database search for pulmonary artery embolectomy since introduction of the Pronto.035' and XL extraction catheter(Vascular Solutions, Minneapolis, MN) at our institution in 10/2009 was performed. Ten consecutive patients were identified in which the Pronto.035' or XL catheter was used between 01/2010 and 03/2013. All patients were referred for catheter based embolectomy due to contraindications to systemic lysis, or for being in such a critical clinical condition that immediate percutaneous treatment deemed warranted. The computed tomography(CT) right to left heart ratio as predictor for the severity of the PE was retrospectively evaluated on standard axial views. The difference between pre- and post-procedure pulmonary pressure measures was taken to assess the procedural effect.RESULTS: Extensive PE was confirmed angiographically in all patients. Measured right- to left ventricle(RV/LV) ratios were elevated beyond one in seven of the eight available CTs. Acute procedural success defined as clinical removal of visible thrombus and improvement in mean pulmonary artery pressure was seen in all recorded patients(n = 8), the mean pulmonary pressures declined from a median(range) of 35.5(19-46) to 23(10-37, P = 0.008) mmHg. Neither death nor other complications occurred intra- or immediately periprocedural, yet short term mortality within 30 d was found in 6 out of 9 patients, one patient was lost in follow up. The cause of death within 30 d in the 6 patients was identified as: Circulatory failure in direct connection with the PE(n = 2), stroke, sepsis, or succumbing to malignancy in a hospice setting(n = 2). CONCLUSION: Success in thrombus removal with improved pulmonary hypertension and systemic hypotension suggests this aspiration technique to be effective. Aspiration catheters should be part of further trials.
文摘Gastroesophageal reflux disease(GERD) has many protean manifestations.Some of the most vexing have to do with the airway.GERD affects the tracheobronchial tree directly,leading to aspiration pneumonia and asthma,or exacerbating existing pulmonary disease,such as asthma or chronic obstructive pulmonary disease.In addition to the respiratory manifestation of GERD,there are unique pharyngeal and laryngeal manifestations.These include voice hoarseness,throat-clearing,chronic cough,globus,and "post-nasal drip".Linking these symptoms to GERD is challenging and frequently the diagnosis is that of exclusion.Despite proton pump inhibitor therapy being the mainstay of treatment,with anti-reflux surgery being reserved for intractable cases,there is no definitive evidence of the superiority of either.
