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Kinnear, D. J. "Development and characterisation of novel anti-infective endotracheal tube biomaterials." Thesis, Queen's University Belfast, 2012. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.557654.
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Nosocomial infection, including ventilator-associated pneumonia (VAP) affects more than 1 million people each year. The first step in VAP is colonization of the endotracheal tube; prevention of which has failed using traditional approaches such as antibiotic prophylaxis. This work looks at the development of anti-infective materials capable of resisting bacterial adherence. The strategy centres around the use of biocides (QACs) which target the negatively charged bacterial cell wall, disrupting cell structure and causing death. Chapter 2 examines the incorporation of 3 QACs into PVC via the solvent cast method. The materials resisted colonization but possessed poor mechanical properties. Chapter 3 examines an alternative method of incorporation, hot melt extrusion. The QACs and PVC were stable despite the application of heat but when combined, the QACs catalyzed the degradation of PVC and resulted in materials unsuitable for use in a medical device. Chapter 4 reconsiders the solvent cast method, but with ion pairs formed from quaternary ammonium cations and docusate anion. This produced ionic liquids with improved solubility in PVC, which improved the mechanical properties of the materials. However, the antimicrobial activity of the materials was not equivalent to that of the precursor QACs. Chapter 5 examines an alternate approach to the modification of PVC, by the production of an ultrahydrophobic surface. This did not prevent adherence but the materials showed no bacterial viability in adhered biofilm after 24 hours incubation. This was attributed to transition metals used to roughen the surfaces. Chapter 6 reports a second attempt at the exchange of anion paired with the quaternary ammonium cation, for sulfonate based anions. This produced films which showed improved mechanical properties and reduced bacterial adherence. This reduces the need for additional plasticisers, and these materials are suggested as suitable candidates for anti-infective ET tube biomaterials.
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Byers, Lisa Marie. "Microbial biofilm and ventilator-associated pneumonia." Thesis, Queen's University Belfast, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.343092.
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Fataar, Danielle. "Endotracheal tube verification in the mechanically ventilated patient in a critical care unit." Thesis, Nelson Mandela Metropolitan University, 2013. http://hdl.handle.net/10948/d1008057.
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Critically ill patients often require assistance by means of intubation and mechanical ventilation to support their spontaneous breathing if they are unable to maintain it. Mechanical ventilation is one of the most commonly used treatment modalities in the care of the critically ill patient and up to 90% of patients world-wide require mechanical ventilation during some or most parts of their stay in critical care units Management of a patient’s airway is a critical part of patient care both in and out of hospital. Although there are many methods used in verifying the correct placement of the endotracheal tube, the need and ability to verify placement of an endotracheal tube correctly is of utmost importance, because many complications can occur should the tube be incorrectly placed. Since unrecognized oesophageal intubation can have many disastrous effects on patients, various methods for verifying correct endotracheal tube placement have been developed and considered. Some of these methods include direct visualization, end-tidal carbon dioxide measurement and oesophageal detector devices. This research study aimed to explore and describe the existing literature on the verification of endotracheal tubes in the mechanically ventilated patient in the critical- care unit. A systematic review was done in order to operationalize the primary objective. Furthermore, based on the literature collected from the systematic review, recommendations for the verification of the endotracheal tube in the mechanically ventilated patient in the critical care unit were made. Ethical considerations were maintained throughout the study and the quality of the systematic review was ensured by performing a critical appraisal of the evidence found.
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Choi, Daniel S. "The effects of oral vs nasal intubation on endotracheal tube complications in cardiac patients." Thesis, Boston University, 2013. https://hdl.handle.net/2144/12072.
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Thesis (M.A.)--Boston UniversityObjective: To test the hypothesis that nasal endotracheal tubes are more secure and associated with fewer complications than oral endotracheal tubes. This involves establishing the incidence of specific endotracheal tube complications between cardiac patients who are intubated via the oral and nasal route. In addition, a secondary objective is to identify specific risk groups that could benefit from a change in practice or implementation of guidelines. Design: A retrospective chart review of 100 patients who were admitted to the Pediatric Cardiac Intensive Care Unit with an endotracheal tube in place was performed. Patients involved in this preliminary study were selected from a larger patient population admitted to Boston Children’s Hospital during the fiscal year of 2011 (October 1, 2010 through September 30, 2011). Variables that were collected include: gender, type of mechanical ventilation, reasons for admission, RACHS-1 scores, outcome of respiratory support, age and weight of patients, duration of ventilation, reason for ventilation, cuffed vs. un-cuffed ETT, size of ETT, initial tube depth, route of intubation, location of intubation, duration of ventilation, CICU and hospital length of stay, and inotropic scores. The specific complications that were analyzed were: inadequate ETT positioning or securing with the need for re-adjustment, accidental or unplanned extubations, device related pressure ulcers and skin breakdown, and feeding problems related to dysphagia. The Z-test was used to determine if the difference in rate of complications between cardiac patients who were orally intubated and cardiac patients who were nasally intubated was statistically significant. The Fisher’s Exact test was also used to confirm the z-test since the sample size was relatively small. Finally, a multi-variable regression with select variables was performed to observe possible confounding factors. The Fisher’s Exact test and Mann-Whitney U-test were used to determine which covariates would be included in the multivariable regression. [TRUNCATED]
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McGovern, James Gerard. "Pathogenesis and control of infection associated with the oropharynx and the polyvinyl chloride endotracheal tube." Thesis, Queen's University Belfast, 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.388226.
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Abud, Tania Mara Vilela. "Efeitos da pressão do balonete de tubos traqueais contendo ou não válvula reguladora de pressão sobre a mucosa traqueal, durante anestesia com óxido nitroso no cão /." Botucatu : [s.n.], 2001. http://hdl.handle.net/11449/100147.
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Orientador: José Reinaldo Cerqueira BrazResumo: Justificativa: a hiperinsuflação do balonete do tubo traqueal, causada pela rápida difusão do óxido nitroso (N2O), pode determinar lesões traqueais. Objetivos: comparar as pressões de balonetes de tubos traqueais, contendo ou não válvula reguladora de pressão, durante anestesia com N2O e estudar as eventuais lesões da mucosa do segmento traqueal em contato com o balonete do tubo traqueal. Método: dezesseis cães foram submetidos à anestesia venosa com pentobarbital sódico e anestesia inalatória com N2O (1,5 L.min-1) e O2 (1,0 L.min -1). Os cães foram distribuídos aleatoriamente em dois grupos de acordo com o tubo traqueal utilizado: G1 (n=8) tubo traqueal convencional com balonete de baixa pressão (Portex Blue-Line, Inglaterra); G2 (n=8) tubo traqueal dotado de válvula reguladora de pressão de Lanz (Mallincrodt, EUA). Em ambos os grupos, a insuflação do balonete foi feita com ar até a pressão de 30 cm H2O. A medida da pressão do balonete foi realizada através de manômetro (Mallincrodt, EUA), antes e após 60, 120 e 180 minutos do início da... (Resumo completo, clicar acesso eletrônico abaixo)
Abstract: Background: High endotracheal tube intracuff pressure caused by fast diffusion of nitrous oxide (N2O) may cause mucosal tracheal lesions. Objectives: We have studied the effects of endotracheal tubes intracuff pressures with or without pressure regulating valve on tracheal mucosa during anesthesia with N2O. Methods: Sixteen dogs were submitted to intravenous anesthesia with pentobarbital and inhalational anesthesia with N2O (1.5 L.min-¹) and O2 (1.0 L.min-¹). The dogs were randomly allocated to two groups according to the endotracheal tube: G1 (n=8) conventional endotracheal tube with low-pressure cuff (Portex Blue-line, England); G2 (n=8) endotracheal tube with pressure regulating valve of Lanz from Mallincrodt (USA). In both groups the cuff insufflation was done with air to adjust cuff pressure to 30 cm H2O. Intracuff pressure was measured using a manometer at zero (control) and 60, 120 and 180 minutes after inhation of the N2O. The animals were sacrificed and biopsy specimens from areas of the trachea in contact with the endotracheal cuff were... (Complete abstract, click electronic address below)
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Hamilton, Virginia. "Patient Discomfort in the ICU: ETT movement effects." VCU Scholars Compass, 2014. http://scholarscompass.vcu.edu/etd/3419.
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Critically ill patients who require MV are at risk for a number of complications, including the development of ventilator-associated events (VAE) and agitation that may require the use of sedation. Patients experience anxiety and discomfort during mechanical ventilation from a variety of sources including unfamiliar breathing assistance and an inability to communicate anxiety and pain verbally, but a primary cause of discomfort identified by these patients is the simply the presence of the endotracheal tube (ETT). Discomfort often leads to agitation and may be exacerbated by ETT movement. Management of agitation typically involves the use of sedative therapy and has been shown to increase the length of stay in the hospital. Additionally, when ETT cuff pressure is not adequately maintained, risk of microaspiration increases and these microaspirations increase the risk of ventilator-associated events. ETT movement may adversely affect the cuff seal against the tracheal mucosa, increasing leakage around the cuff and microaspiration. To date, no studies have described the effect of ETT movement on patient comfort and agitation. Noting the frequency of ETT movement during the provision of nursing care and plausible inadvertent consequences on discomfort and agitation, a research model was created and specific instruments selected in order to study this topic. This dissertation will provide a review of the literature regarding the role of the ETT in microaspiration, as well as detail a study that explores the frequency and amount of ETT movement and its potential effect on agitation.
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Mpasa, Ferestas. "Management of endotracheal tube cuff pressure in mechanically ventilated adult patients in intensive care units in Malawi." Thesis, Nelson Mandela Metropolitan University, 2017. http://hdl.handle.net/10948/19673.
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Patients who are critically ill get often admitted to intensive care units (ICUs). The majority of these patients require support with their breathing and are thus connected to a mechanical ventilator. One aspect to consider in the mechanically ventilated patient is endotracheal tube cuff pressure (ETT) management. The management of ETT cuff pressure entails that nurses working in ICUs have the responsibility of ensuring that ETT cuff pressure is kept within normal range of 20-30 cmH20 for the safety of the patients in order to avoid complication of over and under inflation. Poor management of ETT cuff pressure places the mechanically ventilated patients under risk of tracheal injury. Tracheal injury may also be caused by over or under inflation of the ETT cuff. Over inflation of the ETT cuff can lead to the occlusion of capillaries lining the trachea at the cuff site, tracheal stenosis, and can also lead to the death of mucus membranes around the area, just to mention a few. On the other hand, under inflation of the ETT cuff, can lead to air leaks as well as aspiration of gastric contents into the tracheal tree. Therefore, in order to maintain ETT cuff pressure within normal ranges, evidence-based guidelines related to the management of ETT cuff pressure should be used. However, in Malawi the management of endotracheal tube cuff pressure in mechanically ventilated adult patients by nurses in ICUs is not well explored and it is not clear whether this practice is based on evidence-based guidelines. Furthermore, strategies on how to implement evidence-based guidelines in the ICU might not be known and poorly defined because of the complexity of the context. The study is therefore aimed at implementing and evaluating the effect of an evidence-based guideline on the management of ETT cuff pressure in mechanically ventilated adult patients by nurses in ICUs in Malawi using active (printed educational materials and monitoring visits) and passive (printed educational materials only) implementation strategies. The research study used a quantitative approach with multi-designs. Four phases were used in order to achieve the four objectives that were set. Phase one was the pre-test and used a survey design, two was the expert panel review of the evidence-based guideline, three was the implementation of the reviewed evidence-based guideline using a randomised controlled trial design and phase four was the post-test which used a survey design. The RCT included 25 participants from the control and 27 from the intervention group. Each group had three ICUs of which one in each group was from a private hospital and the other were government. Data collection in phases one and four was by a hand delivered pre-and post-questionnaire. In phase two the expert panel members with experience in critical care used the AGREE II Instrument to review the evidence-based guideline that was implemented. In order to gather data during the monitoring visits, the researcher recorded field notes. The applications that were developed by the University statistician consultant using visual basic applications in excel were used to analyse data. Two different implementation strategies were used to implement the evidence-based guideline. The control group used passive implementation strategy which was printed educational materials thus the evidence-based guideline and algorithm. The intervention group used both active and passive implementation strategies which was the printed educational materials thus the evidence-based guideline and algorithm plus monitoring visits by the researcher. In order to establish the effect of the implemented evidence-based guideline on the nursing care practice for the management of endotracheal tube cuff pressure an evaluative posttest survey was conducted in phase four of the research study. The results revealed that the majority of participants had gaps in both groups regarding nursing care practice for the management of endotracheal tube cuff pressure for the mechanically ventilated adult patients in the pretest but improved in the posttest. In the control group 52% had very low knowledge score, 16% had low score, 28% average, and 4% high score while in the category of very high score there was nobody. However, in the posttest those in the very low score were only 44% while the percentage in the low score remained 16%. There was an improvement in the average scores in the posttest such that only 44% were in this category. There was no one in the high and very high score in the pretest. On the other hand, in the intervention group, 78% had a very low score, 9% low score, and 13% were in the category of average score, while in the high and very high score category there was zero percent in the pretest. However, there was also an improvement in the posttest such that only 44% a very low knowledge score. But 19% had a low score, there were 37% in the average category and no one was in the high and very high score. Statistical analysis revealed that the results were not significantly different between and within groups. Improvements were observed in the two groups regarding the scientific knowledge scores for the nursing care practices in the posttest. Upon qualitative analysis of the data from the open-ended question, two main themes emerged thus the need for documentation of endotracheal tube cuff and the process of implementation the evidence-based guidelines. Sub themes such as lack of documentation; no part of routine care and monitoring not done at all were identified under the main theme of the need for documentation of ETT cuff pressure. The Guideline itself need to be clear; implementation strategies; follow up; incentives; supervision; incentives; time factor; resources or equipment required for successful implementation; nurses buy-in critical for the implementation; training detrimental to EBP implementation; nurses attitude crucial to implementation of EBGs and knowledge of nurses for guideline essential for the implementation were the sub themes identified under the main theme of the process of implementing the evidence-based guideline. All appropriate ethical considerations such as principles of autonomy and self-determination, confidentiality and anonymity, voluntary participation, right to receive treatment, informed consent, were adhered to throughout the research study. The research study was unique in nature because it was the first of its kind in Malawi and it contributed to the awareness of the recommended practice for management of endotracheal tube cuff pressure in the ICUs in the country by implementing an evidence-based guideline. The unique contribution of the study is that it is a challenge to implement evidence-based guideline in poor and resource constraint countries like Malawi.
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Abud, Tania Mara Vilela [UNESP]. "Efeitos da pressão do balonete de tubos traqueais contendo ou não válvula reguladora de pressão sobre a mucosa traqueal, durante anestesia com óxido nitroso no cão." Universidade Estadual Paulista (UNESP), 2001. http://hdl.handle.net/11449/100147.
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Justificativa: a hiperinsuflação do balonete do tubo traqueal, causada pela rápida difusão do óxido nitroso (N2O), pode determinar lesões traqueais. Objetivos: comparar as pressões de balonetes de tubos traqueais, contendo ou não válvula reguladora de pressão, durante anestesia com N2O e estudar as eventuais lesões da mucosa do segmento traqueal em contato com o balonete do tubo traqueal. Método: dezesseis cães foram submetidos à anestesia venosa com pentobarbital sódico e anestesia inalatória com N2O (1,5 L.min-1) e O2 (1,0 L.min -1). Os cães foram distribuídos aleatoriamente em dois grupos de acordo com o tubo traqueal utilizado: G1 (n=8) tubo traqueal convencional com balonete de baixa pressão (Portex Blue-Line, Inglaterra); G2 (n=8) tubo traqueal dotado de válvula reguladora de pressão de Lanz (Mallincrodt, EUA). Em ambos os grupos, a insuflação do balonete foi feita com ar até a pressão de 30 cm H2O. A medida da pressão do balonete foi realizada através de manômetro (Mallincrodt, EUA), antes e após 60, 120 e 180 minutos do início da...
Background: High endotracheal tube intracuff pressure caused by fast diffusion of nitrous oxide (N2O) may cause mucosal tracheal lesions. Objectives: We have studied the effects of endotracheal tubes intracuff pressures with or without pressure regulating valve on tracheal mucosa during anesthesia with N2O. Methods: Sixteen dogs were submitted to intravenous anesthesia with pentobarbital and inhalational anesthesia with N2O (1.5 L.min-¹) and O2 (1.0 L.min-¹). The dogs were randomly allocated to two groups according to the endotracheal tube: G1 (n=8) conventional endotracheal tube with low-pressure cuff (Portex Blue-line, England); G2 (n=8) endotracheal tube with pressure regulating valve of Lanz from Mallincrodt (USA). In both groups the cuff insufflation was done with air to adjust cuff pressure to 30 cm H2O. Intracuff pressure was measured using a manometer at zero (control) and 60, 120 and 180 minutes after inhation of the N2O. The animals were sacrificed and biopsy specimens from areas of the trachea in contact with the endotracheal cuff were... (Complete abstract, click electronic address below)
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DiFranco, James Michael. "Minimal Occlusive Pressure with Cuffed Endotracheal Tubes: A Comparison of Two Different Techniques to Ensure a Tracheal Seal." The Ohio State University, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=osu1471012142.
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Perry, Joshua L. "A Comparison of Gas Flow Resistane in Parker Flex-tip and Mallinckrodt RAE Nasal Endotracheal Tubes." The Ohio State University, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=osu1380284347.
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Davies, Kylie. "Determining standard criteria for endotracheal suctioning in the paediatric intensive care patient: An exploratory study [thesis]." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2008. https://ro.ecu.edu.au/theses/15.
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Endotracheal tube (ETT) suction is a common nursing procedure within the paediatric intensive care (PIC) setting. Significant side effects associated with this procedure can dramatically affect the stability of the critically ill ventilated paediatric patient. A comprehensive literature review failed to establish clear standards for determining when the procedure is warranted, especially in the paediatric population. This can present difficulty for the inexperienced paediatric intensive care nurse when assessing a patient's need for ETT suction. The aim of the research was to design an evidence based endotracheal suction assessment tool (ESAT) for use by nurses caring for paediatric patients. The use of the ESAT aims to improve patient care within paediatric intensive care units by improving nursing practice for patients with an artificial airway in situ.
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Ekholm, Linnéa, and Lena Johansson. "Att förebygga postoperativ halssmärta (POST) som komplikation efter generell anestesi med intubation : Vad kan anestesisjuksköterskan göra?" Thesis, Högskolan i Borås, Akademin för vård, arbetsliv och välfärd, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:hb:diva-14729.
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Postoperativ halssmärta (POST) är en mycket vanlig komplikation hos patienter som genomgått generell anestesi med intubation. POST anses av anestesipersonal vara en relativt lindrig komplikation. Patienter upplever det dock som ett stort problem och därför bör det undvikas. Syftet med denna litteraturstudie var att undersöka vad anestesisjuksköterskor kan göra för att förebygga POST som komplikation hos patienter som genomgått generell anestesi med intubation. Examensarbetet är en integrativ litteraturstudie som innefattar tolv globala studier. Litteraturstudiens resultat visar att det finns flera farmakologiska och icke farmakologiska metoder som kan förebygga POST. Lokal behandling med kortikosteroider och NSAID-preparat har förebyggande effekt på POST. Icke farmakologiska interventioner som konformad kuff, substanser som lakritslösning, magnesium och zink lindrar. Vissa studier finner att kortikosteroider och lidokain kan öka förekomsten av POST. I nuläget kan resultatet inte tillämpas av anestesisjuksköterskor då resultaten är tvetydiga och inte kan utföras utan ordination av anestesiolog. Vidare forskning inom området med inriktning på omvårdnad är av yttersta vikt.
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Allen, Katherine. "Pepsin and amylase in oral and tracheal secretions of patients with standard versus continuous subglottic suctioning endotracheal tubes." Honors in the Major Thesis, University of Central Florida, 2012. http://digital.library.ucf.edu/cdm/ref/collection/ETH/id/649.
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The aspiration of oral and gastric substances is a well-known risk for ventilator associated pneumonia (VAP) in the intubated, mechanically ventilated (MV), patient of the intensive care unit (ICU) population. The gastric biomarker pepsin and the oral biomarker salivary amylase have been identified as evidence of aspiration prior to the manifestation of acute pulmonary illness. In an effort to decrease the risk for aspiration, several evidence based nursing practices are in place. Actions include 30 degree head of the bed positioning, oral care, suctioning, and circuit change interval protocols, as well as the administration of medication with the objective of reducing acid reflux. Additional recommendations concern the type of endotracheal tube (ETT) used to ventilate the intubated patient. The continuous subglottic suctioning endotracheal tube (CSS-ETT) features an additional port which continually suctions secretions that accumulate above the inflated endotracheal cuff. Patients with standard endotracheal tubes (S-ETT) receive manual, as needed suctioning of accumulated secretions in the mouth and the oropharynx per agency protocol. Research of the critical care population has demonstrated a decreased instance of VAP using CSS-ETT as compared to S-ETT utilization. This study sought to compare the incidence of the biomarkers pepsin and salivary amylase in the suctioned oral and tracheal secretions of patients with S-ETT compared to patients with CSS-ETT. Part of the protocol of a descriptive, comparative study of the clinical indicators for suctioning established the collection of the paired suctioned oral and tracheal aspirates. Those collected aspirates were analyzed for a pilot study of pepsin and amylase analysis. This study compares the incidence of aspirates in oral and tracheal secretions by endotracheal tube type.; The intention of this study was that it would assist in demonstrating beneficial aspects of the selection of the CSS-ETT. It is considered that further investigation with a larger population group could add statistical significance.; Tracheal aspirates were obtained with a closed tracheal suction device while oral secretions were obtained with a suction catheter designed to reach the oropharynx. Biomarkers assayed were the gastric marker pepsin and the oropharyngeal marker salivary amylase. Assays of pepsin and salivary amylase were performed using standard procedures in a specialty diagnostic laboratory. Specimens were obtained from 11 subjects: 8 male and 3 female. The majority were Caucasian (n=9), had a CSS-ETT (n=8), were on mechanical ventilation in the synchronized intermittent mandatory ventilation mode, and on tube feedings (n=9) located in the stomach (n=7). The mean age was 56 years. Feeding tubes were placed in 9 patients, and the majority of the tubes were Dobbhoff. Pepsin was found in the oral secretions of 62.5% (n = 5) of the CSS-ETT subjects, while 50.0% (n = 4) had pepsin in the tracheal aspirate. Pepsin was found in the oral secretions of 66.7% (n = 2) of the S-ETT subjects, and 66.7% (n = 2) had pepsin in their tracheal aspirate. All subjects of both groups (n = 11) had oral salivary amylase detected. Salivary amylase was detected in the tracheal aspirate of 100% (n = 3) of the S-ETT subjects versus 62.5% (n = 5) in CSS-ETT group. Based on the results of this study, there was a reduction in the number of subjects who had oral compared to tracheal aspirate pepsin in the CSS-ETT group (n = 5 oral versus n = 4 tracheal) tube type. The S-ETT group had equal number of subjects with oral (n = 2) and tracheal pepsin detected (n = 2). However, the results when comparing the S-ETT and the CSS-ETT groups were not statistically significant (p = 0.898 pepsin oral and 0.621 tracheal pepsin). There may be clinical significance. It appears that the CSS-ETT was beneficial in that group; two fewer subjects had pepsin in their tracheal aspirate (n = 5 oral versus n = 4 tracheal aspirate pepsin).B.S.N.
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Kawati, Rafael. "Evaluation of Respiratory Mechanics by Flow Signal Analysis : With Emphasis on Detecting Partial Endotracheal Tube Obstruction During Mechanical Ventilation." Doctoral thesis, Uppsala University, Anaesthesiology and Intensive Care, 2006. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-6343.
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Evaluating respiratory mechanics during dynamic conditions without interrupting ongoing ventilation and flow, adds to the information obtained from the mechanics derived from static (= no flow) conditions, i.e., the flow signal has the potential to provide information on the properties of the respiratory system (including the tubing system). Hence monitoring the changes in the flow signal during ongoing mechanical ventilation would give information about the dynamic mechanics of the respiratory system. Any change in the mechanics of the respiratory system including the endotracheal tube (ETT) and the ventilatory circuit would affect the shape of the flow signal.
Knowledge of the airway pressure distal to the ETT at the carina level (= tracheal pressure) is required for calculating the extra resistive load exerted by the endotracheal tube in order to compensate for it. In a porcine model, the flow signal was used to non-invasively calculate tracheal pressure. There was good agreement between calculated and measured tracheal pressure with different modes of ventilation. However, calculation of tracheal pressure assumes that the inner diameter of the ETT is known, and this assumption is not met if the inner diameter is narrowed by secretions. Flow that passes a narrowed tube is decelerated and this is most pronounced with the high flow of early expiration, yielding a typical time constant over expiratory volume pattern that is easy to recognize during mechanical ventilation. This pattern reliably detected partial endotracheal obstruction during volume and pressure controlled mechanical ventilation.
A change in compliance of the respiratory system modifies the elastic recoil and this also affects the rate of the expiratory flow and the shape of its signal. In a porcine model, lung volume gains on the flow signal generated by the heartbeats (cardiogenic oscillations) provided information about the compliance of the respiratory system during ongoing mechanical ventilation
In conclusion analyzing the flow signal during ongoing ventilation can be a cheap, non-invasive and reliable tool to monitor the elastic and resistive properties of the respiratory system including the endotracheal tube.
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Kawati, Rafael. "Evaluation or respiratory mechanics by flow signal analysis : with emphasis on detecting partial endotracheal tube obstruction during mechanical ventilation /." Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2006. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-6364.
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Jaensson, Maria. "Postoperative sore throat and hoarseness : clinical studies in patients undergoing general anasthesia." Doctoral thesis, Örebro universitet, Institutionen för hälsovetenskap och medicin, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-31040.
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A common problem following general anesthesia is postoperative sore throat (POST) and postoperative hoarseness (PH). Symptoms directly correlated with less satisfaction according to the patients. The overall aim of this thesis was to describe patients' postoperative sore throat and hoarseness after general anesthesia with endotracheal intubation or laryngeal mask airway. As well as to investigate the risk factors that are associated with the symptoms, and to test methods that may prevent sore throat and hoarseness after a general anaesthetics. A total of 889 patients are included in the four studies. Incidence of POST varied from 21% up to 52 % depending on endotracheal tube (ETT) size in women (I-IV) and in men was the incidence 32-38% (III-IV). There were no gender difference in POST in study III and IV. The overall incidence of PH varied from 42- 59% (I-IV) in all patients, with no gender differences (III-IV). Following a laryngeal mask airway (LMA) 19% of the patients had POST and 33% of the patients reported PH. Patients with POST do seem to be able to localize their pain in the throat (IV). Different risk factors are shown to contribute to both POST and PH in men and women (II-III). To intubate with a smaller ETT size, 6.0 vs. 7.0 decreased POST in women in the early postoperative period as well as their discomfort from their POST (I). Only 6% of men who needed a laryngeal mask airway had POST compared to 26% of women. The symptoms are more discomforting after an ETT vs. an LMA up to 24 hours (IV). More patients have sore throat and hoarseness in the early postoperative period, but the symptoms can remain up to almost 5 days postoperatively (I, IV). In summary, sore throat and hoarseness following general anesthesia, affects many patients postoperatively. To intubate women with endotracheal size 6.0 decreases both sore throat and hoarseness postoperatively. Women are more likely than men to have a sore throat when a laryngeal mask airway is used.
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Svanung, Hulén Linda, and Elwinson Elina Åström. "Det svåra är inte att intubera - det är att extubera : Anestesisjuksköterskors upplevelser av extubationsprocessen." Thesis, Högskolan i Borås, Akademin för vård, arbetsliv och välfärd, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:hb:diva-21472.
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Bakgrund: I anestesisjuksköterskans ansvar ingår att extubera patienten på ett säkert sätt. I anestesisjuksköterskans arbete fodras ett tvärprofessionellt omhändertagande av patienten inom ett team. Det är ett varierande arbetstempo i en komplex och högteknologisk miljö. Extuberingsprocessen kan medföra många komplikationer som kan ge obehag för patienten som har varit sövd i generell anestesi med endotrachealtub. Extubation ställer därmed höga krav på anestesisjuksköterskan som skall ha fördjupande medicinska och omvårdnadskunskaper vid omhändertagandet av patient. Det saknas forskning kring extubationsprocessen ur en anestesisjuksköterskas perspektiv även om det är ett riskfyllt moment. Syfte: Syftet var att beskriva anestesisjuksköterskors upplevelser och erfarenheter av svårigheter i samband med extubation av patient. Metod: Studien innefattade semistrukturerade intervjuer med nio anestesisjuksköterskor från två sjukhus i Västra Götalandsregionen i Sverige. Datamaterialet analyserades med hjälp av en kvalitativ innehållsanalys. Resultat: Resultatet visade betydande trygghet i att ha utbildning, erfarenhet och kunskap om extubationsprocessen då arbetssättet bygger på erfarenhet. Förmåga att förhålla sig till utmaningar bygger på att anestesisjuksköterskorna upplever en stor respekt för extubationsprocessen eftersom det kan innefatta många risker. Trygghet av att se patientens individuella behov var en betydande faktor för ett komplikationsfritt omhändertagande av patienter. För att främja ett systematiskt och patientsäkert sätt kring patienten, beskrev anestesisjuksköterskorna vikten av utbildning inom extubationsprocessen. Diskussion: I diskussionen jämförs det aktuella resultatet med tidigare forskning. Vidare diskuteras kunskapsbristen och forskning kring fenomenet. Slutsats: Anestesisjuksköterskornas arbete kring extubationsprocessen kräver god kunskap och erfarenhet inom anestesisjukvård. Förmåga till kommunikation och teamarbete är viktiga faktorer för en lyckad extubation.
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Antunes, Vívian da Pieve. "EFEITOS DO TUBO OROTRAQUEAL SOBRE AS HABILIDADES ORAIS E A PERFORMANCE ALIMENTAR DE RECÉM-NASCIDOS PRÉ-TERMO." Universidade Federal de Santa Maria, 2013. http://repositorio.ufsm.br/handle/1/6567.
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The increased survival of high-risk preterm infant has required a great number
of studies about his/her quality of life and integration during development process
with the need for a greater improvement and specialization in the other areas who
cares of these children. Many premature infants need to receive mechanical
ventilation and it may represent a risk factor for the development of the
stomatognathic system causing difficulties in the introduction of oral feeding. This
paper aims to evaluate the effects of the endotracheal tube used for mechanical
ventilation on the oral skills and feeding performance of preterm infants. Forty-five
preterm infants were selected in the Neonatal Intensive Care Unit (NICU) at the
University Hospital of Santa Maria (HUSM) from February 2012 to February 2013.
The babies were enrolled at the time to begin oral feeding, after parent s consent was
obtained. Children who presented head or neck malformation, genetic syndromes,
heart problems, perinatal asphyxia, intracranial haemorrhage grades III and IV and
bilirubin encephalopathy were exclude. Participants were divided in two groups
according the use or not of endotracheal tube. The oral skills were evaluated at the
time to begin oral feeding through two distinct protocols: Fujinaga et al. (2005) and
Lau and Smith (2011). The data were analyzed using software Stata 10, being
considered as significant the p value < 0.05. We concluded that the use of
endotracheal tube during neonatal hospitalization negatively influenced the feeding
performance and prolonged the time to acquisition full oral feeding in preterm infants.
However, it seems have no influence on oral skills according the protocols. The
protocol proposed by Fujinaga seems better discriminate the oral skills when
compared to the Lau and Smith s protocol.O aumento na sobrevida do recém-nascido pré-termo (RNPT) de alto risco tem exigido um grande número de estudos acerca da qualidade de vida e da integração da criança prematura ao longo da sua trajetória de desenvolvimento. Para isso, houve necessidade de um aperfeiçoamento e especialização das demais áreas que prestam assistência a estas crianças. Muitos prematuros necessitam da utilização de ventilação mecânica, o que pode representar um fator de risco ao desenvolvimento do sistema estomatognático e, conseqüentemente, dificultar a introdução da alimentação por via oral nesse grupo de crianças. O objetivo deste estudo foi o de avaliar os efeitos da utilização do tubo orotraqueal, durante a ventilação mecânica, sobre as habilidades orais e a performance alimentar do RNPT, na liberação da via oral. Para isso, foram avaliados 45 RNPT na Unidade de Terapia Intensiva Neonatal (UTIN) do Hospital Universitário de Santa Maria (HUSM), na cidade de Santa Maria RS, no período compreendido Fevereiro de 2012 e Fevereiro de 2013. Foram selecionados recém-nascidos pré-termo, de ambos os sexos, no momento da liberação médica para início da alimentação por via oral, cujos pais autorizaram a participação na pesquisa, após assinatura do Termo de Consentimento Livre e Esclarecido. Não foram incluídas crianças com malformações de cabeça e pescoço, síndromes genéticas, complicações cardíacas, asfixia perinatal (Apgar no 5º minuto ≤ 5), hemorragias intracranianas grau III e IV e encefalopatia bilirrubínica. Os participantes foram distribuídos em dois grupos segundo o uso ou não do tubo orotraqueal e submetidos à avaliação das habilidades orais, no momento da liberação para início da via oral, através de dois distintos protocolos ((Fujinaga (2005) e Lau e Smith (2011)). Os dados foram analisados através do software Stata 10, sendo considerado como significativo um valor de p<0,05. Os resultados obtidos, permitiram concluir que a utilização de tubo orotraqueal, durante a internação neonatal, influenciou negativamente a performance alimentar de RNPT, no momento da liberação para a via oral, dificultando a aquisição da via oral plena. No entanto, não houve diferença significativa, entre os grupos, na avaliação das habilidades orais. O protocolo de avaliação de Fujinaga et al.(2005) pareceu discriminar melhor as habilidades orais de RNPT,quando comparado ao de Lau e Smith (2011).
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Mohammadihashemi, Marjan. "Antibacterial and Antifungal Activity of Ceragenins, Mimics of Endogenous Antimicrobial Peptides." BYU ScholarsArchive, 2019. https://scholarsarchive.byu.edu/etd/7411.
Full textAbstract:
The continuous emergence of drug-resistance pathogens is a global concern. As a result, substantial effort is being expended to develop new therapeutics and mechanisms for controlling microbial growth to avoid entering a "post-antibiotic" era in which commonly used antibiotics are no longer effective in treating infections. In this work, we investigate the efficacy and application of ceragenins as non-peptide mimics of antimicrobial peptides (AMPs). First, this work examines the susceptibility of drug-resistant Gram-negative bacteria. The susceptibility of colistin-resistant clinical isolates of Klebsiella pneumoniae to ceragenins and AMPs suggests that there is little to no cross-resistance between colistin and ceragenins/AMPs. Furthermore, Lipid A modifications are found in bacteria with modest changes in susceptibility to ceragenins and with high levels of resistance to colistin. Next, we investigated the potential for cross resistance between chlorhexidine, colistin, AMPs and ceragenins as repeated exposure of bacteria to chlorhexidine might result in cross resistance with colistin, AMPs or ceragenins. Furthermore, a proteomics study on the chlorhexidine-resistant strains showed that chlorhexidine resistance is associated with upregulation of proteins involved in the assembly of LPS for outer membrane biogenesis and virulence factors in Pseudomonas aeruginosa.Second, this dissertation describes the antifungal activity of ceragenins against an emerging multidrug-resistant fungus, Candida auris. We found that lead ceragenins displayed activities comparable to known antifungal agents against C. auris isolates. We also found that fungal cell morphology was altered in response to ceragenin treatment, that ceragenins exhibited activity against sessile organisms in biofilms, and that gel and cream formulations including CSA-44 and CSA-131 resulted in a significant log reduction against established fungal infections in ex vivo mucosal tissues. Finally, a hydrogel film containing CSA-131 was generated on endotracheal tubes (ETTs). ETTs provide an abiotic surface on which bacteria and fungi form biofilms that cause serious infections. In this study, the eluting ceragenin prevented fungal and bacterial colonization of coated ETTs for extended periods while uncoated tubes were colonized by bacteria and fungi. Coated tubes were well tolerated in intubated pigs. The ability of ceragenins to eradicate established biofilms make them attractive potential therapeutics for persistent infections in the lung, including those associated with cystic fibrosis. In ex vivo studies, we initially found that this ceragenin, at concentrations necessary to eradicate established biofilms, also causes loss of cilia function. However, by formulating CSA-131 in poloxamer micelles, cilia damage was eliminated and antimicrobial activity was unaffected. These findings suggest that CSA-131, formulated in micelles, may act as a potential therapeutic for polymicrobial and biofilm-related infections in the lung and trachea.
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Balendran, Poopalasingam. "Flammability of endotracheal tubes." Thesis, London South Bank University, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.326049.
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Batista, Catarina da Conceição Candeias Barreto. "Intervenções de enfermagem na redução de complicações ao doente com entubação endotraqueal." Master's thesis, Instituto Politécnico de Setúbal, Escola Superior de Saúde, 2019. http://hdl.handle.net/10400.26/29375.
Full textAbstract:
Mestrado em Enfermagem, Área de especialização: Enfermagem Médico-cirúrgicaO presente relatório surge no âmbito do 2º Mestrado em Enfermagem em associação, ministrado na Escola Superior de Saúde do Instituto Politécnico de Setúbal. A Teoria das Transições da Afaf Meleis serviu de linha orientadora a este trabalho. Sendo o seu principal objetivo expor todo o processo de desenvolvimento de competências específicas e comuns do enfermeiro especialista e as competências de mestre. Realizando-se uma análise e reflexão acerca do desenvolvimento da aquisição de competências do enfermeiro especialista. O grau de mestre em enfermagem carece dum conhecimento aprofundado no domínio da sua área de especialização. Durante estágio II comtemplou-se a realização dum projeto de intervenção em serviço, segundo a metodologia de projeto, de forma a responder a um problema identificado num contexto de estágio. Com este pretende-se a implementação duma norma – Cuidados de Enfermagem a pessoa com TET, de modo a uniformizar a prática na UCI. O projeto de intervenção contribuiu para o desenvolvimento de competências do enfermeiro especialista, nomeadamente no domínio da gestão de cuidados e da melhoria contínua da qualidade.
This report is presented in the scope of the 2nd Masters in Nursing in association, taught at the higher health school of the Polytechnic Institute of Setúbal. The Afaf Meleis Transition Theory served as a guideline for this work. Being your main goal to expose the entire process of developing specific and common skills of specialist nurse and master skills. An analysis and reflection about the development of skills acquisition of the specialist nurse. The master's degree in nursing requires in-depth knowledge in the field of its area of expertise. During stage II, a project of intervention in service according to the project methodology was contemplated, in order to respond to a problem identified in an internship context. With this it is intended the implementation of a standard - Nursing Care the person with TET, in order to standardize the practice in the ICU. The intervention project contributed to the development of skills of the specialist nurse, namely in the field of care management and continuous quality improvement.
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Batista, Catarina da Conceição Candeias Barreto. "Intervenções de enfermagem na redução de complicações ao doente com entubação endotraqueal." Master's thesis, Universidade de Évora, 2019. http://hdl.handle.net/10174/26703.
Full textAbstract:
Mestrado em Enfermagem, Área de especialização: Enfermagem Médico-cirúrgicaO presente relatório surge no âmbito do 2º Mestrado em Enfermagem em associação, ministrado na Escola Superior de Saúde do Instituto Politécnico de Setúbal. A Teoria das Transições da Afaf Meleis serviu de linha orientadora a este trabalho. Sendo o seu principal objetivo expor todo o processo de desenvolvimento de competências específicas e comuns do enfermeiro especialista e as competências de mestre. Realizando-se uma análise e reflexão acerca do desenvolvimento da aquisição de competências do enfermeiro especialista. O grau de mestre em enfermagem carece dum conhecimento aprofundado no domínio da sua área de especialização. Durante estágio II comtemplou-se a realização dum projeto de intervenção em serviço, segundo a metodologia de projeto, de forma a responder a um problema identificado num contexto de estágio. Com este pretende-se a implementação duma norma – Cuidados de Enfermagem a pessoa com TET, de modo a uniformizar a prática na UCI. O projeto de intervenção contribuiu para o desenvolvimento de competências do enfermeiro especialista, nomeadamente no domínio da gestão de cuidados e da melhoria contínua da qualidade.
This report is presented in the scope of the 2nd Masters in Nursing in association, taught at the higher health school of the Polytechnic Institute of Setúbal. The Afaf Meleis Transition Theory served as a guideline for this work. Being your main goal to expose the entire process of developing specific and common skills of specialist nurse and master skills. An analysis and reflection about the development of skills acquisition of the specialist nurse. The master's degree in nursing requires in-depth knowledge in the field of its area of expertise. During stage II, a project of intervention in service according to the project methodology was contemplated, in order to respond to a problem identified in an internship context. With this it is intended the implementation of a standard - Nursing Care the person with TET, in order to standardize the practice in the ICU. The intervention project contributed to the development of skills of the specialist nurse, namely in the field of care management and continuous quality improvement.
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Feron, Barbara Maria Ellen. "The role of microbial biofilm adherent to endotracheal tuber in nocosomial pneumonia." Thesis, Queen's University Belfast, 1994. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.241392.
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Domike, Kristin Rebecca 1981. "The impact of improved materials in poly(vinyl chloride)-based endotracheal tubes." Thesis, Massachusetts Institute of Technology, 2004. http://hdl.handle.net/1721.1/28871.
Full textAbstract:
Thesis (M. Eng.)--Massachusetts Institute of Technology, Dept. of Materials Science and Engineering, 2004.Includes bibliographical references.
Endotracheal tubes (ETs) are used to aid artificial ventilation in millions of medical patients every year and are known to invoke the proliferative phase in the cell linings. The technical objective of this work was to investigate in vitro the interaction between epithelial cells and current poly(vinyl chloride)-based ET materials, as well as some ET samples embedded with materials intended to improve biocompatibility properties of the tubes. Cells were grown in wells with small samples of ETs and proliferation and migration were observed using phase microscopy. ETs appeared to increase cell growth wherever cells came into contact with the material. The cell morphology altered once in contact with the ET sample. Cell growth on and around the ETs with embedded material appeared to slow, but had significant visible changes in cell morphology. The need for continued research in this area of research and development and future steps are addressed. A proposal for starting a company around a safer material for use in endotracheal tubes was developed and showed significant barriers to entry for a small medical device company with a single product. Subsequently, the most appropriate approach for bringing a new ET to the market would be by way of a licensing with an existing manufacturer.
by Kristin Rebecca Domike.
M.Eng.
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Hagler, Debra Ann 1960. "Dislodgement of bacteria from endotracheal tubes after saline instillation and suction catheter insertion." Thesis, The University of Arizona, 1992. http://hdl.handle.net/10150/278191.
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Bacterial glycocalyx formations on the inner lumens of endotracheal tubes may be dislodged into the lower airway by suction catheter insertions or saline instillations. Repeated introduction of bacteria into the lower airway may overwhelm host defense mechanisms, leading to nosocomial pneumonia. Ten crossover subjects required intubation for 2 to 39 days. A range of 0-62,000 (mean 26,980) viable bacterial colonies per milliliter was dislodged from freshly removed endotracheal tubes by either catheter insertion or saline instillation. There was no significant difference in numbers of viable bacteria dislodged from endotracheal tubes by catheter insertion versus a 5 milliliter saline instillation. The large numbers of coated bacteria dislodged could be an underestimated infectious hazard, particularly as endotracheal suctioning is generally performed multiple times each day for intubated patients. As optional saline instillations have not improved endotracheal suctioning outcomes in previous studies, caregivers should consider deleting saline instillation during endotracheal suctioning.
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Kurmoo, Yasin. "Novel materials and optical fibre sensors to reduce the risk of infection associated with endotracheal tubes." Thesis, University of Nottingham, 2018. http://eprints.nottingham.ac.uk/50954/.
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Lonz-Miglionica, Gloria. "A comparative study of two different techniques utilized for securing endotracheal tubes and the rate of occurrence of oral ulceration /." Staten Island, N.Y. : [s.n.], 1989. http://library.wagner.edu/theses/nursing/1989/thesis_nur_1989_lonz_compa.pdf.
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Hedlund, Niclas. "Tyst kunskap och produktdatasystem vid medicinteknisk tillverkning : Pilotstudie av system för produktdatahantering och kartläggning av den tysta kunskapen vid Nationellt respirationscetrum, NRC." Thesis, Uppsala University, Department of Information Technology, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-126753.
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This thesis looks at two sides of the same coin: how to support the production and future development at a specialist medical technology department at Danderyd Hospital. The two sides are; a pilot study of a product management system (PDM) and an interview based study on the characteristics of the silent knowledge of the technicians. The department (National respiratory centre, NRC) is facing retirement of several key employees.
The technical study shows that the success of an implementation is largely dependent on the users’ prior knowledge and use of a 3D Computer aided design system (CAD).The system itself is shown to fulfill the Lifecycle requirement of tracking the products (mostly tracheostomy tubes) but without a CAD centered workflow, some substantial education and preferably some new recruits, an implementation of the PDM system will fail. The author recommends development of the current “low-tech” system of MS Excel and Access rather than redistribute the dependency from technician towards a complex, commercial software and its vendor.
The analysis of the technicians’ silent knowledge with the newly developed method, epithet for silent knowledge (ETK), shows that the longer employment time:
- the more differentiated technicians become in describing their work,
- practical knowledge are regarded higher and
- the social and collective problem solving factors of the work becomes more important.
Typically, it is shown that a new employee should preferably enjoy problem solving, being pragmatic and social as well as having some prior education or work experience in a CAD and/or a PDM system.
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Gustin, Bernard. "Influence des propriétés viscoélastiques de sondes endotrachéales sur leur interaction avec les voies aériennes supérieures : (élément de définition d'une assurance qualité)." Vandoeuvre-les-Nancy, INPL, 1996. http://www.theses.fr/1996INPL083N.
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Les sondes endotrachéales sont des dispositifs médicaux largement utilisés dans les hôpitaux ; leur mise en place appartient aux gestes de réanimation respiratoire. Ce tube régulièrement courbe et en PVC, introduit par la bouche ou par le nez, rejoint la trachée maintenant les voies respiratoires libres et offrant la possibilité de ventiler le malade en cas de besoin. Ces objets sont achetés par les pharmacies hospitalières et utilisées par les anesthésistes selon une technique bien codifiée. Ils sont présentés sous de nombreuses références mais la qualité requise pour les objets eux-mêmes est peu contrôlée. Or l'intubation présente des difficultés y compris mettant en cause la sonde où est la source d'effets secondaires gênants. Une description précise de l'acte intubatoire a été entreprise à partir de 250 intubations réelles à l'aide d'un questionnaire et de 55 séquences vidéo. Cet acte médical requiert en général moins de 30 secondes au cours desquelles l'anesthésiste rencontre une difficulté (de tout grade) dans un cas sur cinq ; les nombreux palliatifs mis en œuvre sont décrits. Le choix du type de sonde, du calibre obéissent à des règles bien définies. Au cours de son introduction, la sonde est soumise à des efforts en flexion et en rotation en vue d'amener le biseau de la sonde entre les cordes vocales de chaque patient. Lorsqu'elle est en place, la sonde adopte instantanément sa nouvelle géométrie sous l'action d'un grand déplacement et s'échauffe à 37°C en 20 mn. Le PVC plastifié utilisé pour la fabrication de trois sondes largement utilisées dans les hôpitaux français a été analysé et caractérisé mécaniquement. Il se comporte comme une structure viscoélastique et à l'aide d'un modèle mathématique dérivé de l'analogie rhéologique de Maxwell généralisé, nous avons établi une équation pour chaque matériau qui décrit l'évolution de ses propriétés en fonction du temps et la température. La combinaison des deux séries de résultats a permis de proposer une démarche d'évaluation des sondes du marche avec des techniques de complexité croissante qui vont de la simple prédiction de la souplesse en flexion trois points jusqu'au calcul des forces qui s'exercent sur la cartilage cricoïde. Avec le calcul selon la méthode des éléments finis on dispose d'une méthode qui quantifie les forces en présence le long du trajet de la sonde et qui analyse l'amplitude de ces forces selon différents paramètres cliniques: le calibre utilisé, la position du patient ainsi que la marque de la sonde utilisée
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(6612920), Wan-Chu Hung. "Evaluation of Endotracheal Tube Cuff Pressure and The Use of Three Cuff Inflation Syringe Devices in Dogs." Thesis, 2019.
Find full textAbstract:
Over-inflation of an endotracheal tube (ETT) cuff may lead to tracheal necrosis, whereas under- inflation increases the risk of pulmonary aspiration. The objectives of this 2-phase study were to 1) identify the frequency of abnormal ETT cuff inflation in anesthetized dogs, 2) evaluate ETT cuff inflation with 3 devices (regular syringe, Tru-CuffTM syringe, AG Cuffill syringe) in achieving proper cuff pressure (20-30 cmH2O). Dogs undergoing general anesthesia at Purdue Veterinary Medicine Teaching Hospital (PVMTH) were included. The standard operating procedure (SOP) of PVMTH was used for ETT size selection and cuff inflation. The results of objective 1 showed that 50 of the 80 dogs required ETT cuff inflation. Among these 50 dogs, only 14% had proper cuff inflation; 76% of the cuffs were over-inflated and 10% were under-inflated. For objective 2, 90 dogs were equally assigned to the 3 devices for ETT cuff inflation and cuff pressure was assessed with an aneroid manometer. The results showed that 80% of the ETT cuffs were over-inflated with the regular syringe, whereas only 6.7% and 3.3% ETT cuffs were over-inflated with the Tru-CuffTM and AG Cuffill syringes, respectively. The AG Cuffill syringe treatment group had a significantly higher percentage of proper inflated ETT cuffs (86.7%; both p < 0.05) compared to the other two groups (regular [3.3%]; Tru-CuffTM [50%]). We concluded that there was a high frequency of improper ETT cuff inflation when using SOP coupled with a regular syringe. The use of an AG Cuffill syringe significantly reduced improper ETT cuff inflation.
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"Comparing the effect of polyurethane endotracheal tube and polyurethane subglottic secretion drainage endotracheal tube on fluid leakage across endotracheal tube cuff as a measure for preventing microaspiration to reduce ventilator associated pneumonia: a laboratory study." 2015. http://repository.lib.cuhk.edu.hk/en/item/cuhk-1291575.
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Chan, Wing Keung David.Thesis D.Nurs. Chinese University of Hong Kong 2015.
Includes bibliographical references (leaves 115-119).
Abstracts also in Chinese.
Title from PDF title page (viewed on 26, October, 2016).
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Chang, Shiou-Mei, and 張秀梅. "DURING THE DIFFERENT DIAMETER ENDOTRACHEAL TUBE METERED AEROSOL DELIVERY EFFECT." Thesis, 2014. http://ndltd.ncl.edu.tw/handle/40030236429059063562.
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碩士大同大學
生物工程學系(所)
102
Chronic lung disease of infancy refers to all infants in the neonatal period suffered lung damage caused by the final abnormal lung changes. Due to the high lung airway resistance, the disease is often associated with recurrent wheezing, giveg short-acting inhaled Beta2-adrenergic agonist can relieve bronchial contracture and improve ventilation. Inhaled steroids is also used as anti-inflammatory drugs to reduce bronchodilator usage, improve ventilation, reduce the oxygen concentration and shorten ventilator for several days. The purpose of this study is to simulate the positive pressure mechanical ventilation through an endotracheal tube which connected with different device directly to assist the delivery of inhaled drugs,corticosteroid-Duasma. High Performance Liquid Chromatography was used to analzye the deposition amount of drug. The influence of inner diameter endotracheal on the delivery efficiency tube was studied. The results suggest that the bigger endotracheal tube increase the drug delivery efficiency.
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Sousa, Mara Daniela da Silva. "Estimating the ideal endotracheal tube size in children using ultrasound." Master's thesis, 2020. https://hdl.handle.net/10216/128732.
Full textAbstract:
O controlo da via aérea em crianças representa ainda um grande desafio das áreas de anestesia e medicina intensiva. Em termos anatómicos, a via aérea de uma criança apresenta diferenças consideráveis em comparação com a via aérea de um adulto. Uma vez que um tubo endotraqueal inadequadamente grande ou pequeno pode ter consequências adversas para o doente, estimar o tamanho ideal do tubo endotraqueal é um passo essencial no controlo da via aérea. Atualmente, os métodos mais usados para estimar o tamanho do tubo baseiam-se em fórmulas que usam parâmetros demográficos e antropométricos como a idade, peso ou altura, para calcular o diâmetro interno do tubo endotraqueal. Contudo, estes métodos não têm em linha de conta as diferenças individuais do desenvolvimento da via aérea. A necessidade de métodos mais confiáveis levou a que surgissem estudos centrados no uso da ecografia na escolha do tubo endotraqueal. Investigações recentes usam a ecografia para medir o diâmetro transverso da via aérea no seu ponto mais estreito e correlacionar essa medida com o diâmetro externo do tubo endotraqueal. Deste modo, a ecografia permite uma estimativa individualizada do tamanho do tubo endotraqueal. Apesar das vantagens da ecografia, algumas falhas têm de lhe ser apontadas, nomeadamente o facto de ser uma técnica observador dependente e a possibilidade de subestimação do tamanho do tubo endotraqueal. Esta revisão irá, assim, centrar-se na discussão de estudos recentes que comparam a ecografia com métodos tradicionais. Os estudos analisados parecem apontar para uma superioridade da ecografia, no entanto mais investigação é necessária.Airway management is still a challenge in pediatric anesthesiology and intensive care. The airway anatomy of a child presents major differences when compared to an adult's airway. Since using an unsuitable endotracheal tube can cause harm to the patient, estimating the ideal endotracheal tube size is key to secure the airway. Currently, the most used methods to estimate the ideal size for an endotracheal tube in pediatric patients are based on mathematical formulas, that combine demographic and anthropometric parameters like age, weight or height, to calculate the endotracheal tube inner diameter. Notably, these methods do not account for individual differences in airway structures development, which makes them especially unreliable. Considering there's a need for a more trustworthy method, recent research has focused in the use of ultrasound. Numerous studies have suggested that ultrasound may be useful in choosing the endotracheal tube size by measuring the airway minimal transverse diameter and correlate it with the endotracheal tube outer diameter. Therefore, ultrasound allows to estimate the tube's size in an individualized manner, which reduces the risk of harming the patient. In spite of all its advantages, ultrasound also has its limitations; in fact, not only it is an operator dependent technique, it also may underestimate the minimal transverse airway diameter. This paper will focus on recent studies that compare traditional methods to estimate the ideal endotracheal tube size with the use of ultrasound. Although further research is needed, in light of recent studies, ultrasound appears to be a reliable method.
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Sousa, Mara Daniela da Silva. "Estimating the ideal endotracheal tube size in children using ultrasound." Dissertação, 2020. https://hdl.handle.net/10216/128732.
Full textAbstract:
O controlo da via aérea em crianças representa ainda um grande desafio das áreas de anestesia e medicina intensiva. Em termos anatómicos, a via aérea de uma criança apresenta diferenças consideráveis em comparação com a via aérea de um adulto. Uma vez que um tubo endotraqueal inadequadamente grande ou pequeno pode ter consequências adversas para o doente, estimar o tamanho ideal do tubo endotraqueal é um passo essencial no controlo da via aérea. Atualmente, os métodos mais usados para estimar o tamanho do tubo baseiam-se em fórmulas que usam parâmetros demográficos e antropométricos como a idade, peso ou altura, para calcular o diâmetro interno do tubo endotraqueal. Contudo, estes métodos não têm em linha de conta as diferenças individuais do desenvolvimento da via aérea. A necessidade de métodos mais confiáveis levou a que surgissem estudos centrados no uso da ecografia na escolha do tubo endotraqueal. Investigações recentes usam a ecografia para medir o diâmetro transverso da via aérea no seu ponto mais estreito e correlacionar essa medida com o diâmetro externo do tubo endotraqueal. Deste modo, a ecografia permite uma estimativa individualizada do tamanho do tubo endotraqueal. Apesar das vantagens da ecografia, algumas falhas têm de lhe ser apontadas, nomeadamente o facto de ser uma técnica observador dependente e a possibilidade de subestimação do tamanho do tubo endotraqueal. Esta revisão irá, assim, centrar-se na discussão de estudos recentes que comparam a ecografia com métodos tradicionais. Os estudos analisados parecem apontar para uma superioridade da ecografia, no entanto mais investigação é necessária.Airway management is still a challenge in pediatric anesthesiology and intensive care. The airway anatomy of a child presents major differences when compared to an adult's airway. Since using an unsuitable endotracheal tube can cause harm to the patient, estimating the ideal endotracheal tube size is key to secure the airway. Currently, the most used methods to estimate the ideal size for an endotracheal tube in pediatric patients are based on mathematical formulas, that combine demographic and anthropometric parameters like age, weight or height, to calculate the endotracheal tube inner diameter. Notably, these methods do not account for individual differences in airway structures development, which makes them especially unreliable. Considering there's a need for a more trustworthy method, recent research has focused in the use of ultrasound. Numerous studies have suggested that ultrasound may be useful in choosing the endotracheal tube size by measuring the airway minimal transverse diameter and correlate it with the endotracheal tube outer diameter. Therefore, ultrasound allows to estimate the tube's size in an individualized manner, which reduces the risk of harming the patient. In spite of all its advantages, ultrasound also has its limitations; in fact, not only it is an operator dependent technique, it also may underestimate the minimal transverse airway diameter. This paper will focus on recent studies that compare traditional methods to estimate the ideal endotracheal tube size with the use of ultrasound. Although further research is needed, in light of recent studies, ultrasound appears to be a reliable method.
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Su, Han, and 蘇涵. "Oral sensation, salivary secretion and tongue strength following endotracheal tube extubation." Thesis, 2013. http://ndltd.ncl.edu.tw/handle/65982575937942121127.
Full textAbstract:
碩士國立臺灣大學
護理學研究所
101
Loss of oral sensation, declined salivary secretion, and decreased tongue strength may occur after prolonged endotracheal intubation. All the above may affect oral intake following endotracheal extubation. The aim of this study was to assess the functional recovery of oral sensation, salivary secretion, and tongue strength in patients with prolonged endotracheal intubation. A prospective observation study was conducted to assess the functional recovery of oral sensation, salivary secretion, and tongue strength among patients aged 20 years and older following endotracheal extubation. In keeping with previous research, we only include patient who had been intubation for at least 48hours.Data were assessed at three points in time, 48 hours within extubation, and 7 days and 14 days postextubation. Specifically , salivary secretion was measured by oral Schirmer test ; oral sensation was measured by oral stereognosis ,two point discrimination and light touch discrimination on the tongue ;tongue strength was measured by the Iowa Oral Performance Instrument(IOPI) System .The sample consists 30 patients and 36 control. Data revealed that oral sensation, salivary secretion, and tongue strength were all at the lowest point 48 hours within extubation. Oral sensation gradually recovered 14 days after extubation, while salivary secretion and tongue strength did not improve even at 14 days after extubation. The result suggests that functions of oral sensation, salivary secretion, and tongue strength affected significantly after prolonged endotracheal intubation and most did not recovered even after 14 days.
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Chen, Chia-Sui, and 陳佳穗. "Effects of Multimedia Health Education on State Anxiety in Patients with Endotracheal Tube Retained." Thesis, 2015. http://ndltd.ncl.edu.tw/handle/96556472658143940500.
Full textAbstract:
碩士中臺科技大學
護理系碩士班
103
Backgrounds: At ICUs, various factors, such as invasive medical procedures, unfamiliar en-vironment and patients’ inability to verbalize pains and discomforts during treatments, con-tribute to enormous stress for the patients. On top of them, the endotracheal tube retention causes further physical discomfort and anxiety, which may lead to resistance to mechanical ventilation and unplanned extubation and thus adversely impact patient recovery. How to effi-ciently deliver health education becomes imperative in order to alleviate patient anxiety. Therefore, this study investigates the effectiveness of multimedia compact disc health educa-tion on alleviating anxiety in patients with endotracheal tube retention. Methods: This study uses single–blind test. The subjects are patients who were admitted to medical/surgical ICU at one of the teaching hospitals located at Taichung. They are assigned randomly to experimental and control groups. Each group contains 32 subjects. We use mul-timedia compact disc to deliver health education to experimental group, while the control group receives traditional health education. The subjects’ pre-and post-intervention heart rate, respiratory rate, systolic and diastolic blood pressure, mean blood pressure, digital tempera-ture, blood oxygen saturation and anxiety score are collected. The data are analyzed using SPSS13.0 statistical software. Results: Pre-education physiological index t-value for the two groups is 0.79-1.25, and psychological index t-value is 1.35 (p-value >0.05). There is no significant difference. For experimental group, post-education measurements for systolic and diastolic blood pressure, mean blood pressure and blood oxygen saturation achieve statist difference (p value <0.05.). Digital temperature increases 1.16 oC and achieves statistic difference (p value <0.001). Among the psychological index, the anxiety score decrease 9.28 (p value<0.001), which is statistically different. There are no statistic differences in heart rates and respiratory rates. Among anxiety score evaluation, the changes are most significant for items “I feel psycho-logically comfortable now” “I feel very happy now.” “I am relaxed now”. Conclusions: This study shows multimedia compact disc health education is effective in re-ducing patient stress, alleviating emotional anxiety and providing mental relaxation in patients who are experiencing both physical and mental discomforts due to endotracheal tube retention. This shows multimedia compact disc can improve anxiety in patients with endotracheal reten-tion.
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Ali, Ahmad Mousa. "Closed suctioning system of endotracheal tube (CTSS) : the practice and perception of intensive care nurses." Thesis, 2001. http://hdl.handle.net/10413/5203.
Full textAbstract:
Purpose: The of this study was to explore the knowledge, level of practice, and the frequency of problems met during the use of CTSS amongst intensive care unit (ICU) nurses and suggest ways to improve the use of the system. Design: A non experimental exploratory design using a descriptive survey approach was employed. Sample: The sample of participants were taken from three governmental hospitals in Abu Dhabi chosen randomly. It included all nurses in the ICUs of three hospitals who happened to be working at the time of the study. The response was Eighty
three staff nurses, three charge nurses, and one respiratory therapist. Instrument: A questionnaire consisting of twenty one questions was used to explore the ICU nurses' knowledge, experience, practice, and difficulties met by nurses. Averages, tables, figures, and correlation coefficient were used to analyze the data. Results: Results showed a positive correlation
(+0.0433) between the level of knowledge and length of use of the
system but the effect is minimal. Again the knowledge and the frequency of use on ventilated patients were minimally positive (+0.0898). On the other hand, the relation between the frequency of use and the years of experience was more positively related than the frequency of use and the knowledge. Conclusion: There is a need to set a plan aiming at making the
system more frequently used. Not only that , but it should be used safely and appropriately and supported by policy and procedure guidelines.Thesis (M.Cur.)-University of Natal, Durban, 2001.
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Gilliland, Lizil. "Endotracheal tube cuff pressures in adult patients undergoing general anaesthesia in two Johannesburg academic hospitals." Thesis, 2014. http://hdl.handle.net/10539/17377.
Full textAbstract:
Background: Endotracheal tubes (ETTs) play an integral part in anaesthesia. ETT cuff pressure commonly exceeds the recommended range of 20 - 30 cm H₂0 during anaesthesia. This can lead to serious morbidity. No objective means of ETT cuff pressure monitoring is available in the operating theatres of Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) and Chris Hani Baragwanath Academic Hospital (CHBAH). The ETT cuff pressure of patients undergoing general anaesthesia is therefore unknown.
Aim: The aim of this study was to determine what the actual ETT cuff pressures were of patients receiving general anaesthesia at CMJAH and CHBAH and to document the cuff inflation techniques that were used to achieve these pressures.
Method: ETT cuff pressure of 96 adult patients undergoing general anaesthesia without nitrous oxide at CMJAH and CHBAH were measured. A RUSCH Endotest aneroid manometer was used to measure ETT cuff pressure in size 7.0 – 8.5 mm ETTs. The cuff inflation technique that was used by the anaesthetist was also documented. Anaesthetists were blinded to the study.
Results: The mean ETT cuff pressure recorded was 47.5 cm H₂0 (range 10 –120 cm H₂0). ETT cuff pressures exceeded 30 cm H₂0 in 64.58% of patients and 18.75% of patients had ETT cuff pressures within the recommended range of 20 - 30 cm H₂0. There was no statistically significant difference between the ETT cuff pressures measured at the two hospitals (p=0.2480). Minimal occlusive volume was the most frequent technique used to inflate the ETT cuff (37.5%), this was followed by a predetermined volume of air in 31.25% of cases and palpation of the pilot balloon (27.08%). There was no statistical significant difference between the ETT cuff pressure measured and the inflation technique.
Conclusion: ETT cuff pressures of patients undergoing general anaesthesia at two Johannesburg Academic hospitals were high. ETT cuff pressure should routinely be measured using an aneroid manometer.
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Tsai, Wen-Kai, and 蔡文凱. "Investigation of unplanned-extubation of endotracheal tube by health-care matrix and root cause analysis." Thesis, 2010. http://ndltd.ncl.edu.tw/handle/56351045545704651896.
Full textAbstract:
碩士雲林科技大學
健康產業管理研究所碩士班
98
A procedure is based on the concept of medical care with "patient-centered" and "patient safety". In recent years, tube safety is one of the nine goals of patient safety. Literatures pointed out that the tube events are high risk and high frequency of accidents in intensive care unit. According to Taiwan''s patient safety reporting system (TPRs), tube-related incidents accounted for 10-11% and they can cause major complications and death. This research applied root cause analysis (RCA) and "Health Care Matrix": We find that the most frequent occurrence of unplanned extubation, happened at the day shift, junior nurse in rank, and patients of internal medicine. The situation of patients of self-extubation mainly are awake, without usage of sedative agents and non-restriction status. The re-intubation rate is 22.7%. Therefore the basic problems are: 1. Awake patients are uncooperative and attempt to extubation. 2. Insufficient pre-employment training of new stuff leading to inadequate knowledge. 3. The lack of integrity of the assessment of medical treatment and sedatives treatment timely. 4. The lack of medical team to discuss the extubation time. Further, using healthcare matrix to find out feasible improvement plan: initially, the clinical team reviewed the process of patient care to identify whether each of the six quality aims had been reached, and then qualified by six competencies: medical knowledge and skills, interpersonal and communication skills, professionalism, system-based practice and practice-based learning and improvement. The results provide the introspection and the improvement method in safe, timely and effective. These findings may provide the guide for medical team to assess the self-extubation patients, and suitable measure for high risk group such as awake patients without sedatives and physical restriction. Because the appropriate prevention of unplanned-extubation for reducing the incidence and injury, thereby ensuring patient safety, to improve the quality of care and reduce medical resource utilization win-win situation.
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Shu-Pern, Hsu, and 許淑盆. "Comparisons of different oral care protocols on oral mucosa status in patients with an endotracheal tube." Thesis, 2006. http://ndltd.ncl.edu.tw/handle/68289981058187527729.
Full textAbstract:
碩士輔仁大學
護理學系碩士班
94
Abstract The purpose of this study was to compare the effectiveness of three different oral care protocols on oral mucosa status in patients with an endotracheal tube. A quasi-experimental design was used. The convenience samples of 81 patients with an endotracheal tube were recruited from the medical intensive care unit (ICU) of a medical center in North Taiwan. Subjects were divided into three groups based on three different admission time intervals: 27 patients in the control group, 29 patients in the green-tea group, and 25 patients in the boiled-water group. Patients in the control group received only routine oral care. Patients in the experimental groups received either green-tea oral cleaning (the green-tea group) or boiled-water oral cleaning (the boiled-water group) every four hours, in addition to the routine oral care. Data were collected by observation using a structured checklist including demographic data and oral mucosa rating scale. A senior nurse assessed the subjects’ oral mucosa status everyday for 14 days. Data were analyzed by SPSS 12.0 and SAS 9.0 using descriptive statistic, chi-squar test, one way ANOVA and generalized estimation equation（GEE） multiple regression analysis. The results of this study were described as follows: 1.During the 14-day period, the patients in the boiled-water group had significant lower mean score of mucosa status than those in the control group (p<0.05) on six subscales: labial mucosa, tougue mucosa, gingive color, gingivitis, saliva status, and amount of dental plaque. However, the patients in the green-tea group reported signicant lower mean score of mucosa status than those in the control group on only two subscales: saliva status, and amount of dental plaque. 2. The mean score of mucosa status at palate, uvula, and parotid gland subscales were significant higher on the second to sixth day than the first day. 3. There were interactions between groups and time on two subscales: labial mucosa and gingive color. The mean score of labial mucosa subscale on the patients in the boiled-water group was graduately decreased with time, whereas those in the control group reported the opposite results. In additions, the mean score of gingive color subscale was graduately decreased with time on the patients in the green-tea group, whereas those in the control group showed no changes with time. The results of this study confirmed that increased frequency of oral care could improve mucosa status of patients with an endotracheal tube. The effect of oral care with boiled water on mucosa status was better than green tea. Therefore, it was suggested that nurses needed to enhance their knowledge about oral care to provide more effective oral care for the ICU patients, and to prevent further infection.
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Campbell, A. Ryan Jonathan. "The accuracy of anaesthetists in the depth of oral endotracheal tube placement in an academic hospital." Thesis, 2017. https://hdl.handle.net/10539/24799.
Full textAbstract:
A research report submitted to the Faculty of Health Sciences, University
of the Witwatersrand, in partial fulfillment of the requirements for the
degree of Master of Medicine in Anaesthesiology, Johannesburg, 2017.Background: Endotracheal intubation is currently the proverbial “gold standard” for securing and protecting a patient’s airway. However, endotracheal tube (ETT) misplacement is a recognised complication of intubation and can result in significant patient morbidity and mortality. The aims of this study were to describe anaesthetists accuracy at placing oral ETTs to the correct depth, factors which influenced this accuracy and the methods used by anaesthetists to confirm correct ETT placement. Methods: A prospective, contextual, descriptive research design was used. The sample included 138 adult patients presenting for elective surgery requiring oral ETT insertion, and the anaesthetists intubating these patients. Recorded variables included patient age, gender, height, ETT position at the front upper incisors, ETT tip to carina distance and the methods used by anaesthetists to confirm correct ETT placement. Results: Only 45.7% of ETTs were accurately placed with 34.8% being too deep. There were significantly more deep ETT misplacements in females (p=0.0231), and patients with deep ETT placement were significantly shorter than those with accurate ETT placement (p<0.05). The number of methods used by anaesthetists to confirm correct ETT placement did not influence accuracy (p=0.4014). Neither the 21/23 cm nor the 20/22 cm methods were shown to improve the accuracy of ETT placements. Endotracheal tube distance measured at the front upper incisors was weakly correlated to the ETT distance measured above the carina in female patients but not in males. Conclusion: Endotracheal tube misplacement is a frequent event in the intraoperative period, and potential risk factors identified included female gender and extremes of height. Endotracheal tube placement should be individualized. Airway ultrasound is a point of care test that could potentially help confirm correct ETT placement.
LG2018
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Barros, Marta Sofia Penso de. "A prospective study to compare patient laryngo-pharyngeal complaints after laryngeal mask airway verus endotracheal tube insertion." Master's thesis, 2012. https://repositorio-aberto.up.pt/handle/10216/72282.
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Barros, Marta Sofia Penso de. "A prospective study to compare patient laryngo-pharyngeal complaints after laryngeal mask airway verus endotracheal tube insertion." Dissertação, 2012. https://repositorio-aberto.up.pt/handle/10216/72282.
Full text
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Memela, Mduduzi Emmanuel. "A prospective comparative study of continuous and intermittent endotracheal tube cuff pressure measurement in an adult intensive care unit." Thesis, 2010. http://hdl.handle.net/10321/621.
Full textAbstract:
Submitted in fulfilment of the Master's Degree in Clinical Technology, Durban University of Technology, 2010.Introduction: The aim of this study was to establish the most reliable standard method for monitoring endotracheal tube cuff pressure in an intensive care unit. Methodology: The study was conducted at King Edward VIII Hospital ICU on adult patients undergoing prolonged intubation of more than 24 hours. Consent was obtained from the patient’s next of kin. The patient’s Pcuff for this study was recorded in two ways simultaneously for a period of 12 hours during the day. The principal investigator recorded the Pcuff thrice during the study period using the Posey cufflator®. Continuous recording was done using a pressure transducer connected to the Nihon Kohden BSM®. Factors causing changes in Pcuff were also documented. Results: Thirty-five critically ill adult patients were enrolled into the study. Nineteen (54.3%) of the subjects were male. Seventeen out of 35 subjects were studied for the entire 720 minute period. The mean time of study of the group was 667 minutes with the lowest period being 135 minutes for one patient. The group mean ± Standard deviation (SD) was 26.6 8.7 with a 95% confidence index of 9.2 – 44.0 and the median value was 25 for continuous readings. For the entire group, 13% of the time was spent in the low pressure range (< 20 cmH2O), while 23% was spent in the high pressure (> 30 cmH2O). A mean of 64% of the time was spent in the normal pressure range. Overall, the most frequently encountered events that caused pressure changes were body movement, coughing, head movement and suctioning accounting for 26.2%, 20.1%, 19.2% and 9.4% respectively. For intermittent readings, the mean ± SD of all patients for T0 was 25.3 ± 6.9; for T6 25.9 ± 8.7 and for T12 24.8 ± 3.8. The overall mean ± SD for all readings was 25.6 ± 7.1. For the entire group, 12% of the time was spent in the low pressure range (< 20 cmH2O), while 5% was spent in the high pressure (> 30 cmH2O). A mean of 83% of the time was spent in the normal pressure range. The correlation between intermittent pressure and the continuous reading at the same time was r = 0.87. iii Discussion: Continuous monitoring of Pcuff indicated that the endotracheal cuff pressure varies extensively during mechanical ventilation in critically ill patients, such variation being noted both between patients and within an individual patient. In an attempt to compare intermittent and continuous monitoring of endotracheal cuff pressures, a good correlation between the two measurements was demonstrated. However, the variations in pressures noted for an individual patient would not have been detected if endotracheal cuff pressures were monitored intermittently. Hence, with continuous monitoring the pressure changes may be detected early. Conclusion: Continuous monitoring of cuff pressure during mechanical ventilation in intensive care units is thus recommended for all patients. If intermittent monitoring is performed, it should be more frequently than eight-hourly. It is recommended that a pressure range of 20-30 cmH2O still be used as the normal range. The role of self adjusting pressure devices, although needing further exploration, holds much promise.
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Mahmoud, Ramadan Aboelhasan Ahmed [Verfasser]. "The effect of endotracheal tube leakage on the lung protective mechanical ventilation in neonates / von Ramadan Aboelhasan Ahmed Mahmoud." 2010. http://d-nb.info/1010606891/34.
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Wu, Fang-Yu, and 吳芳瑜. "An investigation of Oral Malodor and Oral Care Practices in the Patients with Oral Endotracheal Tube at a Neurosurgery Intensive Care Unit." Thesis, 2009. http://ndltd.ncl.edu.tw/handle/84994904496546093320.
Full textAbstract:
碩士高雄醫學大學
口腔衛生科學研究所碩士在職專班
97
Background：The painful smell is called the halitosis in neurosurgery patients with oral endotracheal tube of intensive care unit .The halitosis problem has been difficult to solve all the time. Purpose：The aim of this study to investigate relevant factors of the halitosis and explore the effect of triple oral hygiene practice (mechanical tongue cleaning, tooth brushing and Scodyl?? mouthwash) on the levels of volatile sulphur compounds(VSCs). Materials and Metholds: Thirty-four patients with oral endotracheal tube at a neurosurgery intensive care unit with heavy tongue coating were assessed for oral malodor. Oral malodor was evaluated by measuring the levels of volatile sulfur compounds using Oral Chroma?? and the organoleptic test score. Twenty-six participants were randomly selected for the subsequent experiments: triple oral hygiene practice consistinf of mechanical tongue cleaning、tooth brushing and chlorhexdine (Scodyl??) mouthwashing. Results：Significant correlations were observed between the OLT and H2S, CH3SH, TCS and VSCs level. Once a day after the triple oral hygiene could reduce over one half of halitosis than baseline. Conclusion：In this study, we found that mouth care was slightly more effective in reducing VSC levels of oral malodor. These findings suggest that triple oral hygiene proctice may be better to reduce malodor and VSCs for neurosurgery intensive care unit patients in neurosurgery intensive care unit twice every day. Keyword：halitosis, oral hygiene, volatile sulfide compounds
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Assadzadeh, Kamran. "Bibehållen position av endotrakealtub i munhålan : en kvantitativ deskriptiv tvärsnittsstudie." Thesis, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:rkh:diva-1410.
Full textAbstract:
Bakgrund: På intensivvårdsavdelningar finns olika rutiner kring huruvida endotrakealtubens position hos intuberade skall skiftas eller bibehållas i samma mungipa, då sidbyten kan leda till allvarliga komplikationer. Rutinen vid CIVA har varit att byta endotrakealtubens position på alla intuberade patienter en gång per dygn. Varken rutinen med skifte samt bibehållen position har utvärderats. Syftet med studien är att undersöka oralt intuberade patienters munhälsa vid bibehållen position av endotrakealtub under vårdtiden. Metod: Studien är en kvantitativ deskriptiv tvärsnittsstudie. Ett protokoll utformades för att undersöka hur stor andel av patienterna som får tryckskador i munnen med bibehållen tublägesposition. Resultat: Av totalt 85 oralt intuberade patienter utvecklade 10 rodnad och 7 sår medan 68 hade helt intakt slemhinna. Flest nyupptäckta sår uppkom efter 3-4 dagars intubering medan rodnader var jämnt fördelat. Slutsats: Endast ett fåtal patienter utvecklade tryckskador. Rutinen att bibehålla endotrakealtuben i samma position lämpar sig på patientkategorin på CIVA eftersom medelvårdtiden för intuberade är 3,2 dagar och flertalet extuberas under de 3 första dagarna. Klinisk betydelse: Studien ligger till grund för CIVA:s ändrade rutin att bibehålla endotrakealtubspositionen i samma mungipa och skulle på sikt kunna bidra till att minska samhällskostnaderna genom att reducera förekomsten av VAP och därmed patientvårdtidenBackground: Intensive care units have different routines whether the endotracheal tube position should be shifted or maintained in the same corner of the mouth. Repositioning of the tube can lead to serious complications. The routine at CIVA has been to change the endotracheal tube position in all intubated patients once per day. None of the routines have been evaluated. The objective of this study is to examine the oral health of intubated patients with maintained tube position. Method: The study is a quantitative descriptive cross-sectional study. A protocol was designed to examine the proportion of patients receiving pressure sores in the mouth. Results: Of a total of 85 orally intubated patients, 10 developed redness and 7 wounds while 68 had intact mucosa. The majority of the newly discovered sores occurred after 3-4 days of intubation. Conclusion: Only a few patients developed pressure sores. The routine to maintain the endotracheal tube in the same position is suitable for the patient category at CIVA since the average length of stay for intubated is 3.2 days and the majority were extubated during the first 3 days . Clinical significance: This study is the basis for CIVA's changed routine to maintain the endotracheal tube position in the same corner of the mouth and could eventually help to reduce the costs for society by reducing the incidence of VAP and thus patient care period.
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Chiang, Shu-Chen, and 江淑禎. "The comparison of closed and open-system endotracheal or tacheal tube suctioning on the effects of arterial oxygenation and breathing effort during mechanical ventilation without pre-oxygenation." Thesis, 2005. http://ndltd.ncl.edu.tw/handle/58339313468909998038.
Full textAbstract:
碩士輔仁大學
護理學系碩士班
93
This study aims at comparing of closed- and open-system endotracheal suctioning on the effects of artierial oxygenation and breathing effort during mechanical ventilation without pre-oxygenation. The independent variable is the endotracheal suctioning method and the dependent variables are the arterial blood oxygen pressure tested from the laboratory and the pressure-time product monitored by the pneumotachograph. The sample consisted 30 patients at the intensive care unit of a medical center in northern region of Taiwan. All the 30 cases were tested for the arterial blood oxygen pressure, only 22 of the 30 cases were tested for pressure-time product. A two groups cross-over experimental research design was applied, in which two patients were selected as a group and were randomly assigned one into Model 1, a closed-open sequencing of endotracheal suctioning system, and the other Model 2, an open-closed sequencing of endotracheal suctioning system. Thus, there were 15 patients in each model for test of arterial blood oxygen pressure and 11 patients for test of pressure-time product. Patients in model 1 were first applied a closed endotracheal suctioning system. Thereafter, these patients were received three measurement for arterial blood oxygen pressure at the time right before endotracheal suctioning, right after endotracheal suctioning and one minute after endotracheal suctioning, and were received six measurement for pressure-time product at the time right before endotracheal suctioning and once per minute for 5 minute after endotracheal suctioning. Thirty minutes after last data collected, patients' closed endotracheal suctioning system were transformed into open endotracheal suctioning system, and the same measures were repeated for tests of arterial blood oxygen pressure and pressure-time product. Patients in model 2, an open-closed sequencing of endotracheal suctioning system, the application of the endotracheal suctioning system was just reverse to model 1, but the measurement method for arterial blood oxygen pressure and pressure-time product was the same as of model 1. A better suctioning system should result in less decrease in the arterial blood oxygen pressure and less increase in the pressure-time product. There are two hypotheses in this study. Hypothesis 1 tests if the decrease on values of arterial blood oxygen pressure for pre-and post-endotracheal suctioning and to that of pre-endotracheal suctioning of the closed endotracheal suctioning system is less than that of the same comparison of the open endotracheal suction system. Result from the modified analysis of GEE model shows that the decrease of the arterial blood oxygen pressure between pre- and post-endotracheal suctioning on the closed endotracheal suctioning system is less than that of the open endotracheal suctioning system by 11.18 mmHg, but the difference does not reach the statistical significance level (p = .10). Hypothesis 2 tests if the increase on values of pressure-time product for pre- and post endotracheal suctioning of the closed endotracheal suctioning system is less than that of the same comparison of the open endotracheal suctioning system. Result from the modified analysis of GEE model shows that the increase of the pressure-time product between pre- and post-endotracheal suctioning on the closed endotracheal suctioning system is less than that of the open endotracheal suctioning system by 27.04 cmH2O．sec/breath, but the difference does not reach the statistical significance level (p = .39). It is suggested that a large sample size should be applied to retest these two hypotheses. Results of this study can be used as a reference to those who care for patients that are highly dependent on ventilators with high concentration of oxygen.
50
Tzou, Li-Ping, and 鄒理萍. "Explore the relationship between ICU nurses'' knowledge level of sedations on patients with ventilator, perceptions of nurses'' role and unplanned endotracheal tube extubation." Thesis, 2011. http://ndltd.ncl.edu.tw/handle/31724931642184584237.
Full textAbstract:
碩士高雄醫學大學
護理學研究所
99
Background: Unplanned endotracheal tube extubation (UEE) is the most common accident in the intensive care units, and served as an important indicator for quality care (Square, Square & Square, 1999 ; Chen, Zeng, Huang & Zheng, 2006). Research showed that the rate of unplanned endotracheal tube extubation among restless patients without proper sedation was about 5% to 15.9% (Chevron et al., 1998). Continuous sedation treatment has become a common regimen for critical patients with a ventilator. Nurses are mainly responsible for the sedative medication dose adjustment after physician’ prescriptions. Therefore, nurses'' knowledge level regarding sedative medication indications, side effects and patient assessment has a huge impact on the success of sedation treatment. However, in the past nurses'' knowledge level was not measured in an objective way. No research ever studied nurses'' perceptions regarding their roles in the patient sedation. Purpose: The purpose of this study was to explore the relationship between ICU nurses'' knowledge level regarding sedations on patients with a ventilator, perceptions of nurses'' role and UEE. Method: This study was a cross sectional correlational survey study. A total of 166 ICU nurses from two medical centers in southern Taiwan was chosen. There were two phases in this study: (a) pilot study for establishing the reliability and validity of instruments; (b) the survey. A total of 209 questionnaires were sent out, and 192 questionnaires were returned. Among those, a total of 166 questionnaires was completed and valid. A structured scale, including basic properties, sedation care knowledge (sedative drug effects, sedation assessment tool, and sedation care guidelines), perceptions of nurses'' role, and the frequency of UEE, was used for data collection, and SPSS14.0 Chinese software package for data analysis. The results showed: (1) nurses had a moderate-low knowledge level in sedative medications with a standardization score of 63.10 ; low knowledge level in the sedation assessment tool with a standardization score of 48.40; and a good knowledge level the sedation care guideline with a standardization score of 81.00; (2) nurses perceptions regarding their role on sedation was within the range of less agreeable and with a standardization score of 65.70; (3) the sedation knowledge level was significantly different among different work units, different advanced levels, different frequencies of sedation care experience, and between with or without taking sedation care conference course or continuing education (χ2 = 38.97, p < .01; χ2 = 10.20, p < .01; χ2 = 9.08, p < .05; Z =- 2.23, p < .05); age and sedative drugs knowledge level, assessment tools knowledge level showed a significantly positive correlation (r = .327, p < .01; r = .317, p < .01) ; and intensive care seniority and sedative drug knowledge level showed a positive correlation (r = .161, p < .01); (4) nurses perceptions on sedation roles were significantly different among different work units (χ2 = 27.59, p < .01); age and the role perceptions were positive correlation (r = .182, p < .01); (5) The frequency of UPE was negatively correlated with age, the knowledge level of sedative drugs, and sedation guidelines (r =-.191, p < .05；r =-.248, p < .01; r =-.181, p < .05) ; (6) different work units and the knowledge level of sedation guidelines were significant predictors for the frequency of UEE. Two variables explained about 11.7% of the variance. Findings can help ICU nurses aware the needs to improve their knowledge level on sedation regimen. Also the findings can serve as the basis for future planning of on-job education and for evaluating clinical practice to ensure better quality of care for critical patients.