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Článek

Porovnanie katétrovej vysokofrekvenčnej dýzovej ventilácie pľúc a konvenčnej ventilácie počas intervenčnej bronchoskopie u pacientov s obštrukciou dýchacích ciest
[Comparison of catheter high-frequency jet ventilation and conventional ventilation during interventional bronchoscopy in patients with upper airway obstruction]

Paulíková, Monika, 1974-
Autor Autorita Oddelenie anestéziológie a intenzívnej medicíny, Východoslovenský onkologický ústav Košice, Slovenská republika
Matula, Pavol, 1943-
Autor Autorita Klinika rádioterapie a onkológie, Východoslovenský onkologický ústav Košice, Slovenská republika

Anesteziologie a intenzivní medicína. 2018 ; 29 (4) : 187-192.

ISSN 1214-2158
Medvik
Zdroj

Cieľ štúdie: Stanoviť bezpečnosť a riziká použitia katétrovej vysokofrekvenčnej dýzovej ventilácie pľúc v laryngeálnej chirurgii s rôznym stupňom obštrukcie dýchacích ciest. Typ štúdie: Prospektívna observačná štúdia. Typ pracoviska: Oddelenie anestéziológie a intenzívnej medicíny onkologického ústavu. Materiál a metóda: Do štúdie bolo zaradených 58 pacientov podstupujúcich intervenčné bronchoskopie s obštrukciou dýchacích ciest, rozdelených do dvoch skupín: 1. pacienti ventilovaní konvenčnou ventiláciou a 2. pacienti ventilovaní katétrovou vysokofrekvenčnou dýzovou ventiláciou, spravidla s prítomnosťou kardiálnych a pľúcnych komorbidít, obezity a fajčenia. Hodnotili sme demografické údaje, efektivitu a bezpečnosť ventilácie, komfort chirurga a anestéziológa. Efektivitu ventilácie sme hodnotili na základe parametrov arteriálnej acidobazickej rovnováhy. Z komplikácií sme hodnotili výskyt hypoxémie, hyperkapnie, barotraumy, laryngospazmu a krvácania. Výsledky: Z celkového počtu 58 pacientov zaradených do štúdie bolo 26 (45 %) zaradených do skupiny 1 a 32 (55 %) do skupiny 2. 72 % pacientov tvorili muži. U 25 (43 %) pacientov bola prítomná obštrukcia dýchacích ciest, pričom nádor bol najčastejšie lokalizovaný v supraglotickej oblasti. V skupine s vysokofrekvenčnou ventiláciou boli signifikantne vyššie hodnoty paCO2. Výskyt komplikácii bol nízky, barotrauma alebo laryngospazmus neboli zaznamenané. V druhej skupine došlo v troch prípadoch (9,4 %) k hypoxémii. Príčinou bola v dvoch prípadoch dislokácia katétra, v jednom prípade bol nutný prechod na KV. Chirurgovia preferovali vysokofrekvenčnú ventiláciu. Záver: Katétrová vysokofrekvenčná ventilácia je efektívna a bezpečná aj v prítomnosti obštrukcie dýchacích ciest. Výhodou je zabránenie zatekaniu debritu a krvi do dýchacích ciest a prehľadné operačné pole.

Objective: To investigate the risks and safety of catheter high-frequency jet ventilation in laryngeal surgery with varying degrees of airway obstruction. Design: Observational, prospective study. Setting: Department of Anaesthesiology at an Oncological Institute. Materials and methods: The study included 58 patients undergoing laryngeal surgery with varying degrees of airway obstruction, who were divided into two groups: patients ventilated by conventional mechanical ventilation and catheter high-frequency jet ventilation. Patients with cardiac and respiratory comorbidities, obesity and smokers were included. We evaluated the demographic data, effectiveness and safety of the two types of ventilation, and surgeon and anaesthesiologist satisfaction. The effectiveness of ventilation was assessed using arterial blood gas analysis. We were watching for complications such as hypoxia, hypercapnia, barotrauma, laryngospasm and bleeding. Results: 58 patients were enrolled in the study, 26 (45%) of whom were ventilated by conventional mechanical ventilation and 32 (55%) were ventilated by catheter high-frequency jet ventilation. 72% of the patients were male. Airway obstruction was present in 25 (43%) patients, with the tumour most often located in the supraglottic area. Hypercapnia was more common in the high-frequency ventilation group. The incidence of complication was low, barotrauma or laryngospasm were not recorded. Hypoxia was present in 3 cases (9.4%) of patients ventilated by catheter high-frequency jet ventilation. In 2 cases there was catheter displacement which necessitated conversion to conventional ventilation in one case. The surgeons preferred high-frequency ventilation. Conclusion: Catheter high-frequency ventilation is effective and safe even under the conditions of various degree of airway obstruction. This approach reduces the risk of entry of debris and blood into the airway and provides a clear surgical field.

Článek

Perception of inappropriate cardiopulmonary resuscitation by clinicians working in emergency departments and ambulance services: The REAPPROPRIATE international, multi-centre, cross sectional survey

Resuscitation. 2018 ; 132 (-) : 112-119. [pub] 20180912

ISSN 1873-1570
Medvik
Zdroj

INTRODUCTION: Cardiopulmonary resuscitation (CPR) is often started irrespective of comorbidity or cause of arrest. We aimed to determine the prevalence of perception of inappropriate CPR of the last cardiac arrest encountered by clinicians working in emergency departments and out-of-hospital, factors associated with perception, and its relation to patient outcome. METHODS: A cross-sectional survey was conducted in 288 centres in 24 countries. Factors associated with perception of CPR and outcome were analyzed by Cochran-Mantel-Haenszel tests and conditional logistic models. RESULTS: Of the 4018 participating clinicians, 3150 (78.4%) perceived their last CPR attempt as appropriate, 548 (13.6%) were uncertain about its appropriateness and 320 (8.0%) perceived inappropriateness; survival to hospital discharge was 370/2412 (15.3%), 8/481 (1.7%) and 8/294 (2.7%) respectively. After adjusting for country, team and clinician's characteristics, the prevalence of perception of inappropriate CPR was higher for a non-shockable initial rhythm (OR 3.76 [2.13-6.64]; P < .0001), a non-witnessed arrest (2.68 [1.89-3.79]; P < .0001), in older patients (2.94 [2.18-3.96]; P < .0001, for patients >79 years) and in case of a "poor" first physical impression of the patient (3.45 [2.36-5.05]; P < .0001). In accordance, non-shockable and non-witnessed arrests were both associated with lower survival to hospital discharge (0.33 [0.26-0.41]; P < 0.0001 and 0.25 [0.15-0.41]; P < 0.0001, respectively), as were older patient age (0.25 [0.14-0.44]; P < 0.0001 for patients >79 years) and a "poor" first physical impression (0.26 [0.19-0.35]; P < 0.0001). CONCLUSIONS: The perception of inappropriate CPR increased when objective indicators of poor prognosis were present and was associated with a low survival to hospital discharge. Factoring clinical judgment into the decision to (not) attempt CPR may reduce harm inflicted by excessive resuscitation attempts.