Purpose: Dysphagia may occur in all critically ill patients, and large-scale clinical data show that post-extubation dysphagia (PED) is commonly observed in intensive care unit (ICU) patients. The study aimed to determine how dysphagia is diagnosed after extubation, and what factors influence the incidence of dysphagia after invasive airway support in selected ICUs. Methods: A prospective observational study was conducted for five months (07/2023 to 11/ 2023), in the acute ICU and long-term ICU of the Teaching hospital in the Czech Republic. Results: Of the 101 extubated patients in the study, only 27.7% (n = 28) were examined by a physician, and PED was confirmed in 26.7% (n = 27), representing 99% of all extubated patients. Age, gender, and ICU type were not significantly related to PED occurrence. However, the type of airway management (p < 0.001), duration of mechanical ventilation (p = 0.017), and main diagnosis (p < 0.001) were significantly associated with PED occurrence. Conclusion: The study confirmed the underdiagnosis of PED in ICU patients post-extubation. Higher PED incidence was linked to tracheostomy + endotracheal cannula use, mechanical ventilation longer than 9 days, and neurological diagnoses. Training health professionals to identify PED symptoms is essential to establish uniform procedures for diagnosing and preventing PED-related complications.
- MeSH
- Airway Extubation * methods adverse effects MeSH
- Intubation, Intratracheal methods adverse effects MeSH
- Humans MeSH
- Ventilators, Mechanical classification adverse effects MeSH
- Critical Care methods MeSH
- Deglutition Disorders * diagnosis etiology MeSH
- Prospective Studies MeSH
- Tracheostomy methods adverse effects MeSH
- Respiration, Artificial methods instrumentation adverse effects MeSH
- Check Tag
- Humans MeSH
- Geographicals
- Czech Republic MeSH
- Keywords
- Archie Brain,
- MeSH
- History, 20th Century MeSH
- History of Medicine MeSH
- Laryngeal Masks history MeSH
- Respiration, Artificial instrumentation MeSH
- Famous Persons MeSH
- Airway Management instrumentation MeSH
- Check Tag
- History, 20th Century MeSH
- Publication type
- Biography MeSH
- Historical Article MeSH
- MeSH
- Laryngeal Masks classification MeSH
- Humans MeSH
- Infant, Newborn MeSH
- Pulmonary Surfactants * administration & dosage pharmacology classification therapeutic use MeSH
- Pulmonary Ventilation MeSH
- Respiratory Distress Syndrome diagnosis drug therapy nursing MeSH
- Respiratory Distress Syndrome, Newborn * diagnosis drug therapy nursing MeSH
- Check Tag
- Humans MeSH
- Infant, Newborn MeSH
- Publication type
- Review MeSH
- Keywords
- gastrická sonda,
- MeSH
- Enteral Nutrition classification methods MeSH
- Intubation, Gastrointestinal * classification methods nursing MeSH
- Humans MeSH
- Feeding Methods classification mortality MeSH
- Infant, Newborn MeSH
- Check Tag
- Humans MeSH
- Infant, Newborn MeSH
- Publication type
- Review MeSH
INTRODUCTION: Airway management is a critical component of out-of-hospital cardiac arrest (OHCA) resuscitation. The primary aim of this study was to describe pre-hospital airway management in adult patients post-OHCA. Secondary aims were to investigate whether tracheal intubation (TI) versus use of supraglottic airway device (SGA) was associated with patients' outcomes, including ventilator-free days within 26 days of randomization, 6 months neurological outcome and mortality. METHODS: Secondary analysis of the Target Temperature Management-2 (TTM2) trial conducted in 13 countries, including adult patients with OHCA and return of spontaneous circulation, with data available on pre-hospital airway management. A multivariate logistic regression model with backward stepwise selection was employed to assess whether TI versus SGA was associated with outcomes. RESULTS: Of the 1900 TTM2 trial patients, 1702 patients (89.5%) were included, with a mean age of 64 years (Standard Deviation, SD = 13.53); 79.1% were males. Pre-hospital airway management was SGA in 484 (28.4%), and TI in 1218 (71.6%) patients. At hospital admission, 87.8% of patients with SGA and 98.5% with TI were mechanically ventilated (p < 0.001). In the multivariate analysis, TI in comparison with SGA was not independently associated with an increase in ventilator-free days within 26 days of randomization, improved neurological outcomes, or decreased mortality. The hazard ratio for mortality with TI vs. SGA was 1.06, 95%Confidence Interval (CI) 0.88-1.28, p = 0.54. CONCLUSIONS: In the multicentre randomized TTM2-trial including patients with OHCA, most patients received prehospital endotracheal intubation to manage their airway. The choice of pre-hospital airway device was not independently associated with patient clinical outcomes. TRIAL REGISTRATION NUMBER: NCT02908308.
- MeSH
- Intubation, Intratracheal * methods MeSH
- Cardiopulmonary Resuscitation * methods MeSH
- Middle Aged MeSH
- Humans MeSH
- Aged MeSH
- Hypothermia, Induced methods MeSH
- Emergency Medical Services * methods MeSH
- Airway Management * methods MeSH
- Out-of-Hospital Cardiac Arrest * therapy mortality MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- Randomized Controlled Trial MeSH
BACKGROUND: The i-gel® Plus is a modified version of the i-gel® supraglottic airway device. It contains a wider drainage port; a longer tip; ramps inside the breathing channel; and an additional port for oxygen delivery. There has been no prospective evaluation of this device in clinical practice. METHODS: This international, multicentre, prospective cohort study aimed to evaluate the performance of the i-gel Plus in adult patients undergoing elective procedures under general anaesthesia. The primary outcome was overall insertion success rate, defined as the ability to provide effective airway management through the device from insertion until the end of the surgical procedure. Secondary outcomes included device performance and incidence of postoperative adverse events. Data from the first 1000 patients are reported. RESULTS: In total, 1012 patients were enrolled; 12 forms were excluded from the final analysis due to incomplete data leaving 1000 included patients (545 female). Overall insertion success rate was 98.6%, with a first-attempt success rate of insertion of 88.2%. A significant difference between females and males was seen for the overall success rate (97.4% vs. 99.6% respectively) but not for first-attempt successful insertion. Mean (SD) oropharyngeal seal pressure was 32 (7) cmH2O. The only independent factor that increased the risk of first-attempt failure was low operator experience. Complications included desaturation < 85% in 0.6%; traces of blood on the device in 7.4%; laryngospasm in 0.5%; and gastric contents inside the bowl in 0.2% of patients. CONCLUSIONS: The i-gel Plus appears to be an effective supraglottic airway device that is associated with a high insertion success rate and a reasonably low incidence of complications.
- MeSH
- Anesthesia, General MeSH
- Equipment Design MeSH
- Adult MeSH
- Elective Surgical Procedures * MeSH
- Intubation, Intratracheal * instrumentation methods MeSH
- Cohort Studies MeSH
- Laryngeal Masks * MeSH
- Middle Aged MeSH
- Humans MeSH
- Postoperative Complications epidemiology MeSH
- Prospective Studies MeSH
- Aged MeSH
- Airway Management instrumentation methods MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- MeSH
- Intubation, Intratracheal methods instrumentation MeSH
- Contraindications, Procedure MeSH
- Humans MeSH
- Heart Massage methods MeSH
- Infant, Premature MeSH
- Infant, Newborn MeSH
- Postnatal Care * methods MeSH
- Resuscitation * classification methods MeSH
- Life Support Care classification MeSH
- Risk Factors MeSH
- Oxygen Saturation MeSH
- Respiration, Artificial methods instrumentation MeSH
- Body Temperature Changes MeSH
- Check Tag
- Humans MeSH
- Infant, Newborn MeSH
- Publication type
- Review MeSH
BACKGROUND: Recent studies have reported that using a stylet does not provide any advantages during intubation within a diverse infant population. Our research focuses on the issue, specifically in premature infants who undergo elective or rescue intubation (EI or RI) in the delivery room (DR). METHODS: We conducted a single-center retrospective observational study comparing the number of intubation attempts, the duration of intubation procedure until successful, and the rate of associated desaturations exceeding 20%. We derived outcomes from video recordings and performed statistical analyses. RESULTS: We have analyzed 104 intubation attempts in 70 infants with a mean gestational age and birth weight of 25±1.9 weeks and 736±221 grams, respectively; 39 of these attempts involved stylet use, and 65 did not. 75% of infants requiring intubation were less than 26 weeks of gestational age. The use of a stylet increased the rate of successful initial attempts [OR (95% CI) 4.3 (1.3-14.8), P=0.019], reduced the duration of the intubation procedure [median (IQR) seconds: 43 (30-72) vs 140 (62-296), P<0.001], and decreased the occurrences of desaturation exceeding 20% (13% vs 50%, P=0.003). CONCLUSION: The benefits of using a stylet during rescue and elective intubations of premature infants in the delivery room outweigh the potential harms. Its use may be advantageous in settings where proactive approaches are implemented for periviable infants.
- MeSH
- Intubation, Intratracheal methods MeSH
- Laryngoscopy methods MeSH
- Laryngoscopes * MeSH
- Humans MeSH
- Check Tag
- Humans MeSH
- Publication type
- Letter MeSH
