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Sample records for silicone tube intubation

  1. Vision-related quality of life in patients undergoing silicone tube intubation for lacrimal passage obstructions.

    PubMed

    Kabata, Yoshiaki; Goto, Satoshi; Takahashi, Genichiro; Tsuneoka, Hiroshi

    2011-07-01

    To evaluate the changes in vision-related quality of life in patients with lacrimal passage obstructions undergoing silicone tube intubations. Prospective, consecutive, comparative, interventional case series. Forty-five patients with the chief complaint of epiphora diagnosed with complete and unilateral lacrimal passage obstructions were enrolled. Exclusion criteria included history of congenital nasolacrimal stenosis; lacrimal passage obstructions resulting from trauma, tumor, or chemotherapy; previous lacrimal passage surgery; and partial and functional nasolacrimal duct obstructions. Silicone tube intubation using a Nunchaku-style tube was performed under direct visualization with dacryoendoscope in all patients. Operations were considered as successful when the irrigating fluid could pass through the lacrimal passage and the disappearance of dye was observed in dye disappearance test and the patients' epiphora symptoms improved 3 months postoperatively. The 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) was self-administered in all patients preoperatively and 3 months postoperatively. Patients' preoperative and 3-months-postoperative NEI VFQ-25 scores were compared. Operations were successful in 40 patients (89%). Fully completed questionnaires were received from 32 patients (80%). Silicone tube intubation using a Nunchaku-style tube was associated with a significant improvement of the NEI VFQ-25 composite score (P = .0001), ocular pain score (P < .0001), and mental health score (P = .0003). Relief of epiphora by silicone tube intubation using a Nunchaku-style tube treatment significantly improved the vision-related quality of life in patients with lacrimal passage obstructions. Copyright © 2011 Elsevier Inc. All rights reserved.

  2. A modified bicanalicular intubation procedure to repair canalicular lacerations using silicone tubes

    PubMed Central

    Liang, X; Lin, Y; Wang, Z; Lin, L; Zeng, S; Liu, Z; Li, N; Wang, Z; Liu, Y

    2012-01-01

    Purpose To explore a modified technique for silicone intubation for the repair of canalicular lacerations. Methods The surgery was performed on 35 eyes in 35 adult patients from October 2007 to September 2009. Using a modified soft probe, silicone tubes were inserted through the lacrimal punctum and left in the bicanaliculi for 3–10 months. Results The surgery was performed successfully in all cases. The tubes were removed after 3–10 months (mean 5.3±1.8 months). The mean follow-up time after tube removal was 13.8 months (range, 6–22 months). Lower punctum splitting occurred in one case (2.86%) after the surgery. No other complications associated with the silicone tubes occurred. All the tubes were removed successfully without any difficulty. No iatrogenic injuries occurred during tube removal. Conclusions The modified bicanalicular intubation procedure described here is an effective and atraumatic procedure for the management of canalicular lacerations in adults, and it is associated with fewer complications than the traditional sutures of canalicular lacerations. PMID:23060024

  3. Intubation Success through I-Gel® and Intubating Laryngeal Mask Airway® Using Flexible Silicone Tubes: A Randomised Noninferiority Trial

    PubMed Central

    Bhardwaj, Neerja; Sen, Indu Mohini; Sondekoppam, Rakesh V.

    2016-01-01

    Introduction. The study aims to test whether flexible silicone tubes (FST) improve performance and provide similar intubation success through I-Gel as compared to ILMA. Our trial is registered in CTRI and the registration number is “CTRI/2016/06/006997.” Methods. One hundred and twenty ASA status I-II patients scheduled for elective surgical procedures needing tracheal intubation were randomised to endotracheal intubation using FST through either I-Gel or ILMA. In the ILMA group (n = 60), intubation was attempted through ILMA using FST and, in the I-Gel group (n = 60), FST was inserted through I-Gel airway. Results. Successful intubation was achieved in 36.67% (95% CI 24.48%–48.86%) on first attempt through I-Gel (n = 22/60) compared to 68.33% (95% CI 56.56%–80.1%) in ILMA (n = 41/60) (p = 0.001). The overall intubation success rate was also lower with I-Gel group [58.3% (95% CI 45.82%–70.78%); n = 35] compared to ILMA [90% (95% CI 82.41%–97.59%); n = 54] (p < 0.001). The number of attempts, ease of intubation, and time to intubation were longer with I-Gel compared to ILMA. There were no differences in the other secondary outcomes. Conclusion. The first pass success rate and overall success of FST through an I-Gel airway were inferior to those of ILMA. PMID:27478436

  4. [Intubation with a tube exchanger on an intubation trainer. Influence of tube tip position on successful intubation].

    PubMed

    Kemper, M; Haas, T; Imach, S; Weiss, M

    2014-07-01

    Securing the airway using a tube exchanger catheter is an important and useful technique in anesthesia. Its success is mainly hampered by tube tip impingement of laryngeal structures. Advancing the tracheal tube along its normal curvature via a tube exchanger catheter has a high risk of tube tip impingement mainly of right laryngeal structures. The authors achieved successful clinical experience by rotating the tracheal tube 90° anticlockwise (ventral tube tip position) before railroading the tube via a tube exchanger catheter or a fiber optic bronchoscope through the larynx. The aim of the study was to investigate the influence of the tracheal tube tip position while intubating an airway trainer over a tube exchange catheter. Volunteer anesthetists with varying years of professional experience were asked to intubate an intubation mannequin (Laerdal Airway Management Trainer) using the orotracheal route with an established tube exchange catheter (Cook Airway Exchange Catheter, 11F). Two different brands of tracheal tubes (Rüsch and Covidien, ID 7.0 mm) were used in a randomized order, each with the tracheal tube tip at first positioned right (90°), then ventrally (0°), left (270°) and finally dorsally (180°), resulting in eight intubation attempts for each participant. To ensure the correct tube tip position the tube was withdrawn before every intubation attempt until the tube tip position was visualized. The oropharnyx, larynx, trachea and tube were sufficiently lubricated with silicon spray (Rüsch Silikospray). The tube and airway exchange catheter size selection were made according to the clinical trial of Loudermilk et al. Successful endotracheal intubation without resistance was recorded for each tube tip position and tracheal tube brand. In total 20 anesthetists (13 consultants and 7 residents) with a median of 9.5 years (range 3-37 years) of professional experience participated in the study. Overall 160 intubation attempts were performed, 2

  5. Evaluation of the Effect of Tracheal Tube Orientation on Success of Intubation through Intubating Laryngeal Mask Airway

    PubMed Central

    Chhatrapati, Swati; Auti, Subhhash Sadashiv; Aswar, Swapnil Ganesh

    2016-01-01

    Introduction Polyvinyl Chloride Endotracheal Tube (PVC ETT) can be used as an alternative to Fastrach Silicone Wire-Reinforced Tube (FTST) for intubation through Intubating Laryngeal Mask Airway (ILMA) as the latter is expensive and has low volume high pressure cuff. Aim To evaluate the effects of orientation of PVC ETT (normal curve and reverse curve) on the success of intubation through ILMA, haemodynamic response and postoperative sore throat. Materials and Methods Sixty healthy adult patients of ASA physical status I & II scheduled for elective surgery under general anaesthesia requiring endotracheal intubation were randomly divided into two groups. In Normal (N) group (n=30), the tracheal tube was inserted with its natural curve following the 90° curvature of ILMA. In Reverse (R) group (n=30), the tracheal tube was inserted with its natural curve directed opposite to the curvature of ILMA. The time taken to intubate, number of attempts, and maneuvers required for successful endotracheal intubation along with haemodynamics and oxygen saturation were noted. Postoperative sore throat was evaluated using a Verbal Analogue Scale (VAS) (0-10). Qualitative data was analysed by Chi-Square test and Fisher’s exact test. Quantitative data was analysed by unpaired t-test and Mann-Whitney test. Results Placement of ILMA was successful in all patients. Total Intubation Time (mean±SD) in Group N was 12.53±1.78 seconds and in Group R was 11.97±1.33 seconds (p>0.05). Tracheal intubation through ILMA was successful in all patients. First attempt success rate in R Group (26 patients, 86.7%) was higher than N Group (22 patients, 73.3%) (p>0.05). Four patients (13.3%) in R Group and 8 patients (26.7%) in N Group required 2nd step of Chandy’s maneuver during second attempt for successful intubation. Incidence of sore throat 6 hours postoperatively was statistically significant (median value 2.00 in N Group vs. 0.00 in R Group) between two groups. Conclusion PVC ETT with

  6. [Intubating laryngeal tube suction disposable: Initial clinical experiences with a novel device for endotracheal intubation].

    PubMed

    Bergold, M N; Kahle, S; Schultzik, T; Bücheler, M; Byhahn, C

    2016-01-01

    According to the recent guidelines supraglottic airways, such as laryngeal tubes are recommended to ensure oxygenation in patients with unexpected difficult airways. The novel Intubating Laryngeal Tube Suction Disposable (iLTS-D) is a modified laryngeal tube designed for secondary tracheal intubation. This pilot study evaluated the use of the iLTS-D in clinical practice with respect to practicality and efficacy. In this study the airways of 30 consecutive adult patients with no evidence of a difficult airway undergoing elective ear, nose and throat (ENT) surgery were managed with the iLTS-D. After induction of anesthesia the iLTS-D was placed in position and checked for correct ventilation. Following muscle relaxation, endotracheal intubation through the iLTS-D was performed under continuous visualization using a flexible bronchoscope. Finally, the iLTS-D was removed leaving the endotracheal tube in place. Data were collected anonymously as part of a quality assurance program. Publication of the data was approved by the institutional review board. Initial iLTS-D placement took a median of 17 s (range 12-90 s) and provided sufficient ventilation in all patients; however, the position of the iLTS-D needed to be adjusted in four patients. Endotracheal intubation through the iLTS-D was achieved in 29 out of 30 patients at the first attempt (n = 23) or after 2 attempts (n = 6) and the median time required for intubation was 32 s (range 18-187 s). In five patients no laryngeal structures could initially be identified by bronchoscopy. Blind endotracheal intubation through the iLTS-D was performed in two cases and in two other patients the endotracheal tube was also blindly advanced but into the esophagus. After removal of the endotracheal tube and repositioning of the iLTS-D, successful tracheal intubation was subsequently achieved under bronchoscopic vision. The procedure was aborted and uneventful conventional intubation using direct laryngoscopy was carried out

  7. Efficacy of nonswallow nasogastric tube intubation: a randomised controlled trial.

    PubMed

    Fan, Luo; Liu, Qin; Gui, Li

    2016-11-01

    To prospectively identify the effect of the nonswallow procedure of nasogastric tube insertion. Nasogastric intubation is one of the most important and basic skills in treatment and nursing. Patients generally experience discomfort and encounter complications during this procedure. Thus, practitioners need a more convenient, effective, quicker and safer method to improve the performance of this procedure. This prospective randomised controlled trial was conducted from March to May 2014 in the four units of Gansun Province Hospital in Lanzhou, China. A total of 80 participants were randomly assigned to an experimental group (n = 40) and a control group (n = 40). Participants in the experimental group underwent a nonswallow procedure for nasogastric tube insertion. There were statistically significant differences in nasogastric tube insertion between the study groups. A marked increase in the success rate at first intubation as well as a markedly reduced occurrence of nausea, tearing, mucosal injury and changes in vital signs (i.e. heart rate, breath, systolic pressure) were observed compared with the control group. No differences in the success rates at second and third intubation were observed between the groups. The nonswallow procedure of nasogastric tube intubation relieves discomfort and ensures the safety of patients. Patients subjected to nasogastric intubation are more likely to benefit from the nonswallow procedure when nasogastric tube insertion is performed. © 2016 John Wiley & Sons Ltd.

  8. Endotracheal Tube Cuff Pressure Following Intubation

    DTIC Science & Technology

    2005-09-08

    inflated ETT cuff. This method may lead to erroneous cuff pressures. Fernandez, Blanch, Mancebo, Bonsoms, and Artigas studied the accuracy of...Laryngologica, 345, suppl: 1-71. 10. Fernandez, R., Blanch, L., Mancebo, J., Bonsoms, N., Artigas , A. (1990). Endotracheal tube cuff pressure assessment

  9. Comparison of the Efficacies of 0.94 mm and Double Silicone Tubes for Treatment of Canalicular Obstruction

    PubMed Central

    Choi, Seong Chan; Choi, Hye Sun; Jang, Jae Woo; Kim, Sung Joo

    2017-01-01

    Purpose To compare the clinical effects of the single wide-diameter bicanalicular silicone tube and the double bicanalicular silicone tube in endonasal dacryocystorhinostomy (DCR) with canalicular trephinization for canalicular obstruction. Methods We retrospectively reviewed the records of 121 patients with monocanalicular or common canalicular obstruction who had undergone endonasal DCR with random bicanalicular insertion of either double silicone tubes (insertion of two tubes into each canaliculus) or a single wide-diameter (0.94 mm) silicone tube. The tubes were removed at around 3 months after surgery. Results This study included 79 eyes of 61 patients in the double-tube intubation group and 68 eyes of 60 patients in the single wide-diameter tube intubation group. Anatomical success, evaluated by syringing, was achieved in 72 of the 79 eyes (91.1%) in the double-tube intubation group and 60 of the 68 eyes (88.2%) in the single wide-diameter tube intubation group. Functional success was achieved in 65 of the 79 eyes (82.3%) in the double-tube intubation group and 61 of the 68 (89.7%) eyes in the single wide-diameter tube intubation group. There were no significant differences in the success rates of surgery between the two groups. One patient in the double-tube intubation group underwent conjunctivodacryocystorhinostomy (CDCR) and two in the wide-diameter tube intubation group underwent CDCR or reintubation to treat recurrence. Conclusions Intubation using a single wide-diameter tube during endonasal DCR is as effective as double-tube intubation for the treatment of canalicular obstruction, with a lower rate of complications such as inflammation or patient discomfort. PMID:28243017

  10. Using a modified nasotracheal tube to prevent nasal ala pressure sore during prolonged nasotracheal intubation.

    PubMed

    Cherng, Chen-Hwan; Chen, Yuan-Wu

    2010-12-01

    Nasotracheal tube induced nasal ala pressure sores or necrosis during prolonged nasotracheal intubation have been reported, and it is a serious but preventable complication. Here we introduce a modified nasotracheal tube to prevent this complication. This modified nasotracheal tube is composed of two parts, an oral endotracheal tube and a proximal part of a preformed nasotracheal tube, which are linked by a connector. The use of this modified nasotracheal tube can prevent nasal ala pressure sores during prolonged nasotracheal intubation.

  11. Unrecognized bronchial intubation associated with the uncuffed pediatric tracheal tube with bilateral Murphy eyes.

    PubMed

    Sugiyama, Kazuna; Manabe, Yozo; Kohjitani, Atsushi

    2012-12-01

    Unreliability of breath sounds auscultation after intubation is reportedly mainly related to the presence of the Murphy eye. This study was performed to ascertain whether an uncuffed pediatric tracheal tube with bilateral Murphy eyes increases the risk of unrecognized bronchial intubation, compared to an uncuffed tube without eyes. Following induction of anesthesia in 50 toddlers, either an uncuffed tube without eyes or an uncuffed tube with bilateral eyes was inserted into the trachea. The tube was then slowly advanced while breath sounds were auscultated using a stethoscope. In study 1, when breath sounds changed and disappeared, the distance from the carina to the tube tip was measured using a fiberoptic bronchoscope. In study 2, when breath sounds changed, the tracheal tube was withdrawn 5, 10, 15 and 20 mm while using a fiberoptic bronchoscope to ascertain whether bronchial intubation had occurred. When breath sounds changed and disappeared, the tip of the tube with bilateral eyes was positioned more deeply below the carina than that of the tube without eyes. When the tube was withdrawn 10 mm from the point at which breath sounds changed, frequencies of bronchial intubation were 13% and 80% in the no eyes and double eyes groups, respectively. An uncuffed pediatric tracheal tube with bilateral Murphy eyes reduces the ability of breath sounds auscultation to detect bronchial intubation and may increase the risk of unrecognized bronchial intubation compared to an uncuffed tube without eyes. © 2012 Blackwell Publishing Ltd.

  12. Laryngeal morbidity after tracheal intubation: the Endoflex(®) tube compared to conventional endotracheal intubation with stylet.

    PubMed

    Sørensen, M K; Rasmussen, N; Kristensen, M S; Bøttger, M; Fredensborg, B B; Hansen, C M; Rasmussen, L S

    2013-07-01

    Tracheal intubation may cause vocal fold damage. The trial was designed to assess laryngeal morbidity comparing the Endoflex(®) tube with a conventional endotracheal tube with stylet. We hypothesised that laryngeal morbidity within the first 24 h after extubation would be lower with the Endoflex tube than with the conventional endotracheal tube with stylet because of less rigidity. This randomised trial included 130 elective surgical patients scheduled for general anaesthesia with endotracheal intubation. Pre- and post-operative assessment of hoarseness, vocal fold pathology, and voice analysis using the Multidimensional Voice Program was performed. Induction of anaesthesia was standardised. After complete neuromuscular paralysis, intubation was done with an Endoflex tube or a conventional endotracheal tube with stylet. Post-operative hoarseness was found in 45% with the Endoflex tube and 55% with the endotracheal tube with stylet at 24 h after extubation (P = 0.44). Post-operative vocal fold injury was present in 23% in the Endoflex tube group and in 36% in the endotracheal tube with stylet group (P = 0.13). The increase in shimmer, the voice analysis variable reflecting vocal fold oedema, was 0.5% in the Endoflex tube group and 2.5% in the endotracheal tube with stylet group (P = 0.02). No significant difference was found in the incidence of hoarseness or vocal fold injury using the Endoflex tube. However, the statistically significant lower increase in the shimmer values in that group implies that the Endoflex may be associated with less laryngeal morbidity. © 2013 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  13. The difficult intraoperative nasogastric tube intubation: A review of the literature and a novel approach

    PubMed Central

    Socias, Stephanie M; Ciesla, David J; Karlnoski, Rachel A; Camporesi, Enrico M; Mangar, Devanand

    2014-01-01

    Nasogastric tube intubation of a patient under general anesthesia with an endotracheal tube in place can pose a challenge to the most experienced anesthesiologist. Physiologic and pathologic variations in a patient’s functional anatomy can present further difficulty. While numerous techniques to the difficult nasogastric tube intubation have been described, there is no consensus for a standard approach. Therefore, selecting the most appropriate approach requires a working knowledge of the techniques available, mindful consideration of individual patient and clinical factors, and the operator’s experience and preference. This article reviews the relevant literature regarding various approaches to the difficult nasogastric tube intubation with descriptions of techniques and results from comparative studies if available. Additionally, we present a novel approach using a retrograde technique for the difficult intraoperative nasogastric tube intubation. PMID:26770713

  14. A new technique to insert nasogastric tube in an unconscious intubated patient.

    PubMed

    Ghatak, Tanmoy; Samanta, Sukhen; Baronia, Arvind Kumar

    2013-01-01

    Insertion of a nasogastric tube in an unconscious intubated patient may be difficult as they cannot follow the swallowing instructions, and therefore has a high first attempt failure rate. We describe here a new technique to insert nasogastric tube in an unconscious intubated patient by neck flexion and using angiography catheter as a stylet and manipulating the cricoid ring of trachea for easy passage of nasogastric tube. The technique is easy and helpful for nasogastric insertion in unconscious intubated patients. Additionally, it neither alters vital responses nor increases intracranial pressure like with laryngoscopy.

  15. A New Technique to Insert Nasogastric Tube in an Unconscious Intubated Patient

    PubMed Central

    Ghatak, Tanmoy; Samanta, Sukhen; Baronia, Arvind Kumar

    2013-01-01

    Background: Insertion of a nasogastric tube in an unconscious intubated patient may be difficult as they cannot follow the swallowing instructions, and therefore has a high first attempt failure rate. Aim and Methods: We describe here a new technique to insert nasogastric tube in an unconscious intubated patient by neck flexion and using angiography catheter as a stylet and manipulating the cricoid ring of trachea for easy passage of nasogastric tube. Results and Conclusions: The technique is easy and helpful for nasogastric insertion in unconscious intubated patients. Additionally, it neither alters vital responses nor increases intracranial pressure like with laryngoscopy. PMID:23378961

  16. Nasogastric tube insertion using airway tube exchanger in anesthetized and intubated patients

    PubMed Central

    Cho, Hyun-Jun; Kim, Hae-Kyu; Cho, Ah-Reum; Oh, Narae

    2016-01-01

    Background A nasogastric tube (NGT) is commonly inserted into patients undergoing abdominal surgery to decompress the stomach during or after surgery. However, for anatomic reasons, the insertion of NGTs into anesthetized and intubated patients may be challenging. We hypothesized that the use of a tube exchanger for NGT insertion could increase the success rate and reduce complications. Methods One hundred adult patients, aged 20–70 years, who were scheduled for gastrointestinal surgeries with general anesthesia and NGT insertion were enrolled in our study. The patients were randomly allocated to the tube-exchanger group or the control group. The number of attempts, the time required for successful NGT insertion, and the complications were noted for each patient. Results In the tube-exchanger group, the success rate of NGT insertion on the first attempt was 92%, which is significantly higher than 68%, the rate in the control group (P = 0.007). The time required for successful NGT insertion in the tube-exchanger group was 18.5 ± 8.2 seconds, which is significantly shorter than the control group, 75.1 ± 9.8 seconds (P < 0.001). Complications such as laryngeal bleeding and the kinking and knotting of the NGT occurred less often in the tube-exchanger group. Conclusions There were many advantages in using a tube-exchanger as a guide to inserting NGTs in anesthetized and intubated patients. Compared to the conventional technique, the use of a tube-exchanger resulted in a higher the success rate of insertion on the first attempt, a shorter procedure time, and fewer complications. PMID:27924196

  17. Nasogastric tube insertion using airway tube exchanger in anesthetized and intubated patients.

    PubMed

    Kim, Hyae-Jin; Lee, Hyeon Jeong; Cho, Hyun-Jun; Kim, Hae-Kyu; Cho, Ah-Reum; Oh, Narae

    2016-12-01

    A nasogastric tube (NGT) is commonly inserted into patients undergoing abdominal surgery to decompress the stomach during or after surgery. However, for anatomic reasons, the insertion of NGTs into anesthetized and intubated patients may be challenging. We hypothesized that the use of a tube exchanger for NGT insertion could increase the success rate and reduce complications. One hundred adult patients, aged 20-70 years, who were scheduled for gastrointestinal surgeries with general anesthesia and NGT insertion were enrolled in our study. The patients were randomly allocated to the tube-exchanger group or the control group. The number of attempts, the time required for successful NGT insertion, and the complications were noted for each patient. In the tube-exchanger group, the success rate of NGT insertion on the first attempt was 92%, which is significantly higher than 68%, the rate in the control group (P = 0.007). The time required for successful NGT insertion in the tube-exchanger group was 18.5 ± 8.2 seconds, which is significantly shorter than the control group, 75.1 ± 9.8 seconds (P < 0.001). Complications such as laryngeal bleeding and the kinking and knotting of the NGT occurred less often in the tube-exchanger group. There were many advantages in using a tube-exchanger as a guide to inserting NGTs in anesthetized and intubated patients. Compared to the conventional technique, the use of a tube-exchanger resulted in a higher the success rate of insertion on the first attempt, a shorter procedure time, and fewer complications.

  18. Strengths and weaknesses of in-tube solid-phase microextraction: A scoping review.

    PubMed

    Fernández-Amado, M; Prieto-Blanco, M C; López-Mahía, P; Muniategui-Lorenzo, S; Prada-Rodríguez, D

    2016-02-04

    In-tube solid-phase microextraction (in-tube SPME or IT-SPME) is a sample preparation technique which has demonstrated over time its ability to couple with liquid chromatography (LC), as well as its advantages as a miniaturized technique. However, the in-tube SPME perspectives in the forthcoming years depend on solutions that can be brought to the environmental, industrial, food and biomedical analysis. The purpose of this scoping review is to examine the strengths and weaknesses of this technique during the period 2009 to 2015 in order to identify research gaps that should be addressed in the future, as well as the tendencies that are meant to strengthen the technique. In terms of methodological aspects, this scoping review shows the in-tube SPME strengths in the coupling with LC (LC-mass spectrometry, capillary LC, ultra-high-pressure LC), in the new performances (magnetic IT-SPME and electrochemically controlled in-tube SPME) and in the wide range of development of coatings and capillaries. Concerning the applicability, most in-tube SPME studies (around 80%) carry out environmental and biomedical analyses, a lower number food analyses and few industrial analyses. Some promising studies in proteomics have been performed. The review makes a critical description of parameters used in the optimization of in-tube SPME methods, highlighting the importance of some of them (i.e. type of capillary coatings). Commercial capillaries in environmental analysis and laboratory-prepared capillaries in biomedical analysis have been employed with good results. The most consolidated configuration is in-valve mode, however the cycle mode configuration is frequently chosen for biomedical analysis. This scoping review revealed that some aspects such as the combination of in-tube SPME with other sample treatment techniques for the analysis of solid samples should be developed in depth in the near future.

  19. McGrath Series 5 videolaryngoscope vs Airtraq DL videolaryngoscope for double-lumen tube intubation

    PubMed Central

    Wan, Li; Liao, Mingfeng; Li, Li; Qian, Wei; Hu, Rong; Chen, Kun; Zhang, Chuanhan; Yao, Wenlong

    2016-01-01

    Abstract Background: Many studies have shown Airtraq videolaryngoscope provided faster tracheal intubation and a higher success rate than other videolaryngoscopes. Recently, different types of videolaryngoscopes have been reported for use in double-lumen tube (DLT) intubation. However, the advantages and disadvantages between them remain undetermined for DLT intubation. In this study, we compared the Airtraq DL videolaryngoscope with the McGrath Series 5 videolaryngoscope for DLT intubation by experienced anesthesiologists. Methods: Ninety patients with expected normal airways were randomly allocated to either the Airtraq or McGrath group. The primary outcome was DLT intubation time. The secondary outcomes were glottic view, success rate, subjective ease of intubation (100-mm visual analog scale, 0 = easy; 100 = difficult), incidence of DLT malposition, and postoperative intubation-related complication. Results: The airway characteristics were comparable between the 2 groups. Cormack and Lehane grades significantly improved with the use of the McGrath and Airtraq videolaryngoscopes, compared with the Macintosh laryngoscope. The intubation success rate on the first attempt was 93% in the Airtraq group and 95% in the McGrath group (P > 0.05). The intubation time in the McGrath group is longer than that in the Airtraq group (39.9 [9.1]s vs 28.6 [13.6]s, P < 0.05). But intubation difficulty score, the incidence of DLT malposition and intubation-related complication were comparable between groups (P > 0.05). Conclusions: When using videolaryngoscopes for DLT intubation, the Airtraq DL is superior to the McGrath Series 5 in intubation time, but it does not decrease intubation difficulty. PMID:28002347

  20. Tracheal intubation with a camera embedded in the tube tip (Vivasight(™) ).

    PubMed

    Huitink, J M; Koopman, E M; Bouwman, R A; Craenen, A; Verwoert, M; Krage, R; Visser, I E; Erwteman, M; van Groeningen, D; Tijink, R; Schauer, A

    2013-01-01

    We studied tracheal intubation in manikins and patients with a camera embedded in the tip of the tracheal tube (Vivasight(™) ). Four people in two teams and two individuals attempted intubation of a manikin through an i-gel(™) 10 times each. The tracheas of 12 patients with a Mallampati grade of 1 were intubated with a Vivasight tracheal tube through a Berman airway, passed over a Frova(™) introducer. All 60 manikin intubations were successful, taking a mean (SD) time of 1.4 (0.5) s. The fastest intubation was performed in 0.5 s. All 12 participants' tracheas were successfully intubated in a median (IQR [range]) time of 90 (70-120 [50-210]) s. Seven participants complained of a sore throat, comparable with earlier findings for standard laryngoscopy and intubation: five mild; one moderate; and one severe. Tracheal intubation with the Vivasight through the i-gel or Berman airway is an alternative to existing techniques, against which it should be compared in randomised controlled trials in human participants. It has potential as a fast airway rescue technique.

  1. Proper size of endotracheal tube for cleft lip and palate patients and intubation outcomes.

    PubMed

    Abdollahifakhim, Shahin; Sheikhzadeh, Dariush; Shahidi, Nikzad; Nojavan, Gholamreza; Bayazian, Gholamreza; Aleshi, Hamideh

    2013-05-01

    The aim of the current study was to identify the proper size of endotracheal tube for intubation of cleft lip and palate patients and intubation outcomes in these patients. In this analytic cross-sectional study, 60 nonsyndromic cleft lip and palate patients were selected who had surgery between April 2010 and April 2012 at Pediatrics Hospital, Tabriz University of Medical Sciences, Iran. Demographic findings, previous admissions, and surgical history were registered. The proper tube size was measured by normal children formulas. Then tube size was confirmed by patients' minimum resistance to intubation, proper ventilation reported by anesthesiologist, and appropriate air leakage at an airway pressure of 15-20 cm H₂O. If intubation was unsuccessful then smaller size of endotracheal tube would be tried. Frequency of intubation trials and the biggest endotracheal tube size were recorded. Their average age, weight and height were 21.39 ± 4.95 months, 9.97 ± 1.18 kg and 74.30 ± 26.61 cm, respectively. The average tracheal tube size and frequency of intubation trials were 4.34 ± 0.78 and 1.63 ± 0.80, respectively. Seven cases required an endotracheal tube size smaller than the recommended size for that age including one case in unilateral cleft palate, three cases in unilateral cleft lip, one case in unilateral cleft lip and palate, and two cases in bilateral cleft lip and palate. Findings proved that considering subglottic stenosis incidence in these children, it is reasonable to determine the tube size for nonsyndromic cleft lip and palate patients by applying the currently available standards for normal children. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  2. Atraumatic intubation: experience using a 5.0 endotracheal tube without a stylet for laryngeal surgery.

    PubMed

    Moore, Jaime E; Hu, Amanda; Rutt, Amy; Green, Parmis; Hawkshaw, Mary; Sataloff, Robert T

    2015-02-01

    Vocal fold injury is a well-know complication of intubation, with rates reported as high as 69%. Laryngology textbooks recommend the use of a small endotracheal tube (ETT) to help avoid these complications and optimize visualization. Case reports have suggested that the rigid stylet can lead to laryngeal injury. Given the additional risks, intubation without the stylet is our preferred practice. There is limited documentation in the literature regarding this viewpoint. Our study investigated the feasibility of and potential barriers to intubation using 5.0 ETT without a stylet. Prospective study. Consecutive adult patients undergoing laryngeal surgery were recruited for intubation with a 5.0 ETT without a stylet. Demographic data, specialty and training level of the intubator, and factors that would predict a difficult intubation were recorded. Descriptive statistical analysis was performed. Findings of the participants (n = 67) included average American Society of Anesthesiologists (ASA) physical status classification (2.2), average Mallampati score (1.7), average Cormack-Lehane grade (1.5), and average body mass index (28.0). Five patients (7.4%) required intubation using a stylet, and one of these five participants was intubated initially with a stylet. Of these five participants, 80% required use of a GlideScope (P < .001), and they had significantly higher ASA classification (P = .047) and number of intubation attempts (P = .042). One patient sustained an oropharyngeal injury during intubation with a stylet. No participants had laryngeal injury. Most patients can be intubated successfully using a 5.0 ETT without a stylet. There were no cases of laryngeal trauma with this technique. 2b. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

  3. The Fast and Easy Way for Double-Lumen Tube Intubation: Individual Angle-Modification

    PubMed Central

    Min, Jeong Jin; Lee, Jong-Hwan; Kang, Se Hee; Kim, Eunhee; Lee, Sangmin M.; Cho, Jong Ho; Kim, Hong Kwan

    2016-01-01

    To find the faster and easier way than the existing intubating technique for double-lumen tube, we modified the angle of double-lumen tube according to an individual’s upper airway anatomy and compared the time needed and the number of attempts for successful intubation between individually angle-modified and non-modified double-lumen tubes. Adult patients undergoing elective thoracic surgery were randomly allocated in either non-angle-modified (Group N, n = 54) or angle-modified (Group M, n = 54) groups. During mask ventilation in the sniffing position, angle-modification was performed in Group M as follows: the distal tip of the tube was placed at the level of the cricoid cartilage and the shaft was bent at the intersection of the oral and pharyngeal axes estimated from the patient’s surface anatomy. The time needed and the number of attempts for successful intubation and Cormack and Lehane (C-L) grade were recorded. Overall median intubation time (sec) was significantly shorter in Group M than in Group N [10.2 vs. 15.1, P<0.001]. In addition, Group M showed the shorter median intubation time (sec) in C-L grades I-III [8.2 vs. 11.1 in C-L grade I, (P = 0.003), 10.3 vs. 15.3 in II, (P = 0.001), and 11.8 vs. 27.9 in III, (P<0.001), respectively]. Moreover, all intubation was successfully performed at the first attempt in patients with C-L grades I-III in Group M (P = 0.027). Our study showed an individual angle-modification would be useful for the fast and easy intubation of double-lumen tube in patients with C-L grades I-III. Trial Registration: ClinicalTrials.gov NCT02190032 PMID:27537372

  4. Quality control in QuantiFERON-TB gold in-tube for screening latent tuberculosis infection in health care workers.

    PubMed

    Igari, Hidetoshi; Watanabe, Akira; Ichimura, Yasunori; Sakurai, Takayuki; Taniguchi, Toshibumi; Ishiwada, Naruhiko

    2017-04-01

    QuantiFERON-TB gold in-tube has been used for screening latent tuberculosis infection in newly employed health care workers in Japan. There have been a few studies concerning quality control. We retrospectively analysed QuantiFERON-TB gold in-tube results in a hospital in Japan. Interferon-γ values in three blood collection tubes for QuantiFERON-TB gold in-tube were analysed in association with the positivity rate. The data set consisted of health care workers aged 20-29 years during the 7 years between 2010 and 2016. The yearly QuantiFERON-TB gold in-tube positivity rate was 0.9%, 16.4%, 3.0%, 39.3%, 2.8%, 0.9% and 1.5%, and was extremely high in 2011 and 2013. The interferon-γ values in the tuberculosis antigen tube were elevated in these two years, as indicated by higher median and wider interquartile range. The interferon-γ value in the negative control tube was also higher in 2011. The higher interferon-γ values in collection tubes (tuberculosis antigen tube and/or negative control tube) resulted in higher QuantiFERON-TB gold in-tube positivity rate. The distribution of interferon-γ in tuberculosis antigen tube and negative control tube, as evaluated by median and interquartile range, proved to be an effective index for the quality control of QuantiFERON-TB gold in-tube.

  5. Sampling Artifacts from Conductive Silicone Tubing

    SciTech Connect

    Timko, Michael T.; Yu, Zhenhong; Kroll, Jesse; Jayne, John T.; Worsnop, Douglas R.; Miake-Lye, Richard C.; Onasch, Timothy B.; Liscinsky, David; Kirchstetter, Thomas W.; Destaillats, Hugo; Holder, Amara L.; Smith, Jared D.; Wilson, Kevin R.

    2009-05-15

    We report evidence that carbon impregnated conductive silicone tubing used in aerosol sampling systems can introduce two types of experimental artifacts: 1) silicon tubing dynamically absorbs carbon dioxide gas, requiring greater than 5 minutes to reach equilibrium and 2) silicone tubing emits organic contaminants containing siloxane that adsorb onto particles traveling through it and onto downstream quartz fiber filters. The consequence can be substantial for engine exhaust measurements as both artifacts directly impact calculations of particulate mass-based emission indices. The emission of contaminants from the silicone tubing can result in overestimation of organic particle mass concentrations based on real-time aerosol mass spectrometry and the off-line thermal analysis of quartz filters. The adsorption of siloxane contaminants can affect the surface properties of aerosol particles; we observed a marked reduction in the water-affinity of soot particles passed through conductive silicone tubing. These combined observations suggest that the silicone tubing artifacts may have wide consequence for the aerosol community and should, therefore, be used with caution. Gentle heating, physical and chemical properties of the particle carriers, exposure to solvents, and tubing age may influence siloxane uptake. The amount of contamination is expected to increase as the tubing surface area increases and as the particle surface area increases. The effect is observed at ambient temperature and enhanced by mild heating (<100 oC). Further evaluation is warranted.

  6. Temporal variation of the leak pressure of uncuffed endotracheal tubes following pediatric intubation: an observational study.

    PubMed

    Patel, Shreya; Lalwani, Kirk; Koh, Jeffrey; Wu, Lei; Fu, Rongwei

    2014-06-01

    Uncuffed endotracheal tubes are still preferred over cuffed tubes in certain situations in pediatric anesthesia. Inaccurately sized uncuffed endotracheal tubes may lead to inadequate ventilation or tracheal mucosal damage during anesthesia. Endotracheal tube size in children is usually assessed by measuring the audible leak pressure; if the fit of the tube and the leak pressure decrease significantly with time, reintubation during surgery as a result of inability to ventilate effectively may be challenging, and could lead to patient morbidity. There is no evidence to indicate whether leak pressure increases or decreases with time following endotracheal intubation with uncuffed tubes in children. We measured leak pressure for 30 min following tracheal intubation in 46 ASA I children age 0-7 years after excluding factors known to modify leak pressure. The largest mean change in leak pressure occurred between time points 0 and 15 min, an increase of 3.5 cmH2O. Endotracheal tube size and type of procedure were associated with the leak pressure. In the final linear mixed model, there were no statistically significant variations in leak pressure over time (P = 0.129) in this group of children. We did not identify a consistent change in leak pressure within 30 min following tracheal intubation with uncuffed endotracheal tubes in this group of children.

  7. [Comparison of Shikani optical stylet and Macintosh laryngoscope for double-lumen endotracheal tube intubation].

    PubMed

    Xu, Ting; Li, Min; Guo, Xiang-yang

    2015-10-18

    To compare the efficacy and safety of Shikani (S)optical stylet and Macintosh(M) laryngoscope for double-lumen endotracheal tube intubation. In the study, 60 patients undergoing elective thoracic surgery were randomly allocated to group S(n=30) and group M (n=30). After general anesthesia induction, the patients in group S and group M were intubated double-lumen endotracheal tube (DLT) by Shikani optical stylet (SOS) and macintosh laryngoscope respectively. Intubation time, intubation attempts, cuff broken and oral mucosal or dental injury were recorded; Blood pressure and heart rate at baseline (T0), at the time of intubaiton onset (T1), 1 minute after intubaiton (T2), 3 minutes after intubation (T3) and 5 minutes after intubation (T3) were also recorded; Hoarseness and throat sore of the patients 24 hours after surgery were evaluated. The intubaiton time with the SOS was faster than with the Macintosh [(37.4±9.7) s vs. (43.9±13.7) s, P=0.039] and the first attempt success rate (87% vs. 80%, P=0.488) did not differ between the groups; No tube cuff broke in both the groups; Group S had fewer patients who suffered oral mucosal or dental injury than group M (8 vs.2, P=0.038); The blood pressure and heart rate at T0,T1,T2,T3 and T4 did not differ between the groups; Throat sore (7 vs.10, P=0.390) and hoarseness (5 vs.7, P=0.519) incidence did not differ between the groups. By comparison of the Macintosh laryngoscope, the SOS provides faster DLT intubation and causes less oral Mucosal or dental injury.

  8. Thoracoscopy without lung isolation utilizing single lumen endotracheal tube intubation and carbon dioxide insufflation.

    PubMed

    Sancheti, Manu S; Dewan, Brendan P; Pickens, Allan; Fernandez, Felix G; Miller, Daniel L; Force, Seth D

    2013-08-01

    This study evaluated the feasibility of performing thoracoscopy without lung isolation employing single lumen endotracheal tube (SLET) intubation and carbon dioxide insufflation. Eighty-two patients underwent a variety of thoracoscopic procedures without lung isolation using SLET intubation and carbon dioxide (CO2) insufflation between January and December 2012. Sixty-five of these patients underwent wedge resections and were isolated for analysis. Operations were accomplished using percutaneously placed laparoscopic trocars and insufflation up to 15 mm Hg. Operative times, length of stay, and vital signs were compared with 52 patients who underwent thoracoscopic wedge resections with double lumen endotracheal tube (DLET) intubation. A retrospective analysis was performed on 65 patients (30 females, mean age 58) who underwent thoracoscopic wedge resections with SLET intubation compared with 52 patients undergoing the same procedure with DLET intubation. Operating room time (111 ± 4.74 minutes), time to incision (49 ± 1.91 minutes), and operative time (48 ± 2.89 minutes) were significantly decreased in the SLET group (p < 0.05). Intraoperative hemodynamic parameters showed no significant aberrations. Two postoperative complications (3.1%) were identified in the SLET group. Length of stay was similar (3 ± 0.49 days versus 3 ± 0.23 days). Single lumen endotracheal tube intubation is a feasible and safe airway management alternative for thoracoscopic procedures. This method resulted in shorter operative times, no aberrant hemodynamic shifts, low complication rates, and similar hospital stays as compared with traditional DLET intubation. Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  9. A Novel and Innovative Way of Nasogastric Tube Insertion in Anesthetized Intubated Patient

    PubMed Central

    Sahu, Sandeep; Kishore, Kamal; Sachan, Vertika; Chatterjee, Arnidam

    2017-01-01

    Nasogastric tube (NGT) placement in anesthetized and intubated is sometimes very challenging with more than 50% failure rate in the first attempt. We describe a newer innovative Sahu's three in one, technique with use of GlideScope and forward placement of intubated trachea by external laryngeal maneuver, these both techniques lead to separation of trachea from esophagus so that endoscopic jejunal feeding tube guide wire strengthen NGT can be guided and manipulated to esophagus under direct vision. After informed consent, we used Sahu's three in one combo technique to insert NGT in adult anesthetized and intubated patients of both the sexes with high success in the first attempt. We found this technique easy, helpful, less time consuming with high success rate. PMID:28298795

  10. A Novel and Innovative Way of Nasogastric Tube Insertion in Anesthetized Intubated Patient.

    PubMed

    Sahu, Sandeep; Kishore, Kamal; Sachan, Vertika; Chatterjee, Arnidam

    2017-01-01

    Nasogastric tube (NGT) placement in anesthetized and intubated is sometimes very challenging with more than 50% failure rate in the first attempt. We describe a newer innovative Sahu's three in one, technique with use of GlideScope and forward placement of intubated trachea by external laryngeal maneuver, these both techniques lead to separation of trachea from esophagus so that endoscopic jejunal feeding tube guide wire strengthen NGT can be guided and manipulated to esophagus under direct vision. After informed consent, we used Sahu's three in one combo technique to insert NGT in adult anesthetized and intubated patients of both the sexes with high success in the first attempt. We found this technique easy, helpful, less time consuming with high success rate.

  11. Factors Associated with Misplaced Endotracheal Tubes During Intubation in Pediatric Patients.

    PubMed

    Miller, Kelsey A; Kimia, Amir; Monuteaux, Michael C; Nagler, Joshua

    2016-07-01

    Correct positioning of the endotracheal tube (ETT) during emergent pediatric intubations can be challenging, and incorrect placement may be associated with higher rates of complications. The aims of this study are to: 1) assess the prevalence of clinically undetected misplaced ETTs after intubation in the pediatric emergency department; 2) identify predictors of ETT misplacement; and 3) evaluate for any association between intubation-related complications and ETT position. In this retrospective cross-sectional study, the primary outcome was rate of unrecognized low or high ETTs detected on confirmatory chest radiographs. The secondary outcome was frequency of complications (i.e., hypoxemia, difficult ventilation, atelectasis, pneumothorax, pneumomediastinum, and aspiration) associated with misplaced ETTs. Multivariable analyses were used to evaluate the associations between patient and procedural characteristics and misplaced ETTs and between ETT position and complications. Seventy-seven of 201 (38.3%) intubations performed in the emergency department resulted in clinically unrecognized misplaced ETTs. Of the misplaced tubes, 45 of 77 (58%) were identified as low and 32 (42%) were high. In multivariable analyses, female sex and decreasing age were associated with increased risk of low tube placement (odds ratio for female sex, 2.4 [95% confidence interval, 1.1-5.1]; odds ratio of decreasing age, 1.16 [95% confidence interval, 1.0-1.3]). Low tube misplacement was associated with an increased risk of intubation-related complications compared to both correct and high tube placement (p < 0.05, Chi-square). Clinically unrecognized ETT misplacement occurs frequently in the pediatric emergency department, with low placement being most common, particularly in girls and younger children. Measures to improve clinical or radiographic recognition of incorrect tube position should be considered. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. Rabbit model of tracheal stenosis induced by prolonged endotracheal intubation using a segmented tube.

    PubMed

    Lee, Hyoung Shin; Kim, Sung Won; Oak, Chulho; Ahn, Yeh-Chan; Kang, Hyun Wook; Chun, Bong Kwon; Lee, Kang Dae

    2015-12-01

    Animal model of tracheal stenosis based on pathophysiology of prolonged endotracheal intubation has been rarely reported. We sought to verify the feasibility of inducing an animal model of tracheal stenosis by segmented endotracheal tube insertion in the New Zealand white rabbit model. Tracheal stenosis was induced by inserting a segmented endotracheal tube of 1.5cm length which was wrapped with a commercialized absorbable hemostat in 15 New Zealand white rabbits, while sham surgery controls (n=3) underwent tracheotomy and direct closure of tracheal exposure. The tube was removed transorally, 1 week after tube insertion. All rabbits were evaluated endoscopically at 1 week, 2 weeks and 3 weeks after the tube insertion. The rabbits were sacrificed 3 weeks after the surgery, and the excised tissue of trachea was processed along with the procedure of standard hematoxylin eosin staining and observed under a microscope. Tracheal stenosis was induced in all rabbits (range 32-84% stenosis) with no death of rabbits during the study. The histological features of tracheal stenosis demonstrated thickening and fibrosis of lamina propria and submucosa with relatively intact cartilage framework. We developed a rabbit model of tracheal stenosis induced by endotracheal intubation using a segmented tracheal tube. Since the model is based on the physiologic condition of prolonged endotracheal intubation, it may be used in variable studies related to tracheal stenosis. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  13. Nasogastric tube insertion in anesthetized and intubated patients: a new and reliable method

    PubMed Central

    2012-01-01

    Background The “Rusch” intubation stylet is used to make endotracheal tube intubation easy. We designed this study to evaluate the usage of this equipment in the guidance of nasogastric tube (NGT) insertion. Methods A total of 103 patients, aged 23 to 70 years, undergoing gastrointestinal or hepatic surgeries that required intraoperative NGT insertions were enrolled into our study. The patients were randomly allocated to the control group (Group C) or the stylet group (Group S) according to a computerized, random allocation software program. In the control group, the NGT was inserted with the patient’s head in an intubating position. In the stylet group, the NGT was inserted with the assistance of a “Rusch” intubation stylet tied together at the tips by a slipknot. The success rates of the two methods, the durations of the insertions, and the occurrences of complications were recorded. All of the failed cases in the control group were subjected to the new technique used in the stylet group, and the successful rescue rate was also evaluated. Results Successful insertions were recorded for 52/53 patients (98.1%) in Group S and for 32/50 patients (64%) in Group C. The mean insertion times were 39.5 ± 19.5 seconds in Group C and 40.3 ± 23.2 seconds in Group S. Successful rescues of failure cases in Group C were achieved in 17/18 patients (94.4%) with the assistance of a “Rusch” intubation stylet. Conclusions The “Rusch” intubation stylet-guided method is reliable with a high success rate of NGT insertion in anesthetized and intubated patients. Trial registration Institutional Review Board of Chang Gung Memorial Hospital (IRB: 98-2669B) and Australian New Zealand Clinical Trials Registry (ACTRN12611000423910) PMID:22853453

  14. Nasogastric tube insertion in anesthetized and intubated patients: a new and reliable method.

    PubMed

    Tsai, Yung-Fong; Luo, Chiao-Fen; Illias, Amina; Lin, Chih-Chung; Yu, Huang-Ping

    2012-08-01

    The "Rusch" intubation stylet is used to make endotracheal tube intubation easy. We designed this study to evaluate the usage of this equipment in the guidance of nasogastric tube (NGT) insertion. A total of 103 patients, aged 23 to 70 years, undergoing gastrointestinal or hepatic surgeries that required intraoperative NGT insertions were enrolled into our study. The patients were randomly allocated to the control group (Group C) or the stylet group (Group S) according to a computerized, random allocation software program. In the control group, the NGT was inserted with the patient's head in an intubating position. In the stylet group, the NGT was inserted with the assistance of a "Rusch" intubation stylet tied together at the tips by a slipknot. The success rates of the two methods, the durations of the insertions, and the occurrences of complications were recorded. All of the failed cases in the control group were subjected to the new technique used in the stylet group, and the successful rescue rate was also evaluated. Successful insertions were recorded for 52/53 patients (98.1%) in Group S and for 32/50 patients (64%) in Group C. The mean insertion times were 39.5 ± 19.5 seconds in Group C and 40.3 ± 23.2 seconds in Group S. Successful rescues of failure cases in Group C were achieved in 17/18 patients (94.4%) with the assistance of a "Rusch" intubation stylet. The "Rusch" intubation stylet-guided method is reliable with a high success rate of NGT insertion in anesthetized and intubated patients. Institutional Review Board of Chang Gung Memorial Hospital (IRB: 98-2669B) and Australian New Zealand Clinical Trials Registry (ACTRN12611000423910).

  15. [Comparison of different methods of nasogastric tube insertion in anesthetized and intubated patients].

    PubMed

    Kavakli, Ali Sait; Kavrut Ozturk, Nilgun; Karaveli, Arzu; Onuk, Asuman Arslan; Ozyurek, Lutfi; Inanoglu, Kerem

    2017-05-22

    Nasogastric tube insertion may be difficult in anesthetized and intubated patients with head in the neutral position. Several techniques are available for the successful insertion of nasogastric tube. The primary aim of this study was to investigate the difference in the first attempt success rate of different techniques for insertion of nasogastric tube. Secondary aim was to investigate the difference of the duration of insertion using the selected technique, complications during insertion such as kinking and mucosal bleeding. 200 adult patients, who received general anesthesia for elective abdominal surgeries that required nasogastric tube insertion, were randomized into four groups: Conventional group (Group C), head in the lateral position group (Group L), endotracheal tube assisted group (Group ET) and McGrath video laryngoscope group (Group MG). Success rates, duration of insertion and complications were noted. Success rates of nasogastric tube insertion in first attempt and overall were lower in Group C than Group ET and Group MG. Mean duration and total time for successful insertion of NG tube in first attempt were significantly longer in Group ET. Kinking was higher in Group C. Mucosal bleeding was statistically lower in Group MG. Use of video laryngoscope and endotracheal tube assistance during NG tube insertion compared with conventional technique increase the success rate and reduce the kinking in anesthetized and intubated adult patients. Use of video laryngoscope during nasogastric tube insertion compared to other techniques reduces the mucosal bleeding in anesthetized and intubated adult patients. Copyright © 2016 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  16. Repositioning a displaced tracheostomy tube with an Aintree intubation catheter mounted on a fibre-optic bronchoscope.

    PubMed

    Rajendram, R; McGuire, N

    2006-10-01

    Although tracheostomy tube displacement is uncommon, the management is often difficult and the associated mortality is high. It is important to ensure that the airway is secure and then either replace or reposition the tracheostomy tube. This case report describes the use of an Aintree intubation catheter (C-CAE-19.0-56-AIC, William Cook Europe, Denmark) mounted on an intubating fibre-optic bronchoscope (11302BD1, Karl Storz Endoskope, Germany) to reposition a partially displaced tracheostomy tube.

  17. Effect of Endotracheal Tube Cuff Shape on Postoperative Sore Throat After Endotracheal Intubation.

    PubMed

    Chang, Jee-Eun; Kim, Hyerim; Han, Sung-Hee; Lee, Jung-Man; Ji, Sanghwan; Hwang, Jin-Young

    2017-03-31

    Although minor, a sore throat after endotracheal intubation can adversely affect patient satisfaction and postoperative function. We compared the effects of 2 endotracheal tube cuff shapes on postoperative sore throat. One hundred ninety-one adult patients were included in the study. After induction of anesthesia, patients were randomized to endotracheal intubation with a conventional cylindrical-shaped cuff (Group C, n = 95) or a tapered-shaped cuff (Group T, n = 96). The number of intubation attempts, time to achieve endotracheal intubation, and duration of intubation were recorded. Postoperative sore throat and hoarseness were assessed at 1, 6, and 24 hours after surgery. A 0- to 100-mm visual analog scale was used to evaluate sore throat severity. The primary outcome of this study was the overall cumulative incidence of postoperative sore throat in the 24-hour evaluation period in the 2 groups. The overall incidence of postoperative sore throat was lower in Group T than in Group C (32% vs 54%; relative risk = 0.60, 95% confidence interval: 0.43-0.85; P = .003). At 6 hours after surgery, the incidence and severity of postoperative sore throat were lower in Group T compared with Group C (Bonferroni-corrected P < .05). Postoperative hoarseness also occurred less frequently in Group T compared with Group C (19% vs 37%; P = .006). Group T had lower incidence of hoarseness at 1 and 6 hours after surgery than Group C (Bonferroni-corrected P <.05), but the incidence of hoarseness at 24 hours after surgery did not differ between groups. Intubation using an endotracheal tube with a tapered cuff reduced the incidence and severity of postoperative sore throat and the incidence of hoarseness after surgery when compared with an endotracheal tube with a cylindrical cuff.

  18. Early laryngeal outcome of prolonged intubation using an anatomical tube: a double blind, randomised study.

    PubMed

    Nordang, Leif; Lindholm, Carl-Eric; Larsson, Jan; Linder, Arne

    2016-03-01

    The objective of this study was to study the short-term impact on larynx by a newly designed anatomical tube. A prospective randomised trial of a newly designed anatomical tube versus a standard endotracheal tube in patients operated under general anaesthesia for at least 12 h. Seventy adults were included and randomised to either type of tube. The patients were evaluated by means of fibre-optic laryngoscopy and VAS-rating of symptoms on two occasions in the first post-operative week. The evaluating investigators and the patients were blinded to the type of tube used. 27 cases and 23 controls had complete data for evaluation. Age, gender and intubation times were comparable. Symptoms such as hoarseness, coughing, and pain were rated above 30 % of maximum during at least one of the first post-operative days by 21 and 19 patients, respectively. At the first examination (within 24 h), 38 % of patients in the anatomical tube group stated no hoarseness; compared to 13 % of the controls (p = 0.057). Fibre-optic laryngoscopy showed some kind of pathology in all the patients examined within 24 h of extubation. After 3-6 days, seven patients with the anatomical tube and four patients in the control group showed complete resolution of the lesions, and the changes were limited to redness in the vocal process area in another seven and four, respectively. The differences between the groups did not attain statistical significance. The study shows considerable short-term laryngeal morbidity after prolonged intubation, and the anatomical tube only showed an advantage concerning hoarseness. Further improvement of the endotracheal tubes and intubation routines are still needed.

  19. A comparison of augmentation techniques during in-tube evaporation of R-113

    SciTech Connect

    Reid, R.S. ); Pate, M.B. ); Bergles, A.E. )

    1991-05-01

    An experimental study was conducted to determine the potential of three techniques for augmenting in-tube evaporation of refrigerants: high-fin tubes, microfin tubes, and twisted tape inserts. Five tubes with internal fins and one smooth tube with a twisted-tape insert were tested. Additionally, experiments were performed with two reference smooth tubes having diameters similar to the maximum inside diameters of the finned tubes. All experiments involved evaporating Refrigerant 113 (R-113) by direct electrical heating of the tube wall. Local evaporation heat transfer coefficients were measured as a function of quality for a range of mass fluxes and heat fluxes. Enhancement factors were calculated by forming ratios of the heat transfer coefficient for the augmented tube and a smooth tube of the same maximum inside diameter. Mass fluxes, pressure levels, and qualities were fixed when enhancement factors were calculated. For the internally finned tubes the enhancement factors varied from 1.1 to 2.8. An internally finned tube having helical spiral angles of 16 deg produced the largest enhancement of heat transfer. The tube with the twisted-tape insert typically had an enhancement factor of about 1.5. Pressure gradient ratios and enhancement performance ratios are also presented.

  20. Traumatic Canalicular Laceration Repair with a New Monocanalicular Silicone Tube.

    PubMed

    Tavakoli, Mehdi; Karimi, Sayeh; Behdad, Bahareh; Dizani, Setareh; Salour, Hossein

    This study evaluated the efficacy of a new pushed monocanalicular silicone tube in reconstructing traumatic canalicular laceration. This interventional case series enrolled 48 patients with a traumatic canalicular laceration. Patients with bicanalicular involvement were excluded. Canalicular repair was performed under an operating microscope and involved proximal end exploration of the canaliculus, stenting of the canaliculus with a 35-mm Masterka tube, and approximation of the lacerated canaliculi margins. After 6 months, anatomical and functional success rates were evaluated by diagnostic probing and by asking the patients (or their guardians) about tearing. The mean age of patients was 32.2 ± 21.2 years (1.5-75 years). Of the 48 patients included, 38 were males. Lower canaliculus was involved in 35 patients. Other ocular injuries were observed in 38 patients. The average interval between the surgery and Masterka removal was 12.2 ± 1.4 weeks (10-16 weeks). Early tube extrusion was observed in 3 patients. No significant complication was observed in this series. Anatomical and functional success rates were 87% and 100%, respectively. The results demonstrated that intubation of lacerated canaliculi with Masterka tube for canalicular repair was safe, effective, and simple with minimal complications.

  1. [Study on antibacterial property of silver loaded titanium dioxide antibacterial coated endotracheal intubation tube].

    PubMed

    Jiang, Xuhong; Wang, Yuan; Hua, Junyi; Lyu, Bin

    2014-05-01

    To study the antibacterial property of silver loaded titanium dioxide (TiO2) antibacterial coated endotracheal intubation tube, and to determine the minimum effective antibacterial concentration. Intubation tubes coated with different concentrations of antibacterial agents were prepared with sol gel method. Polyethylene endotracheal intubation tubes were used as substrate, and silver loaded TiO2 was used as the antibacterial agent. According to the different antibacterial concentrations of the antibacterial agent, the tubes were divided into nine groups: 10.0% group, 5.0% group, 2.0% group, 1.5% group, 1.0% group, 0.8% group, 0.6% group, 0.2% group, and control group. They were respectively immersed in three standard bacteria suspensions with 1.0×10(5) cfu/mL: Pseudomonas aeruginosa, Staphylococcus aureus, and Escherichia coli. Together with standard bacteria liquid group, there were 10 experimental groups. They were kept overnight for 24 hours. 10 μL of respective culture medium was smeared on blood agar culture medium. After being cultured overnight in 35 centigrade, the number of bacteria colonies was respectively counted. In 1.0×10(5) cfu/mL of three standard bacteria liquids with antibacterial agent concentration ≥1.0%, three bacterial colonies had un-obviously growth rate. Almost the same strong antibacterial effects to achieve sterilizing rates of more than 98% was shown in each group of the antibacterial coating endotracheal intubation tubes (all P>0.05). As the antibacterial agent concentration decreased, three bacterial colonies were increasing gradually. Intermediate antibacterial effects were shown in tubes of 0.8% group, with significant statistic difference as compared with 1.0% and 0.6% groups [Pseudomonas aeruginosa: 7.300 (4.050, 8.350) vs. 0.200 (0.050, 1.200), 9.700(9.000, 10.000); Staphylococcus aureus: 4.100 (3.300, 4.650) vs. 0.000 (0.000, 0.150), 5.800 (5.350, 7.650); Escherichia coli: 1.400 (0.750, 3.750) vs. 0.050 (0.025, 0.050), 9

  2. Dependence of Initial Plasma Size on Laser-driven In-Tube Accelerator (LITA) Performance

    SciTech Connect

    Kim, Sukyum; Jeung, In-Seuck; Ohtani, Toshiro; Sasoh, Akihiro; Choi, Jeong-Yeol

    2004-03-30

    At Tohoku University, experiments of Laser-driven In-Tube Accelerator (LITA) have been carried out. In order to observe the initial state of plasma and blast wave, the visualization experiment was carried out using the shadowgraph method. In this paper, dependency of initial plasma size on LITA performance is investigated numerically. The plasma size is estimated using shadowgraph images and the numerical results are compared with the experimental data of pressure measurement and results of previous modeling.

  3. Numerical Simulation of Laser-Driven In-Tube Accelerator Operation

    SciTech Connect

    Ohnishi, N.; Ogino, Y.; Sawada, K.; Ohtani, T.; Mori, K.; Sasoh, A.

    2006-05-02

    To achieve a higher thrust performance in the laser-driven in-tube accelerator operation, numerical analysises have been carried out. The computational code covers from the generation of the blast wave to its interactions with the projectile and the acceleration wall. The thrust history and the momentum coupling coefficient evaluated from the numerical simulation depend on the fill pressure and the projectile shape. The confinement effect can be clearly found using the projectile attached with a shroud.

  4. Latent tuberculosis diagnosis in children by using the QuantiFERON-TB Gold In-Tube test.

    PubMed

    Lighter, Jennifer; Rigaud, Mona; Eduardo, Roger; Peng, Chia-Hui; Pollack, Henry

    2009-01-01

    The QuantiFERON-TB Gold test was the first blood test to be approved for the diagnosis of latent tuberculosis infection. Although it has been shown to be sensitive and specific in adults, limited data on its performance in children are available. This was a prospective study of children receiving health care in New York, New York. Each child was assessed for risk factors for Mycobacterium tuberculosis infection, underwent tuberculin skin testing, and had a QuantiFERON-TB Gold In-Tube test performed. The concordance between tuberculin skin test and QuantiFERON-TB Gold In-Tube test results was calculated, and the results were analyzed according to the likelihood of exposure to M tuberculosis. Data for 207 children with valid tuberculin skin test and QuantiFERON-TB Gold In-Tube test results were analyzed. There was excellent correlation between negative tuberculin skin test results and negative QuantiFERON-TB Gold In-Tube test results; however, only 23% of children with positive tuberculin skin test results had positive QuantiFERON-TB Gold In-Tube test results. Positive QuantiFERON-TB Gold In-Tube test results were associated with increased likelihood of M tuberculosis exposure, and interferon gamma levels were higher in children with known recent exposure to M tuberculosis, compared with children with older exposure histories. Younger children produced lower interferon gamma levels in response to the mitogen (phytohemagglutinin) control used in the QuantiFERON-TB Gold In-Tube test, but indeterminant results were low for children of all ages. Performance characteristics were similar across all age groups. The QuantiFERON-TB Gold In-Tube test is a specific test for M tuberculosis exposure in children, with performance characteristics similar to those for adults residing in regions with low levels of endemic disease. Concerns about test sensitivity, especially for children <2 years of age, will require additional prospective long-term evaluation.

  5. Online in-tube microextractor coupled with UV-Vis spectrophotometer for bisphenol A detection.

    PubMed

    Poorahong, Sujittra; Thammakhet, Chongdee; Thavarungkul, Panote; Kanatharana, Proespichaya

    2013-01-01

    A simple and high extraction efficiency online in-tube microextractor (ITME) was developed for bisphenol A (BPA) detection in water samples. The ITME was fabricated by a stepwise electrodeposition of polyaniline, polyethylene glycol and polydimethylsiloxane composite (CPANI) inside a silico-steel tube. The obtained ITME coupled with UV-Vis detection at 278 nm was investigated. By this method, the extraction and pre-concentration of BPA in water were carried out in a single step. Under optimum conditions, the system provided a linear dynamic range of 0.1 to 100 μM with a limit of detection of 20 nM (S/N ≥3). A single in-tube microextractor had a good stability of more than 60 consecutive injections for 10.0 μM BPA with a relative standard deviation of less than 4%. Moreover, a good tube-to-tube reproducibility and precision were obtained. The system was applied to detect BPA in water samples from six brands of baby bottles and the results showed good agreement with those obtained from the conventional GC-MS method. Acceptable percentage recoveries from the spiked water samples were obtained, ranging from 83-102% for this new method compared with 73-107% for the GC-MS standard method. This new in-tube CPANI microextractor provided an excellent extraction efficiency and a good reproducibility. In addition, it can also be easily applied for the analysis of other polar organic compounds contaminated in water sample.

  6. The novel intubating laryngeal tube (iLTS-D) is comparable to the intubating laryngeal mask (Fastrach) - a prospective randomised manikin study.

    PubMed

    Ott, Thomas; Fischer, Matthias; Limbach, Tobias; Schmidtmann, Irene; Piepho, Tim; Noppens, Ruediger R

    2015-06-08

    Supraglottic devices are helpful for inexperienced providers who perform ventilation in emergency situations. Most supraglottic devices do not allow secondary tracheal intubation through the device. The novel intubating laryngeal tube (iLTS-D) and the intubating laryngeal mask (Fastrach) are devices that offer supraglottic ventilation and secondary tracheal intubation. We evaluated the novel iLTS-D and compared it to the established Fastrach using a manikin-based study. Participants used both devices in a randomised order. The participants conducted four consecutive trials on a manikin. One trial was composed of the following procedures. First, participants ventilated the manikin using either iLTS-D or Fastrach. 'Time to ventilation', success rates and number of attempts were recorded for the supraglottic device. Second, participants intubated the manikin through the previously inserted supraglottic device. 'Time to tracheal ventilation', success rate and tube localisation were recorded. The primary endpoint was the results of the final fourth trial, which mirrored the standardised training of trials 1, 2 and 3. A total of 64 participants were enrolled. All of the participants successfully inserted both devices on their first attempt in trial 4. Fastrach was applied 1 s faster in trial 4 than the iLTS-D (median 'time to ventilation' Fastrach: 13.5 s., iLTS-D: 14.5 s., p = 0.04). All participants successfully intubated through both devices in trial 4. There was no difference in 'time to tracheal ventilation' by tracheal intubation between either device (median 'time to tracheal ventilation': Fastrach: 14.0 s., iLTS-D: 14.0 s., p = 0.16). The iLTS-D performed similarly to the ILMA in insertion and intubation times in a manikin setting.

  7. Managing risk for silicone tubing applications.

    PubMed

    Curtis, Jim

    2009-01-01

    Quality must be designed into medical devices, including into their raw materials and components. Operating according to the critical principles of medical device good manufacturing practices ensures that the silicone tubing incorporated into devices has the highest standards of quality and safety.

  8. Comparison of intubation performance by junior emergency department doctors using gum elastic bougie versus stylet reinforced endotracheal tube insertion techniques.

    PubMed

    Brazil, Victoria; Grobler, Catharina; Greenslade, Jaimi; Burke, John

    2012-04-01

    Endotracheal intubation is a challenging procedure in emergency medicine. Junior doctors lack experience and confidence in this task. The use of a gum elastic bougie (GEB) to facilitate intubation may improve success rates, especially in difficult situations. Junior doctors working in the ED were studied. Endotracheal intubation was simulated using part-task trainers in "easy" positioning and "difficult" positioning modes. Intubation was attempted in both positions using either an endotracheal tube, with re-enforcing stylet (ETT-S), or insertion of a gum elastic bougie (GEB), with subsequent passage of the endotracheal tube over the bougie. Success rates and time to complete intubation were measured with GEB, and with ETT-S. Participants were asked to record the perceived ease of intubation. One hundred and four intubations were performed by 26 study subjects. Overall, mean time to intubation with ETT-S technique was 16.14 s (14.49-17.98 95% CI), and was faster than with GEB 24.18 (21.45-27.25 95% CI) in both airway difficulty grades (P < 0.01). The success rate for intubation using the GEB was 100%, compared with 92.9% with ETT-S. This difference was not statistically significant. Perceived ease of intubation was similar for GEB and ETT-S (VAS 6.808 vs 6.904). The use of a GEB marginally increases the time taken to perform endotracheal intubation. Success rates for junior doctors attempting endotracheal intubation were not significantly different between the two techniques. Success rates for novice practitioners using a GEB were high after even limited instruction and practice. © 2011 The Authors. EMA © 2011 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  9. Video laryngoscopy versus direct laryngoscopy for double-lumen endotracheal tube intubation: a retrospective analysis.

    PubMed

    Purugganan, Ronaldo V; Jackson, Timothy A; Heir, Jagtar Singh; Wang, Hao; Cata, Juan P

    2012-10-01

    The authors hypothesized that video laryngoscopy (VL) facilitated double-lumen tube (DLT) insertion compared with direct laryngoscopy (DL). A retrospective analysis. An academic hospital. Patients older than 18 years of age undergoing thoracic surgery requiring DLT placement between 2005 and 2011. Patients without airway predictors of difficult intubation who were intubated under DL with Macintosh (DL-MAC, n = 40) or Miller (DL-MIL, n = 44) blades and VL with McGrath MAC (Aircraft Medical, Edinburgh, UK) and C-MAC (Karl Storz, Tuttlingen, Germany) laryngoscopes (n = 46) were included in the study. Patients who were intubated with both VL devices were grouped into a VL group. Patients in all 3 groups had comparable preoperative demographics. Mallampati scores and ease of manual ventilation after the induction of anesthesia were also similar in all groups. The Cormack Lehane (C-L) grade views were significantly higher in patients in the DL-MAC than in the DL-MIL and VL groups (p < 0.006). The number of intubation attempts was similar in all 3 groups; however, the percentage of intubation reported to be difficult was higher in the DL-MAC than in the other 2 groups (p = 0.014). No damage to the airway was found in any of the groups. DLT placement using VL appeared to overcome some of the limitations of DL-MAC but was similar to DL-MIL. The authors speculated that the ease of placement was related to the improved visualization of the vocal cords because there was a significantly greater number of C-L views 3 and 4 in the DL-MAC group as compared with the VL and DL-MIL groups. Hence, the authors advocate using VL, particularly when the laryngoscopist is inexperienced using DL-MIL for DLT placement. Copyright © 2012 Elsevier Inc. All rights reserved.

  10. Comparison of success rate of intubation through Air-Q with ILMA using two different endotracheal tubes.

    PubMed

    Malhotra, S K; Bharath, K V; Saini, Vikas

    2016-04-01

    Air-Q™ is a newly introduced airway device, which can be used to facilitate endotracheal intubation. The primary aim of this study was to assess whether use of two different endotracheal tubes (ETTs) (standard polyvinyl chloride [PVC] and reinforced PVC) increases the success rate of blind intubation through Air-Q™ (Group Q) when compared with intubating laryngeal mask airway (ILMA- Fastrach™) keeping ILMA as control (Group I). One hundred and twenty patients aged between 18 and 60 years with American Society of Anesthesiologists physical status I-II, undergoing elective surgery under general anaesthesia, were enrolled into this prospective, randomised, case-control study to compare the success rate of tracheal intubation between ILMA (Fastrach™) and Air-Q™ intubating laryngeal airway. Those patients with anticipated difficult airway were excluded from the study. All the recruited patients completed the study. Reinforced PVC ETT was used in both airway devices to secure intubation. Since standard PVC tube is recommended for use in Air-Q, when first intubation attempt failed, second or third attempt was made with standard PVC ETT. Total of three attempts were made for each procedure: Whereas in ILMA group, only reinforced tube was used in all three attempts. The overall success rate after three attempts was more with Air-Q (96.6%) in our study compared with ILMA (91.6%) but no significant difference was seen between the groups (P = 0.43). The present study shows that when intubation with reinforced tube fails, the success rate with use of conventional PVC tube is more with Air-Q when compared with ILMA.

  11. Comparison of success rate of intubation through Air-Q with ILMA using two different endotracheal tubes

    PubMed Central

    Malhotra, SK; Bharath, KV; Saini, Vikas

    2016-01-01

    Background and Aims: Air-Q™ is a newly introduced airway device, which can be used to facilitate endotracheal intubation. The primary aim of this study was to assess whether use of two different endotracheal tubes (ETTs) (standard polyvinyl chloride [PVC] and reinforced PVC) increases the success rate of blind intubation through Air-Q™ (Group Q) when compared with intubating laryngeal mask airway (ILMA- Fastrach™) keeping ILMA as control (Group I). Methods: One hundred and twenty patients aged between 18 and 60 years with American Society of Anesthesiologists physical status I-II, undergoing elective surgery under general anaesthesia, were enrolled into this prospective, randomised, case–control study to compare the success rate of tracheal intubation between ILMA (Fastrach™) and Air-Q™ intubating laryngeal airway. Those patients with anticipated difficult airway were excluded from the study. All the recruited patients completed the study. Reinforced PVC ETT was used in both airway devices to secure intubation. Since standard PVC tube is recommended for use in Air-Q, when first intubation attempt failed, second or third attempt was made with standard PVC ETT. Total of three attempts were made for each procedure: Whereas in ILMA group, only reinforced tube was used in all three attempts. Results: The overall success rate after three attempts was more with Air-Q (96.6%) in our study compared with ILMA (91.6%) but no significant difference was seen between the groups (P = 0.43). Conclusion: The present study shows that when intubation with reinforced tube fails, the success rate with use of conventional PVC tube is more with Air-Q when compared with ILMA. PMID:27141106

  12. [Determination of alkyl-phenols in textiles by in-tube capillary solid-phase extraction-gas chromatography].

    PubMed

    Zhang, Luohong; Du, Ting; Zhong, Jiayu

    2015-10-01

    An in-tube capillary solid-phase extraction (SPE) -gas chromatography (GC) method was developed for confirmation and quantitative determination of octylphenol (OP) and nonylphenol (NP) in textiles. To make the in-tube capillary SPE column, the best SPE cartridge was chosen from four kinds of SPE cartridges. The adsorbent in the cartridge was used as the filling material to make the in-tube capillary SPE column. The nature, volume used, flow rate and adsorption capacity of the eluent were compared. Finally, the in-tube capillary solid-phase extraction was combined with gas chromatography to detect the alkyl phenols (APs). Abselut NEXUS extraction cartridge was chosen as the best solid phase extractant. The optimal in-tube capillary SPE extraction conditions were as follows: 1.2 μL methanol and 1.2 μL ultra-pure water for activating the extraction column, 1.2 μL methanol for eluting, 0.4 μL/min for solution loading. The method showed a good linear relationship in the low concentration range, and the enrichment ratios for the APs were about 100 times. The detection limits of octylphenol and nonylphenol were 3.7 μg/L and 4.5 μg/L, respectively. The recoveries of octylphenol were 85.6%-98.2%, and those of nonylphenol were 83.8%-95.7%. The experimental results demonstrated that the method is simple, rapid, and useful for detecting APs in textiles.

  13. Numerical Simulation of Laser-driven In-Tube Accelerator on Supersonic Condition

    SciTech Connect

    Kim, Sukyum; Jeung, In-Seuck; Choi, Jeong-Yeol

    2004-03-30

    Recently, several laser propulsion vehicles have been launched successfully. But these vehicles remained in a very low subsonic flight. Laser-driven In-Tube Accelerator (LITA) is developed as unique laser propulsion system at Tohoku University. In this paper, flow characteristics and momentum coupling coefficients are studied numerically in the supersonic condition with the same configuration of LITA. Because of the aerodynamic drag, the coupling coefficient could not get correctly especially at the low energy input. In this study, the coupling coefficient was calculated using the concept of the effective impulse.

  14. Numerical Simulation of Laser-driven In-Tube Accelerator on Supersonic Condition

    NASA Astrophysics Data System (ADS)

    Kim, Sukyum; Jeung, In-Seuck; Choi, Jeong-Yeol

    2004-03-01

    Recently, several laser propulsion vehicles have been launched successfully. But these vehicles remained in a very low subsonic flight. Laser-driven In-Tube Accelerator (LITA) is developed as unique laser propulsion system at Tohoku University. In this paper, flow characteristics and momentum coupling coefficients are studied numerically in the supersonic condition with the same configuration of LITA. Because of the aerodynamic drag, the coupling coefficient could not get correctly especially at the low energy input. In this study, the coupling coefficient was calculated using the concept of the effective impulse.

  15. Use of silicone tubes to repair canalicular lacerations via a novel method.

    PubMed

    Liu, Zhiping; Sha, Xiangyin; Liang, Xuanwei; Wang, Zhonghao

    2013-12-01

    To develop a novel method to repair canalicular lacerations using silicone tubes. A total of 47 adult patients (47 eyes) with canalicular lacerations were collected from the outpatient department from November 2010 to December 2012. The age ranged from 16 to 53 years. Among the 47 eyes, 37 had lower canalicular lacerations, 6 had upper canalicular lacerations, and 4 had bicanalicular lacerations. A soft probe was made using a stainless steel acupuncture needle, which was inserted into the lumen of the proximal part of the catheter to increase its rigidity. The probe was then inserted into the lacrimal sac and nasolacrimal duct. After retrieval of the catheters, the two ends of the silicone tube were securely tied (end to end) to the catheters. The silicon tube outside the nostril formed a U-shape. The catheters were then pulled upward until the silicone tube was completely located in the canalicular system. The catheters were cut off of the silicone tube near the site of the connection. The two ends of the silicone tube were cut short, -2mm out of the lacrimal punctum, and tied securely, end to end. The length of the tube between the upper and lower punctum was adjusted to ensure that no tension was present in the medial cathus, and the suture was removed through the nostril. The silicone tube was removed 3-10 months after this novel canalicular intubation procedure (NCI). All cases were anatomically rehabilitated after surgery. The silicone tube was removed after implanted in 3-10 months (mean 4.5 +/- 1.3 months), the average follow-up time was 11.8 months after removal. In total, 45 eyes in all 47 eyes (95.74%) were free from obstruction. Among them, 41 eyes (91.11%) achieved complete success (completely disappearance of epiphora after tube removal), 4 eyes (8.89%) achieved partial success (irritation occurs under stimulation conditions, such as wind or cold conditions), 4 eyes showed postoperative tearing, with three eyes having inferior lacrimal duct laceration

  16. Radiological evaluation of tube depth and complications of prehospital endotracheal intubation in pediatric trauma: a descriptive study.

    PubMed

    Simons, T; Söderlund, T; Handolin, L

    2017-01-27

    Pediatric prehospital endotracheal intubation (PHETI) is a difficult and rarely performed procedure that remains the gold standard for prehospital airway management when ventilation and/or anesthesia is required, but high complications rates, including malposition continue to concern. We reviewed the experience in our institution of pediatric intubations with particular emphasis on the position of the endotracheal tube (ETT) tip within the trachea and related complications. Intubated pediatric patients presenting directly from the scene to our level 1 trauma center, between 2006 and 2014, were included in our study. Patient records and radiographs were retrospectively reviewed to identify the ETT tip-to-carina distance and possible intubation-related complications. ETT tips identified beyond the carina on radiographs or by clinical diagnosis were defined as misplaced. Because head movement causes a significant ETT movement within the trachea, which is age related, we also defined ETT tip placement (1) less than 2 cm above the carina in children younger than 8 and (2) less than 3 cm above the carina in children 8 years or older as "near miss" intubations. From a total of 34 cases, ETT misplacement was identified in seven cases. Diagnosis was made radiologically in five cases and clinically in two cases. Four of these patients had left lung atelectasis due to tube misplacement. Tube thoracotomy was performed in two of these patients without concurrent evidence of chest injury. "Near miss" intubations accounted for 7/9 and 9/25 in children <8 years and ≥8 years old, respectively, totaling 16/34, with two of these leading to late displacements. Pediatric endotracheal tube intubation carries a high rate of tube malposition and left lung atelectasis in our experience of pediatric trauma patients, with less than a third of ETTs placed in a safe position.

  17. Electron microscopic analysis of biofilm on endotracheal tubes removed from intubated neonates.

    PubMed

    Zur, Karen B; Mandell, David L; Gordon, Ronald E; Holzman, Ian; Rothschild, Michael A

    2004-04-01

    To determine if the phenomenon of biofilm accumulation and associated microbial colonization occurs on the surface of endotracheal tubes in the region of the subglottis in neonates. Endotracheal tubes removed from 9 consecutive neonatal patients intubated for more than 12 hours were processed (range, 13 hours to 8 days). A sterile control tube was also processed. For each, the portion of the endotracheal tube that had been in contact with the subglottis was determined using a previously published nomogram. A 1-cm-long cross-sectional segment of the endotracheal tube corresponding to the level of the subglottis was divided into 2 portions for both electron microscopy and aerobic/anaerobic cultures. Two of 9 (22%) luminal surface cultures grew Staphylococcus species, 1 (11%) grew normal flora, and 6 (66%) had no growth. Three of 9 (33%) outer-surface cultures grew Staphylococcus species, 1 (11%) had gram-negative rods on staining but a sterile culture, and one enterococcal contaminant was found. Electron microscopy revealed that 8 of 9 inner lumen surfaces harbored bacteria and biofilm formation. All outer lumen surfaces had biofilm formation; 6 of 9 had bacterial colonization. There was no obvious difference in the appearance of the inner and outer tube surface accretions. No time-dependent differences were noted except of the longest indwelling tube (8 days). This study demonstrates for the first time the presence of biofilm on the outer surface of neonatal endotracheal tubes. The data suggest that the presence of bacteria and/or biofilm does not correlate with other traditional indicators of microbial colonization.

  18. To assess the efficacy of i-gel for ventilation, blind tracheal intubation and nasogastric tube insertion.

    PubMed

    Bhandari, Geeta; Shahi, K S; Asad, Mohd; Parmar, Nitish Kumar; Bhakuni, Rajni

    2013-01-01

    The i-gel is a novel supraglottic airway device with a soft and non-inflatable cuff. In our study we attempted to evaluate the performance of i-gel as a ventilatory device, as a conduit to blind tracheal intubation using conventional polyvinyl chloride tracheal tube and gastric tube insertion through it. A total of 180 patients of American Society of Anesthesiologist (ASA) physical status I/II undergoing elective surgery under general anesthesia were included in this study. After induction of anesthesia, i-gel was inserted and the following parameters were recorded: Time taken for successful i-gel insertion, airway leak pressures, ease of gastric tube insertion and laryngeal view using fiberscope. Following this blind tracheal intubation was attempted. First attempt and overall success rate in blind tracheal intubation and gastric tube insertion were evaluated and tracheal intubation time was measured. Also presence of any side effects or complication following removal was recorded. We achieved a 100% success rate in insertion of i-gel and in 171 out of 180 patients; i-gel was inserted in the 1(st) attempt itself. We also were able to achieve an overall success rate for blind endotracheal intubation via i-gel in 78.33% cases, and successful gastric tube placement was possible in 92.22%. In our study we also achieved a leak pressure of 25.52 (±2.33) cm of H2O. I-gel may be effectively used for ventilation, nasogastric tube insertion and as a conduit to blind endotracheal intubation with minimal complication and acceptable airway sealing pressures.

  19. Biofilm formation on coated silicone tympanostomy tubes.

    PubMed

    Ojano-Dirain, Carolyn P; Silva, Rodrigo C; Antonelli, Patrick J

    2013-02-01

    Tympanostomy tube (TT) surface modifications have been promoted as a means of reducing biofilm formation, otorrhea, and occlusion. The goal of this study was to determine if biofilm formation on silicone TTs could be prevented by commercially available surface coatings. Silicone TTs with and without polyvinylpyrrolidone (PVP) or/and silver oxide were exposed to human plasma and cultured with Pseudomonas aeruginosa or Staphylococcus aureus (22 TTs per group). After 4 days, antibiotics were added to kill planktonic bacteria. Biofilm formation was assessed by quantitative bacterial counts and scanning electron microscopy. PVP, silver, and PVP-silver coatings reduced P. aeruginosa biofilm formation relative to silicone by over 1 log (p<0.0001). PVP was superior to silver (p=0.04) and PVP-silver (p<0.0001). PVP and PVP-silver coatings increased S. aureus biofilm formation nominally (p=0.01 & 0.003). PVP and silver coatings reduce P. aeruginosa biofilm formation on silicone TTs. Combining PVP and silver coatings does not further improve biofilm resistance. TT surface coatings warrant further study through clinical trials. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  20. Contamination from electrically conductive silicone tubing during aerosol chemical analysis

    SciTech Connect

    Yu, Yong; Alexander, M. L.; Perraud, Veronique; Bruns, Emily; Johnson, Stan; Ezell, Michael J.; Finlayson-Pitts, Barbara J.

    2009-06-01

    Electrically conductive silicone tubing is used to minimize losses in sampling lines during the analysis of airborne particle size distributions and number concentrations. We report contamination from this tubing using gas chromatography-mass spectrometry (GC-MS) of filter-collected samples as well as by particle mass spectrometry. Comparison of electrically conductive silicone and stainless steel tubing showed elevated siloxanes only for the silicone tubing. The extent of contamination increased with length of tubing to which the sample was exposed, and decreased with increasing relative humidity.

  1. An in-tube radar for detecting cracks in metal tubing

    SciTech Connect

    CAFFEY,THURLOW W. H.; NASSERSHARIF,BAHRAM; GARCIA,GABE V.; SMITH,PHILLIP R.; JEDLICKA,RUSSELL P.; HENSEL,EDWARD C.

    2000-06-12

    A major cause of failures in heat exchangers and steam generators in nuclear power plants is degradation of the tubes within them. The tube failure is often caused by the development of cracks that begin on the outer surface of the tube and propagate both inwards and laterally. A new technique will be described for detection of defects using a continuous-wave radar device within metal tubing. The technique is 100% volumetric, and may find smaller defects, find them more rapidly, and find them less expensively than present methods. Because this project was started only recently, there is no demonstrated performance to report so far. However, the basic engineering concepts will be presented together with a description of the milestone tasks and dates.

  2. In-tube magnetic solid phase microextraction of some fluoroquinolones based on the use of sodium dodecyl sulfate coated Fe3O4 nanoparticles packed tube.

    PubMed

    Manbohi, Ahmad; Ahmadi, Seyyed Hamid

    2015-07-23

    In-tube magnetic solid phase microextraction (in-tube MSPME) of fluoroquinolones from water and urine samples based on the use of sodium dodecyl sulfate (SDS) coated Fe3O4 nanoparticles packed tube has been reported. After the preparation of Fe3O4 nanoparticles (NPs) by a batch synthesis, these NPs were introduced into a stainless steel tube by a syringe and then a strong magnet was placed around the tube, so that the Fe3O4 NPs were remained in the tube and the tube was used in the in-tube SPME-HPLC/UV for the analysis of fluoroquinolones in water and urine samples. Plackett-Burman design was employed for screening the variables significantly affecting the extraction efficiency. Then, the significant factors were more investigated by Box-Behnken design. Calibration curves were linear (R(2)>0.990) in the range of 0.1-1000μgL(-1) for ciprofloxacin (CIP) and 0.5-500μgL(-1) for enrofloxacin (ENR) and ofloxacin (OFL), respectively. LODs for all studied fluoroquinolones ranged from 0.01 to 0.05μgL(-1). The main advantages of this method were rapid and easy automation and analysis, short extraction time, high sensitivity, possibility of fully sorbent collection after analysis, wide linear range and no need to organic solvents in extraction. Copyright © 2015 Elsevier B.V. All rights reserved.

  3. Identifying and Managing a Malpositioned Endotracheal Tube Bite Block in an Orotracheally Intubated Patient: A Case Report.

    PubMed

    Chou, Hui-Ling; Ruan, Sheng-Yuan; Wu, Huey-Dong

    2016-03-01

    The universal bite block is increasingly used in orotracheally intubated patients. Here, we report a case of pilot tube dysfunction caused by a malpositioned universal bite block in an orotracheally intubated patient. We summarize the key points on identifying and managing a malpositioned universal bite block from this case and literature review.A 74-year-old woman was emergently intubated during an episode of hyperkalemia-related cardiac arrest. A universal bite block was used for fixing the endotracheal tube. After her condition stabilized, ventilator weaning was attempted; however, a positive cuff-leak test result was observed.The cuff-leak test revealed a lack of elasticity of the pilot balloon, which was completely deflated after 2 mL of air was removed. Pilot tube dysfunction was highly suspected. The bite block was slightly pulled out, and 8 mL of air was aspirated from the pilot tube. The patient was successfully extubated without stridor and respiratory distress.Our case highlighted that a malpositioned bite block may obstruct the pilot tube, causing unfavorable consequences. While fixing the bite block on an endotracheal tube, it is crucial to ensure that the takeoff point of the pilot tube is located within the C-notch of the bite block.

  4. Prediction of in-tube pressure drop of low GWP refrigerants during condensation and evaporation

    NASA Astrophysics Data System (ADS)

    Khan, Md. Masud Rana; Hossain, Md. Anowar; Afroz, Hasan M. M.; Miyara, Akio

    2017-06-01

    In the present work, a new in-tube two phase pressure drop correlation of low GWP refrigerants during condensation and evaporation has been proposed in this paper. This correlation for the prediction of condensation and evaporation pressure drop inside smooth horizontal tube by incorporating the effect of mass velocity, tube geometry and surface tension. By comparing with other existing well-known correlations and the newly proposed correlation of two-phase pressure drop have been used to predict the condensation and evaporation pressure drop of R1234ze(E), R32, R410A, dimethyl ether (DME), CO2/DME mixtures (10/90, 25/75 and 45/55 weight %) and R1234ze(E)/R32 mixtures (30/70 and 45/55 weight %) inside a horizontal smooth tube. The predicted results have been compared with the available experimental data which is done inside a water heated double tube heat exchanger. The test section is a horizontally installed smooth tube with effective length of 3.6m and inner diameter of 4.35mm. The experiment had been carried out under the conditions of mass flux varying from 147 to 403 kgm-2s-1 and the saturation temperatures ranging between 30 and 45°C for condensation and 5-10°C for evaporation, over the vapor quality range 0.00 to 1.00. From the analysis and results of comparison, proposed correlation shows better performance. Proposed correlation can predict all the experimental condensation and evaporation data within ±13.91%.

  5. [Intubation of a patient with rheumatoid arthritis with a 7.5-mm-ID armored endotracheal tube using a laryngeal mask airway].

    PubMed

    Mashio, H; Kojima, T; Goda, Y; Kawahigashi, H; Ito, Y; Kato, M

    1997-12-01

    A 71-year-old male patient with rheumatoid arthritis was scheduled for posterior fusion of the cervical spine. He showed limited cervical movement and atrophic mandible. Tracheal intubation was difficult in his last anesthetic management for the same surgery. This time, we planned a special procedure for predicted difficult tracheal intubation. After induction of general anesthesia, a size-4 laryngeal mask airway was inserted. Next, a flexible fiberscope sheathed with a 6.0-mm-ID cuffed endotracheal tube was inserted through a laryngeal mask airway into the trachea, and the fiberscope was withdrawn. Then, an endotracheal tube changer was inserted through the endotracheal tube. The laryngeal mask airway and the endotracheal tube were withdrawn simultaneously leaving the tube changer. Finally, a 7.5-mm-ID armored endotracheal tube was inserted through the tube changer. The procedure applied in this case is a safe and reliable intubating method in patients with difficult tracheal intubation.

  6. Paramedic Intubation Experience Is Associated With Successful Tube Placement but Not Cardiac Arrest Survival.

    PubMed

    Dyson, Kylie; Bray, Janet E; Smith, Karen; Bernard, Stephen; Straney, Lahn; Nair, Resmi; Finn, Judith

    2017-09-01

    Paramedic experience with intubation may be an important factor in skill performance and patient outcomes. Our objective is to examine the association between previous intubation experience and successful intubation. In a subcohort of out-of-hospital cardiac arrest cases, we also measure the association between patient survival and previous paramedic intubation experience. We analyzed data from Ambulance Victoria electronic patient care records and the Victorian Ambulance Cardiac Arrest Registry for January 1, 2008, to September 26, 2014. For each patient case, we defined intubation experience as the number of intubations attempted by each paramedic in the previous 3 years. Using logistic regression, we estimated the association between intubation experience and (1) successful intubation and (2) first-pass success. In the out-of-hospital cardiac arrest cohort, we determined the association between previous intubation experience and patient survival. During the 6.7-year study period, 769 paramedics attempted intubation in 14,857 patients. Paramedics typically performed 3 intubations per year (interquartile range 1 to 6). Most intubations were successful (95%), including 80% on the first attempt. Previous intubation experience was associated with intubation success (odds ratio 1.04; 95% confidence interval 1.03 to 1.05) and intubation first-pass success (odds ratio 1.02; 95% confidence interval 1.01 to 1.03). In the out-of-hospital cardiac arrest subcohort (n=9,751), paramedic intubation experience was not associated with patient survival. Paramedics in this Australian cohort performed few intubations. Previous experience was associated with successful intubation. Among out-of-hospital cardiac arrest patients for whom intubation was attempted, previous paramedic intubation experience was not associated with patient survival. Copyright © 2017 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

  7. Randomized study comparing the efficacy of a self-retaining bicanaliculus intubation stent with Crawford intubation in patients with canalicular obstruction

    PubMed Central

    Tabatabaie, Syed Ziaeddin; Rajabi, Mohammad Taher; Rajabi, Mohammad Bagher; Eshraghi, Bahram

    2012-01-01

    Background The purpose of this study was to compare the efficacy of self-retaining stent (SRS) bicanalicular intubation with bicanalicular silicone (Crawford) intubation in patients with canalicular and punctal obstruction. Methods In this prospective, randomized clinical trial, 38 patients with canalicular or punctal obstruction (25 partial, 13 complete) and epiphora were randomized into two groups. Twenty-one patients (14 with partial and seven with complete obstruction) underwent SRS intubation and 17 patients underwent bicanalicular silicon intubation in a randomized fashion. Results After a mean follow-up of 6 months following tube removal, 16 (76%, 12 partial, four complete) of the 21 eyes in the SRS intubation group and 13 (76%, 10 partial, three complete) in the bicanalicular silicon intubation group had a successful outcome and remained symptom-free. For partial obstructions, the success rate was 85% and 90% for the SRS and bicanalicular silicon intubation groups, respectively. The corresponding values for complete obstruction were 63% and 50% for the SRS and bicanalicular silicon intubation groups, respectively. Conclusion SRS could effectively substitute for a more extensive procedure such as bicanalicular silicon intubation in patients with canalicular obstruction, particularly those with partial obstruction. The newly developed SRS intubation procedure has the advantages of simple, easy implementation and extubation, low cost, and a lower rate of trauma when compared with bicanalicular silicon intubation. PMID:22259230

  8. An organically modified silica aerogel for online in-tube solid-phase microextraction.

    PubMed

    Bu, Yanan; Feng, Juanjuan; Tian, Yu; Wang, Xiuqin; Sun, Min; Luo, Chuannan

    2017-09-29

    Aerogels have received considerable attentions because of its porous, high specific surface, unique properties and environmental friendliness. In this work, an organically modified silica aerogel was functionalized on the basalt fibers (BFs) and filled into a poly(ether ether ketone) (PEEK) tube, which was coupled with high performance liquid chromatography (HPLC) for in-tube solid-phase microextraction (IT-SPME). The aerogel was characterized by scanning electron microscopy (SEM) and fourier transform infrared spectrometry (FT-IR). The extraction efficiency of the tube was systematically investigated and shown enrichment factors from 2346 to 3132. An automated, sensitive and selective method was developed for the determination of five estrogens. The linear range was from 0.03 to 100μgL(-1) with correlation coefficients (r) higher than 0.9989, and low detection limits (LODs) were 0.01-0.05μgL(-1). The relative standard deviations (RSDs) for intra-day and inter-day were less than 4.5% and 6.7% (n=6), respectively. Finally, the analysis method was successfully applied to detect estrogens in sewage and emollient water samples. Copyright © 2017 Elsevier B.V. All rights reserved.

  9. Endotracheal Tube Cuff Pressures in Patients Intubated Prior to Helicopter EMS Transport

    PubMed Central

    Tennyson, Joseph; Ford-Webb, Tucker; Weisberg, Stacy; LeBlanc, Donald

    2016-01-01

    Introduction Endotracheal intubation is a common intervention in critical care patients undergoing helicopter emergency medical services (HEMS) transportation. Measurement of endotracheal tube (ETT) cuff pressures is not common practice in patients referred to our service. Animal studies have demonstrated an association between the pressure of the ETT cuff on the tracheal mucosa and decreased blood flow leading to mucosal ischemia and scarring. Cuff pressures greater than 30 cmH2O impede mucosal capillary blood flow. Multiple prior studies have recommended 30 cmH2O as the maximum safe cuff inflation pressure. This study sought to evaluate the inflation pressures in ETT cuffs of patients presenting to HEMS. Methods We enrolled a convenience sample of patients presenting to UMass Memorial LifeFlight who were intubated by the sending facility or emergency medical services (EMS) agency. Flight crews measured the ETT cuff pressures using a commercially available device. Those patients intubated by the flight crew were excluded from this analysis as the cuff was inflated with the manometer to a standardized pressure. Crews logged the results on a research form, and we analyzed the data using Microsoft Excel and an online statistical analysis tool. Results We analyzed data for 55 patients. There was a mean age of 57 years (range 18–90). The mean ETT cuff pressure was 70 (95% CI= [61–80]) cmH2O. The mean lies 40 cmH2O above the maximum accepted value of 30 cmH2O (p<0.0001). Eighty-four percent (84%) of patients encountered had pressures above the recommended maximum. The most frequently recorded pressure was >120 cmH2O, the maximum pressure on the analog gauge. Conclusion Patients presenting to HEMS after intubation by the referral agency (EMS or hospital) have ETT cuffs inflated to pressures that are, on average, more than double the recommended maximum. These patients are at risk for tracheal mucosal injury and scarring from decreased mucosal capillary blood flow

  10. Endotracheal Tube Cuff Pressures in Patients Intubated Prior to Helicopter EMS Transport.

    PubMed

    Tennyson, Joseph; Ford-Webb, Tucker; Weisberg, Stacy; LeBlanc, Donald

    2016-11-01

    Endotracheal intubation is a common intervention in critical care patients undergoing helicopter emergency medical services (HEMS) transportation. Measurement of endotracheal tube (ETT) cuff pressures is not common practice in patients referred to our service. Animal studies have demonstrated an association between the pressure of the ETT cuff on the tracheal mucosa and decreased blood flow leading to mucosal ischemia and scarring. Cuff pressures greater than 30 cmH2O impede mucosal capillary blood flow. Multiple prior studies have recommended 30 cmH2O as the maximum safe cuff inflation pressure. This study sought to evaluate the inflation pressures in ETT cuffs of patients presenting to HEMS. We enrolled a convenience sample of patients presenting to UMass Memorial LifeFlight who were intubated by the sending facility or emergency medical services (EMS) agency. Flight crews measured the ETT cuff pressures using a commercially available device. Those patients intubated by the flight crew were excluded from this analysis as the cuff was inflated with the manometer to a standardized pressure. Crews logged the results on a research form, and we analyzed the data using Microsoft Excel and an online statistical analysis tool. We analyzed data for 55 patients. There was a mean age of 57 years (range 18-90). The mean ETT cuff pressure was 70 (95% CI= [61-80]) cmH2O. The mean lies 40 cmH2O above the maximum accepted value of 30 cmH2O (p<0.0001). Eighty-four percent (84%) of patients encountered had pressures above the recommended maximum. The most frequently recorded pressure was >120 cmH2O, the maximum pressure on the analog gauge. Patients presenting to HEMS after intubation by the referral agency (EMS or hospital) have ETT cuffs inflated to pressures that are, on average, more than double the recommended maximum. These patients are at risk for tracheal mucosal injury and scarring from decreased mucosal capillary blood flow. Hospital and EMS providers should use ETT cuff

  11. Direct Laryngoscopy and Endotracheal Intubation Complicated by Anterior Tracheal Laceration Secondary to Protrusion of Preloaded Endotracheal Tube Stylet.

    PubMed

    Warner, Matthew A; Fox, Jonathan F

    2016-02-15

    Tracheal wall disruption is a rare complication of endotracheal intubation, typically occurring in the posterior (membranous) trachea lacking cartilaginous support. We present the case of a 68-year-old man who developed an anterior tracheal tear after routine endotracheal intubation, most likely occurring secondary to protrusion of a factory-preloaded stylet beyond the distal orifice of the endotracheal tube. Tracheal disruption should be considered in any patient with subcutaneous emphysema and respiratory distress after tracheal extubation and confirmed with bronchoscopy. Conservative management may be appropriate for those with small tears, hemodynamic stability, and the ability to isolate the tear from positive pressure ventilation.

  12. Prompt correction of endotracheal tube positioning after intubation prevents further inappropriate positions.

    PubMed

    Rigini, Nugzar; Boaz, Mona; Ezri, Tiberiu; Evron, Shmuel; Trigub, Dimitry; Jackobashvilli, Simon; Izakson, Alexander

    2011-08-01

    To determine whether the timely correction of endotracheal tube (ETT) positioning prevents further inappropriate positions. Prospective crossover study. University-affiliated hospital. 44 adult, ASA physical status 1, 2, and 3 patients undergoing open or laparoscopic abdominal procedures. ETT positioning was verified by both auscultation and fiberoptic bronchoscopy (FOB), after intubation, and before extubation. In laparoscopic procedures, two additional measurements were performed: after maximal abdominal gas insufflation and with head-down position. An ETT in the bronchus or at the carina was considered an inappropriate placement. An ETT ≤ one cm from the carina was considered a critical placement. The frequency of inappropriate and critical ETT positioning with both auscultation and FOB and the number of ETTs that remained in an incorrect position despite repositioning. FOB detected 5 inappropriately positioned ETTs, 4 of which were also detected by chest auscultation (P = 0.99). Critical positioning was detected by FOB in 6 patients, three of which were also detected by auscultation (P = 0.24). There were 15 other "out-of-desired range" positions (out of the 3-5 cm range) - one placed too high and 14 placed too low, while 18 were placed within the range of positions. All patients with inappropriate ETT positioning were women (P = 0.005). Age, body mass index, Mallampati grade > 3, thyromental distance < 6 cm, or laryngoscopy grade ≥ 2 were not associated with either inappropriate or critical placement. No episodes of inappropriate or critical positioning were detected by FOB or auscultation at the end of surgery. Early detection and prompt correction of inappropriate ETT positioning after intubation prevented further ETT migration into undesired positions. Copyright © 2011 Elsevier Inc. All rights reserved.

  13. Suctioning via the tube during endotracheal intubation in a model of severe upper airway haemorrhage: is there an advantage vs. suctioning with a separate catheter?

    PubMed

    Mitterlechner, Thomas; Wipp, Artur; Paal, Peter; Strasak, Alexander M; Wenzel, Volker; Felbinger, Thomas W; Schmittinger, Christian A

    2011-06-01

    In a model of severe simulated upper airway haemorrhage, we compared two techniques of performing endotracheal intubation: (1) suctioning via the endotracheal tube during laryngoscopy with subsequently advancing the endotracheal tube, and (2) the standard intubation strategy with performing laryngoscopy, and performing suction with subsequently advancing the endotracheal tube. Forty-one emergency medical technicians intubated the trachea of a manikin with severe simulated airway haemorrhage using each technique in random order. There was no significant difference in the number of oesophageal intubations between suctioning via the tube and the standard intubation strategy [8/41 (20%) vs. 6/41 (15%); P = 0.688], but suctioning via the endotracheal tube needed significantly more time [median (IQR, CI 95%): 42 (20, 39-60) vs. 33 (15, 35-48)s; P = 0.015]. Suctioning via the endotracheal tube showed no benefit regarding the number of oesophageal intubations and needed more time when compared to the standard intubation strategy. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  14. A styletted tracheal tube with a posterior-facing bevel reduces epistaxis during nasal intubation: a randomized trial.

    PubMed

    Sugiyama, Kazuna; Manabe, Yozo; Kohjitani, Atsushi

    2014-05-01

    Epistaxis is a common complication of nasal intubation. Ease of insertion of the tracheal tube may be influenced by bevel orientation and tip bending. We examined ease of insertion and epistaxis with two tubes with different orientations and with or without a stylet to modify tip bending. Two hundred patients scheduled to undergo oral or maxillofacial surgery were randomized into four groups according to method of nasal intubation used after induction of anesthesia. In one group, a Portex(®) tracheal tube was inserted with bevel facing left (Portex Group). In the second group, a Parker Flex-Tip(®) tube (Parker Group) was inserted with the bevel facing posteriorly, and in the last two groups, a stylet bent at 60° anteriorly was used with the Portex tube (Stylet-Portex Group) or Parker tube (Stylet-Parker Group). When the tube advanced without resistance, insertion was defined as "smooth", and when resistance was encountered, insertion was defined as "impinged". Severity of epistaxis was evaluated as none, mild, moderate, or severe. Smooth insertion was observed in 60% of patients in the Portex Group; 80% in the Parker Group; 100% in the Stylet-Portex Group; and 100% in the Stylet-Parker Group. Epistaxis was found in 50%, 24%, 20%, and 4% of patients, respectively. The styletted tip (difference: 30%; 95% confidence interval [CI]: 20.3 to 38.5; P < 0.0001) was found to improve ease of insertion. Both the posterior-facing bevel (difference: 21%; 95% CI: 9.0 to 32.1; P = 0.0005) and stylet (difference: 25%; 95% CI: 13.1 to 35.9; P < 0.0001) contributed significantly to absence of epistaxis. Using a styletted tracheal tube with a posterior-facing bevel improves ease of insertion through the nasopharynx and decreases the severity of epistaxis during nasal intubation. UMIN Clinical Trials Registry (UMIN-CTR), UMIN000011327.

  15. Array capillary in-tube solid-phase microextraction: a rapid preparation technique for water samples.

    PubMed

    Yan, Xiaohui; Wu, Dapeng; Peng, Hong; Ding, Kun; Duan, Chunfeng; Guan, Yafeng

    2012-06-29

    A rapid sample preparation technique, namely array capillary in-tube solid-phase microextraction (ACIT-SPME) for direct extraction of organic pollutants from water samples, was developed and evaluated. The ACIT-SPME cartridge consisted of a bundle of glass capillary tubes of 0.5 mm I.D. × 30mm contained inside a quartz liner of 4 mm I.D. The high ratio of cross-section area of channel-to-wall allowed water sample flow through the cartridge just under gravity. Both the internal/external surfaces of the array capillary tubing were coated with extraction phase of 2-5 μm in thickness, which provided large extraction surface area up to 30 cm² for a cartridge containing 19 glass capillaries. The large surface area and thin extraction phase improved greatly both the mass transfer process of extraction and the thermo desorption process, leading to fast extraction and fast desorption. The extracted analytes were thermally desorbed in a homemade thermal desorption unit (TDU), which was coupled to a gas chromatograph equipped with a flame ionization detector for analysis. By using polydimethylsiloxane (PDMS) as the extraction phase and polycyclic aromatic hydrocarbons (PAHs) as the model analytes, the performance of the ACIT-SPME cartridge was systematically investigated. The extraction time was 2 min for 350 mL of water sample, and detection limits were between 0.8 and 1.7 ng/L with deviation of 2.8-9.7% RSD. Relative recoveries of analytes for real water samples were between 65.0% and 116%. The extraction time can even be further shortened to 10s for 250 mL sample by applying vacuum at the outlet of the cartridge, with detection limits of 2.2-5.3 ng/L and deviation of 4.0-12% RSD.

  16. [Comparison of two shaping methods for double-lumen endotracheal tube intubation by Shikani optical stylet laryngoscope].

    PubMed

    Xu, T; Li, M; Xu, M; Guo, X Y

    2016-12-18

    To compare the efficacy and safety of two different shaping methods for double-lumen endotracheal tube (DLT).DLT was shaped with the rod of a Shikani optical stylet (SOS) with the tracheal orifice aligned with the convex aspect of the distal curvature or the concave aspect of the distal curvature. Patients scheduled for elective thoracic surgery and required intubation with a left-sided DLT were enrolled in this study. They were randomized into two groups. They were intubated with a DLT, which was shaped with the rod of a SOS with its tracheal orifice aligned with the convex aspect of the distal curvature (group T) or the concave aspect of the distal curvature (group U). Time for SOS manipulation, intubation attempts, intubation resistance score, malposition of bronchial intubation, time for fiberoptic bronchoscope (FOB) identification of bronchial placement, total intubation time and oral mucosal or dental injury were recorded. Hoarseness and throat sore of the patients were evaluated 1 hour and 24 hours after surgery. A total of 136 patients completed the study, with 68 in each group. Time for SOS manipulation was significantly shorter in group U [(35.1±6.1) s vs. 39.6±11.8) s, P=0.007]. First attempt success rate did not differ between the groups (92.6% vs.88.2%, P=0.561). Intubation resistance score was significantly lower in group U. Group T had fewer patients who suffered malposition of bronchial intubation than group U (4 vs.13, P=0.020) and cost less time for FOB identification of bronchial placement [(44.1±20.9) s vs.(53.6±29.2) s, P=0.032]. Total intubation time and the incidence of oral mucosal or dental injury did not differ between the groups. The severity and incidence of hoarseness were lower in group U than in group T 1 hour after surgery. The severity and incidence of sore throat were lower in group U than in group T 1 hour and 24 hours postoperatively. When lacing a left-sided DLT using a SOS, shaping the DLT with the tracheal orifice aligned

  17. [Ring-intubation set for bicanalicular intubation (Murube del Castillo technic)].

    PubMed

    Ruprecht, K W

    1983-12-01

    A new intubation set for the lacrimal canaliculi is described. The set consists of a silicon tube 0.64 mm thick containing a 4-0 Suturamid conducting filament. The silicon tube is conical and is attached to the filament with glue. Thus, the entire system can be introduced very easily into the lacrimal punctae and through the canaliculi in the way described by Murube del Castillo.

  18. Ease of intubation with the Parker Flex-Tip or a standard Mallinckrodt endotracheal tube using a video laryngoscope (GlideScope).

    PubMed

    Radesic, Brian P; Winkelman, Chris; Einsporn, Richard; Kless, Jack

    2012-10-01

    Two endotracheal tubes (ETTs) are available for use in operative suites for intubation: the Parker Flex-Tip (PFT, Parker Medical) and the standard Mallinckrodt (Covidien). To the authors' knowledge, no study has compared these 2 ETTs with each other when the anesthesia provider uses the GlideScope video laryngoscope (Verathon) for intubation. The purpose of the study was to determine if there are differences related to ease of intubation reported by anesthesia providers who use the PFT tube compared with the standard tube while using the GlideScope. The study was a randomized block intervention design. The sample consisted of 58 observed intubations in an operating room setting. Data analysis was completed with a 2-factor analysis of covariance using 2 covariates. The PFT tube in suboptimal conditions demonstrated a significantly greater ease of intubation, as measured by decreased time for ETT insertion and greater ease of ETT insertion score. The number of redirections at the glottis to intubate the trachea once the glottis was visualized was not statistically different. Based on the findings from this study, anesthesia providers may want to consider the use of the PFT tube when using the GlideScope to promote ease of intubation.

  19. Blast Wave Formation by Laser-Sustained Nonequilibrium Plasma in the Laser-Driven In-Tube Accelerator Operation

    SciTech Connect

    Ogino, Yousuke; Ohnishi, Naofumi; Sawada, Keisuke; Sasoh, Akihiro

    2006-05-02

    Understanding the dynamics of laser-produced plasma is essentially important for increasing available thrust force in a gas-driven laser propulsion system such as laser-driven in-tube accelerator. A computer code is developed to explore the formation of expanding nonequilibrium plasma produced by laser irradiation. Various properties of the blast wave driven by the nonequilibrium plasma are examined. It is found that the blast wave propagation is substantially affected by radiative cooling effect for lower density case.

  20. Headspace in-tube microextraction coupled with micellar electrokinetic chromatography of neutral aromatic compounds.

    PubMed

    Cho, Sung Min; Park, Bum Su; Jung, Woo Sung; Lee, Sang Won; Jung, Yunhwan; Chung, Doo Soo

    2016-02-01

    Headspace (HS) extraction can be carried out easily and aptly via single drop microextraction coupled with capillary electrophoresis (CE). However, one drawback is the difficulty of keeping the single drop stably at the capillary tip. To solve this problem, we have recently demonstrated HS in-tube microextraction (ITME) of acidic compounds such as chlrophenols in an acidic sample using a basic run buffer plug in the separation capillary for CE as an acceptor phase. In this report, an organic acceptor plug in a capillary was used to extract neutral organic volatile pollutants such as BTEX (benzene, toluene, ethylbenzene, and m-xylene). After extraction, the analytes enriched in the organic acceptor plug were analyzed with micellar electrokinetic chromatography (MEKC). The enrichment factors for BTEX in a standard solution were up to 350 under an optimal condition of 25°C for 20 min. As an application, BTEX spiked into bottled water were analyzed with HS-ITME-MEKC, and the enrichment factors for BTEX were up to 320. The limits of detections were 1-4 ppb, which are at least 200 times lower than the US Environmental Protection Agency guidelines for drinking water, except benzene. The entire procedure of HS-ITME-MEKC was carried out automatically using a commercial CE instrument.

  1. In-tube extraction for the determination of the main volatile compounds in Physalis peruviana L.

    PubMed

    Kupska, Magdalena; Jeleń, Henryk H

    2017-01-01

    An analytical procedure based on in-tube extraction followed by gas chromatography with mass spectrometry has been developed for the analysis of 24 of the main volatile components in cape gooseberry (Physalis peruviana L.) samples. According to their chemical structure, the compounds were organized into different groups: one hydrocarbon, one aldehyde, four alcohols, four esters, and 14 monoterpenes. By single-factor experiments, incubation temperature, incubation time, extraction volume, extraction strokes, extraction speed, desorption temperature, and desorption speed were determined as 60°C, 20 min, 1000 μL, 20, 50:50 μL/s, 280°C, 100 μL/s, respectively. Quantitative analysis using authentic standards and external calibration curves was performed. The limit of detection and limit of quantification for the analytical procedure were calculated. Results shown the benzaldehyde, ethyl butanoate, 2-methyl-1-butanol, 1-hexanol, 1-butanol, α-terpineol, and terpinen-4-ol were the most abundant volatile compounds in analyzed fruits (68.6-585 μg/kg). The obtained data may contribute to qualify cape gooseberry to the group of superfruits and, therefore, increase its popularity. © 2016 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  2. Nasogastric Tube Insertion in Anesthetized Intubated Patients Undergoing Laparoscopic Hysterectomies: A Comparative Study of Three Techniques.

    PubMed

    Siddhartha, B S Vijay; Sharma, N G Anish; Kamble, Shashank; Shankaranarayana, P

    2017-01-01

    Insertion of a nasogastric tube (NGT) in an anesthetized, comatose intubated patient is not always as easy as in a conscious, cooperative patient. Various techniques have been tried with varying success. The aim of this randomized study was to compare and evaluate the two techniques of NGT insertion with the conventional technique of insertion with respect to success rate, time taken for insertion and adverse effects. Patients admitted for laparoscopic hysterectomy were chosen and then were divided into three equal groups of forty each, by randomized technique. Group C included patients in whom conventional method was used to insert NGT. Group R where reverse Sellick's technique was used. Group F where neck flexion with lateral pressure was used. Both the techniques were better than the conventional method. Among both the techniques, reverse Sellick's technique was the best method but not without adverse effects. The required insertion time was very less and success in the first attempt was more in the group where reverse Sellick's was used. Modified techniques of NGT insertion were better than the conventional method. Further studies after eliminating major limitations are required to really find a superior technique.

  3. Magnetism-Enhanced Monolith-Based In-Tube Solid Phase Microextraction.

    PubMed

    Mei, Meng; Huang, Xiaojia; Luo, Qing; Yuan, Dongxin

    2016-02-02

    Monolith-based in-tube solid phase microextraction (MB/IT-SPME) has received wide attention because of miniaturization, automation, expected loading capacity, and environmental friendliness. However, the unsatisfactory extraction efficiency becomes the main disadvantage of MB/IT-SPME. To overcome this circumstance, magnetism-enhanced MB/IT-SPME (ME-MB/IT-SPME) was developed in the present work, taking advantage of magnetic microfluidic principles. First, modified Fe3O4 nanoparticles were mixed with polymerization solution and in situ polymerized in the capillary to obtain a magnetic monolith extraction phase. After that, the monolithic capillary column was placed inside a magnetic coil that allowed the exertion of a variable magnetic field. The effects of intensity of magnetic field, adsorption and desorption flow rate, volume of sample, and desorption solvent on the performance of ME-MB/IT-SPME were investigated in detail. The analysis of six steroid hormones in water samples by the combination of ME-MB/IT-SPME with high-performance liquid chromatography with diode array detection was selected as a paradigm for the practical evaluation of ME-MB/IT-SPME. The application of a controlled magnetic field resulted in an obvious increase of extraction efficiencies of the target analytes between 70% and 100%. The present work demonstrated that application of different magnetic forces in adsorption and desorption steps can effectively enhance extraction efficiency of MB/IT-SPME systems.

  4. A paediatric tube and capsule for suction biopsy of the small intestinal mucosa designed for direct nasogastric intubation

    PubMed Central

    Schneider, R. E.; Chang, R.

    1971-01-01

    The use of a modified paediatric tube and capsule for suction biopsy of the mucosa of the small intestine is discussed. The tube is small in diameter and can be introduced through the nose without local trauma and with minimal discomfort. The intubation technique was followed in 72 instances to obtain suction biopsies from the proximal mucosa of the small intestine in protein-calorie malnourished children, and the results obtained with this instrument are also presented. ImagesFig. 1Fig. 2 PMID:5112174

  5. Epistaxis during nasotracheal intubation: a randomized trial of the Parker Flex-Tip™ nasal endotracheal tube with a posterior facing bevel versus a standard nasal RAE endotracheal tube.

    PubMed

    Earle, Rosie; Shanahan, Enda; Vaghadia, Himat; Sawka, Andrew; Tang, Raymond

    2017-04-01

    Nasotracheal intubation is a widely performed technique to facilitate anesthesia induction during oral, dental, and maxillofacial surgeries. The technique poses several risks not encountered with oropharyngeal intubation, most commonly epistaxis due to nasal mucosal abrasion. The purpose of this study was to test whether the use of the Parker Flex-Tip™ (PFT) nasal endotracheal tube (ETT) with a posterior facing bevel reduces epistaxis when compared with the standard nasal RAE ETT with a leftward facing bevel. Sixty American Society of Anesthesiologists physical status I and II patients undergoing oral or maxillofacial surgery with nasotracheal intubation were recruited. Patients were randomized to either a standard nasal RAE ETT or a PFT nasal ETT. The ETT was thermosoftened and lubricated for both study groups prior to insertion, and the size of the tube was chosen at the discretion of the attending anesthesiologist. The primary outcome was the incidence of epistaxis, with a secondary outcome of epistaxis severity (scored as none, mild, moderate, or severe). An investigator measured both outcomes five minutes after intubation was completed. Mild or moderate epistaxis was experienced by 22 of 30 (73%) patients in the PFT group compared with 21 of 30 (70%) patients in the standard nasal RAE ETT group (absolute risk reduction, 3%; 95% confidence interval, -19 to 25; P = 0.78). There were no occurrences of severe epistaxis in either group. There was no difference in the incidence or severity of epistaxis following nasal intubation using the Parker Flex-Tip nasal ETT when compared with a standard nasal RAE ETT. This trial was registered at ClinicalTrials.gov, identifier: NCT02315677.

  6. A feasibility study on bedside upper airway ultrasonography compared to waveform capnography for verifying endotracheal tube location after intubation

    PubMed Central

    2013-01-01

    Background In emergency settings, verification of endotracheal tube (ETT) location is important for critically ill patients. Ignorance of oesophageal intubation can be disastrous. Many methods are used for verification of the endotracheal tube location; none are ideal. Quantitative waveform capnography is considered the standard of care for this purpose but is not always available and is expensive. Therefore, this feasibility study is conducted to compare a cheaper alternative, bedside upper airway ultrasonography to waveform capnography, for verification of endotracheal tube location after intubation. Methods This was a prospective, single-centre, observational study, conducted at the HRPB, Ipoh. It included patients who were intubated in the emergency department from 28 March 2012 to 17 August 2012. A waiver of consent had been obtained from the Medical Research Ethics Committee. Bedside upper airway ultrasonography was performed after intubation and compared to waveform capnography. Specificity, sensitivity, positive and negative predictive value and likelihood ratio are calculated. Results A sample of 107 patients were analysed, and 6 (5.6%) had oesophageal intubations. The overall accuracy of bedside upper airway ultrasonography was 98.1% (95% confidence interval (CI) 93.0% to 100.0%). The kappa value (Κ) was 0.85, indicating a very good agreement between the bedside upper airway ultrasonography and waveform capnography. Thus, bedside upper airway ultrasonography is in concordance with waveform capnography. The sensitivity, specificity, positive predictive value and negative predictive value of bedside upper airway ultrasonography were 98.0% (95% CI 93.0% to 99.8%), 100% (95% CI 54.1% to 100.0%), 100% (95% CI 96.3% to 100.0%) and 75.0% (95% CI 34.9% to 96.8%). The likelihood ratio of a positive test is infinite and the likelihood ratio of a negative test is 0.0198 (95% CI 0.005 to 0.0781). The mean confirmation time by ultrasound is 16.4 s. No adverse effects

  7. QuantiFERON–TB Gold In-Tube test performance in Denmark.

    PubMed

    Hermansen, Thomas; Lillebaek, Troels; Hansen, Ann-Brit E; Andersen, Peter H; Ravn, Pernille

    2014-12-01

    Little is known about the QuantiFERON-TB Gold In-Tube Test (QFT) in extreme age groups. The test performance has been reported to be impaired in children and elderly, but reports are diverging. The aim of this study was to evaluate QFT performance in patients with and without Tuberculosis (TB). A retrospective study analysing the results of 18,850 QFT performed in Denmark 2005-2010. The effect of age, sex, localisation of TB, and result of culture on QFT performance (positive, negative and indeterminate results) was determined. Among 383 patients with TB, indeterminate rate was low (3.9%, 15/383). Sensitivity was high (86.1%, 317/368) and not affected by sex or localization of TB disease, but declined with increasing age (p < 0.0001). In children 1-4 years old, sensitivity was high (100%, 9/9). Among 15,709 persons without TB, the indeterminate rate was 5.1% (804/15,709) and significantly higher in infants <1 year (15.6%, 5/32) and elderly >65 years (8.1%, 219/2715) compared to the adult population 15-64 years (4.5%, 552/12,317). Indeterminate results were due to a low positive control in 99.6% (801/804). In Denmark, a TB low incidence country, the overall QFT performance was good. The sensitivity in children (≥ 1) was high although few children were included, whereas sensitivity declined with increasing age. Indeterminate rates were higher in infants and elderly. In contrast to current guidelines, our data suggest that the QFT performs well in children ≥ 1 years in low endemic regions but that the test should be used with care among the elderly.

  8. Novel and simple headspace in-tube microextraction coupled with capillary electrophoresis.

    PubMed

    Lee, Hye Ryeo; Cho, Sung Min; Kim, Jihye; Chung, Doo Soo

    2014-06-13

    In liquid phase microextraction, high enrichment factors can be obtained using an acceptor phase of small volume. By hanging an acceptor drop at the separation capillary tip, single drop microextraction (SDME) can be in-line coupled with capillary electrophoresis (CE). The small surface-to-volume ratio of the drop enables high enrichment factors to be obtained in a short time. One practical issue in SDME is how to keep the drop attached to the capillary stable. Here, we present novel but extremely simple in-tube microextraction (ITME) using the liquid inside the capillary as an acceptor phase, without forming a drop at the capillary tip. As a first example, ITME has been combined with headspace (HS) extraction. Simply by placing a capillary filled with a basic run buffer in the HS above an acidic donor solution, volatile acidic analytes were extracted into the acceptor phase in the capillary. After extraction, electrophoresis of the extracts in the capillary was carried out. Owing to the robust nature of the acceptor phase, the extraction temperature and time ranges of HS-ITME can be extended significantly, compared to HS-SDME. The enrichment factors for chlorophenols in a standard solution were up to 1100 under an optimal HS-ITME condition of 80°C for 15min and the limits of detections (LODs) obtained by monitoring the absorbance at 214nm were about 4nM. The whole procedures of HS-ITME-CE were carried out automatically using built-in programs of a commercial CE instrument.

  9. Quantiferon-TB Gold In-Tube Improves Tuberculosis Diagnosis in Children.

    PubMed

    Petrucci, Roberta; Lombardi, Giulia; Corsini, Ilaria; Bacchi Reggiani, Maria Letizia; Visciotti, Francesca; Bernardi, Filippo; Landini, Maria Paola; Cazzato, Salvatore; Dal Monte, Paola

    2017-01-01

    The diagnostic accuracy of Quantiferon-TB Gold In-Tube (QFT-IT) is uncertain in the pediatric population, while tuberculin skin test (TST) is still conventionally used despite its limitations. The aim of this study was to compare the performance of QFT-IT with TST in a large cohort of children screened for tuberculosis (TB) infection because of contact tracing, suspected TB, arrival from endemic country or immunosuppressive therapy. A retrospective analysis was conducted on 517 children 0-14 years of age evaluated at the pediatric unit of the S. Orsola-Malpighi University Hospital of Bologna, Italy; 366 of them were also tested with TST. Results were analyzed for Calmette-Guérin bacillus vaccination, country of origin, reason for testing, diagnosis and age. The overall agreement between the 2 tests was 89.9%, but it was highly affected by Calmette-Guérin bacillus vaccination (P < .0001). According to diagnosis and age, QFT-IT detected latent tuberculous infection cases better than TST in all age groups. Sensitivity for diagnosing active TB in symptomatic children was higher for QFT-IT than TST (93.3% vs. 86.5%), especially in children younger than 2 years, while specificity was high for both tests (99.3% and 98.8%, respectively). Low rate of indeterminate QFT-IT results (3.9%) was not differently distributed among age groups, but was associated with diagnosis of TB exclusion (P < 0.0001), mainly pneumonia (35%), and to Italian children (P = 0.0024). Despite the concern about the use of QFT-IT in children because of their immature immune system, our results suggest the preferential use of QFT-IT as a support tool for diagnosis and management of TB, even in infants.

  10. The QuantiFERON-TB Gold In-Tube Assay in Neuro-Ophthalmology.

    PubMed

    Little, Leanne M; Rigi, Mohammed; Suleiman, Ayman; Smith, Stacy V; Graviss, Edward A; Foroozan, Rod; Lee, Andrew G

    2017-09-01

    Although QuantiFERON-TB Gold In-Tube (QFT-GIT) testing is regularly used to detect infection with Mycobacterium tuberculosis, its utility in a patient population with a low risk for tuberculosis (TB) has been questioned. The following is a cohort study analyzing the efficacy of QFT-GIT testing as a method for detection of active TB disease in low-risk individuals in a neuro-ophthalmologic setting. Ninety-nine patients from 2 neuro-ophthalmology centers were identified as having undergone QFT-GIT testing between January 2012 and February 2016. Patients were divided into groups of negative, indeterminate, and positive QFT-GIT results. Records of patients with positive QFT-GIT results were reviewed for development of latent or active TB, as determined by clinical, bacteriologic, and/or radiographic evidence. Of the 99 cases reviewed, 18 patients had positive QFT-GIT tests. Of these 18 cases, 12 had documentation of chest radiographs or computed tomography which showed no evidence for either active TB or pulmonary latent TB infection (LTBI). Four had chest imaging which was indicative of possible LTBI. None of these 18 patients had symptoms of active TB and none developed active TB within the follow-up period. Based on our results, we conclude that routine testing with QFT-GIT in a low-risk cohort did not diagnose active TB infection. We do not recommend routine QFT-GIT testing for TB low-risk individuals, as discerned through patient and exposure history, ocular examination, and clinical judgment, in neuro-ophthalmology practice.

  11. Flexible bronchoscopic intubation through the AuraGain™ laryngeal mask versus a slit Guedel tube: a non-inferiority randomized-controlled trial.

    PubMed

    Moser, Berthold; Audigé, Laurent; Keller, Christian; Brimacombe, Joseph; Gasteiger, Lukas; Bruppacher, Heinz R

    2017-07-17

    AuraGain(TM), a novel third-generation laryngeal mask, can facilitate insertion of a gastric tube and provide the potential advantage of intubation. Data are lacking on intubation through the AuraGain laryngeal mask. Eighty-eight hip or knee surgery patients were enrolled in this parallel randomized-controlled trial. We hypothesized that intubation time using the AuraGain laryngeal mask would be no longer than that for standard flexible bronchoscopic intubation over a slit Guedel tube, with a non-inferiority margin of five seconds. The following data were recorded during a maximum of three intubation attempts: intubation time, number of intubation attempts, degree of resistance to advance the endotracheal tube, and mask placement (i.e., Brimacombe score). Follow-up outcomes, including neck pain, hoarseness, and dysphagia, were also measured two and 24 hr postoperatively. Patients and outcome assessors remained blinded until the last examination. Mean intubation time was similar between the Guedel tube and AuraGain groups (23.6 sec vs 21.4 sec, respectively). The upper limit of the 95% confidence interval (CI) of the difference in mean intubation time between groups fell below our pre-specified non-inferiority margin; therefore, we found the AuraGain laryngeal mask to be non-inferior to the slit Guedel tube (adjusted group difference, -1.6 sec; 95% CI, -3.7 to 0.5). Successful intubation was achieved in the majority of patients (≥ 95%) in each group on the first attempt. No resistance to insertion of the endotracheal tube was encountered in the majority of patients in each group, and no complications were reported during the 24-hr postoperative period. There was no difference in the Brimacombe score or in the status of postoperative morbidity between the two groups. We conclude that flexible bronchoscopic intubation through an AuraGain laryngeal mask can be achieved at least as fast as standard bronchoscopic intubation without contributing to additional patient

  12. Determination of fluoroquinolones in eggs using in-tube solid-phase microextraction coupled to high-performance liquid chromatography.

    PubMed

    Huang, Jing-Fang; Lin, Bo; Yu, Qiong-Wei; Feng, Yu-Qi

    2006-03-01

    A simple, rapid, and sensitive method using in-tube solid-phase microextraction (in-tube SPME) based on poly(methacrylic acid-ethylene glycol dimethacrylate) (MAA-EGDMA) monolith coupled to HPLC with fluorescence and UV detection was developed for the determination of five fluoroquinolones (FQs). Ofloxacin (OFL), norfloxacin (NOR), ciprofloxacin (CIP), enrofloxacin (ENRO), and sarafloxacin (SARA) can be enriched and determined in the spiked eggs and albumins. CIP/ENRO in eggs and albumins of ENRO-treated hens were also studied using the proposed method. Only homogenization, dilution, and centrifugation were required before the sample was supplied to the in-tube microextraction, and no organic solvents were consumed in the procedures. Under the optimized extraction conditions, good extraction efficiency for the five FQs was obtained with no matrix interference in the process of extraction and the subsequent chromatographic separation. The detection limits (S/N=3) were found to be 0.1-2.6 ng g(-1) and 0.2-2.4 ng g(-1) in whole egg and egg albumin, respectively. Good linearity could be achieved over the range 2-500 ng mL(-1) for the five FQs with regression coefficients above 0.9995 in both whole egg and albumin. The reproducibility of the method was evaluated at three concentration levels, with the resulting relative standard deviations (RSDs) less than 7%. The method was successfully applied to the analysis of ENRO and its primary metabolite CIP in the eggs and albumins of ENRO-treated hens.

  13. Comparison of McGRATH MAC and Macintosh laryngoscopes for double-lumen endotracheal tube intubation by anesthesia residents: a prospective randomized clinical trial.

    PubMed

    Kido, Haruki; Komasawa, Nobuyasu; Matsunami, Sayuri; Kusaka, Yusuke; Minami, Toshiaki

    2015-09-01

    This study aimed to compare the utility of McGRATH MAC (McG) and Macintosh (McL) laryngoscopes for double-lumen endotracheal tube intubation in patients undergoing elective surgery. Randomized clinical trial. Operating room. Fifty adult patients scheduled for elective surgery under 1-lung ventilation with American Society of Anesthesiologists physical status 1 to 3. Double-lumen endotracheal tube intubation was performed with the McG (McG group; 25 patients) or conventional McL (McL group; 25 patients) laryngoscope by anesthesia residents. The number of attempts to successful intubation, intubation time, percentage of glottis opening score, and subjective difficulty of laryngoscopy and tube passage through the glottis were assessed. The total numbers of intubation attempts were 1 (McG group, 24 patients; McL group, 16 patients), 2 (McG group, 1 patient; McL group, 8 patients), and 3 (McG group, 0 patient; McL group, 1 patient), with significant differences between the two groups (P = .018). Intubation time was significantly shorter in the McG group compared with the McL group (McG: 17.1 ± 4.6 seconds vs McL: 20.8 ± 5.9 seconds, P = .026). The percentage of glottis opening score was significantly higher in the McG group compared with the McL group (McG: 88.4% ± 13.7% vs McL: 71.4% ± 20.4%, P = .004). The McG demonstrated a better intubation profile compared with the McL, possibly due to its ease of use for double-lumen endotracheal tube intubation. Clinical Trial registry number: UMIN000014636. Copyright © 2015 Elsevier Inc. All rights reserved.

  14. To characterize the incidence of airway misplacement of nasogastric tubes in anesthetized intubated patients by using a manometer technique.

    PubMed

    Hsieh, Shao-Wei; Chen, Hung-Shu; Chen, Yi-Ting; Hung, Kuo-Chuan

    2017-04-01

    This study characterized the incidence of airway misplacement of nasogastric (NG) tubes in surgical patients, and the benefit of using a manometer to discriminate gastric placement from airway placement of NG tubes. Subjects included adult patients scheduled for abdominal surgery. After tracheal intubation, a 16 Fr. NG tube was inserted blindly through the nostril, and its position was assessed using the auscultation (10-ml air insufflation) or manometer (attached to NG tubes) techniques. Briefly, a biphasic pressure change synchronous with airway pressure during mechanical ventilation indicated airway misplacement. The presence of a notable pressure change while compressing the epigastric area indicated a gastric placement. A surgeon made the final confirmation of NG tube placement within the stomach using manual palpation of the tube immediately after laparotomy. The first-attempt success rate was 82.7 % in 104 patients. There were 29 misplacements of 130 attempted insertions (oral cavity, n = 23; trachea, n = 3; distal esophagus, n = 3). The incidence of airway misplacement was 2.9 % (3 of 104 cases). For confirmation of gastric placement, the auscultation technique had a sensitivity of 100.0 % and a specificity of 79.3 %. In contrast, the manometer technique had a sensitivity of 100.0 % and a specificity of 100.0 % in the discrimination of gastric placement from airway placement of NG tubes. Airway misplacement of NG tubes is not uncommon in surgical patients, and the manometer technique may be a reliable and safe method to discriminate gastric placement from airway placement of NG tubes.

  15. Application of silicon image tubes (SIVIT and SIT) to ground-based astronomy

    NASA Technical Reports Server (NTRS)

    Westphal, J. A.

    1973-01-01

    Studies conducted with ordinary silicon target tubes (SIVIT) and with silicon intensified tubes (SIT) are described. The operational characteristics of each type are given along with the advantages and disadvantages in various applications.

  16. Development of a cheap and accessible carbon fibers-in-poly(ether ether ketone) tube with high stability for online in-tube solid-phase microextraction.

    PubMed

    Feng, Juanjuan; Sun, Min; Bu, Yanan; Luo, Chuannan

    2016-02-01

    Carbon fibers (CFs) are one kind of important industrial materials that can be obtained commercially at low price. Based on the high extraction efficiency of carbon sorbents, a cheap and accessible carbon fibers-in-poly(ether ether ketone) (PEEK) tube was developed for online in-tube solid-phase microextraction (SPME) method. Coupled to high performance liquid chromatography (HPLC), the CFs-in-tube SPME was applied to analyze eight polycyclic aromatic hydrocarbons (PAHs) in environmental aqueous samples. Extraction conditions (sampling rate, extraction time, methanol content) and desorption time were investigated for optimization of conditions. Under the optimum conditions, the CFs-in-tube SPME-HPLC method provided high extraction efficiency with enrichment factors up to 1748. Good linearity (0.05-50 μg L(-1), 0.5-50 μg L(-1)) and low detection limits (0.01-0.1 μg L(-1)) were also obtained. The online analysis method was finally applied to determine several model PAHs analytes in real environmental aqueous samples. Some target analytes were detected and relative recoveries were in the range of 92.3-111%. Due to natural chemical stability of carbon fibers and PEEK tube, the CFs-in-tube device exhibited high resistance to organic solvent, acid and alkaline conditions.

  17. Comparison of rabbit facial nerve regeneration in nerve growth factor-containing silicone tubes to that in autologous neural grafts.

    PubMed

    Spector, J G; Lee, P; Derby, A; Roufa, D G

    1995-11-01

    Previous reports suggest that nerve growth factor (NGF) enhanced nerve regeneration in rabbit facial nerves. We compared rabbit facial nerve regeneration in 10-mm silicone tubes prefilled with NGF or cytochrome C (Cyt C), bridging an 8-mm nerve gap, to regeneration of 8-mm autologous nerve grafts. Three weeks following implantation, NGF-treated regenerates exhibited a more mature fascicular organization and more extensive neovascularization than Cyt C-treated controls. Morphometric analysis at the middle of the tube of 3- and 5-week regenerates revealed no significant difference in the mean number of myelinated or unmyelinated axons between NGF- and Cyt C-treated implants. However, when the numbers of myelinated fibers in 5-week regenerates were compared to those in their respective preoperative controls, NGF-treated regenerates had recovered a significantly greater percentage of myelinated axons than Cyt C-treated implants (46% versus 18%, respectively). The number of regenerating myelinated axons in the autologous nerve grafts at 5 weeks was significantly greater than the number of myelinated axons in the silicone tubes. However, in the nerve grafts the majority of the axons were found in the extrafascicular connective tissue (66%). The majority of these myelinated fibers did not find their way into the distal nerve stump. Thus, although the number of regenerating myelinated axons within the nerve grafts is greater than that of axons within silicone tube implants, functional recovery of autologous nerve graft repairs may not be superior to that of intubational repairs.

  18. Tube-Furnace Production of Silicon

    NASA Technical Reports Server (NTRS)

    Farrier, E. G.; Rexer, J.; Timmel, P. J.

    1982-01-01

    Packed-bed reactor produces silicon by decomposing ultrapure silane gas in temperature gradient. Based on previous experiments with relatively low decomposition temperatures and with temperature gradients, heterogeneous decomposition will produce few fines. Fines produced are screened out and reinserted into furnace.

  19. Self-propelled in-tube shuttle and control system for automated measurements of magnetic field alignment

    NASA Astrophysics Data System (ADS)

    Boroski, W. N.; Nicol, T. H.; Pidcoe, S. V.; Zink, R. A.

    1990-03-01

    A magnetic field alignment gauge is used to measure the field angle as a function of axial position in each of the magnets for the Superconducting Super Collider (SSC). Present measurements are made by manually pushing the gauge through the magnet bore tube and stopping at intervals to record field measurements. Gauge location is controlled through graduation marks and alignment pins on the push rods. Field measurements are recorded on a logging multimeter with tape output. Described is a computerized control system being developed to replace the manual procedure for field alignment measurements. The automated system employs a pneumatic walking device to move the measurement gauge through the bore tube. Movement of the device, called the Self-Propelled In-Tube Shuttle (SPITS), is accomplished through an integral, gas driven, double-acting cylinder. The motion of the SPITS is transferred to the bore tube by means of a pair of controlled, retractable support feet. Control of the SPITS is accomplished through an RS-422 interface from an IBM-compatible computer to a series of solenoid-actuated air valves. Direction of SPITS travel is determined by the air-valve sequence, and is managed through the control software. Precise axial position of the gauge within the magnet is returned to the control system through an optically-encoded digital position transducer attached to the shuttle. Discussed is the performance of the transport device and control system during preliminary testing of the first prototype shuttle.

  20. Comparison of the performance of 'Intubating LMA' and 'Cobra PLA' as an aid to blind endotracheal tube insertion in patients scheduled for elective surgery under general anesthesia.

    PubMed

    Darlong, Vanlal; Chandrashish, Chakravarty; Chandralekha; Mohan, Virender Kumar

    2011-03-01

    Supraglottic airways (SGA) through which blind endotracheal intubation is made possible is an area of considerable interest. Our study aimed at comparing the Cobra Perilaryngeal Airway (CPLA) with the Intubating Laryngeal Mask Airway (ILMA) with regard to the performance of the former as a conduit for facilitating blind endotracheal intubation. American Society of Anesthesiologists (ASA) I-II patients consenting to the study, with no predictors of difficult airway, scheduled for elective surgery were randomized into two groups of 30 each. Anesthesia was induced with fentanyl, propofol and vecuronium. CPLA was inserted in Group I and ILMA in Group II. Fibreoptic scoring of the laryngeal view was done through the SGA. Blind intubation through either CPLA or ILMA was then carried out with cuffed polyvinyl chloride (PVC) tube in Group I and ILMA-tracheal tube in Group II. Demographic and surgical data were comparable between the two groups. The success rate of intubation (87% through CPLA and 90% through ILMA) (p value 1), number of attempts made and the fibreoptic scores (p value 0.12) were comparable between the two groups. Insertion time was significantly longer in Group I as compared with Group II (9 s vs. 4 s; p value 0.004). Trauma and sore throat were more common in Group I (p value -0.1, 0.19 respectively). Hemodynamic monitoring showed more tachycardia during CPLA insertion as compared with ILMA (p value 0.006). We conclude that CPLA can be used as an effective conduit for blind endotracheal intubation with cuffed PVC tube and has comparable efficacy in tracheal intubation as that with ILMA. Copyright © 2011. Published by Elsevier B.V.

  1. Analysis of phthalate contamination in infusion solutions by automated on-line in-tube solid-phase microextraction coupled with high-performance liquid chromatography.

    PubMed

    Mitani, Kurie; Izushi, Fumio; Kataoka, Hiroyuki

    2004-10-01

    Contamination of infusion solutions with phthalates was analyzed, and its origin was determined. Phthalates were determined by on-line in-tube solid-phase microextraction coupled with high-performance liquid chromatography (in-tube SPME-HPLC) with UV detection. In-tube SPME is an extraction technique for organic compounds in aqueous samples, in which analytes are extracted from the sample directly into an open tubular capillary by repeated draw/eject cycles of sample solution. The infusion solutions were used without any pretreatment, and the phthalates in these solutions were automatically analyzed by the on-line in-tube SPME-HPLC system. The limits of detection of phthalates in the infusion solutions were 1-10 ng/mL. With a few exceptions, the recoveries of phthalates added to the infusion solutions were above 80%. Di-n-butyl phthalate (DBP) was detected at a concentration of 7-60 ng/mL in most infusion solutions in plastic containers but was not detected in those in glass bottles. On the other hand, no other phthalates were detected in infusion solutions in either plastic or glass containers. Large amounts of DBP were detected in the adhesive used to affix the paper labels to the plastic bottles and bags, but not in the plastic containers themselves. Furthermore, DBP was shown to be readily eluted from the adhesive into water and alcohol and easily pass through the plastic. These results indicated that the source of the DBP was the adhesive used to affix the paper labels, and DBP contaminated the infusion solutions by passing through the plastic. The in-tube SPME-HPLC method is simple and rapid and provides a useful tool for the screening and determination of phthalate contamination in infusion solutions.

  2. Selective molecularly imprinted polymer combined with restricted access material for in-tube SPME/UHPLC-MS/MS of parabens in breast milk samples.

    PubMed

    Souza, Israel D; Melo, Lidervan P; Jardim, Isabel C S F; Monteiro, Juliana C S; Nakano, Ana Marcia S; Queiroz, Maria Eugênia C

    2016-08-17

    A new molecularly imprinted polymer modified with restricted access material (a hydrophilic external layer), (MIP-RAM) was synthesized via polymerization in situ in an open fused silica capillary. This stationary phase was used as sorbent for in-tube solid phase microextraction (in-tube SPME) to determine parabens in breast milk samples by ultra-high-performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS). Scanning electron micrographs (SEM) illustrate MIP surface modification after glycerol dimethacrylate (hydrophilic monomer) incorporation. The interaction between parabens and MIP-RAM was investigated by Fourier-transform infrared (FTIR) spectroscopy. The Scatchard plot for MIP-RAM presented two linear parts with different slopes, illustrating binding sites with high- and low-affinity. Endogenous compounds exclusion from the MIP-RAM capillary was demonstrated by in-tube SPME/LC-UV assays carried out with blank milk samples. The in-tube SPME/UHPLC-MS/MS method presented linear range from 10 ng mL(-1) (LLOQ) to 400 ng mL(-1) with coefficients of determination higher than 0.99, inter-assay precision with coefficient of variation (CV) values ranging from 2 to 15%, and inter-assay accuracy with relative standard deviation (RSD) values ranging from -1% to 19%. Analytical validation parameters attested that in-tube SPME/UHPLC-MS/MS is an appropriate method to determine parabens in human milk samples to assess human exposure to these compounds. Analysis of breast milk samples from lactating women demonstrated that the proposed method is effective. Copyright © 2016 Elsevier B.V. All rights reserved.

  3. Comparison of the GlideScope and the McGrath method using vascular forceps and a tube exchanger in cases of simulated difficult airway intubation

    PubMed Central

    Shim, Jae-Hang; Jeon, Woo Jae; Choe, Gyu Ho

    2016-01-01

    Background A "difficult airway" can be simulated with an extrication collar, which restricts cervical motion and mouth opening. The purpose of this study is to compare the efficacy of the GlideScope and the McGrath in difficult airway simulation. Methods Patients were randomized using computer-generated numbers and were placed into the GlideScope group or the McGrath group. The total intubation time was defined as the time measured from when the anesthesiologist picks up the device to the time at which three successive end-tidal CO2 values are acquired after intubation. Results There was no significant difference in total intubation time between the two groups (73.0 ± 25.3 sec vs. 72.3 ± 20.9 sec, P = 0.92). The success rates of the first intubation attempt did not differ between the two groups (82.8% vs. 83.3%, P = 0.95). Conclusions Our results suggest that there are no significant differences in the intubations with GlideScope and McGrath using vascular forceps and tube exchangers in difficult intubation scenarios. PMID:27066203

  4. Custom prefabrication of silicone tubes from urinary catheters for experimental peripheral nerve surgery

    PubMed Central

    Saray, Aydin

    2004-01-01

    The entubulation principle represents a neurobiological approach to nerve surgery in which the role of the surgeon is limited and intrinsic healing capabilities of the nerve play the primary role. Herein, a technique for fabricating custom-made silicone tubes from a silicone urinary catheter is described. Silicone tubes with varying size and dimensions can be tailored depending on the diameter of the silicone urinary catheter (14 F to 18 F). Tubes crafted from silicone urinary catheters were used either as a nerve conduit to facilitate regeneration or as compressive nerve banding to simulate compressive neuropathy in the rat sciatic nerve. Custom-made silicone tubes have similar pros and cons to the commercially available silicone tubes regarding the capsule and foreign body reaction. It can be concluded that these cost effective tubes can be easily cut and used in experimental peripheral nerve surgery in developing countries where the cost of such materials becomes an important issue for the researchers. PMID:24115867

  5. Electroplating of nanostructured polyaniline-polypyrrole composite coating in a stainless-steel tube for on-line in-tube solid phase microextraction.

    PubMed

    Asiabi, Hamid; Yamini, Yadollah; Seidi, Shahram; Esrafili, Ali; Rezaei, Fatemeh

    2015-06-05

    In this work, a novel and efficient on-line in-tube solid phase microextraction method followed by high performance liquid chromatography was developed for preconcentration and determination of trace amounts of parabens. A nanostructured polyaniline-polypyrrole composite was electrochemically deposited on the inner surface of a stainless steel tube and used as the extraction phase. Several important factors that influence the extraction efficiency, including type of solid-phase coating, extraction and desorption times, flow rates of the sample solution and eluent, pH, and ionic strength of the sample solution were investigated and optimized. Under the optimal conditions, the limits of detection were in the range of 0.02-0.04 μg L(-1). This method showed good linearity for parabens in the range of 0.07-50 μg L(-1), with coefficients of determination better than 0.998. The intra- and inter-assay precisions (RSD%, n=3) were in the range of 5.9-7.0% and 4.4-5.7% at three concentration levels of 2, 10, and 20 μg L(-1), respectively. The extraction recovery values for the spiked samples were in the acceptable range of 80.3-90.2%. The validated method was successfully applied for analysis of methyl-, ethyl-, and propyl parabens in some water, milk, and juice samples. Copyright © 2015 Elsevier B.V. All rights reserved.

  6. [Results and complications of bicanalicular intubation in external dacryocystorhinostomy].

    PubMed

    Vieira, Gisele Scholte de Souza; Xavier, Maria Emília

    2008-01-01

    To analyze the success rate and complications in patients with lacrimal obstruction submitted to surgeries. The data of patients operated in the "Hospital do Servidor Público Estadual of São Paulo" were analyzed. The lacrimal intubation was performed with a silicone tube, removed after 8 weeks. Surgeries were considered successful in those cases where patients had no postoperative epiphora or ocular secretion, and with a good passage of fluid to the nose or oropharynx. The complications related to the silicone tube were grouped in a table. The patients were operated from April 2002 to July 2006 with an average follow-up period of three months. In a total of 65 eyes, success was obtained in 89.2% of the cases. Seven patients presented postoperative epiphora, and 5 of them were reoperated. In 7 eyes there was an extrusion of the silicone in less than 15 days from surgery, and in this group one patient needed a reoperation. Six eyes presented complications with the silicone: tube prolapse (4 cases), granuloma formation in the nasal cavity (1 case) and lacrimal puncta adhesion (1 case). This group of patients presented a high success rate with Ex-DCR surgery associated with lacrimal intubation. The intraoperative intubation with silicone tube is not free of complications.

  7. A comparison of a traditional endotracheal tube versus ETView SL in endotracheal intubation during different emergency conditions: A randomized, crossover cadaver trial.

    PubMed

    Truszewski, Zenon; Krajewski, Paweł; Fudalej, Marcin; Smereka, Jacek; Frass, Michael; Robak, Oliver; Nguyen, Bianka; Ruetzler, Kurt; Szarpak, Lukasz

    2016-11-01

    Airway management is a crucial skill essential to paramedics and personnel working in Emergency Medical Services and Emergency Departments: Lack of practice, a difficult airway, or a trauma situation may limit the ability of paramedics to perform direct laryngoscopy during cardiopulmonary resuscitation. Videoscope devices are alternatives for airway management in these situations. The ETView VivaSight SL (ETView; ETView Ltd., Misgav, Israel) is a new, single-lumen airway tube with an integrated high-resolution imaging camera. To assess if the ETView VivaSight SL can be a superior alternative to a standard endotracheal tube for intubation in an adult cadaver model, both during and without simulated CPR. ETView VivaSight SL tube was investigated via an interventional, randomized, crossover, cadaver study. A total of 52 paramedics participated in the intubation of human cadavers in three different scenarios: a normal airway at rest without concomitant chest compression (CC) (scenario A), a normal airway with uninterrupted CC (scenario B) and manual in-line stabilization (scenario C). Time and rate of success for intubation, the glottic view scale, and ease-of-use of ETView vs. sETT intubation were assessed for each emergency scenario. The median time to intubation using ETView vs. sETT was compared for each of the aforementioned scenarios. For scenario A, time to first ventilation was achieved fastest for ETView, 19.5 [IQR, 16.5-22] sec, when compared to that of sETT at 21.5 [IQR, 20-25] sec (p = .013). In scenario B, the time for intubation using ETView was 21 [IQR, 18.5-24.5] sec (p < .001) and sETT was 27 [IQR, 24.5-31.5] sec. Time to first ventilation for scenario C was 23.5 [IQR, 19-25.5] sec for the ETView and 42.5 [IQR, 35-49.5] sec for sETT. In normal airways and situations with continuous chest compressions, the success rate for intubation of cadavers and the time to ventilation were improved with the ETView. The time to glottis view, tube insertion

  8. The Multiple Silicone Tube Device, “Tubes within a Tube,” for Multiplication in Nerve Reconstruction

    PubMed Central

    Dahlin, Lars B.

    2014-01-01

    Multiple nerve branches were created during the regeneration procedure after a nerve injury and such multiple branches are suggested to be used to control, for example, prosthesis with many degrees of freedom. Transected rat sciatic nerve stumps were inserted into a nine mm long silicone tube, which contained four, five mm long, smaller tubes, thus leaving a five mm gap for regenerating nerve fibers. Six weeks later, several new nerve structures were formed not only in the four smaller tubes, but also in the spaces in-between. The 7–9 new continuous nerve structures, which were isolated as individual free nerves after removal of the tubes, were delineated by a perineurium and contained both myelinated and unmyelinated nerve fibers as well as blood vessels. Stimulation of the proximal nerve elicited contractions in distal muscles. Thin metal electrodes, inserted initially into the smaller tubes in some experiments, became embedded in the new nerve structures and when stimulated contractions of the distal muscles were observed. The “tubes within a tube” technique, creating multiple new nerves from a single “mother” nerve, can be used to record multiple signals for prosthetic device control or as sources for supply of multiple denervated targets. PMID:24864255

  9. Custom built bite-block endotracheal tube holder for prolonged intubation.

    PubMed

    Sung, E C; Chung, E M; Park, J H

    2004-04-01

    This case report describes an intensive care patient with recurrent endotracheal tube occlusion due to biting. The use and fabrication of a new form of custom built bite-block to resolve these problems is described. The device described may also provide better access for mouth care and simplify airway management compared with bite-blocks commonly used.

  10. End-tidal capnography and upper airway ultrasonography in the rapid confirmation of endotracheal tube placement in patients requiring intubation for general anaesthesia.

    PubMed

    Abhishek, Chintamani; Munta, Kartik; Rao, S Manimala; Chandrasekhar, C N

    2017-06-01

    Confirmation of correct endotracheal tube placement is essential immediately after intubation for general anaesthesia. In this study, we have compared upper airway ultrasonography (USG) with reference to capnography for rapid confirmation of endotracheal tube placement after general anaesthesia. A prospective, single centre, observational study was conducted on 100 patients requiring tracheal intubation for general anaesthesia. Both capnography and upper airway USG were performed immediately after intubation to confirm the endotracheal tube (ETT) placement. Sensitivity, specificity, and positive and negative predictive values of upper airway USG were determined against capnography as the reference method. Agreement between the methods and time required to determine ETT placement by the two methods were assessed with kappa statistics and Student's t-test. Upper airway USG detected all five cases of oesophageal intubation, but could not detect five patients with correct tracheal intubation. Upper airway USG had a sensitivity of 96.84% (95% confidence interval [CI]: 94.25%-96.84%), specificity of 100% (95% CI: 50.6%-100%), positive predictive value of 100% (95% CI: 97.3%-100%) and negative predictive value of 62.5% (95% CI: 31.6%-62.5%). Kappa value was found to be 0.76, indicating a good agreement between upper airway USG and capnography for confirmation of ETT placement. Time taken for confirmation of ETT by capnography was 8.989 ± 1.043 s vs. 12.0 ± 1.318 s for upper airway USG (P < 0.001). Both capnography and upper airway USG may be used as primary procedures for the confirmation of ETT placement.

  11. Comparison of Medpor Coated Tear Drainage Tube versus Silicon Tear Drainage Tube in Conjunctivodacryocystorhinostomy: Problems and Solutions

    PubMed Central

    Sendul, Selam Yekta; Cagatay, Halil Huseyin; Dirim, Burcu; Demir, Mehmet; Yıldız, Ali Atakhan; Acar, Zeynep; Cinar, Sonmez; Guven, Dilek

    2014-01-01

    Purpose. This study aims at comparing two different types of drainage tubes in conjunctivodacryocystorhinostomy, which are used for upper lacrimal system obstruction or damage, with respect to their respective postoperative problems and solutions. Methods. Nineteen eyes of 17 patients who underwent conjunctivodacryocystorhinostomy (CDCR) or conjunctivorhinostomy (CR) surgery with a Medpor coated tear drainage tube or silicon tube placement between October, 2010, and February, 2014, were included in this retrospective comparative study. Results. In the initial surgery, Medpor coated tear drainage tubes were used in 11 eyes by CDCR, whereas silicon tear drainage tubes were implanted into 2 eyes by CR and 6 eyes by CDCR. In group 1, proximal and distal obstructions developed postoperatively in 4 eyes, while 1 eye showed tube malposition and 3 eyes developed luminal obstruction by debris 3 times. In group 2, tube extrusion developed in 4 eyes, whereas tube malposition developed in 6 eyes and luminal obstruction by debris developed in 6 eyes at different times, for a total of 20 times. Conclusions. In our study, the most significant complication we observed in the use of silicon tear drainage tubes was tube extrusion,whereas the leading complication related to the use of Medpor coated tear drainage tubes was tube obstruction. PMID:25379518

  12. Comparison of Medpor coated tear drainage tube versus silicon tear drainage tube in conjunctivodacryocystorhinostomy: problems and solutions.

    PubMed

    Sendul, Selam Yekta; Cagatay, Halil Huseyin; Dirim, Burcu; Demir, Mehmet; Yıldız, Ali Atakhan; Acar, Zeynep; Cinar, Sonmez; Guven, Dilek

    2014-01-01

    This study aims at comparing two different types of drainage tubes in conjunctivodacryocystorhinostomy, which are used for upper lacrimal system obstruction or damage, with respect to their respective postoperative problems and solutions. Nineteen eyes of 17 patients who underwent conjunctivodacryocystorhinostomy (CDCR) or conjunctivorhinostomy (CR) surgery with a Medpor coated tear drainage tube or silicon tube placement between October, 2010, and February, 2014, were included in this retrospective comparative study. In the initial surgery, Medpor coated tear drainage tubes were used in 11 eyes by CDCR, whereas silicon tear drainage tubes were implanted into 2 eyes by CR and 6 eyes by CDCR. In group 1, proximal and distal obstructions developed postoperatively in 4 eyes, while 1 eye showed tube malposition and 3 eyes developed luminal obstruction by debris 3 times. In group 2, tube extrusion developed in 4 eyes, whereas tube malposition developed in 6 eyes and luminal obstruction by debris developed in 6 eyes at different times, for a total of 20 times. In our study, the most significant complication we observed in the use of silicon tear drainage tubes was tube extrusion,whereas the leading complication related to the use of Medpor coated tear drainage tubes was tube obstruction.

  13. Clinical trial: a randomized study comparing the durability of silicone and latex percutaneous endoscopic gastrostomy tubes.

    PubMed

    Campoli, Paulo; Cardoso, Daniela; Turchi, Marilia; Mota, Orlando

    2011-04-01

    The use of percutaneous endoscopic gastrostomy (PEG) for nutrition support is increasing worldwide, but few studies have evaluated the durability of and complications related to the different materials used to manufacture gastrostomy tubes. Latex PEG tubes are widely used in our clinical setting, but no studies have compared their durability with silicone PEG tubes. The aim of the present study was to compare the durability of latex tubes with the durability of silicone tubes. A randomized clinical trial was conducted in patients with head and neck cancer with indications for PEG. Sixty patients were randomized to receive either latex or silicone PEG tubes and followed up for 90 days. The analyzed outcomes were duration, peristomal infection, granulated tissue formation, and leakage around the tube. The durability of silicone PEG tubes was significantly greater than the durability of latex PEG tubes. The survival curves showed that silicone PEG tubes lasted twice as long (hazard ratio = 2.0, 95% confidence interval = 1.1-3.7, P = 0.01). No differences were found with regard to rate of peristomal infection, granulated tissue formation, or leakage. Silicone PEG tubes are associated with a reduced need for replacement (attributable to higher durability) compared with latex PEG tubes. © 2010 The Authors. Digestive Endoscopy © 2010 Japan Gastroenterological Endoscopy Society.

  14. [Intubation Using a Double-lumen Tube with a Combination of Fiberoptic Bronchoscope and the Glidescope in a Patient with Difficult Airway].

    PubMed

    Tateura, Nao; Sato, Hiromi; Arai, Takero; Asai, Takashi; Okuda, Yasuhisa

    2015-08-01

    A 54-year-old man with lung cancer was scheduled for thoracoscopic upper lobe resection under general anesthesia. About half a year previously, he had undergone surgery for oropharyngeal cancer and tongue cancer. As a result of the surgery, elasticity of the neck skin bending of the neck were restricted (Mallampati classification IV). A narrow-bored tracheostomy tube (speech cannula) was inserted. In the operating room, the tip of a 5.0 mm ID standard tube was inserted from the tracheostomy tube, and connected to a breathing circuit. Anesthesia was induced with inhalation of sevoflurane, followed by intravenous propofol, fentanyl, and rocuronium. Four anesthesiologists were required to intubate the trachea. One person held the tracheal tube placed in the tracheotomy tube. The second person performed jaw thrusting. The third person inserted the Glidescope to shift the transplanted tongue to the side. It was then possible for the forth anesthesiologist to manage to see the glottis using a fiberoptic bronchoscope, and a double-lumen tube (DLT) could be inserted to the trachea orally. Inserting a DLT over the fiberoptic bronchoscope is a blind method, but we felt that combined with a variety of tools such as video laryngoscope, the success rate in intubation will increase.

  15. [Isolated rupture of the left main-stem bronchus during intubation with a Carlens tube].

    PubMed

    Ortolo, B; Sainte-Rose, G; Brémant, S; Lecoeur, J; Rouge, M

    1988-01-01

    A case is reported of bronchial rupture due to a Carlens double-lumen tube. A 73 year old male patient was to undergo a double right lower and middle lobectomy for carcinoma. All went well and as expected until 20 min after the start of left-sided unilateral ventilation by way of the double-lumen tube. A sudden increase in the inspiratory pressures led to the discovery, first, of a leak around the cuff, and then, air bubbles in the mediastinum. Surgical exploration showed up the 4 cm long rupture in the pars membrana of the left main bronchus through which the cuff was herniating. The patient was reintubated and the rupture surgically repaired. The right upper lobe had not been ventilated for 45 min and there were signs of micro-atelectasia. The immediate postoperative course was rather stormy, with severe cardiac failure, recurring right upper lobe atelectasia and bilateral pulmonary infection. The patient was only definitely weaned from the respirator 40 days after the surgical incident. Although such complications with double-lumen tubes are rare, they must be recognized and surgically repaired very rapidly. A few simple rules to prevent these complications are discussed.

  16. Determination of ochratoxins in nuts and grain samples by in-tube solid-phase microextraction coupled with liquid chromatography-mass spectrometry.

    PubMed

    Saito, Keita; Ikeuchi, Risa; Kataoka, Hiroyuki

    2012-01-13

    A simple and sensitive method for the determination of ochratoxins A and B in nuts and grain samples was developed using an automated in-tube solid-phase microextraction (SPME) coupled with liquid chromatography-mass spectrometry (LC-MS). Ochratoxins were separated within 5 min by high-performance liquid chromatography using an Inertsil ODS-3 column with 5mM anmonium acetate/acetonitrile (65/35, v/v) as the mobile phase. Electrospray ionization conditions in the positive ion mode were optimized for mass spectrometric detection of ochratoxins. The pseudo molecular ion [M+H](+) was used to detect ochratoxins with selected ion monitoring (SIM) mode. The optimum in-tube SPME conditions were 20 draw/eject cycles of 40 μL of sample using a Carboxen-1006 PLOT capillary column as an extraction device. The extracted ochratoxins were easily desorbed from the capillary by passage of the mobile phase, and no carryover was observed. Using the in-tube SPME/LC-MS with SIM method, good linearities of the calibration curves (r=0.9993 for ochratoxin A and r=0.9989 for ochratoxin B) were obtained in the concentration range from 0.5 to 20 ng/mL. The detection limits (S/N=3) for ochratoxins A and B were 92 and 89 pg/mL, respectively. The in-tube SPME method showed above 15-19-fold greater sensitivity than the direct injection method (10 μL injection). The within-day and between-day precisions (relative standard deviations) were below 5.1% and 7.7% (n=6), respectively. This method was applied successfully to analysis of nuts and grain samples without interference peaks. The recoveries of ochratoxins spiked into extraction solution from nut samples were above 88%. Ochratoxins were detected at 0.7-8.8 ng/g levels in various nuts and grain samples.

  17. In-tube extraction of volatile organic compounds from aqueous samples: an economical alternative to purge and trap enrichment.

    PubMed

    Laaks, Jens; Jochmann, Maik A; Schilling, Beat; Schmidt, Torsten C

    2010-09-15

    A novel in-tube extraction device (ITEX 2) for headspace sampling was evaluated for GC/MS analysis of aqueous samples. Twenty compounds of regulatory and drinking water quality importance were analyzed, including halogenated hydrocarbons, BTEX compounds (benzene, toluene, ethylbenzene, xylenes), fuel oxygenates, geosmin, and 2-methylisoborneol. Five commercially available sorbent traps were compared for their compound specific extraction yield. On the basis of the results, a mixed bed trap was prepared and evaluated. The extraction parameters were optimized to yield maximum sensitivity within the time of a GC run, to avoid unnecessary downtime of the system. Method detection limits of 1-10 ng L(-1) were achieved for volatile organic compounds (VOCs), which is much lower than demands by regulatory limit values. The performance of the ITEX system is similar to that of purge and trap systems, but it requires lower sample volumes and is less prone to contamination, much simpler, more flexible, and affordable. Average relative standard deviations below 10% were achieved for all analytes, and recoveries from spiked tap water samples were between 90% and 103%, mostly. The extraction is nonexhaustive, removing a fraction of 7% to 55% of the target compounds, depending on the air-water partitioning coefficients. The method was also tested with nonsynthetic samples, including tap, pond, and reservoir water and different soft drinks.

  18. Role of QuantiFERON(®)-TB Gold In-Tube in tuberculosis contact investigation: experience in a tuberculosis unit.

    PubMed

    Gonzślez-Moreno, Juan; García-Gasalla, Mercedes; Gállego-Lezaun, Cristina; Fernández-Baca, Victoria; Mir Viladrich, Isabel; Cifuentes-Luna, Carmen; Serrano Bujalance, Araceli; Salom Vallespir, Andrea; Payeras Cifre, Antoni

    2015-04-01

    Interferon-γ release assays (IGRAs) are increasingly used for the diagnosis of latent tuberculosis infection (LTBI). Because of the lack of a gold standard for the diagnosis of LTBI, IGRAs are compared to the tuberculin skin test (TST) and yield conflicting results. We assessed the usefulness of an IGRA test, QuantiFERON(®)-TB Gold In-Tube (QFT-G-IT), for diagnosing LTBI compared with TST in the setting of a contact screening study. A prospective comparison between the QFT-G-IT and the TST in TB contact subjects in a low TB burden area was conducted sequentially between January 2006 and December 2012. A moderate concordance between the two tests (κ = 0.44 for TST cut-off of 5 mm and κ = 0.56 for TST cut-off of 15 mm) was found. A better agreement was shown in younger contacts and in non-vaccinated contacts when using a TST of 15 mm. Independent risk factors for a TST(+)/QFT-G-IT(-) discordance were history of BCG vaccination and age between 31 and 59 years. Discordance was also more frequent using a TST cut-off value of 5 mm. QFT-G-IT(+)/TST(-) was infrequent and was found in older contacts. Based on our data, we cannot recommend the use of QFT-G-IT as the only test to rule out LTBI, especially in older patients.

  19. [Analysis of discordance between tuberculin test and QuantiFERON-TB® Gold In-Tube in studies of contacts].

    PubMed

    Ballaz, Aitor; Salinas, Carlos; Aguirre, Urko; López de Goicoechea, Maria José; Diez, Rosa; Egurrola, Mikel

    2013-04-15

    Our objective is to compare the tuberculin skin test (TST) and the QuantiFERON-TB(®) Gold In-Tube (QFT) in the diagnosis of latent tuberculosis infection (LTI) in a population of contacts of patients with pulmonary tuberculosis, and to analyze the influence of different variables in the discordance. From March 2008 to September 2010, among a population of 300,000 inhabitants of the Basque Country, we analyzed all contacts of patients with pulmonary tuberculosis. All patients underwent the TST and the value of QFT was measured. Sociodemographic variables and vaccination were examined and we analyzed the discordance between the 2 tests. Seven hundred and four were included in the study, with a mean age of 27 years. Of these, 397 were vaccinated, with similar proportion between native and foreign. Increasing the age to 59 years (odds ratio [OR] 10.53, P<.001), being foreign (OR 2.71, P=.02) and vaccination (OR 4.22, P<.001) were predictors of the discordance between a positive TST and negative QFT. It seems that the QFT, alone or combined with the TST, is a safe method for the diagnosis of LTI and its use would contribute to a more specific selection of individuals who would need preventive treatment. Copyright © 2012 Elsevier España, S.L. All rights reserved.

  20. QuantiFERON®-TB Gold In-Tube for contact screening in BCG-vaccinated adults: A longitudinal cohort study.

    PubMed

    Muñoz, Laura; Gonzalez, Lucia; Soldevila, Laura; Dorca, Jordi; Alcaide, Fernando; Santin, Miguel

    2017-01-01

    To assess the utility of QuantiFERON®-TB Gold In-tube (QFT-GIT) for targeting preventive therapy in BCG-vaccinated contacts of tuberculosis (TB), based on its high specificity and negative predictive value for development of TB. We compared two screening strategies for TB contact tracing in two consecutive periods: the tuberculin skin test (TST) period, when all contacts were screened with the TST alone; and the QFT-GIT period, when BCG-vaccinated contacts underwent TST and QFT-GIT. Diagnosis of TB infection among BCG-vaccinated contacts relied on TST ≥5 mm in the TST period, while in the QFT-GIT period either a positive QFT-GIT or a TST ≥15 mm was required. Six hundred and sixty-one contacts were compared. In the QFT-GIT period there was a reduction in diagnoses of TB infection (77.4% vs. 51.2%; p <0.01) and preventive therapy prescribed (62.1% vs. 48.2%; p = 0.02) among the 290 BCG-vaccinated contacts. After a median follow-up of 5 years, cumulative incidences of TB were 0.62 and 0.29 in the TST and QFT-GIT periods respectively (p = 0.59). In BCG-vaccinated TB contacts, the addition of QFT-GIT safely reduced TB diagnosis and treatment rates without increasing the risk of subsequent active TB.

  1. Rapid Identification of Unknown Organic Iodine in Small-Volume Complex Biological Samples Based on Nanospray Mass Spectrometry Coupled with in-Tube Solid Phase Microextraction.

    PubMed

    Chang, Qing; Peng, Yue'e; Yun, Lifen; Zhu, Qingxin; Hu, Shenghong; Shuai, Qin

    2017-04-04

    A new method for rapid screening of unknown organic iodine (OI) in small-volume complex biological samples was developed using in-tube solid phase microextraction (SPME) nanospray mass spectrometry (MS). The method proposed a new identification scheme for OI based on nanospray high-resolution mass spectrometry (HR-MS). The mass ranges of OI ions were confirmed using the t-MS(2) scan mode first; then, the possible precursor ions of OI were selected and identified orderly in full MS/ddMS(2) and t-MS(2) scan modes. Besides, in-tube SPME was used for the pretreatment of small-volume biological samples, and it was the first time in-tube SPME combined with nanospray MS for OI identification. The whole analysis procedure took only 8 min and consumed 50 μL per sample. Using the new method, six kinds of OI added to urine and an unknown OI C12H23O11I in human milk were successfully identified. Moreover, the proposed identification scheme is also suitable for other ambient mass spectrometry (AMS) to determine unknown compounds with characteristic fragment ions.

  2. Impactless, in-tube sabot separation technique useful for modest-sized supersonic ballistic ranges

    NASA Astrophysics Data System (ADS)

    Sasoh, Akihiro; Oshiba, Shin

    2006-10-01

    A simple and high performance sabot separation technique which is useful even in about 10-m-long supersonic ballistic ranges has been developed. The normal in-flight sabot separation distance is vastly reduced by adding an addition tube with no diaphragm that may cause damage to the projectile. The launch tube of the ballistic range is subdivided to the acceleration, ventilation, and sabot separation sections. In the ventilation section, both the precursor shock wave driven by the sabot when coasting through the acceleration section and the driver gas is vented out to the dump chamber. In the sabot separation section, only the sabot experiences a great dragging pressure imbalance whereas the drag to the projectile is kept negligible. Initially, the whole system except for the driver gas chamber is connected without any diaphragm; the range operation is not accompanied by any high-speed impact among the sabot, diaphragm, and other related solid parts. The experimental environment can be kept clean. The influence of the muzzle blast is eliminated within a reasonably short distance from the muzzle because it delays owing to the ventilation section. Calibration experiments and the demonstration of flow visualization and boom measurement of supersonic flight were conducted using a 25mm bore, Mach-2 ballistic range.

  3. Impact of blood volume, tube shaking, and incubation time on reproducibility of QuantiFERON-TB gold in-tube assay.

    PubMed

    Gaur, Rajiv L; Pai, Madhukar; Banaei, Niaz

    2013-11-01

    Gamma interferon (IFN-γ) release assays (IGRAs) are functional assays used serially to measure the efficacy of novel tuberculosis (TB) vaccines and to screen health care workers for latent tuberculosis infection (LTBI). However, studies have shown nonreproducible IGRA results. In this study, we investigated the effects of blood volume (0.8, 1.0, and 1.2 ml), tube shaking (gentle versus vigorous), and incubation duration (16, 20, and 24 h) on the reproducibility of QuantiFERON-TB Gold In-Tube (QFT-GIT) results for 50 subjects (33 uninfected and 17 infected). The median IFN-γ TB response (TB antigen [Ag] minus nil value) was significantly higher with 0.8 ml blood (1.04 IU/ml) than with 1.0 ml (0.85 IU/ml; P = 0.002) or 1.2 ml (0.49 IU/ml; P < 0.001) for subjects with LTBI. Compared with 0.8 ml (11.8%), there were larger proportions of false-negative results with 1.0 ml (29.4%; P = 0.2) and 1.2 ml (41.2%; P = 0.05) of blood for infected subjects. Blood volume did not significantly change the proportions of positive results in uninfected controls. Compared with gentle shaking, vigorous shaking increased the median IFN-γ response in nil (0.04 versus 0.06 IU/ml; P < 0.001) and TB Ag (0.12 versus 0.24 IU/ml; P = 0.004) tubes and increased TB responses (TB Agvigorous minus nilgentle) (0.02 versus 0.08 IU/ml; P = 0.004). The duration of incubation did not have a significant impact on the proportion of positive results in uninfected or infected subjects. This study identified blood volume and tube shaking as novel preanalytical sources of variability which require further standardization in order to improve the quality and reproducibility of QFT-GIT results.

  4. Tubeless video-assisted thoracoscopic surgery (VATS) under non-intubated, intravenous anesthesia with spontaneous ventilation and no placement of chest tube postoperatively

    PubMed Central

    Cui, Fei; Liu, Jun; Li, Shuben; Yin, Weiqiang; Xin, Xu; Shao, Wenlong

    2016-01-01

    Background To assess the feasibility and safety of tubeless video-assisted thoracoscopic surgery (VATS) under non-intubated, intravenous anesthesia with spontaneous ventilation and no placement of a chest tube postoperatively compared with VATS under intubated anesthesia with single-lung mechanical ventilation. Methods A total of 91 patients undergoing tubeless VATS (60 sympathectomies, 22 bullae resections, and 9 mediastinal tumor resections) between December 2012 and December 2015 were included. Additionally, 82 patients were treated by VATS by the same team while under intubated general anesthesia (52 sympathectomies, 19 bullae resections, and 11 mediastinal tumor resections). Comprehensive early outcome data, including intraoperative and postoperative variables, were compared between the subgroups. Results In total, 89 patients in the tubeless group underwent an effective operation and exhibited good postoperative recovery, while 2 (one sympathectomy and one bullae resection) had their operation aborted for some reason. The tubeless group showed advantages in the postoperative fasting time, the mean duration of the postoperative hospital stay, and postoperative pain scores, while no significant difference was found in intraoperative blood loss, the operation time or postoperative complications between the tubeless group and the intubated group. Furthermore, 83% (49/59) of sympathectomies, 81% (17/21) of bullae resections, and 56% (5/9) of mediastinal tumor resections were achieved via day surgery. Conclusions In this study, our experience has shown that tubeless VATS is a safe and feasible surgery with certain advantages in selected patients with thoracic disease and that we can achieve day surgery in these cases. PMID:27621880

  5. Incidental left main bronchus obstruction during left-sided double-lumen tube intubation of a patient with an unrecognized tracheal bronchus

    PubMed Central

    Cho, Ho Bum; Kim, Hyoung June; Gong, Hyung Youn; Kim, Mun Gyu; Kim, Sang Ho

    2016-01-01

    Abstract Introduction: Tracheal bronchus is a right-sided anomalous bronchus arising from the trachea above the main carina and occurs in 0.1% to 2% of the general population. Case presentation: We present a case of left main bronchus obstruction during a left-sided double-lumen tube intubation in a patient with an unrecognized tracheal bronchus. After the intubation, to confirm the position of the tube, we observed what we believed was the carina with a fiberoptic bronchoscope, but it was a site between the tracheal bronchus and the right main bronchus. Thus, a right-sided intubation was performed, and the left main bronchus was obstructed with a bronchial cuff. As a result of the inappropriate ventilation, peak inspiratory pressure was elevated and arterial oxygen saturation decreased. Conclusion: Anesthesiologists should keep in mind the possibility of anatomical variation in the large airways, and bronchoscopy should be accompanied by cautious auscultation and confirmation of the division of the bronchus. PMID:28033257

  6. Inorganic-organic hybrid coating material for the online in-tube solid-phase microextraction of monohydroxy polycyclic aromatic hydrocarbons in urine.

    PubMed

    Wang, ShuLing; Xu, Hui

    2016-12-01

    An inorganic-organic hybrid nanocomposite (zinc oxide/polypyrrole) that represents a novel kind of coating for in-tube solid-phase microextraction is reported. The composite coating was prepared by a facile electrochemical polymerization strategy on the inner surface of a stainless-steel tube. Based on the coated tube, a novel online in-tube solid-phase microextraction with liquid chromatography and mass spectrometry method was developed and applied for the extraction of three monohydroxy polycyclic aromatic hydrocarbons in human urine. The coating displayed good extraction ability toward monohydroxy polycyclic aromatic hydrocarbons. In addition, long lifespan, excellent stability, and good compression resistance were also obtained for the coating. The experimental conditions affecting the extraction were optimized systematically. Under the optimal conditions, the limits of detection and quantification were in the range of 0.039-0.050 and 0.130-0.167 ng/mL, respectively. Good linearity (0.2-100 ng/mL) was obtained with correlation coefficients larger than 0.9967. The repeatability, expressed as relative standard deviation, ranged between 2.5% and 9.4%. The method offered the advantage of process simplicity, rapidity, automation, and sensitivity in the analysis of human urinary monohydroxy polycyclic aromatic hydrocarbons in two different cities of Hubei province. An acceptable recovery of monohydroxy polycyclic aromatic hydrocarbons (64-122%) represented the additional attractive features of the method in real urine analysis.

  7. Automated and quantitative headspace in-tube extraction for the accurate determination of highly volatile compounds from wines and beers.

    PubMed

    Zapata, Julián; Mateo-Vivaracho, Laura; Lopez, Ricardo; Ferreira, Vicente

    2012-03-23

    An automatic headspace in-tube extraction (ITEX) method for the accurate determination of acetaldehyde, ethyl acetate, diacetyl and other volatile compounds from wine and beer has been developed and validated. Method accuracy is based on the nearly quantitative transference of volatile compounds from the sample to the ITEX trap. For achieving that goal most methodological aspects and parameters have been carefully examined. The vial and sample sizes and the trapping materials were found to be critical due to the pernicious saturation effects of ethanol. Small 2 mL vials containing very small amounts of sample (20 μL of 1:10 diluted sample) and a trap filled with 22 mg of Bond Elut ENV resins could guarantee a complete trapping of sample vapors. The complete extraction requires 100 × 0.5 mL pumping strokes at 60 °C and takes 24 min. Analytes are further desorbed at 240 °C into the GC injector under a 1:5 split ratio. The proportion of analytes finally transferred to the trap ranged from 85 to 99%. The validation of the method showed satisfactory figures of merit. Determination coefficients were better than 0.995 in all cases and good repeatability was also obtained (better than 7% in all cases). Reproducibility was better than 8.3% except for acetaldehyde (13.1%). Detection limits were below the odor detection thresholds of these target compounds in wine and beer and well below the normal ranges of occurrence. Recoveries were not significantly different to 100%, except in the case of acetaldehyde. In such a case it could be determined that the method is not able to break some of the adducts that this compound forms with sulfites. However, such problem was avoided after incubating the sample with glyoxal. The method can constitute a general and reliable alternative for the analysis of very volatile compounds in other difficult matrixes.

  8. Serial testing for latent tuberculosis using QuantiFERON-TB Gold In-Tube: A Markov model.

    PubMed

    Moses, Mark W; Zwerling, Alice; Cattamanchi, Adithya; Denkinger, Claudia M; Banaei, Niaz; Kik, Sandra V; Metcalfe, John; Pai, Madhukar; Dowdy, David

    2016-07-29

    Healthcare workers (HCWs) in low-incidence settings are often serially tested for latent TB infection (LTBI) with the QuantiFERON-TB Gold In-Tube (QFT) assay, which exhibits frequent conversions and reversions. The clinical impact of such variability on serial testing remains unknown. We used a microsimulation Markov model that accounts for major sources of variability to project diagnostic outcomes in a simulated North American HCW cohort. Serial testing using a single QFT with the recommended conversion cutoff (IFN-g > 0.35 IU/mL) resulted in 24.6% (95% uncertainty range, UR: 23.8-25.5) of the entire population testing false-positive over ten years. Raising the cutoff to >1.0 IU/mL or confirming initial positive results with a (presumed independent) second test reduced this false-positive percentage to 2.3% (95%UR: 2.0-2.6%) or 4.1% (95%UR: 3.7-4.5%), but also reduced the proportion of true incident infections detected within the first year of infection from 76.5% (95%UR: 66.3-84.6%) to 54.8% (95%UR: 44.6-64.5%) or 61.5% (95%UR: 51.6-70.9%), respectively. Serial QFT testing of HCWs in North America may result in tremendous over-diagnosis and over-treatment of LTBI, with nearly thirty false-positives for every true infection diagnosed. Using higher cutoffs for conversion or confirmatory tests (for initial positives) can mitigate these effects, but will also diagnose fewer true infections.

  9. Sensitivity of the Quantiferon-Gold In-Tube Assay in Sputum Smear Positive TB Cases in Indonesia

    PubMed Central

    Rutherford, Merrin; Alisjahbana, Bachti; Maharani, Winni; Sampurno, Hedy; van Crevel, Reinout; Hill, Philip C.

    2010-01-01

    Background As part of a formal evaluation of the Quantiferon-Gold in-tube assay (QFT-IT) for latent TB infection we compared its sensitivity to the tuberculin skin test (TST) in confirmed adult TB cases in Indonesia. Smear-positive TB disease was used as a proxy gold standard for latent TB infection. Methods and Findings We compared the sensitivity of QFT-IT and TST in 98 sputum smear and chest x-ray positive TB cases and investigated risk factors for negative and discordant results in both tests. Both tests showed high sensitivity; (QFT-IT; 88.7%: TST; 94.9%), not significantly different from each other (p value 0.11). Very high sensitivity was seen when tests were combined (98.9%). There were no variables significantly associated with discordant results or with a negative TST. For QFT-IT which particular staff member collected blood was significantly associated with test positivity (p value 0.01). Study limitations include small sample size and lack of culture confirmation or HIV test results. Conclusions The QFT-IT has similar sensitivity in Indonesian TB cases as in other locations. However, QFT-IT, like the TST cannot distinguish active TB disease from LTBI. In countries such as Indonesia, with high background rates of LTBI, test specificity for TB disease will likely be low. While our study was not designed to evaluate the QFT-IT in the diagnosis of active TB disease in TB suspects, the data suggest that a combination of TST and QFT-IT may prove useful for ruling out TB disease. Further research is required to explore the clinical role of QFT-IT in combination with other TB diagnostic tests. PMID:20711257

  10. Serial testing for latent tuberculosis using QuantiFERON-TB Gold In-Tube: A Markov model

    PubMed Central

    Moses, Mark W.; Zwerling, Alice; Cattamanchi, Adithya; Denkinger, Claudia M.; Banaei, Niaz; Kik, Sandra V.; Metcalfe, John; Pai, Madhukar; Dowdy, David

    2016-01-01

    Healthcare workers (HCWs) in low-incidence settings are often serially tested for latent TB infection (LTBI) with the QuantiFERON-TB Gold In-Tube (QFT) assay, which exhibits frequent conversions and reversions. The clinical impact of such variability on serial testing remains unknown. We used a microsimulation Markov model that accounts for major sources of variability to project diagnostic outcomes in a simulated North American HCW cohort. Serial testing using a single QFT with the recommended conversion cutoff (IFN-g > 0.35 IU/mL) resulted in 24.6% (95% uncertainty range, UR: 23.8–25.5) of the entire population testing false-positive over ten years. Raising the cutoff to >1.0 IU/mL or confirming initial positive results with a (presumed independent) second test reduced this false-positive percentage to 2.3% (95%UR: 2.0–2.6%) or 4.1% (95%UR: 3.7–4.5%), but also reduced the proportion of true incident infections detected within the first year of infection from 76.5% (95%UR: 66.3–84.6%) to 54.8% (95%UR: 44.6–64.5%) or 61.5% (95%UR: 51.6–70.9%), respectively. Serial QFT testing of HCWs in North America may result in tremendous over-diagnosis and over-treatment of LTBI, with nearly thirty false-positives for every true infection diagnosed. Using higher cutoffs for conversion or confirmatory tests (for initial positives) can mitigate these effects, but will also diagnose fewer true infections. PMID:27469388

  11. The use of Quantiferon-TB gold in-tube test in screening latent tuberculosis among Saudi Arabia dialysis patients

    PubMed Central

    Al Wakeel, Jamal Saleh; Makoshi, Ziyad; Al Ghonaim, Mohammed; Al Harbi, Ali; Al Suwaida, Abdulkareem; Algahtani, Farjah; Al Hedaithy, Mogbil; Almogairin, Sultan; Abdullah, Sami

    2015-01-01

    BACKGROUND AND AIM: Screening for tuberculosis (TB) is a key strategy for controlling infection. This study aimed to detect latent TB among dialysis patients. METHODS: This is a prospective study conducted in King Saud University, Riyadh involving hemodialysis (HD) and peritoneal dialysis (PD) patients aged ≥18 years. Patients were screened for latent TB infection (LTBI) using both TBskin test (TST) and QuantiFERONTB Gold In-Tube test (QFT-GIT). All participants were followed-up clinically and radiologically every 3 months for 2 years. RESULTS: A total of 243 (181 HD and 62 PD) patients were included and 112(46.1%) were males. 45.3% showed positive QFT in HD patients with sensitivity of 91.7%, specificity of 71.4%, positive predictive value (PPV) of 19.5%, and negative predictive value (NPV) of 91.1%. TST results in HD showed that positive TST was 17.4%, sensitivity was 63.2%, specificity was 95.5%, PPV was 51.5%, and NPV was 91.1%. Five (8.1%) showed positive QFT in PD patients with sensitivity of 7.7%, specificity of 91.8%, PPV of 6.6%, and NPV of 92.3%. TST results in PD showed that positive TST was 9.8%, sensitivity was 35.7%, specificity was 97.9%, PPV was 55.8%, and NPV was 93.3%. Previous TB infection was significantly correlated with QFT only in HD patients, but significantly associated with TST in both HD and PD patients. Also in HD, QFT was significantly associated with TST (P = 0.043). CONCLUSIONS: Due to high variability of QFT-GIT sensitivity, we recommend its use for its NPV and to use either TST or QFT in screening latent TB. PMID:26664568

  12. Preliminary Study on Biosynthesis of Bacterial Nanocellulose Tubes in a Novel Double-Silicone-Tube Bioreactor for Potential Vascular Prosthesis.

    PubMed

    Hong, Feng; Wei, Bin; Chen, Lin

    2015-01-01

    Bacterial nanocellulose (BNC) has demonstrated a tempting prospect for applications in substitute of small blood vessels. However, present technology is inefficient in production and BNC tubes have a layered structure that may bring danger after implanting. Double oxygen-permeable silicone tubes in different diameters were therefore used as a tube-shape mold and also as oxygenated supports to construct a novel bioreactor for production of the tubular BNC materials. Double cannula technology was used to produce tubular BNC via cultivations with Acetobacter xylinum, and Kombucha, a symbiosis of acetic acid bacteria and yeasts. The results indicated that Kombucha gave higher yield and productivity of BNC than A. xylinum. Bacterial nanocellulose was simultaneously synthesized both on the inner surface of the outer silicone tube and on the outer surface of the inner silicone tube. Finally, the nano BNC fibrils from two directions formed a BNC tube with good structural integrity. Scanning electron microscopy inspection showed that the tubular BNC had a multilayer structure in the beginning but finally it disappeared and an intact BNC tube formed. The mechanical properties of BNC tubes were comparable with the reported value in literatures, demonstrating a great potential in vascular implants or in functional substitutes in biomedicine.

  13. Preliminary Study on Biosynthesis of Bacterial Nanocellulose Tubes in a Novel Double-Silicone-Tube Bioreactor for Potential Vascular Prosthesis

    PubMed Central

    Wei, Bin; Chen, Lin

    2015-01-01

    Bacterial nanocellulose (BNC) has demonstrated a tempting prospect for applications in substitute of small blood vessels. However, present technology is inefficient in production and BNC tubes have a layered structure that may bring danger after implanting. Double oxygen-permeable silicone tubes in different diameters were therefore used as a tube-shape mold and also as oxygenated supports to construct a novel bioreactor for production of the tubular BNC materials. Double cannula technology was used to produce tubular BNC via cultivations with Acetobacter xylinum, and Kombucha, a symbiosis of acetic acid bacteria and yeasts. The results indicated that Kombucha gave higher yield and productivity of BNC than A. xylinum. Bacterial nanocellulose was simultaneously synthesized both on the inner surface of the outer silicone tube and on the outer surface of the inner silicone tube. Finally, the nano BNC fibrils from two directions formed a BNC tube with good structural integrity. Scanning electron microscopy inspection showed that the tubular BNC had a multilayer structure in the beginning but finally it disappeared and an intact BNC tube formed. The mechanical properties of BNC tubes were comparable with the reported value in literatures, demonstrating a great potential in vascular implants or in functional substitutes in biomedicine. PMID:26090420

  14. Development of a Biocompatible In-Tube Solid-Phase Microextraction Device: A Sensitive Approach for Direct Analysis of Single Drops of Complex Matrixes.

    PubMed

    Piri-Moghadam, Hamed; Lendor, Sofia; Pawliszyn, Janusz

    2016-12-20

    The aim of the current study is to develop a sensitive solid-phase microextraction (SPME) device for direct and rapid analysis of untreated complex matrixes (i.e., single drop of the samples, V ≤ 2 μL). A thin layer of a biocompatible nanostructured polypyrrole (PPy) was electrochemically deposited inside a medical grade spinal needle, minimizing the matrix effect. Microsampling was facilitated by loading the sample inside the in-tube SPME device (withdraw of sample via plunger), where extraction was performed under static conditions. Two strategies were used for analysis of the compounds including offline desorption and running the extract to the liquid chromatograph-tandem mass spectrometer (LC-MS/MS) or direct coupling of the in-tube SPME device to the MS. Given the high surface-area-to-volume ratio of the coating, a short equilibrium time (i.e., t ≤ 2 min) was obtained. The whole analytical procedure (i.e., extraction, rinsing, desorption, and LC-MS/MS analysis) was performed within 10 min by LC-MS/MS, and 3 min by in-tube-MS/MS. Possible matrix effects for the prepared device were evaluated in whole blood samples at three levels of concentration, and encouraging results were achieved in the range of 83-120%. The obtained results, no matrix effect, are attributed to the smooth surface and small pore size of the biocompatible PPy coating, which was prepared in the presence of cetyltrimethylammonium bromide (CTAB) surfactant. The in-tube SPME device was shown to be very sensitive, with high total recoveries obtained for all compounds in phosphate-buffered saline (PBS) and urine samples owing to the large volume and capacity of the coating. Subnanogram per milliliter levels of detection were achieved for urine samples, and low nanogram per milliliter levels were found in whole blood samples for all studied compounds with a high protein binding index. Rapid analysis of whole blood samples was achieved without need of any pretreatment or manipulation of sample

  15. Determination of anabolic steroids in human urine by automated in-tube solid-phase microextraction coupled with liquid chromatography-mass spectrometry.

    PubMed

    Saito, Keita; Yagi, Katsuharu; Ishizaki, Atsushi; Kataoka, Hiroyuki

    2010-09-05

    A simple, rapid and sensitive method was developed for determining the presence of seven anabolic steroids (boldenone, nandrolone, testosterone, methyltestosterone, epiandrosterone, androsterone, and atnozolol) in human urine. Glucuronide-conjugates of these compounds were hydrolyzed with beta-glucuronidase. The anabolic steroids were analyzed by on-line in-tube solid-phase microextraction (SPME) coupled with liquid chromatography-mass spectrometry (LC-MS). The steroids were separated within 14 min by high performance liquid chromatography using a Chromolith RP-18e column and 5 mM ammonium formate/methanol (35/65, v/v) as a mobile phase at a flow rate of 1.0 mL/min. Electrospray ionization conditions in the positive ion mode were optimized for the MS detection of these compounds. The optimum in-tube SPME conditions were 20 draw/eject cycles with a sample size of 40 microL using a Supel-Q PLOT capillary column for the extraction. The extracted compounds could be desorbed readily from the capillary column by flow of the mobile phase, and no carryover was observed. Using the in-tube SPME LC-MS with SIM mode detection, good linearity of the calibration curve (r>0.995) was obtained in the concentration range of 0.5-20 ng/mL, except for stanozolol. The detection limits (S/N=3) of anabolic steroids were in the range 9-182 pg/mL and the proposed method showed 20-33-fold higher sensitivity than the direct injection method. The within-day and between-day precisions were below 4.0% and 7.3% (n=5), respectively. This method was applied successfully to the analysis of urine samples without the interference peaks. The recovery rates of anabolic steroids spiked into urine samples were above 85%. This method is useful to analyze the urinary levels of these compounds in anti-doping tests.

  16. Comparison of tuberculin skin test and QuantiFERON®-TB Gold In-Tube for the diagnosis of childhood tuberculosis.

    PubMed

    Uzunhan, Ozan; Törün, Selda Hançerli; Somer, Ayper; Salman, Nuran; Köksalan, Kaya

    2015-10-01

    Tuberculosis (TB) is an important worldwide ongoing health issue. To be able to control TB, one should not only cure active TB but also identify childhood TB patients who have the possibility to develop active disease in the future. The aim of this study was to compare a century-old tuberculin skin test (TST) and QuantiFERON-TB Gold In-Tube (QFT-GIT) test, developed as an alternative to TST and which has been claimed to be superior to TST in several ways, in the diagnosis of childhood TB. Fifty-three children with TB between 5 months and 17.5 years of age and 92 healthy children from the same age group with no risk factors for TB were recruited into the study. All children underwent TST and QFT-GIT test and their demographic, clinic and laboratory data were recorded. Data were analyzed using SPSS 14. A total of 53 patients were diagnosed with TB. Mean patient age was 8.5 ± 4.3 years (range, 5 months-17.5 years). A total of 41.7% of the patients were female. Sixteen of 53 patients had confirmation on culture. QFT-GIT test was positive in 16 and TST was positive in 15 among 16 children with culture-confirmed TB. The sensitivity of TST and QFT-GIT were 93.8% and 100.0%, and the specificity of TST and QFT-GIT were 100.0% and 97.8%, respectively. With regard to the 53 TB children including those without bacteriological confirmation, QFT-GIT was positive in 33 children, and TST was positive in 44 children. The sensitivity of TST and QFT-GIT was then 83.0% and 62.3%, and the specificity, 100.0% and 97.8%, respectively. Although positive QFT-GIT test is very significant for TB, negative results will not exclude TB infection. TST and QFT-GIT used together may provide more efficient results. © 2015 Japan Pediatric Society.

  17. [Tuberculosis screening program for undocumented immigrant teenagers using the QuantiFERON(®)-TB Gold In-Tube test].

    PubMed

    Salinas, Carlos; Ballaz, Aitor; Díez, Rosa; Aguirre, Urko; Antón, Ane; Altube, Lander

    2015-07-06

    The aim of this study was to determine the prevalence of tuberculosis infection in undocumented immigrant teenagers using a tuberculin skin test (TST) for initial screening and QuantiFERON(®)-TB Gold In-Tube (QFT-GIT) as a confirmatory test. From 2007 to 2012, under 19 year-old immigrant teenagers from 2 accommodation centers of the Basque Country (Spain) were included in the study. The TST was done in all of them and the QFT-GIT was done in selected patients with a TST≥5mm. Eight hundred and forty-five immigrants were included, most of them from Africa (99.5%). Fifty-one percent of immigrants with TST ≥ 5 mm has a positive QFT-GIT. We found 2 cases of active tuberculosis (2/845: 0.24%). The concordance between TST (≥ 10 mm) and QFT-GIT was 63%, with 57% of positive concordance cases and 96% of negative concordances. There were 246 cases with TST ≥ 10 mm (29%), with significant differences between Magrebis (21.5%) and Subsaharians (67%) (P<.001). Vaccination with Calmette-Guéin bacille was an independent predictor for having a TST ≥ 10 mm (OR: 2.11; P<.001) and for the discordance TST+/QFT-GIT-, both for a TST≥5 and a TST≥10mm (OR 2.16, 95% confidence interval [95% CI] 1.46-3.20, and OR 1.91 95% CI 1.23-2.97, respectively). The positive value of QFT-GIT increased significantly as the TST increased, with a positive association in all the cut-off points analyzed: 10-14 mm (OR 7.95, 95% CI 1.79-35.33), 15-19 mm (OR 35, 95% CI 7.93-154.52) and ≥ 20 mm (OR 91.3, 95% CI 18.20-458.11). Due to the high prevalence of latent tuberculosis infection in Subsaharian immigrants, we recommend implementing screening programs in this population. Using QFT-GIT, the number of candidates for chemoprophylaxis was reduced to 43% compared with TST alone (≥ 10 mm). Copyright © 2013 Elsevier España, S.L.U. All rights reserved.

  18. On-line electrochemically controlled in-tube solid phase microextraction of inorganic selenium followed by hydride generation atomic absorption spectrometry.

    PubMed

    Asiabi, Hamid; Yamini, Yadollah; Seidi, Shahram; Shamsayei, Maryam; Safari, Meysam; Rezaei, Fatemeh

    2016-05-30

    In this work, for the first time, a rapid, simple and sensitive microextraction procedure is demonstrated for the matrix separation, preconcentration and determination of inorganic selenium species in water samples using an electrochemically controlled in-tube solid phase microextraction (EC-in-tube SPME) followed by hydride generation atomic absorption spectrometry (HG-AAS). In this approach, in which EC-in-tube SPME and HG-AAS system were combined, the total analysis time, was decreased and the accuracy, repeatability and sensitivity were increased. In addition, to increases extraction efficiency, a novel nanostructured composite coating consisting of polypyrrole (PPy) doped with ethyleneglycol dimethacrylate (EGDMA) was prepared on the inner surface of a stainless-steel tube by a facile electrodeposition method. To evaluate the offered setup and the new PPy-EGDMA coating, it was used to extract inorganic selenium species in water samples. Extraction of inorganic selenium species was carried out by applying a positive potential through the inner surface of coated in-tube under flow conditions. Under the optimized conditions, selenium was detected in amounts as small as 4.0 parts per trillion. The method showed good linearity in the range of 0.012-200 ng mL(-1), with coefficients of determination better than 0.9996. The intra- and inter-assay precisions (RSD%, n = 5) were in the range of 2.0-2.5% and 2.7-3.2%, respectively. The validated method was successfully applied for the analysis of inorganic selenium species in some water samples and satisfactory results were obtained. Copyright © 2016 Elsevier B.V. All rights reserved.

  19. Poly(methacrylic acid-ethylene glycol dimethacrylate) monolith in-tube solid phase microextraction coupled to high performance liquid chromatography and analysis of amphetamines in urine samples.

    PubMed

    Fan, Yi; Feng, Yu-Qi; Zhang, Jian-Tao; Da, Shi-Lu; Zhang, Min

    2005-05-13

    In-tube solid-phase microextraction (SPME) based on a poly(methacrylic acid-ethylene glycol dimethacrylate) monolithic capillary column was investigated for the extraction of amphetamine, methamphetamine and their methylenedioxy derivatives. The monolithic capillary column showed high extraction efficiency towards target analytes, which could be attributed to its larger loading amount of extraction phase than conventional open-tubular extraction capillaries and the convective mass transfer procedure provided by its monolithic structure. The extraction mechanism was studied, and the results indicated that the extraction process of the target analytes was involved with hydrophobic interaction and ion-exchange interaction. The polymer monolith in-tube SPME-HPLC system with UV detection was successfully applied to the determination of amphetamine, methamphetamine and their methylenedioxy derivatives in urine samples, yielding the detection limits of 1.4 - 4.0 ng/mL. Excellent method reproducibility (RSD < 2.9%) was found over a linear range of 0.05-5 microg/mL, and the time for the whole analysis was only approximately 25 min. The monolithic capillary column was reusable in coping with the complicated urine samples.

  20. EHD enhancement of pool and in-tube boiling of alternate refrigerants. Final report, 15 January 1993--15 June 1993

    SciTech Connect

    Ohadi, M.M.; Dessiatoun, S.; Singh, A.; Fanni, M.A.

    1993-08-01

    The Electrohydrodynamic (EHD) is an active heat transfer augmentation technique which utilizes the effect of secondary motions generated through the application of an electrostatic potential to a dielectric fluid. Net result is better momentum and heat transfer between the fluid and the heat transfer wall through destabilization of the thermal boundary layer and better mixing of the fluid adjacent to the heat transfer surface. EHD enhancement of refrigerant/refrigerant oil mixtures heat transfer using the Electrohydrodynamic (EHD) technique is the subject of a three-year experimental investigation in a project funded by the US Department of Energy, effective June 1, 1993. For the interim period between November 1992 and June 1993 when the DOE funds became available, the Air-Conditioning and Refrigeration Technology Institute (ARTI) provided partial funding for our EHD research program with the aim of accomplishing three major tasks: (1) conduct a comprehensive search of the literature on EHD-enhanced, in-tube and external boiling heat transfer enhancement of alternate refrigerants; (2) Design, fabricate, and instrument an in-tube, EHD-enhanced boiling/condensation test rig and perform preliminary testing of the setup; (3) conduct experiments and document new findings on EHD-enhanced external boiling of alternate refrigerants/refrigerant mixtures in an existing pool boiling test rig apparatus. Description of Tasks performed are described and results are discussed.

  1. Spallation and migration of silicone from blood-pump tubing in patients on hemodialysis

    SciTech Connect

    Leong, A.S.; Disney, A.P.; Gove, D.W.

    1982-01-21

    Spalled particles of silicone were observed in the livers of patients with chronic renal failure treated by hemodialysis. The refractile particles of silicone were associated with various degrees of hepatic inflammation and fibrosis, and granulomatous hepatitis was evident in nine cases. Retrospective examination revealed the material in 18 of 38 liver-biopsy samples from patients on hemodialysis who had clinical hepatic dysfunction. Of 31 autopsies of patients who had undergone hemodialysis, 22 revealed silicone in the liver, and silicone was also present in the spleen in all cases and in the marrow, lungs, and nodes in some. Giant cells containing silicone were also observed in these organs. Silicone was present in patients who had undergone hemodialysis for six weeks to 84 months (mean, 24 months). The identity of the material was confirmed by atomic absorption and by electron microprobe analysis. The silicone was traced to a segment of silicone tubing located in the roller pump of the dialysis machine.

  2. [Comparing insertion characteristics on nasogastric tube placement by using GlideScope™ visualization vs. MacIntosh laryngoscope assistance in anaesthetized and intubated patients].

    PubMed

    Wan Ibadullah, Wan Hafsah; Yahya, Nurlia; Ghazali, Siti Salmah; Kamaruzaman, Esa; Yong, Liu Chian; Dan, Adnan; Md Zain, Jaafar

    2016-01-01

    This was a prospective, randomized clinical study to compare the success rate of nasogastric tube insertion by using GlideScope™ visualization versus direct MacIntosh laryngoscope assistance in anesthetized and intubated patients. Ninety-six ASA I or II patients, aged 18-70 years were recruited and randomized into two groups using either technique. The time taken from insertion of the nasogastric tube from the nostril until the calculated length of tube had been inserted was recorded. The success rate of nasogastric tube insertion was evaluated in terms of successful insertion in the first attempt. Complications associated with the insertion techniques were recorded. The results showed success rates of 74.5% in the GlideScope™ Group as compared to 58.3% in the MacIntosh Group (p=0.10). For the failed attempts, the nasogastric tube was successfully inserted in all cases using rescue techniques. The duration taken in the first attempt for both techniques was not statistically significant; Group A was 17.2±9.3s as compared to Group B, with a duration of 18.9±13.0s (p=0.57). A total of 33 patients developed complications during insertion of the nasogastric tube, 39.4% in Group A and 60.6% in Group B (p=0.15). The most common complications, which occurred, were coiling, followed by bleeding and kinking. This study showed that using the GlideScope™ to facilitate nasogastric tube insertion was comparable to the use of the MacIntosh laryngoscope in terms of successful rate of insertion and complications. Copyright © 2015 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  3. Comparing insertion characteristics on nasogastric tube placement by using GlideScope™ visualization vs. MacIntosh laryngoscope assistance in anaesthetized and intubated patients.

    PubMed

    Wan Ibadullah, Wan Hafsah; Yahya, Nurlia; Ghazali, Siti Salmah; Kamaruzaman, Esa; Yong, Liu Chian; Dan, Adnan; Md Zain, Jaafar

    2016-01-01

    This was a prospective, randomized clinical study to compare the success rate of nasogastric tube insertion by using GlideScope™ visualization versus direct MacIntosh laryngoscope assistance in anesthetized and intubated patients. Ninety-six ASA I or II patients, aged 18-70 years were recruited and randomized into two groups using either technique. The time taken from insertion of the nasogastric tube from the nostril until the calculated length of tube had been inserted was recorded. The success rate of nasogastric tube insertion was evaluated in terms of successful insertion in the first attempt. Complications associated with the insertion techniques were recorded. The results showed success rates of 74.5% in the GlideScope™ Group as compared to 58.3% in the MacIntosh Group (p=0.10). For the failed attempts, the nasogastric tube was successfully inserted in all cases using rescue techniques. The duration taken in the first attempt for both techniques was not statistically significant; Group A was 17.2±9.3s as compared to Group B, with a duration of 18.9±13.0s (p=0.57). A total of 33 patients developed complications during insertion of the nasogastric tube, 39.4% in Group A and 60.6% in Group B (p=0.15). The most common complications, which occurred, were coiling, followed by bleeding and kinking. This study showed that using the GlideScope™ to facilitate nasogastric tube insertion was comparable to the use of the MacIntosh laryngoscope in terms of successful rate of insertion and complications. Copyright © 2015 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  4. Preparation and evaluation of a novel molecularly imprinted polymer coating for selective extraction of indomethacin from biological samples by electrochemically controlled in-tube solid phase microextraction.

    PubMed

    Asiabi, Hamid; Yamini, Yadollah; Seidi, Shahram; Ghahramanifard, Fazel

    2016-03-24

    In the present work, an automated on-line electrochemically controlled in-tube solid-phase microextraction (EC-in-tube SPME) coupled with HPLC-UV was developed for the selective extraction and preconcentration of indomethacin as a model analyte in biological samples. Applying an electrical potential can improve the extraction efficiency and provide more convenient manipulation of different properties of the extraction system including selectivity, clean-up, rate, and efficiency. For more enhancement of the selectivity and applicability of this method, a novel molecularly imprinted polymer coated tube was prepared and applied for extraction of indomethacin. For this purpose, nanostructured copolymer coating consisting of polypyrrole doped with ethylene glycol dimethacrylate was prepared on the inner surface of a stainless-steel tube by electrochemical synthesis. The characteristics and application of the tubes were investigated. Electron microscopy provided a cross linked porous surface and the average thickness of the MIP coating was 45 μm. Compared with the non-imprinted polymer coated tubes, the special selectivity for indomethacin was discovered with the molecularly imprinted coated tube. Moreover, stable and reproducible responses were obtained without being considerably influenced by interferences commonly existing in biological samples. Under the optimal conditions, the limits of detection were in the range of 0.07-2.0 μg L(-1) in different matrices. This method showed good linearity for indomethacin in the range of 0.1-200 μg L(-1), with coefficients of determination better than 0.996. The inter- and intra-assay precisions (RSD%, n = 3) were respectively in the range of 3.5-8.4% and 2.3-7.6% at three concentration levels of 7, 70 and 150 μg L(-1). The results showed that the proposed method can be successfully applied for selective analysis of indomethacin in biological samples. Copyright © 2016 Elsevier B.V. All rights reserved.

  5. Determination of Ochratoxin A in wine by packed in-tube solid phase microextraction followed by high performance liquid chromatography coupled to tandem mass spectrometry.

    PubMed

    Andrade, Mariane A; Lanças, Fernando M

    2017-04-14

    Ochratoxin A (OTA), a widely studied mycotoxin, can be found in a variety of food matrices. As its concentration in food is generally low (in the order of μg kg(-1)), sample preparation techniques are necessary for the analyte purification and pre-concentration in order to achieve the required low detection limits. The separation and detection methods used for OTA analysis should also offer proper sensitivity in order to allow the adequate quantification of the analyte. This manuscript addresses the development of a methodology aiming the analysis of OTA in wine samples by packed in-tube SPME in flow through extraction mode coupled to HPLC-MS/MS. The in-tube SPME set up utilized a PEEK tube packed with C18 particles as the extraction column. The method was optimized by a central composite design 2(2)+3 extra central points, having as factors the percentage of ACN and time in the sample load step. The functionalities of the method were attested and its analytical conditions, enhanced by using 22% of ACN and 6min in the sample load step. Validation of the method was also accomplished prior to analyses of both dry red wine and dry white wine samples. The method demonstrated proper sensitivity, with detection and quantification limits equal to 0.02 and 0.05μgL(-1), respectively. Linearity and precision exhibited a 0.996 correlation coefficient and RSD under 6%, respectively. The method proved to be accurate at medium and higher concentration levels with a maximum recovery of 73% at higher concentration levels. OTA was not detected in either dry red and dry white wine samples evaluated in this work. If present, it would be at concentrations lower than the detection and quantification limits established for the proposed method, and considered not a potential danger to human health according to our present knowledge. Copyright © 2017 Elsevier B.V. All rights reserved.

  6. Determination of nicotine, cotinine, and related alkaloids in human urine and saliva by automated in-tube solid-phase microextraction coupled with liquid chromatography-mass spectrometry.

    PubMed

    Kataoka, Hiroyuki; Inoue, Reiko; Yagi, Katsuharu; Saito, Keita

    2009-01-15

    A simple, rapid and sensitive method for the determination of nicotine, cotinine, nornicotine, anabasine, and anatabine in human urine and saliva was developed. These compounds were analyzed by on-line in-tube solid-phase microextraction (SPME) coupled with liquid chromatography-mass spectrometry (LC-MS). Nicotine, cotinine and related alkaloids were separated within 7 min by high performance liquid chromatography (HPLC) using a Synergi 4u POLAR-RP 80A column and 5 mM ammonium formate/methanol (55/45, v/v) as a mobile phase at a flow-rate of 0.8 mL/min. Electrospray ionization conditions in the positive ion mode were optimized for MS detection of these compounds. The optimum in-tube SPME conditions were 25 draw/eject cycles with a sample size of 40 microL using a CP-Pora PLOT amine capillary column as the extraction device. The extracted compounds could be desorbed easily from the capillary by passage of the mobile phase, and no carryover was observed. Using the in-tube SPME LC-MS method, the calibration curves were linear in the concentration range of 0.5-20 ng/mL of nicotine, cotinine and related compounds in urine and saliva, and the detection limits (S/N=3) were 15-40 pg/mL. The method described here showed 20-46-fold higher sensitivity than the direct injection method (5 microL injection). The within-run and between-day precision (relative standard deviations) were below 4.7% and 11.3% (n=5), respectively. This method was applied successfully to analysis of urine and saliva samples without interference peaks. The recoveries of nicotine, cotinine and related compounds spiked into urine and saliva samples were above 83%, and the relative standard deviations were below 7.1%. This method was used to analyze urinary and salivary levels of these compounds in nicotine intake and smoking.

  7. Tying a slipknot to an intubation stylet for facilitating insertion of a nasogastric tube in liver transplant recipients: a prospective, randomized study.

    PubMed

    Tsai, Y-F; Liu, F-C; Lin, C-C; Lee, W-C; Yu, H-P

    2012-03-01

    It is sometimes difficult and harmful to insert a nasogastric tube (NGT) into a patient with a tendency to bleed and anesthetized recipient of liver transplantation. As a "Rusch" intubation stylet tied by a slipknot, Highwayman's hitch, to the NGT, it is easy to introduce the NGT through nasal cavity and oropharyngeal space. We designed this study to evaluate the usage of this novel method in the guidance of NGT insertion in liver transplant recipients. Eighty recipients were randomly allocated to both groups. In the control group (group C), the NGT was inserted with the patient's head in neutral position. In the stylet group (group S), the NGT was inserted with the assistance of a Rusch intubation stylet tied together at the tips. The success rates, duration of insertions, and occurrences of complications were recorded. All of the failed cases in group C and the rescue success rate with the new technique were also evaluated. Successful insertions were recorded in 38/40 patients (95%) in group S and in 27/40 patients (67.5%) in group C, and the difference was statistically significant. The incidences of kinked NGT were 17.5% in group C and 2.5% in group S, respectively, and the difference was statistically significant. The rates of nasal mucosal bleeding were 22.5% in group C and 25% in group S. The rescue success rate of 13 failure cases in the group C was 84.6%. The intubation stylet-guided method is reliable, with high success rate of NGT insertion in patients with a tendency to bleed anesthetized recipients of liver transplantation. Copyright © 2012 Elsevier Inc. All rights reserved.

  8. Comparison of airway management with the intubating laryngeal mask, laryngeal tube and CobraPLA by paramedical students in anaesthetized patients.

    PubMed

    Kurola, J; Pere, P; Niemi-Murola, L; Silfvast, T; Kairaluoma, P; Rautoma, P; Castrén, M

    2006-01-01

    Because of the importance of airway management in emergency care, alternative methods with shorter learning curves for inexperienced personnel have been looked for as a substitute for endotracheal intubation (ETI). We compared the success of insertion, oxygenation and ventilation of the intubating laryngeal mask (ILMA), laryngeal tube (LT) and CobraPLA (COB) in anaesthetized patients when used by paramedical students. After informed consent, 96 patients were monitored and anaesthetized for general surgery without the use of a muscle relaxant. After the induction of anaesthesia, 32 paramedical students inserted the ILMA, LT or COB in a random order and ventilated the patient for a 60-s period. The number of insertion attempts, the time needed for insertion, and oxygenation and ventilation parameters were recorded. The students gave a subjective evaluation of the airway devices after the test. Twenty-four of the 32 students (75%) successfully inserted ILMA at the first attempt, compared with 14 of 32 (44%) for LT and seven of 32 (22%) for COB (P<0.001, ILMA vs. COB). One student failed to insert ILMA after all three attempts, compared with seven of 32 (21%) using LT and seven of 32 (21%) using COB (P=not significant). Oxygenation and ventilation parameters did not differ between the groups after successful insertion. Clinically inexperienced paramedical students can successfully use ILMA in anaesthetized patients. Further investigations are warranted to study whether ILMA or LT can replace ETI in emergency airway management when used by inexperienced medical or paramedical staff.

  9. [Diagnostic sensitivity of QuantiFERON-TB Gold In-Tube and tuberculin skin test in active tuberculosis: influence of immunocompromission and radiological extent of disease].

    PubMed

    Guglielmetti, Lorenzo; Conti, Michela; Cazzadori, Angelo; Lo Cascio, Giuliana; Sorrentino, Annarita; Concia, Ercole

    2012-03-01

    Tuberculosis (TB) is a pathology whose control is still unsatisfactory at global level. Traditional diagnostic techniques for active TB diagnosis are inadequate: the diagnostic gold standard is the cultural exam which suffers from lengthy processing and requires highly specialized laboratories. This study analyzed the diagnostic sensitivity of the tuberculin skin test (TST) and QuantiFERON-TB Gold In-Tube (QFT-IT) in 135 active, microbiologically confirmed TB cases. Sensitivity was 76% for both tests and reached cumulative levels close to 90%. QFT-IT revealed a statistically higher sensitivity than TST in a group of patients affected by various causes of immunosuppression, but was less sensitive in subjects with low levels of circulating CD4+ cells. The number of circulating CD4+ cells showed a direct correlation with the stimulated IFN-gamma production. QFT-IT also demonstrated a decreased IFN-gamma production, with a significant sensitivity reduction, in patients affected by advanced forms of pulmonary TB.

  10. Silica supported Fe(3)O(4) magnetic nanoparticles for magnetic solid-phase extraction and magnetic in-tube solid-phase microextraction: application to organophosphorous compounds.

    PubMed

    Moliner-Martinez, Y; Vitta, Yosmery; Prima-Garcia, Helena; González-Fuenzalida, R A; Ribera, Antonio; Campíns-Falcó, P; Coronado, Eugenio

    2014-03-01

    This work demonstrates the application of silica supported Fe3O4 nanoparticles as sorbent phase for magnetic solid-phase extraction (MSPE) and magnetic on-line in-tube solid-phase microextraction (Magnetic-IT-SPME) combined with capillary liquid chromatography-diode array detection (CapLC-DAD) to determine organophosphorous compounds (OPs) at trace level. In MSPE, magnetism is used as separation tool while in Magnetic-IT-SPME, the application of an external magnetic field gave rise to a significant improvement of the adsorption of OPs on the sorbent phase. Extraction efficiency, analysis time, reproducibility and sensitivity have been compared. This work showed that Magnetic-IT-SPME can be extended to OPs with successful results in terms of simplicity, speed, extraction efficiency and limit of detection. Finally, wastewater samples were analysed to determine OPs at nanograms per litre.

  11. Physical Processes of the Interaction Between Laser-Generated Plasma and Blast Wave Appearing in Laser-Driven In-Tube Accelerator Configuration

    SciTech Connect

    Sasoh, Akihiro; Mori, Koichi; Ohtani, Toshiro; Ohnishi, Naofumi; Ogino, Yosuke; Sawada, Keisuke

    2006-05-02

    Flow visualizations of the interaction between a laser-pulse-generated plasma and a shock wave driven by it have been experimentally conducted. The configuration of the experimental set-up corresponds to the laser-driven, in-tube accelerator. Primary-mode deformation of the plasma is governed by Richtmyer-Meshkov instability which is produced by the vector product between the pressure and density gradients, which in turn correspond to a reflected shock wave and to the plasma, respectively. Higher-mode contact surface deformations are supposedly originated in Rayleigh-Taylor instability in the shrinkage phase of the plasma, and is enhanced due to the passage of the reflected shock wave.

  12. In situ hydrothermal growth of polyaniline coating for in-tube solid-phase microextraction towards ultraviolet filters in environmental water samples.

    PubMed

    Bu, Yanan; Feng, Juanjuan; Wang, Xiuqin; Tian, Yu; Sun, Min; Luo, Chuannan

    2017-02-03

    A facile, low cost, sensitive and environmentally friendly polyaniline (PANI) coating was prepared onto the basalt fibers (BFs) by in situ hydrothermal growth method. PANI functionalized BFs were placed into a poly(ether ether ketone) (PEEK) tube as a fibers-in-tube solid-phase microextraction (SPME) device. The extraction and analysis processes were carried out by connecting it to high performance liquid chromatography (HPLC). Three ultraviolet filters including 2-hydroxy-4-methoxybenzophenone, phenyl salicylate and 2,4-dihydroxybenzophenone were employed as model analytes. Under the optimal extraction and desorption conditions, online in-tube SPME-HPLC analysis method was established and afforded satisfactory enrichment factors (1323-1555), wide linear ranges (0.06-100μgL(-1)) with correlation coefficients ranging from 0.9995 to 0.9999, low limits of detection (0.02-0.05μgL(-1)) and acceptable extraction repeatability (RSD<7.8%, n=6) and preparation repeatability (RSD<9.7%, n=3). The proposed method was successfully applied to the determination of the three ultraviolet filters in two environmental water samples. Copyright © 2016 Elsevier B.V. All rights reserved.

  13. Effect of prophylactic benzydamine hydrochloride on postoperative sore throat and hoarseness after tracheal intubation using a double-lumen endobronchial tube: a randomized controlled trial.

    PubMed

    Chang, Jee-Eun; Min, Seong-Won; Kim, Chong-Soo; Han, Sung-Hee; Kwon, Yong-Suk; Hwang, Jin-Young

    2015-10-01

    We evaluated the prophylactic effect of benzydamine hydrochloride (BH) spray on postoperative sore throat and hoarseness secondary to intubation with a double-lumen endobronchial tube (DLT). Ninety-two adult patients undergoing thoracic surgery using DLT intubation were studied. The DLT cuff and oropharyngeal cavity were sprayed with normal saline (Group S; n = 46) or BH (Group BH; n = 46) prior to intubation. Postoperative sore throat and hoarseness were evaluated at one, six, and 24 hr after surgery. Sore throat was evaluated using a 0-100 mm visual analogue scale (VAS). Hoarseness was defined as a change in voice quality. Compared with Group S, postoperative sore throat occurred less frequently in Group BH at one hour (mean difference, 28.3%; 95% confidence interval [CI], 8.7 to 45.1; P = 0.01), at six hours (mean difference, 32.6%; 95% CI, 12.6 to 49.2; P < 0.01), and at 24 hr (mean difference, 28.3%; 95% CI, 9.3 to 44.7; P = 0.01) after surgery. Group BH had lower VAS scores for postoperative sore throat at one hour (mean difference, 12.8; 95% CI, 4.9 to 20.7), at six hours (mean difference, 11.9; 95% CI, 4.8 to 19.1; P < 0.01), and at 24 hr (mean difference, 5.3; 95% CI, 0.9 to 9.7; P = 0.01) after surgery. Hoarseness also occurred less frequently in Group BH at one hour (mean difference, 23.9%; 95% CI, 6.8 to 39.6; P = 0.01), at six hours (mean difference, 23.9%; 95% CI, 7.4 to 39.3; P = 0.01), and at 24 hr (mean difference, 21.7%; 95% CI, 5.5 to 37.0; P = 0.02) after surgery (P < 0.01). Prophylactic application of BH to the DLT cuff and oropharyngeal cavity reduces the incidence and severity of postoperative sore throat and the incidence of hoarseness associated with DLT intubation. The trial was registered at the Clinical Research Information Service (KCT0001068).

  14. Automated in-tube solid-phase microextraction coupled with liquid chromatography-electrospray ionization mass spectrometry for the determination of selected benzodiazepines.

    PubMed

    Yuan, H; Mester, Z; Lord, H; Pawliszyn, J

    2000-01-01

    A simple, rapid, and sensitive method, which allowed us to simultaneously determine seven benzodiazepines (diazepam, nordiazepam, temazepam, oxazepam, 7-aminoflunitrazepam, N-desmethylflunitrazepam, and clonazepam) in buffer solution and in urine and serum samples, was investigated by automated in-tube solid-phase microextraction (SPME) coupled with liquid chromatography-electrospray ionization mass spectrometry (LC-ESI-MS). In-tube SPME, in which the analytes were extracted from the sample directly into an open tubular capillary column by repeated draw/eject cycles of sample solution, is an extraction technique for organic compounds in aqueous samples. The separation of benzodiazepines was carried out under ion-suppressed reversed-phase conditions by using methanol/50mM ammonium acetate in water (60:40) as a mobile phase with a Supelco LC-18 column. The optimal extraction condition was 10 draw/eject cycles of 30 mL of sample in 100mM Tris-HCl (pH 8.5) at a flow rate of 0.3 mL/min using a piece of 60-cm length Supelco-Q plot capillary column as the extraction capillary. The quantitative study was explored by operating in selected-ion monitoring (SIM) mode. The calibration curves were linear in the range from 0.5 ng/mL or 2 ng/mL to 500 ng/mL. The detection limits were from 0.02 ng/mL to 2 ng/mL. At the optimized capillary and fragmentor voltages, the characteristic ions for each compound clearly showed up in the spectra and it is possible to use the LC-MS to identify these compounds. The method was applied to the analysis of biological samples without interfering peaks. However, the recoveries for some of the compounds in serum samples need to be further improved.

  15. Low temperature solder process to join a copper tube to a silicon wafer

    NASA Astrophysics Data System (ADS)

    Versteeg, Christo; Scarpim de Souza, Marcio

    2014-06-01

    With the application for wafer level packages, which could be Complementary Metal-Oxide-Semiconductor (CMOS) based, and which requires a reduced atmosphere, a copper tube connection to a vacuum pump and the package is proposed. The method evaluated uses laser assisted brazing of a solder, to join the copper tube to a silicon wafer. The method was applied to a silicon wafer coated with a metallic interface to bond to the solder. The hermeticity of the joint was tested with a helium leak rate tester and the bonding energy thermal extent was verified with a thin layer of indium that melted wherever the substrate temperature rose above its melting temperature.

  16. Awake intubation.

    PubMed

    Peiris, Kawshala; Frerk, Chris

    2008-03-01

    Securing the airway is a core skill in anaesthesia, the gold standard of which is tracheal intubation. Normally this is achieved after induction of anaesthesia. However, some circumstances demand an awake approach. Awake intubation can be achieved via several methods. Using the fibreoptic laryngoscope is the most widely used technique in the UK with minimal patient discomfort and a wide margin of safety. When compared with attempts at difficult direct laryngoscopy, awake fibreoptic intubation provides excellent cardiovascular stability when performed under good topical anaesthesia and conscious sedation. Understanding the equipment used as well as preparing the patient and being aware of potential pitfalls are important elements to performing a successful awake intubation.

  17. Difficult passage of the endotracheal tube and massive nasal bleeding during awake nasal fiberoptic intubation in a patient with airway obstruction caused by neck hematoma--a case report.

    PubMed

    Inoue, Satoki; Fujimoto, Yuko; Kawano, Yasunobu; Furuya, Hitoshi

    2011-02-01

    A 60 yr-old male underwent anterior cervical fusion under general anesthesia. Neck swelling was observed at the next morning. Subsequently, emergent CT scanning was performed, which revealed a retropharyngeal hematoma narrowing the upper airway and right anterior neck hematoma significantly deviating the trachea and larynx. Nasal intubation was attempted but difficult passage of the endotracheal tube counteracted this procedure. Immediately, massive nasal bleeding occurred, which worsened the situation. Subsequently, oral fiberoptic intubation with the aid of McCoy type laryngoscope was tried and intubation was barely established. The patient was submitted to emergent evacuation of the hematoma. Reevaluation of the preoperative CT images showed the nasal cavity narrowing because of widespread nasal mucosal swelling. It is necessary to anticipate that nasal mucosal swelling and bleeding tendency due to impairment of venous drainage can exist in such a case.

  18. Polydopamine-based immobilization of zeolitic imidazolate framework-8 for in-tube solid-phase microextraction.

    PubMed

    Zhang, Juan; Zhang, Wenpeng; Bao, Tao; Chen, Zilin

    2015-04-03

    Zeolitic imidazolate frameworks (ZIFs), a subfamily of metal-organic frameworks (MOFs), have received considerable attention as a novel porous material for sample preparation due to their fascinating structures and unique properties. Here, we developed a novel bio-inspired polydopamine (PDA) method to immobilize ZIFs inside the chemical resistance poly(ether ether ketone) (PEEK) tube for online solid-phase microextraction (SPME). Firstly, PDA layer was assembled inside the PEEK tube. Secondly, attributing to its noncovalent adsorption and covalent reaction ability, PDA could attract and anchor ZIF-8 nutrients onto the inner surface of PEEK tube to promote the nucleation and growth of ZIF-8. The morphology and surface properties of the prepared ZIF-8-PDA-PEEK tube were characterized by scanning electron microscopy and energy dispersive X-ray spectrometry. The ZIF-8-PDA-PEEK tube exhibits excellent extraction efficiency toward six polycyclic aromatic hydrocarbons (PAHs), with enrichment factor from 550 to 734. The developed online SPME-HPLC method shows good linearity (10-5000pg/mL) and low detection limits (0.5-5 pg/mL) for six PAHs. It also has been used to determine PAHs in environmental samples, with recoveries in the range of 82.5-98.6%. Copyright © 2015 Elsevier B.V. All rights reserved.

  19. Timing for Removal of Asymptomatic Long-Term Ventilation Tube in Children.

    PubMed

    Abdel-NabyAwad, Osama G

    2016-12-01

    Otitis media with effusion (OME) is the most frequent illness in children. Surgical treatment options include ventilation tube insertion, adenoidectomy or both. Opinions regarding the risks, benefits and intubation period of ventilation tube insertion vary greatly. To determine the appropriate time for when to remove asymptomatic longterm ventilation T-tubes in children. In this prospective study, we analyzed the results of 120 pediatric patients (6-12 years) (240 ears) with persistent OME; we employed the Goode T-silicone tubes. We intentionally planned to remove the tubes at different time points of the study and divided our patients randomly into four subgroups with 30 patents (60 ears in each) according to the intubation period; group I: intubation for 6 months, group II: intubation for 12 months, group III: intubation for 18 months and group IV: intubation for 24 months. The relationship between intubation period and OME recurrence, the rate of persistent tympanic membrane (TM) perforation, granulation tissue or discharge near the tympanostomy tubes, normalization of Eustachian tube function and change of hearing level was analyzed in each patient group. The χ(2) analysis showed that the rate of normalization of ET function was significantly higher when tubes were removed after 12-months of intubation (P = 0.002), the rate of OME recurrence was significantly higher when tubes were removed before 12-months of intubation (P = 0.004), The rate of otorrhea significantly increased after 12-months of intubation, development of granulation around tubes was significantly higher after 18-months of tube insertion. The rate of appearance of permanent TM perforation significantly increased after 18-months from tube insertion (P = 0.008). Adenoidectomy did not significantly influence the recurrence rate of OME or the rate of persistent TM peroration after tube removal. Our present results suggest that the appropriate intubation period for healing OME in

  20. [Endotracheal intubation in pediatric patients].

    PubMed

    Humberg, Alexander; Göpel, Wolfgang

    2016-09-01

    Procedure of intubation of children is different to intubation in adults and requires specific considerations. Before intubation management of difficult airway problems should be anticipated. Risk of developing hypoxia is common in children usually due to a reduced apnea tolerance and demands skill of the medical team. Due to soft tissues of the upper airways and the V-shaped epiglottis several laryngoscopes are available. Attention should be kept on a physiological subglottic stenosis, which determines the size of the endotracheal tube. Beyond neonatal period cuffed tubes can be applied when cuff pressure is regularly monitored. Long time complications of traumatic intubations comprise subglottic stenosis or granulomas. © Georg Thieme Verlag KG Stuttgart · New York.

  1. 2-Hydroxypropyl-beta-cyclodextrin extracts 2-phenylphenol from silicone tubing.

    PubMed

    den Brok, Monique W J; van der Schoot, Sabien C; Nuijen, Bastiaan; Hillebrand, Michel J X; Beijnen, Jos H

    2004-07-08

    Cyclodextrins are capable to solubilise lipophilic drugs via (partial) inclusion in their lipophilic cavity. This, however, also provides the potential for the extraction of small molecules from production materials. In the present study, the potency of the commercially available and used cyclodextrin, 2-hydroxypropyl-beta-cyclodextrin (HPbetaCD) to extract the preservative 2-phenylphenol (2-PP) from platinum cured silicone tubing was tested. The presence of 2-PP was structurally confirmed with HPLC-UV and LC/MS/MS in HPbetaCD solutions after incubation with platinum cured silicone tubing. HPbetaCD concentration and prior tubing sterilisation were found not to influence the levels of 2-PP extracted. Interestingly, extraction to ethanol was 15-fold higher than observed for HPbetaCD solutions. 2-PP was extracted from silicone tubing during routine manufacture of a blank dosage form formulated with only HPbetaCD, resulting in detectable levels of 2-PP in the final product. In a freeze-dried dosage form containing HPbetaCD and an active pharmaceutical ingredient (exhibiting a stability constant for HPbetaCD/drug of 1045 L/mol), on the other hand, 2-PP was undetectable.

  2. Simple and rapid determination of amphetamine, methamphetamine, and their methylenedioxy derivatives in urine by automated in-tube solid-phase microextraction coupled with liquid chromatography-electrospray ionization mass spectrometry.

    PubMed

    Kataoka, H; Lord, H L; Pawliszyn, J

    2000-01-01

    A simple and rapid method for the determination of amphetamine, methamphetamine, and their 3,4-methylenedioxy derivatives in urine samples was developed using automated in-tube solid-phase microextraction (SPME) coupled with liquid chromatography-electrospray ionization mass spectrometry (LC-ESI-MS). In-tube SPME is an extraction technique for organic compounds in aqueous samples in which analytes are extracted from the sample directly into an open tubular capillary by repeated draw/eject cycles of sample solution. LC-MS analyses of stimulants were initially performed by liquid injection onto an LC column to determine spectra. Five stimulants tested in this study gave very simple ESI mass spectra, and strong signals corresponding to [M+H]+ were observed for all stimulants. The stimulants were well separated with a Supelcosil LC-CN column using acetonitrile/50mM ammonium acetate (15:85) as a mobile phase. In order to optimize the extraction of stimulants, several in-tube SPME parameters were examined. The optimum extraction conditions were 15 draw/eject cycles of 35 microL of sample in 50mM Tris-HCI (pH 8.5) at a flow rate of 100 microL/min using an Omegawax 250 capillary column. The stimulants extracted by the capillary were easily desorbed by mobile phase flow, and carryover of stimulants was not observed. Using in-tube SPME-LC-ESI-MS with selected ion monitoring, the calibration curves of stimulants were linear in the range from 2 to 100 ng/mL with correlation coefficients above 0.9985 (n = 18) and detection limits (S/N = 3) of 0.38-0.82 ng/mL. This method was successfully applied to the analysis of human urine samples without interference peaks. The recoveries of stimulants spiked into urine samples were above 81%.

  3. Assessing the Prevalence of Latent Tuberculosis among Health Care Providers in Zagazig City, Egypt Using Tuberculin Skin Test and QuantiFERON-TB Gold In-Tube Test.

    PubMed

    El-Sokkary, Rehab H; Abu-Taleb, Ashwak M; El-Seifi, Omnia S; Zidan, Haidy E; Mortada, Eman M; El-Hossary, Dalia; Farag, Salama E

    2015-12-01

    Early detection of latent tuberculosis infection (LTBI) will prevent development of active TB among health care providers. The aim of the study was to assess the prevalence of LTBI among health care providers and compare the QuantiFERON-TB Gold In-Tube Test (QFT-GIT) and Tuberculin skin test in efforts to detect LTBI and to investigate possible associated risk factors of infection. A cross sectional study was carried out during the period of 6 months in the Chest Hospital in Zagazig city and the Nephrology Unit at Zagazig University Hospitals in 132 randomly selected health care providers who were examined for LTBI by QFT-GIT and Tuberculin skin test and for the associated risk factors as well. The prevalence of LTBI identified by QFT-GIT and by Tuberculin skin test was 28.8% and 59.1%, respectively. Poor agreement was observed between the two tests (kappa=0.10). Working more than 10 years, being nurse, diabetic and smoker were risk factors significantly associated with LTBI (p<0.05). QFT-GIT is considered a useful tool in detecting LTBI cases, especially in a country where BCG vaccination is a national policy (as in Egypt). Duration of work, profession, diabetes and smoking are the risk factors for LTBI. Active surveillance and infection control measures are recommended to reduce the risk of LTBI. Copyright© by the National Institute of Public Health, Prague 2015.

  4. Tuberculin Skin Test and QuantiFERON(®)-TB Gold In-Tube Test for Diagnosing Latent Tuberculosis Infection among Thai Healthcare Workers.

    PubMed

    Khawcharoenporn, Thana; Apisarnthanarak, Anucha; Sangkitporn, Somchai; Rudeeaneksin, Janisara; Srisungngam, Sopa; Bunchoo, Supranee; Phetsuksiri, Benjawan

    2016-05-20

    A cross-sectional study was conducted on the performance of the tuberculin skin test (TST) and QuantiFERON(®)-TB Gold In-Tube test (QFT-IT) for detecting latent tuberculosis infection among Thai healthcare workers (HCWs). Each HCW underwent both the TST and QFT-IT during the annual health screening. Among the 260 HCWs enrolled, the median age was 30 years (range 19-60 years), 92% were women, 64% were nurses and nurse assistants, 78% were Bacillus Calmette Guérin vaccinated, and 37% had previously taken the TST. Correlation between TST reaction size and the interferon-γ level was weak (r = 0.29; P < 0.001). Of the HCWs, 38% and 20% had a reactive TST and a positive QFT-IT, respectively. Using QFT-IT positivity as a standard for latent tuberculosis diagnosis, the cut-off for TST reactivity with the best performance was ≥13 mm with a sensitivity, specificity, false positivity, and false negativity of 71%, 70%, 30%, and 29%, respectively (area under the curve 0.73; P < 0.001). The independent factor associated with a false reactive TST was a previous TST (adjusted odds ratio 1.83; P = 0.04). Our findings suggest that the QFT-IT may be the preferred test among HCWs with previous TST. In settings where the QFT-IT is not available, appropriate cut-offs for TST reactivity should be evaluated for use among HCWs.

  5. In-tube solid-phase microextraction coupled by in valve mode to capillary LC-DAD: Improving detectability to multiresidue organic pollutants analysis in several whole waters.

    PubMed

    Campíns-Falcó, P; Verdú-Andrés, J; Sevillano-Cabeza, A; Herráez-Hernández, R; Molins-Legua, C; Moliner-Martinez, Y

    2010-04-16

    A simple and fast capillary chromatographic method has been developed to identify and quantify organic pollutants at sub-ppb levels in real water samples. The major groups of pesticides (organic halogens, organic phosphorous, and organic nitrogen compounds), some hydrocarbons (polycyclic aromatic hydrocarbons), phthalates and some phenols such as phenol and bisphenol A (endocrine disruptors) were included in this study. The procedure was based on coupling, in-tube solid-phase microextraction (IT-SPME) by using a conventional GC capillary column (95% methyl-5% phenyl substituted backbone, 80cmx0.32mm i.d., 3microm film thickness) in the injection valve to capillary liquid chromatography with diode array detection. A comparative study between the IT-SPME manifold and a column-switching device using a C(18) column (35mmx0.5mm i.d., 5microm particle size) has been performed. The IT-SPME procedure was optimal, it allows reaching limits of detection (LODs) between 0.008 and 0.2microg/L. No matrix effect was found and recoveries between 70 and 116% were obtained. The precision of the method was good, and the achieved intra- and inter-day variation coefficients were between 2 and 30%. This procedure has been applied to the screening analysis of 28 compounds in whole waters from several points of the Mediterranean coast (Valencia Community, Spain).

  6. Automated on-line in-tube solid-phase microextraction-assisted derivatization coupled to liquid chromatography for quantifying residual dimethylamine in cationic polymers.

    PubMed

    Prieto-Blanco, M C; Cháfer-Pericás, C; López-Mahía, P; Campíns-Falcó, P

    2008-04-25

    A method for the analysis of dimethylamine (DMA) by automated in-tube solid-phase microextraction (IT-SPME)-supported chemical derivatization coupled with high-performance liquid chromatography was developed. Extraction, derivatization and desorption were studied by using a capillary coated with 95% polydimethylsiloxane and 5% polydiphenylsiloxane. Solution derivatization and automated IT-SPME derivatization using 9-fluorenylmethyl chloroformate (FMOC) were compared. The proposed procedure provided adequate linearity, accuracy and precision in the 0.2-2.0 microg/mL concentration interval, and the limit of detection (LOD) was 50 ng/mL. The main advantages of the proposed procedure are: (i) no off-line sample manipulation, (ii) rapidity, as the total analysis time is about 10 min, (iii) specificity for the samples assayed, (iv) minimal consumption of FMOC reagent and (v) minimal residues. Therefore, the proposed method is an environmental-friendly and cost-effective alternative for the control of residual DMA in polymeric cationic surfactants used like flocculants in water treatment.

  7. Presumed latent ocular tuberculosis diagnosed with the positive quantiFERON-TB Gold In-Tube Test in a HLA-A29-positive patient.

    PubMed

    Rangel, Carlos Mario; Atencia, Cesar; Merayo-Lloves, Jesus; Fernandez-Vega Sanz, Alvaro

    2015-06-04

    A 59-year-old Hispanic woman presented with a 3-year history of floaters associated with bilateral reduced visual acuity. Her best-corrected visual acuity (BCVA) was 20/40. Both anterior segments were without inflammation, but fundoscopy showed mild vitreous inflammation and multiple inflammatory choroidal lesions. Tests for inflammatory and infectious diseases were negative except for human leucocyte antigen A29. The patient was diagnosed with birdshot choroidoretinopathy, and treatment was initiated with cyclosporine A 2.5 mg/kg/day. One year after treatment, the patient reported systemic symptoms with no improvement in visual acuity. Fundus findings remained with vitreal inflammation. QuantiFERON-TB Gold In-Tube Test was positive, and a diagnosis of presumed latent ocular tuberculosis (TB) was made. We initiated anti-TB treatment for 9 months. At 6 months of anti-TB therapy, there was no active inflammation. The patient was followed for 2 years with no medications and no active inflammation. Her final BCVA was 20/25.

  8. Laryngeal tube and intubating laryngeal mask insertion in a manikin by first-responder trainees after a short video-clip demonstration.

    PubMed

    Jokela, Jorma; Nurmi, Jouni; Genzwuerker, Harald V; Castrén, Maaret

    2009-01-01

    This study was performed in the Finnish Defense Forces to assess the potential applicability and value of short video clips as educational material to teach advanced airway management and as the first means of introducing the use of a laryngeal tube (LT) or an intubating laryngeal mask (ILMA) to inexperienced, military, first-responder trainees with no prior hands-on experience. The 60 non-commissioned medical officers participating in this study were randomly assigned into one of two groups: the LT- and the ILMA-group. After viewing the video clips, the trainees were required to perform 10 consecutive, successful insertions of the given instrument into a manikin. The number and duration of the attempts required prior to the 10 consecutive successful insertions were measured. The goal of 10 consecutive successful insertions was attained by all 30 subjects in the LT-group, and by 27 of 29 subjects in the ILMA-group with a maximum of 30 attempts. Improvement in the ease and speed of insertion was evident between the first and last consecutive insertions in both groups. "Satisfactory" to "good" skill levels are achieved with the applied video-clip demonstration method, even in inexperienced first-responder trainees lacking previous hands on experience.

  9. A new on-line, in-tube pre-column derivatization technique for high performance liquid chromatographic determination of azithromycin in human serum.

    PubMed

    Bahrami, Gholamreza; Mohammadi, Bahareh

    2006-01-18

    Pre-column derivatization methods for high performance liquid chromatographic assay of specific pharmaceutical agents using 9-fluorenylmethyl chloroformate (FMOC-Cl) have received special attention because highly fluorescent and stable adducts are provided by these methods. However, unlike the post-column on-line techniques, long derivatization time is needed and the reaction cannot be well controlled. A new, sensitive and fast pre-column on-line derivatization technique coupled with high-performance liquid chromatography using FMOC-Cl as labeling agent is described and validated for determination of azithromycin in human serum. After extraction of the drug from serum, the residue was reconstituted in mixture of acetonitrile-phosphate buffer (3:1, v/v; pH 8.5) and directly injected onto the chromatographic system. Continuous on-line derivatization and analysis of the compounds were successfully performed using in-tube elution of FMOC-Cl. The total time needed for derivatization and chromatographic analysis of the drug was 13 min. The assay was reliable and reproducible, with limit of quantification of 10 ng/ml. The described technique may offer significant advantages over existing off-line derivatization methods using FMOC-Cl.

  10. Airway management in cardiac arrest--comparison of the laryngeal tube, tracheal intubation and bag-valve mask ventilation in emergency medical training.

    PubMed

    Kurola, J; Harve, H; Kettunen, T; Laakso, J-P; Gorski, J; Paakkonen, H; Silfvast, T

    2004-05-01

    Tracheal intubation (ETI) is considered the method of choice for securing the airway and for providing effective ventilation during cardiac arrest. However, ETI requires skills which are difficult to maintain especially if practised infrequently. The laryngeal tube (LT) has been successfully tested and used in anaesthesia and in simulated cardiac arrest in manikins. To compare the initiation and success of ventilation with the LT, ETI and bag-valve mask (BVM) in a cardiac arrest scenario, 60 fire-fighter emergency medical technician (EMT) students formed teams of two rescuers at random and were allocated to use these devices. We found that the teams using the LT were able to initiate ventilation more rapidly than those performing ETI (P < 0.0001). The LT and ETI provided equal minute volumes of ventilation, which was significantly higher than that delivered with the BVM (P < 0.0001). Our data suggest that the LT may enable airway control more rapidly and as effectively as ETI, and compared to BVM, may provide better minute ventilation when used by inexperienced personnel.

  11. Added value of QuantiFERON TB-gold in-tube for detecting latent tuberculosis infection among persons living with HIV/AIDS.

    PubMed

    Souza, Josiane Maria Oliveira; Evangelista, Maria do Socorro Nantua; Trajman, Anete

    2014-01-01

    To evaluate the added value of QuantiFERON TB-Gold in-Tube (QTF-GIT) over the tuberculin skin testing (TST) for detecting latent tuberculosis (TB) infection (LTBI) among patients with AIDS in a city with a low TB incidence rate (11.1/100,000 inhabitants) and universal BCG coverage. Three hundred consecutive patients with AIDS in eight outpatient sexually transmitted disease public clinics in Brasilia were submitted to QFT-IT and TST between May 2011 and March 2013. A positive result of either test was considered to be LTBI. Median CD4-cell count was 477.5 cells/mm(3); 295 (98.3%) were using antiretroviral therapy. Eighteen patients (6%, 95% CI: 3.6%-9.3%) had LTBI, of whom 4 (1.3%, 95% CI: 0.04%-2.63%) had only a positive TST, 8 (2.7%, 95% CI: 0.8%-4.5%) had only a QFT-GIT positive test, and 6 (2%, 95% CI: 0.4%-3.6%) had positive results for both tests. This represents an 81.8% relative increase in LTBI detection when QFT-GIT is added to TST. The concordance between both tests was 96% (k = 0.48). The QFT-GIT alone was more effective to detect LTBI than TST alone and had an 81% added value as an add-on sequential test in this population with mild immunosuppression. The cost-effectiveness of these strategies remains to be evaluated.

  12. Modification of the QuantiFERON-TB Gold (In-Tube) assay for the diagnosis of Mycobacterium bovis infection in African buffaloes (Syncerus caffer).

    PubMed

    Parsons, Sven D C; Cooper, David; McCall, Alicia J; McCall, Warren A; Streicher, Elizabeth M; le Maitre, Nicholas C; Müller, Annélle; Gey van Pittius, Nicolaas C; Warren, Robin M; van Helden, Paul D

    2011-07-15

    African buffaloes (Syncerus caffer) are the most significant wildlife maintenance hosts of Mycobacterium bovis, the causative organism of bovine tuberculosis (BTB). Current diagnostic tests for the detection of M. bovis infection in free-ranging buffaloes have numerous limitations and we wished to evaluate a modification to a human TB assay, the QuantiFERON-TB Gold (In-Tube) assay (QFT), as a practical diagnostic test for BTB in buffaloes. One hundred and seventy-five buffaloes were tested using the single intradermal comparative tuberculin test (SICTT) and a modified QFT (mQFT). An appropriate cut-off point for the mQFT was derived from SICTT results using receiver operator characteristic curve analysis. Twenty-six SICTT-positive buffaloes were killed and subjected to necropsy, and selected tissues were processed for mycobacterial culture and speciation. An optimal cut-off point for the mQFT was calculated as 66pg/ml. The assay correctly detected 39/40 SICTT-positive buffaloes and 129/134 TST-negative buffaloes and M. bovis was cultured from 21/26 slaughtered SICTT/mQFT-positive animals. The mQFT shows promise as a practical test for M. bovis infection in buffaloes and shows a sensitivity and specificity at least similar to that of the TST.

  13. Headspace in-tube extraction gas chromatography-mass spectrometry for the analysis of hydroxylic methyl-derivatized and volatile organic compounds in blood and urine.

    PubMed

    Rasanen, Ilpo; Viinamäki, Jenni; Vuori, Erkki; Ojanperä, Ilkka

    2010-04-01

    A novel headspace in-tube extraction gas chromatography-mass spectrometry (ITEX-GC-MS) approach was developed for broad-scale analysis of low molecular weight organic compounds in blood and/or urine. One sample was analyzed following in-vial derivatization with dimethyl sulfate for ethylene glycol (EG), glycolic acid (GA), formic acid (FA), other hydroxylic compounds, and another sample for underivatized volatile organic compounds. Tenax adsorbent resin was used in the microtrap, and a porous layer, open tubular GC capillary column was used for separation. MS was operated in the full-scan mode, identification was based on the Automated Mass Spectral Deconvolution and Identification System, and quantification was based on extracted ions. The limits of quantification for EG, GA, and FA in blood were 10, 50, and 30 mg/L, respectively, and the expanded uncertainties of measurement were 20%, 16%, and 14%, respectively. The procedure allowed for the first time the inclusion of EG and GA as their methyl derivatives within a quantitative HS analysis. The ITEX method described here was more sensitive for analysis of volatile organic compounds than the corresponding static headspace analysis as demonstrated for 11 representative compounds.

  14. Detection of Mycobacterium tuberculosis infection in chacma baboons (Papio ursinus) using the QuantiFERON-TB gold (in-tube) assay.

    PubMed

    Parsons, Sven D C; Gous, Tertius A; Warren, Robin M; de Villiers, Charon; Seier, Jürgen V; van Helden, Paul D

    2009-12-01

    Early diagnosis of simian tuberculosis (TB) is vital to prevent transmission of this disease. We evaluated the ability of the QuantiFERON-TB Gold (In-Tube Method) assay (QFG-IT) to detect TB in chacma baboons (Papio ursinus). Fifty-one baboons were tested using the Tuberculin Skin Test (TST) and the QFG-IT. Baboons testing positive, and animals exposed to infected individuals, were euthanised and subjected to necropsy. Selected tissues were processed for histopathology, mycobacterial culture and genetic speciation. Tuberculosis was confirmed in one TST positive/QFG-IT positive animal and one TST negative/QFG-IT positive animal. One TST positive/QFG-IT negative animal and five TST negative/QFG-IT negative animals were confirmed uninfected following necropsy. The QFG-IT correctly detected TB in two baboons, including one TST negative individual and correctly identified six baboons as uninfected, including one TST positive individual. The QFG-IT shows promise as a sensitive, specific test for TB in chacma baboons.

  15. Placement of Intubating Laryngeal Mask Airway Is Easier than Placement of Laryngeal Tube during Manual In-Line Stabilisation of The Neck

    PubMed Central

    Komatsu, R.; Nagata, O.; Kamata, K.; Yamagata, K.; Sessler, D.I.; Ozaki, M.

    2005-01-01

    Summary We compared the usefulness of the laryngeal tube (LT) with the intubating laryngeal mask airway (ILMA) in 51 patients whose necks were stabilised by manual in-line traction. After induction of anaesthesia and neuromuscular block, the LT and ILMA were inserted consecutively in a randomised, crossover design. During pressure-controlled ventilation (20 cmH2O inspiratory pressure), we measured insertion attempts, time to establish positive-pressure ventilation, tidal volume, gastric insufflation, and minimum airway pressure at which gas leaked around the cuff. Data were compared using Wilcoxon signed-rank tests; P<0.05 was considered significant. Insertion was more difficult with the LT (successful at first attempt in 16 patients) than with the ILMA (successful at first attempt in 42 patients, P<0.0001). Time required for insertion was longer for the LT (28 [23–35] sec, median [interquartile range]) than the ILMA (20 [15–25] sec, P=0.0009). Tidal volume was less for the LT (440 [290–670] ml) than the ILMA. (630 [440–750] ml, P=0.013). Minimum airway pressure at which gas leak occurred and incidence of gastric insufflation were similar with two devices. In patients whose necks were stabilised with manual in-line traction, insertion of the ILMA was easier and quicker than insertion of the LT and tidal volume was greater with the ILMA than the LT. PMID:15644005

  16. QuantiFERON-TB Gold In-Tube test (QFT-GIT) for the screening of latent tuberculosis in recent immigrants to Italy.

    PubMed

    Saracino, Annalisa; Scotto, Gaetano; Fornabaio, Chiara; Martinelli, Domenico; Faleo, Giuseppina; Cibelli, Donatella; Tartaglia, Alessandra; Di Tullio, Rocco; Fazio, Vincenzina; Prato, Rosa; Monno, Laura; Angarano, Gioacchino

    2009-10-01

    To evaluate the agreement between QuantiFERON-TB Gold In-Tube test (QFT-GIT) and tuberculin skin test (TST) for the screening of latent tuberculosis infection (LTBI) in recent immigrants to Italy, 279 subjects were submitted to concomitant TST and QFT-GIT. The agreement was analyzed using k statistics. A total of 72/279 (25.8%) individuals were TST positive, while 107/279 (38.3%) were QFT-GIT positive. The overall agreement between QFT-GIT and TST was 70.9%, with k statistic of 0.35. Using different TST and QFT-GIT cut-offs, the best concordance value was obtained for QFT-GIT at > 2.64 IU/ml and TST at > 10mm (k = 0.409). Discordant results were found for 58 subjects (21%) with QFT-GIT positive/TST negative and 23 (8%) with QFT-GIT negative/TST positive. A high amount of discordance QFT-GIT+/TST- was described. QFT-GIT might increase the identification of LTBI cases among recent immigrants.

  17. In-tube electro-membrane extraction with a sub-microliter organic solvent consumption as an efficient technique for synthetic food dyes determination in foodstuff samples.

    PubMed

    Bazregar, Mohammad; Rajabi, Maryam; Yamini, Yadollah; Asghari, Alireza; Abdossalami asl, Yousef

    2015-09-04

    A simple and efficient extraction technique with a sub-microliter organic solvent consumption termed as in-tube electro-membrane extraction (IEME) is introduced. This method is based upon the electro-kinetic migration of ionized compounds by the application of an electrical potential difference. For this purpose, a thin polypropylene (PP) sheet placed inside a tube acts as a support for the membrane solvent, and 30μL of an aqueous acceptor solution is separated by this solvent from 1.2mL of an aqueous donor solution. This method yielded high extraction recoveries (63-81%), and the consumption of the organic solvent used was only 0.5μL. By performing this method, the purification is high, and the utilization of the organic solvent, used as a mediator, is very simple and repeatable. The proposed method was evaluated by extraction of four synthetic food dyes (Amaranth, Ponceau 4R, Allura Red, and Carmoisine) as the model analytes. Optimization of variables affecting the method was carried out in order to achieve the best extraction efficiency. These variables were the type of membrane solvent, applied extraction voltage, extraction time, pH range, and concentration of salt added. Under the optimized conditions, IEME-HPLC-UV provided a good linearity in the range of 1.00-800ngmL(-1), low limits of detection (0.3-1ngmL(-1)), and good extraction repeatabilities (RSDs below 5.2%, n=5). It seems that this design is a proper one for the automation of the method. Also the consumption of the organic solvent in a sub-microliter scale, and its simplicity, high efficiency, and high purification can help one getting closer to the objectives of the green chemistry. Copyright © 2015 Elsevier B.V. All rights reserved.

  18. Digital assistance of nasogastric tube insertion in intubated patients under general anesthesia: A single-blinded prospective randomized study

    PubMed Central

    Kandeel, Alrefaey; Elmorhedi, Mohammed; Abdalla, Usama

    2017-01-01

    Background: Nasogastric tube (NGT) insertion may pose a special problem in patients under general anesthesia with first attempt failure rates up to 50%. To increase insertion success rate and decreases related complications, several techniques have been developed. In this study, digital assistance technique is compared to the classic insertion technique in neck flexion. Materials and Methods: In this prospective randomized study, 160 patients were randomly allocated into two groups; control group (Group C, n = 80) where NGT tube will be inserted with the neck in flexion position and digital facilitation group (Group D, n = 80). Results: Overall success rate and first attempt success were statistically higher in Group D compared to Group C (94% vs. 81%, P = 0.02, 80% vs. 62%, P = 0.01 respectively) with significantly lower insertion time in Group D (13 ± 5 s. vs. 10 ± 3 s., P = 0.00). Conclusions: Digital assistance of NGT insertion in the anesthetized or unconscious patient is an effective, fast, and safe method that can be either used as a routine technique or as a rescue in case of failed other methods. PMID:28757827

  19. Digital assistance of nasogastric tube insertion in intubated patients under general anesthesia: A single-blinded prospective randomized study.

    PubMed

    Kandeel, Alrefaey; Elmorhedi, Mohammed; Abdalla, Usama

    2017-01-01

    Nasogastric tube (NGT) insertion may pose a special problem in patients under general anesthesia with first attempt failure rates up to 50%. To increase insertion success rate and decreases related complications, several techniques have been developed. In this study, digital assistance technique is compared to the classic insertion technique in neck flexion. In this prospective randomized study, 160 patients were randomly allocated into two groups; control group (Group C, n = 80) where NGT tube will be inserted with the neck in flexion position and digital facilitation group (Group D, n = 80). Overall success rate and first attempt success were statistically higher in Group D compared to Group C (94% vs. 81%, P = 0.02, 80% vs. 62%, P = 0.01 respectively) with significantly lower insertion time in Group D (13 ± 5 s. vs. 10 ± 3 s., P = 0.00). Digital assistance of NGT insertion in the anesthetized or unconscious patient is an effective, fast, and safe method that can be either used as a routine technique or as a rescue in case of failed other methods.

  20. Oral alimentation following intubation for esophageal carcinoma.

    PubMed Central

    Haffejee, A A; Angorn, I B

    1977-01-01

    The nutritional status of 15 patients suffering from unresectable carcinoma of the midthoracic esophagus was evaluated before and after palliative pulsion intubation. All patients showed evidence of protein-calorie malnutrition, prior to intubation. Oral alimentation using a formulated hospital ward diet with an elemental dietary supplement reversed the nutritional deficit. A mean daily positive nitrogen balance of seven grams was achieved three weeks following intubation. No episode of tube blockage was observed and the elemental diet supplement was well tolerated. PMID:74985

  1. Oral alimentation following intubation for esophageal carcinoma.

    PubMed

    Haffejee, A A; Angorn, I B

    1977-12-01

    The nutritional status of 15 patients suffering from unresectable carcinoma of the midthoracic esophagus was evaluated before and after palliative pulsion intubation. All patients showed evidence of protein-calorie malnutrition, prior to intubation. Oral alimentation using a formulated hospital ward diet with an elemental dietary supplement reversed the nutritional deficit. A mean daily positive nitrogen balance of seven grams was achieved three weeks following intubation. No episode of tube blockage was observed and the elemental diet supplement was well tolerated.

  2. Traumatic tibialis anterior tendon rupture: treatment with a two-stage silicone tube and an interposition hamstring tendons graft protocol.

    PubMed

    Kontogeorgakos, Vasileios; Koutalos, Antonios; Hantes, Michael; Manoudis, Gregory; Badras, Leonidas; Malizos, Konstantinos

    2015-03-01

    A novel technique for managing ruptured tibialis anterior tendon complicated by infection and tendon substance loss in a young adult is described. A two-stage reconstruction technique with a silicon tube and tendon autograft was performed. At first, after local control of the infection, scar excision and placement of a silicone tube was performed. Ten weeks later, ipsilateral hamstrings tendons were harvested and bridged the 7 cm tendon gap. Eighteen months later, the patient has excellent clinical and functional outcome.

  3. Shock-tube studies of silicon-compound vapors

    NASA Technical Reports Server (NTRS)

    Park, C.; Fujiwara, T.

    1977-01-01

    Test gas mixtures containing SiO, SiO2, Si2, and SiH were produced in a shock tube by processing shock waves through a mixture of SiCl4 + N2O + Ar, SiH4 + Ar, or SiH4 + O2 + Ar. Absorption spectra of the test gases were studied photographically in the reflected shock region using a xenon flash lamp as the light source in the range of wavelengths between 250 and 600 nm. SiO was found to be a dominant species in the vapors produced by the SiCl4 + N2O and SiH4 + O2 mixtures. Spontaneous combustion was observed in the SiH4 + O2 + Ar mixture prior to the shock arrival, and the resulting solid SiO2 particles evaporated behind the shock wave. Spectral absorption characteristics of SiO, SiO2, Si2, and SiH were determined by studying the test gases.

  4. Shock-tube studies of silicon-compound vapors

    NASA Technical Reports Server (NTRS)

    Park, C.; Fujiwara, T.

    1977-01-01

    Test gas mixtures containing SiO, SiO2, Si2, and SiH were produced in a shock tube by processing shock waves through a mixture of SiCl4 + N2O + Ar, SiH4 + Ar, or SiH4 + O2 + Ar. Absorption spectra of the test gases were studied photographically in the reflected shock region using a xenon flash lamp as the light source in the range of wavelengths between 250 and 600 nm. SiO was found to be a dominant species in the vapors produced by the SiCl4 + N2O and SiH4 + O2 mixtures. Spontaneous combustion was observed in the SiH4 + O2 + Ar mixture prior to the shock arrival, and the resulting solid SiO2 particles evaporated behind the shock wave. Spectral absorption characteristics of SiO, SiO2, Si2, and SiH were determined by studying the test gases.

  5. Extraction of o-phenylphenol from silicone tubing by a sulfobutylether cyclodextrin formulation.

    PubMed

    Zimmerman, Jeffrey A; Ballard, John M; Wang, Hai; Wu, Allen; Gallagher, Kimberly A

    2003-11-28

    During a compatibility study between a formulation containing sulfobutylether cyclodextrin (SBECD) and silicone tubing, an extraneous peak was observed in the HPLC chromatograms. The extraneous material was identified by LC/MS, MS/MS and UV as a previously unreported tubing extractable, o-phenylphenol (o-PP). Several studies were conducted to assess the impact of formulation and process-related variables on the amount of the o-PP extracted, including contact time, sulfobutylether cyclodextrin concentration, formulation pH, and tubing sterilization and storage conditions. Results show that the concentration of the SBECD, tubing processing and storage conditions and the duration of the study influenced the levels of o-PP extracted. However, the largest contributor to the amount extracted was the lot of tubing tested. The extracted levels varied widely from lot to lot (0.007-3.89microg/cm(2) of tubing surface area). A dynamic study conducted to simulate a manufacturing process also resulted in the extraction of o-PP by the formulation.

  6. Nasal intubation: A comprehensive review

    PubMed Central

    Chauhan, Varun; Acharya, Gaurav

    2016-01-01

    Nasal intubation technique was first described in 1902 by Kuhn. The others pioneering the nasal intubation techniques were Macewen, Rosenberg, Meltzer and Auer, and Elsberg. It is the most common method used for giving anesthesia in oral surgeries as it provides a good field for surgeons to operate. The anatomy behind nasal intubation is necessary to know as it gives an idea about the pathway of the endotracheal tube and complications encountered during nasotracheal intubation. Various techniques can be used to intubate the patient by nasal route and all of them have their own associated complications which are discussed in this article. Various complications may arise while doing nasotracheal intubation but a thorough knowledge of the anatomy and physics behind the procedure can help reduce such complications and manage appropriately. It is important for an anesthesiologist to be well versed with the basics of nasotracheal intubation and advances in the techniques. A thorough knowledge of the anatomy and the advent of newer devices have abolished the negative effect of blindness of the procedure. PMID:27994382

  7. Effect of micronutrient deficiency on QuantiFERON-TB Gold In-Tube test and tuberculin skin test in diagnosis of childhood intrathoracic tuberculosis.

    PubMed

    Mukherjee, A; Saini, S; Kabra, S K; Gupta, N; Singh, V; Singh, S; Bhatnagar, S; Saini, D; Grewal, H M S; Lodha, R

    2014-01-01

    Data on performance of QuantiFERON-TB Gold In-Tube test (QFT) and tuberculin skin test (TST) in children with active tuberculosis from high burden countries in the context of micronutrient deficiency are scarce. The objective of this study was to evaluate the effect of micronutrient deficiency on the performance of TST and QFT in children with intrathoracic tuberculosis. Children with probable intrathoracic tuberculosis underwent TST, QFT, gastric lavages and induced sputum examination for AFB (Acid-Fast Bacilli) smear and culture. Zinc, copper, ferritin and vitamin D were measured on stored serum samples. The study used cross-sectional data at initiation of anti-tubercular therapy. Three hundred and sixty-two children (median age 115.5 months (interquartile range: 73, 144), 200 (55.3%) girls) were enrolled in the study. Microbiological confirmation of tuberculosis could be obtained in 128 patients. TST and QFT were positive in 337 (93%) and 297 (82%) children, respectively. Performance of both the tests was unaffected by weight-for-age and height-for-age 'z-scores' or by serum copper levels. TST was not affected by serum zinc and ferritin levels. Children with negative QFT results had lower mean serum zinc level (P=0.01) and higher ferritin levels (P=0.007) as compared to those with positive test. Higher proportion of children with positive TST were vitamin D deficient/insufficient (P=0.003). Micronutrient status, especially serum levels of zinc, may influence the performance of QFT in children with intrathoracic tuberculosis. Considering the high prevalence of zinc deficiency in developing countries, QFT should be used cautiously for diagnosing tuberculosis.

  8. Tuberculin skin test and QuantiFERON-TB Gold In-tube Test for latent tuberculosis in Thai HIV-infected adults.

    PubMed

    Khawcharoenporn, Thana; Apisarnthanarak, Anucha; Phetsuksiri, Benjawan; Rudeeaneksin, Janisara; Srisungngam, Sopa; Mundy, Linda M

    2015-02-01

    Limited data exist for the performance of QuantiFERON-TB Gold In-tube Test (QFT-IT) in comparison to tuberculin skin test (TST) for detecting latent tuberculosis (LTB) in patients with human immunodeficiency virus (HIV) infection from tuberculosis (TB)-endemic Asia-Pacific countries. A cohort study of Thai HIV-infected patients without history of TB or LTB treatment was conducted from March 2012 through March 2013. Each patient underwent simultaneous TST and QFT-IT. Among the 150 enrolled subjects, the median age was 40 years (range 17-65), 53% were male, and the median CD4 count was 367 cells/μL (range 8-1290). Reactive TST and positive QFT-IT were 16% and 13%, respectively, with low concordance between tests (kappa = 0.26); correlation between TST reaction size and level of interferon-γ was moderate (r = 0.34). Independent factors associated with discordant results were long-term smoking (adjusted odds ratio (aOR) 5.74; P = 0.002) for TST-reactive, QFT-IT-negative subjects, and age greater than 52 years (aOR 5.56; P = 0.02) and female gender (aOR 4.40; P = 0.04) for TST non-reactive, QFT-IT-positive subjects. The level of agreement between both tests improved when using a TST cut-off of ≥ 10 mm (kappa = 0.39). In our setting where QFT-IT is available but has limited use due to cost, TST with a cut-off of 10 mm for reactivity should be the initial LTB test. HIV-infected women and persons older than 52 years with non-reactive TST and long-term smokers with reactive TST may benefit from subsequent QFT-IT. © 2014 Asian Pacific Society of Respirology.

  9. Evaluation of the QuantiFERON?-TB Gold In-Tube assay and tuberculin skin test for the diagnosis of Mycobacterium tuberculosis infection in northeastern Thailand.

    PubMed

    Reechaipichitkul, Wipa; Pimrin, Wilailuk; Bourpoern, Janpen; Prompinij, Supapim; Faksri, Kiatichai

    2015-09-01

    The diagnosis of latent Mycobacterium tuberculosis infection (LTBI) is currently based on the immunological response of T-cells to M. tuberculosis (MTB) antigens. However, the QuantiFERON®-TB Gold In-Tube assay (QFT) has not yet been evaluated in the Thai adult population. To evaluate the diagnostic performance and determine predictors of discordant results between the QFT and tuberculin skin test (TST). Active tuberculosis (ATB) patients (n=54), close contacts (CCs) living in the same household as a TB patient (n=100) and healthy controls (HCs) (n=60) were interviewed and underwent the QFT and TST at Srinagarind Hospital in Thailand. Various cut-off values for the QFT (0.25-0.35 IU/mL) and TST (5-15 mm) were applied. The maximum agreement rate between the tests was 71.5% (κ=0.41) with cut-offs of 0.35 IU/mL and 10 mm or 0.25 IU/mL and 10 mm. Based on standard cut-off values (0.35 IU/mL and 10 mm) and using ATB patients and HCs as positive and negative controls, the TST was more sensitive than the QFT (87.0% vs. 66.7%, respectively), whereas the QFT was more specific than the TST (83.3% vs. 70.0%, respectively). Being underweight (OR 3.86, 95%CI 1.3-11.48) or overweight (OR 5.9, 95%CI 1.24-28.16) was significantly associated with TST+/QFT- results. Diabetes (OR 32.56, 95%CI 1.73-613.49) and poor or fair nutrition (OR 7.4, 95%CI 1.23-44.57) were significantly associated with TST-/QFT+ results. The TST should be used as a screening test based on its higher sensitivity, whereas the QFT should be used as a confirmatory test because of its higher specificity.

  10. A novel ionic liquid-modified organic-polymer monolith as the sorbent for in-tube solid-phase microextraction of acidic food additives.

    PubMed

    Wang, Ting-Ting; Chen, Yi-Hui; Ma, Jun-Feng; Hu, Min-Jie; Li, Ying; Fang, Jiang-Hua; Gao, Hao-Qi

    2014-08-01

    A novel ionic liquid-modified organic-polymer monolithic capillary column was prepared and used for in-tube solid-phase microextraction (SPME) of acidic food additives. The primary amino group of 1-aminopropyl-3-methylimidazolium chloride was reacted with the epoxide group of glycidyl methacrylate. The as-prepared new monomer was then copolymerized in situ with acrylamide and N,N'-methylenebisacrylamide in the presence of polyethylene glycol (PEG)-8000 and PEG-10,000 as porogens. The extraction performance of the developed monolithic sorbent was evaluated for benzoic acid, 3-hydroxybenzoic acid, cinnamic acid, 2,4-dichlorophenoxyacetic acid, and 3-(trifluoromethyl)-cinnamic acid. Such a sorbent, bearing hydrophobic and anion-exchange groups, had high extraction efficiency towards the test compounds. The adsorption capacities for the analytes dissolved in water ranged from 0.18 to 1.74 μg cm(-1). Good linear calibration curves (R(2) > 0.99) were obtained, and the limits of detection (S/N = 3) for the analytes were found to be in the range 1.2-13.5 ng mL(-1). The recoveries of five acidic food additives spiked in Coca-Cola beverage samples ranged from 85.4 % to 98.3 %, with RSD less than 6.9 %. The excellent applicability of the ionic liquid (IL)-modified monolithic column was further tested by the determination of benzoic acid content in Sprite samples, further illustrating its good potential for analyzing food additives in complex samples.

  11. Comparison of QuantiFERON-TB gold in-tube test with tuberculin skin test in children who had no contact with active tuberculosis case.

    PubMed

    Metin Timur, Özge; Tanir, Gönül; Öz, Fatma Nur; Bayhan, Gülsüm İclal; Aydin Teke, Türkan; Tuygun, Nilden

    2014-01-01

    In this study, we aimed to compare QuantiFERON-TB gold in-tube test (QFT-GIT) and tuberculin skin test (TST) as a diagnosis of latent tuberculosis infection in the children with Bacille Calmette-Guerin (BCG) vaccine. We evaluated 81 children in the study who have positive TST result without a known history of tuberculosis contact from 2008 to 2011 prospectively. Patients were separated into groups according to their ages, the reason of TST application, number of BCG vaccination scars and diameter of TST induration. Posteroanterior, lateral chest radiographies and computerized tomography, if necessary, were performed. The study consists of 48 (59.3%) boys and 33 (40.7%) girls with a mean age of 94.8 ± 51.9 months (ranged from 6 to 193 months). Sixty nine (85.2%) children had one and 12 (14.8%) had two BCG vaccination scars. The TST induration diameters were 15-19 mm in 65 (80.2%) children and ≥ 20 mm in 16 (19.8%) children. QFT-GIT positivity was found in 12 (14.8%) of the evaluated patients. QFT-GIT positive patients were treated with triple anti-tuberculosis regime or isoniazid (INH). In three years period of study, there were no tuberculosis disease observed among the children who had not been treated with anti-tuberculosis drugs. As a result of the study it is suggested to confirm positive TST results with tests based on interferon-gamma (IFN-γ) because it can reduce false positive diagnosis and treatment of latent tuberculosis infection, thus adverse reactions of drugs, in countries where BCG vaccination is routinely recommended especially for low risk children.

  12. QuantiFERON-TB Gold In-Tube for the detection of Mycobacterium tuberculosis infection in children with household tuberculosis contact.

    PubMed

    Kasambira, T S; Shah, M; Adrian, P V; Holshouser, M; Madhi, S A; Chaisson, R E; Martinson, N A; Dorman, S E

    2011-05-01

    Improved strategies are needed for detecting Mycobacterium tuberculosis infection in children in TB-endemic settings. To determine the prevalence of M. tuberculosis infection by tuberculin skin testing (TST) and by the QuantiFERON-TB Gold In-Tube (QFT-GIT) test in children with an adult household contact with pulmonary TB in South Africa. Cross-sectional study. A total of 167 adult pulmonary TB cases (153/167, 92% human immunodeficiency virus [HIV] infected) and 270 pediatric contacts (median age 6 years, 14/270, 5% HIV-infected) were enrolled. All children completed QFT-GIT testing and 254 (94.1%) completed TST testing. Prevalence of M. tuberculosis infection was 28% (71/254, 95%CI 23-34) using TST (5 mm cut-off) and 29% (79/270, 95%CI 24-35) using QFT-GIT (P = 0.49). Agreement between TST and QFT-GIT was 81% (kappa 0.58). Nineteen (7%) QFT-GIT results were indeterminate. Children aged <2 years were more likely than older children to have indeterminate QFT-GIT results (aOR 5.7, 95%CI 1.5-22, P = 0.01) and discordant QFT-GIT and TST results (aOR 3.5, 95%CI 1.7-7.6, P = 0.001). Prevalence of M. tuberculosis infection in pediatric contacts was high regardless of the diagnostic method used. TST should not be excluded for the detection of pediatric M. tuberculosis infection in this setting, but QFT-GIT may be a feasible alternative in children aged ≥ 2 years.

  13. QuantiFERON®-TB Gold In-Tube assay vs. tuberculin skin test in Indonesian children living with a tuberculosis case.

    PubMed

    Rutherford, M E; Nataprawira, M; Yulita, I; Apriani, L; Maharani, W; van Crevel, R; Hill, P C; Alisjahbana, B

    2012-04-01

    The tuberculin skin test (TST) has limitations in diagnosing latent tuberculosis (TB) infection (LTBI). Interferon-gamma release assays may improve diagnostic accuracy. We compared QuantiFERON®-TB Gold In-Tube (QFT-GIT) and TST in Indonesian children. Children aged from 6 months to 9 years exposed to a TB case at household and neighbourhood levels were recruited. The children underwent QFT-GIT and TST. Test responsiveness was assessed according to an exposure gradient. A total of 299 household-exposed and 72 neighbourhood-exposed children were analysed. Overall, respectively 46% and 41% were positive using QFT-GIT and the TST. Test positivity increased with exposure (QFT-GIT P value for trend <0.001, and TST P < 0.001); however, only QFT-GIT responded significantly to a 'within-household' gradient. The TST was less likely to be positive than the QFT-GIT in neighbourhood-exposed children (P = 0.05). BCG-vaccinated children were less likely to be QFT-GIT-positive, while older children were more likely to be QFT-GIT-positive. Both tests had increasing positivity with increasing smear grade. QFT-GIT performed similarly to the TST in Indonesian children living with an infectious TB case. Test accuracy was not compromised by young age or BCG vaccination. Our findings suggest that QFT-GIT offers little advantage over the TST in this population. High rates of LTBI diagnosed in household-exposed children by both tests support preventive therapy.

  14. Effect of prolonged incubation time on results of the QuantiFERON TB gold in-tube assay for diagnosis of latent tuberculosis infection.

    PubMed

    Min, Joo-Won; Lee, Ha-Youn; Lee, Ji Sun; Lee, Jinwoo; Chung, Jae Ho; Han, Sung Koo; Yim, Jae-Joon

    2013-09-01

    Previous reports have shown that the sensitivity of the 6-day lymphocyte stimulation test is much higher than those of commercially available gamma interferon release assays (IGRAs). The aim of this study was to elucidate the effect of prolonged incubation on the results of the QuantiFERON TB Gold in-tube (QFT-GIT) assay. Patients aged >20 years with suspected tuberculosis (TB) were recruited prospectively from 1 May 2009 to 31 December 2010. In addition, healthy volunteers with no history of TB treatment were included as controls. For each participant, three sets of the QFT-GIT assay were performed using 24-, 48-, and 72-h incubation tests, and the results were compared. Thirty-seven patients with suspected pulmonary TB and 33 healthy controls were enrolled in the study. Of the 37 patients with suspected TB, the QFT-GIT assay results were positive for 28 (75.7%) after a 24-h incubation period. After prolonged incubation, the results differed in four (10.8%) of the 37 patients suspected of having TB. Among 27 patients with culture-confirmed TB, the sensitivities of the QFT-GIT assay after the 24-, 48-, and 72-h incubation tests were 85.2%, 81.5%, and 81.5%, respectively. Among the 33 healthy controls, the QFT-GIT assay results were positive in two (6.1%) after a 24-h incubation period. The results changed for two (6.1%) of the 33 healthy controls after prolonged incubation. The specificities of the QFT-GIT assay after 24, 48, and 72 h of incubation were 93.9%, 87.9%, and 90.9%, respectively. Prolonging the incubation time did not increase the sensitivity of the QFT-GIT assay. The manufacturer-recommended incubation time of 16 to 24 h should be respected because prolonged incubation can cause indeterminate or false-positive results.

  15. High Proportion of Indeterminate QuantiFERON-TB Gold In-Tube Results in an Inpatient Population Is Related to Host Factors and Preanalytical Steps

    PubMed Central

    Fabre, Valeria; Shoham, Shmuel; Page, Kathleen R.; Shah, Maunank

    2014-01-01

    Background  QuantiFERON-TB Gold In-Tube test (QFT-GIT) can be used as an alternative to tuberculin skin testing (TST) for the targeted testing of latent tuberculosis. Due to many shortcomings with TST, QFT-GIT usage is increasing. QFT-GIT implementation in the inpatient setting remains unclear. Methods  We retrospectively identified patients admitted to a tertiary care academic center who received either a TST or a QFT-GIT in the 18 months prior to and after QFT-GIT implementation in March 2012. Risk factors associated with indeterminate results were evaluated. Results  The proportion of inpatients receiving a test for tuberculosis infection doubled following QFT-GIT implementation (1.4% vs 2.9%). After QFT-GIT became available, 75% of tested people received a QFT-GIT and 25% received a TST. We found indeterminate test results in 19.8%. Independent predictors of indeterminate results were female sex (adjusted odds ratio [AOR], 1.64), lymphopenia (AOR, 2.21), hypoalbuminemia (AOR, 6.81) and sample collection by nonphlebotomists (AOR, 3.0, vs phlebotomists). Of patients who had indeterminate results, 42% had a subsequent indeterminate result on repeat testing. All indeterminate results were due to a low mitogen response. Conclusions  QFT-GIT testing in the inpatient setting is associated with a high proportion of indeterminate results that is associated with host factors and preanalytical errors. Careful selection of patients to be tested and training on sample processing for QFT-GIT testing should be considered to decrease indeterminate results. PMID:25734154

  16. Predictive value of the tuberculin skin test and QuantiFERON-tuberculosis Gold In-Tube test for development of active tuberculosis in hemodialysis patients

    PubMed Central

    Seyhan, Ekrem Cengiz; Gunluoglu, Gulşah; Gunluoglu, Mehmet Zeki; Tural, Seda; Sökücü, Sinem

    2016-01-01

    BACKGROUND: Hemodialysis (HD) patients are at increased risk of reactivation of latent tuberculosis infection (LTBI) compared with the general population. QuantiFERON-TB Gold (QFT-G) for LTBI detection is more promising than tuberculin skin test (TST) in HD patients. AIM: In our study, we evaluated the value of the TST and QFT-G In-Tube (QFG-IT) test in the development of active tuberculosis (TB), in the HD patients, and in healthy controls. METHODS: The study enrolled 95 HD patients and ninety age-matched, healthy controls. The TST and QFG-IT were performed. All the subjects were followed up 5 years for active TB disease. RESULTS: Compared to the healthy controls, a high prevalence of LTBI was found in the HD patients by QFG-IT (41% vs. 25%). However, no significant difference was detected by TST (32% vs. 31%). Four HD patients and one healthy control progressed to active TB disease within the 5-year follow-up. For active TB discovered subjects, QFG-IT was positive in all, but TST was positive in two (one patient and one healthy control). In HD patients; sensitivity, specificity, positive and negative predictive values of QFG-IT, and TST for active TB was 100% and 25%, 62% and 67%, 10%, and 3%, and 100% and 95%, respectively. Receiver operating curve analysis revealed that the results are significantly different (P = 0.04). CONCLUSION: QFG-IT test is a more useful diagnostic method than TST for detecting those who will progress to active TB in HD patients. PMID:27168859

  17. Effective extraction of triazines from environmental water samples using magnetism-enhanced monolith-based in-tube solid phase microextraction.

    PubMed

    Mei, Meng; Huang, Xiaojia; Yang, Xiaodong; Luo, Qing

    2016-09-21

    This article reports on the effective extraction of triazines from environmental water samples using magnetism-enhanced monolith-based in-tube solid phase microextraction (ME-MB/IT-SPME). Firstly, monolithic poly (octyl methacrylate-co-ethyleneglycol dimethacrylate) capillary column doped with magnetic nanoparticles was synthesized inside a fused silica. After that, the monolithic capillary column was placed inside a magnetic coil that allowed the exertion of a variable magnetic field during adsorption and desorption steps. The effects of intensity of magnetic field, adsorption and desorption flow rate, volume of sample and desorption solvent, pH value and ionic strength in sample matrix on the performance of ME-MB/IT-SPME for triazines were investigated in details. Under the optimized conditions, the developed ME-MB/IT-SPME showed satisfactory quantitative extraction efficiencies of the target analytes between 64.8% and 99.7%. At the same time, the ME-MB/IT-SPME was combined with high-performance liquid chromatography with diode array detection to detect six triazines in water samples. The limits of detection (S/N = 3) and limits of quantification (S/N = 10) were in the ranges of 0.074-0.23 μg/L and 0.24-0.68 μg/L, respectively. The precision of the proposed method was evaluated in terms of intra- and inter-assay variability calculated as relative standard deviation, and it was found that the values were all below 10%. Finally, the developed method was successfully applied for environmental water samples such as farmland, lake and river water with spiked recoveries in the range of 70.7-119%. Copyright © 2016 Elsevier B.V. All rights reserved.

  18. Advantages of monolithic over particulate columns for multiresidue analysis of organic pollutants by in-tube solid-phase microextraction coupled to capillary liquid chromatography.

    PubMed

    Moliner-Martínez, Y; Molins-Legua, C; Verdú-Andrés, J; Herráez-Hernández, R; Campíns-Falcó, P

    2011-09-16

    The performance of a monolithic C(18) column (150 mm×0.2 mm i.d.) for multiresidue organic pollutants analysis by in-tube solid-phase microextraction (IT-SPME)-capillary liquid chromatography has been studied, and the results have been compared with those obtained using a particulate C(18) column (150 mm×0.5 mm i.d., 5 μm). Chromatographic separation has been carried out under isocratic elution conditions, and for detection and identification of the analytes a UV-diode array detector has been employed. Several compounds of different chemical structure and hydrophobicity have been used as model compounds: simazine, atrazine and terbutylazine (triazines), chlorfenvinphos and chlorpyrifos (organophosphorous), diuron and isoproturon (phenylureas), trifluralin (dinitroaniline) and di(2-ethylhexyl)phthalate. The results obtained revealed that the monolithic column was clearly advantageous in the context of multiresidue organic pollutants analysis for a number of reasons: (i) the selectivity was considerably improved, which is of particular interest for the most polar compounds triazines and phenyl ureas that could not be resolved in the particulate column, (ii) the sensitivity was enhanced, and (iii) the time required for the chromatographic separation was substantially shortened. In this study it is also proved that the mobile-phase flow rates used for separation in the capillary monolithic column are compatible with the in-valve IT-SPME methodology using extractive capillaries of dimensions similar to those used in conventional scale liquid chromatography (LC). On the basis of these results a new method is presented for the assessment of pollutants in waters, which permits the characterization of whole samples (4 mL) in less than 30 min, with limits of detection in the range of 5-50 ng/L.

  19. Ion-pair in-tube solid phase microextraction for the simultaneous determination of phthalates and their degradation products in atmospheric particulate matter.

    PubMed

    Fernández-Amado, M; Prieto-Blanco, M C; López-Mahía, P; Muniategui-Lorenzo, S; Prada-Rodríguez, D

    2017-10-20

    An in-tube solid phase microextraction, coupled with high-performance liquid chromatography with diode array detection (IT-SPME-HPLC-DAD) method, has been developed for the simultaneous determination of 13 diesters (from dimethyl to dioctylphthalate plus diisobutyl, benzylbutyl, di-2-ethylhexyl, diisononyl and diisodecylphthalate) and 2 monoesters of phthalic acid (mono-butyl and mono-(2-ethylhexyl) phthalate) in particulate matter (PM10). Triethylamine at pH=3 was used as an ion-pair reagent with a double function, of regulating the chromatographic retention of the monoesters and the most hydrophilic diesters on a monolithic silica column, and of improving their extraction on a porous polymer with divinylbenzene-4-vinylpyridine capillary. The chromatographic separation was achieved in 13min. A previous ultrasound-assisted extraction from PM10filters was also optimized using methanol as solvent. The method detection limits were 0.09-0.52ngm(-3), the inter-day precision at concentration of 20ngmL(-1) was between 4.2% and 12.7% (n=15), and the average recovery was 87.3%. The average absolute IT-SPME recovery was 26.2% and the linear range reached up to 109ngm(-3) for most analytes. The method was applied to PM10 samples from different environments collected in Galicia (Spain). DiBP was the major phthalate, followed by its isomer DnBP in urban sites and by DEP in the suburban area. In all samples, DEHP quantified correlates with the isomers of dibutylphthalate. Total PAE concentration was between 14.5 and 245.5ngm(-3). To the best of our knowledge, this is the first time that a method allows the simultaneous determination of 13 phthalates and their degradation products in particulate matter. Copyright © 2017 Elsevier B.V. All rights reserved.

  20. Outbreak of Transient Conversions of the QuantiFERON-TB Gold In-Tube Test in Laboratory Health Care Worker Screenings

    PubMed Central

    Peracchi, Marta; Zorzi, Diego; Fiorio, Silvia; Fallico, Loredana; Palù, Giorgio

    2012-01-01

    Gamma interferon release assays were recently introduced in health care worker (HCWs) screenings for tuberculosis surveillance. In longitudinal surveys, conversions and reversions are seen, and yet whether these changes are unspecific or are an expression of new infections and microbial clearance remains unclear. In order to further elucidate these changes, we analyzed an outbreak of 15 transient conversions in 53 HCWs who operate in the same laboratory and handle specimens potentially containing Mycobacterium tuberculosis who underwent screening by the QuantiFERON-TB Gold In-Tube (QFT-GIT) test between 11 May and 30 June 2010: 15/46 (33%) negative HCWs showed a conversion and then reverted after 7 to 107 days. To validate these results, an evaluation of methodological procedures and test reliability, as well as an analysis of results obtained during the same period and processed by the same laboratory, was carried out. For the latter purpose, QFT-GIT results determined for 78 ward HCWs who underwent screening during the same period and were employed in departments with at least 3 infectious tuberculosis patients per year or had cared for an infectious patient without airborne precautions were analyzed with the following results: 6/63 (9%) HCWs with negative results in 3 different departments showed transient conversion (P = 0.002; odds ratio, 4.60; 95% confidence interval, 1.62 to 13.04). A retrospective survey of in-house biosafety practices led to determination of a single exposure factor within the laboratory. These data emphasize the validity of the hypothesis that a transient conversion demonstrates the presence of a real tubercular infection and could be an important indicator for occupational biosafety concerns. They also confirm that subjects with recent conversion should be retested before chest radiography and chemotherapy is offered. PMID:22518010

  1. Added Value of QuantiFERON TB-Gold in-Tube for Detecting Latent Tuberculosis Infection among Persons Living with HIV/AIDS

    PubMed Central

    Souza, Josiane Maria Oliveira

    2014-01-01

    Objective. To evaluate the added value of QuantiFERON TB-Gold in-Tube (QTF-GIT) over the tuberculin skin testing (TST) for detecting latent tuberculosis (TB) infection (LTBI) among patients with AIDS in a city with a low TB incidence rate (11.1/100,000 inhabitants) and universal BCG coverage. Methods. Three hundred consecutive patients with AIDS in eight outpatient sexually transmitted disease public clinics in Brasilia were submitted to QFT-IT and TST between May 2011 and March 2013. A positive result of either test was considered to be LTBI. Results. Median CD4-cell count was 477.5 cells/mm3; 295 (98.3%) were using antiretroviral therapy. Eighteen patients (6%, 95% CI: 3.6%–9.3%) had LTBI, of whom 4 (1.3%, 95% CI: 0.04%–2.63%) had only a positive TST, 8 (2.7%, 95% CI: 0.8%–4.5%) had only a QFT-GIT positive test, and 6 (2%, 95% CI: 0.4%–3.6%) had positive results for both tests. This represents an 81.8% relative increase in LTBI detection when QFT-GIT is added to TST. The concordance between both tests was 96% (k = 0.48). Conclusions. The QFT-GIT alone was more effective to detect LTBI than TST alone and had an 81% added value as an add-on sequential test in this population with mild immunosuppression. The cost-effectiveness of these strategies remains to be evaluated. PMID:24991546

  2. Comparison of the Sensitivity of QuantiFERON-TB Gold In-Tube and T-SPOT.TB According to Patient Age

    PubMed Central

    Bae, Won; Park, Kyoung Un; Song, Eun Young; Kim, Se Joong; Lee, Yeon Joo; Park, Jong Sun; Cho, Young-Jae; Yoon, Ho Il; Yim, Jae-Joon; Lee, Choon-Taek; Lee, Jae Ho

    2016-01-01

    Currently, there are two types of interferon-gamma release assays (IGRAs) in use for the detection of tuberculosis (TB) infection, the QuantiFERON-TB Gold In-Tube test (GFT-GIT) and T-SPOT.TB. Owing to contradictory reports regarding whether the results of these IGRAs are affected by the age of the patient, we aimed to determine if these two tests have age-related differences in sensitivity. We retrospectively reviewed the medical records of diagnosed TB patients who were tested using either QFT-GIT or T-SPOT.TB from February 2008 to December 2013. The positivity of the two tests was analyzed and compared with true TB infection, which was defined as active TB based on either a positive Mycobacterium culture or a positive TB polymerase chain reaction. The QFT-GIT group included 192 TB patients, and the T-SPOT.TB group included 212 TB patients. Of the patients with pulmonary TB, 76 (39.6%) were in the QFT-GIT group and 143 (67.5%) in the T-SPOT.TB group. The overall sensitivity was 80.2% for QFT-GIT and 91.0% for T.SPOT.TB. The sensitivities of QFT-GIT and T-SPOT.TB according to age group were as follows: <29 years, 93.3% and 96.7%; 30–49 years, 86.5% and 94.7%; 50–69 years, 76.8% and 87.5%; and >70 years, 68.3% and 85.7%, respectively. The trend of age-related changes in sensitivity was significant for both QFT-GIT (p = 0.004) and T.SPOT.TB (p = 0.039). However, only QFT-GIT was significantly related to age in the multivariate analysis. QFT-GIT, but not T-SPOT.TB, was significantly affected by patient age. PMID:27258377

  3. Multiple automated headspace in-tube extraction for the accurate analysis of relevant wine aroma compounds and for the estimation of their relative liquid-gas transfer rates.

    PubMed

    Zapata, Julián; Lopez, Ricardo; Herrero, Paula; Ferreira, Vicente

    2012-11-30

    An automated headspace in-tube extraction (ITEX) method combined with multiple headspace extraction (MHE) has been developed to provide simultaneously information about the accurate wine content in 20 relevant aroma compounds and about their relative transfer rates to the headspace and hence about the relative strength of their interactions with the matrix. In the method, 5 μL (for alcohols, acetates and carbonyl alcohols) or 200 μL (for ethyl esters) of wine sample were introduced in a 2 mL vial, heated at 35°C and extracted with 32 (for alcohols, acetates and carbonyl alcohols) or 16 (for ethyl esters) 0.5 mL pumping strokes in four consecutive extraction and analysis cycles. The application of the classical theory of Multiple Extractions makes it possible to obtain a highly reliable estimate of the total amount of volatile compound present in the sample and a second parameter, β, which is simply the proportion of volatile not transferred to the trap in one extraction cycle, but that seems to be a reliable indicator of the actual volatility of the compound in that particular wine. A study with 20 wines of different types and 1 synthetic sample has revealed the existence of significant differences in the relative volatility of 15 out of 20 odorants. Differences are particularly intense for acetaldehyde and other carbonyls, but are also notable for alcohols and long chain fatty acid ethyl esters. It is expected that these differences, linked likely to sulphur dioxide and some unknown specific compositional aspects of the wine matrix, can be responsible for relevant sensory changes, and may even be the cause explaining why the same aroma composition can produce different aroma perceptions in two different wines. Copyright © 2012 Elsevier B.V. All rights reserved.

  4. A combination of the QuantiFERON-TB Gold In-Tube assay and the detection of adenosine deaminase improves the diagnosis of tuberculous pleural effusion.

    PubMed

    Liu, Yuanyuan; Ou, Qinfang; Zheng, Jian; Shen, Lei; Zhang, Bingyan; Weng, Xinhua; Shao, Lingyun; Gao, Yan; Zhang, Wenhong

    2016-08-03

    The differential diagnosis of tuberculous pleural effusion (TPE) and malignant pleural effusion (MPE) remains difficult despite the availability of numerous diagnostic tools. The current study aimed to evaluate the performance of the whole blood QuantiFERON-TB Gold In-Tube (QFT-GIT) assay and conventional laboratory biomarkers in differential diagnosis of TPE and MPE in high tuberculosis prevalence areas. A total of 117 patients with pleural effusions were recruited, including 91 with TPE and 26 with MPE. All of the patients were tested with QFT-GIT, and the conventional biomarkers in both blood and pleural effusion were detected. The level of antigen-stimulated QFT-GIT in the whole blood of TPE patients was significantly higher than that of MPE (2.89 vs 0.33 IU/mL, P<0.0001). The sensitivity and specificity of QFT-GIT for the diagnosis of TPE were 93.0% and 60.0%, respectively. Among the biomarkers in blood and pleural effusion, pleural adenosine deaminase (ADA) was the most prominent biomarker, with a cutoff value of 15.35 IU/L. The sensitivity and specificity for the diagnosis of TPE were 93.4% and 96.2%, respectively. The diagnostic classification tree from the combination of these two biomarkers was 97.8% sensitive and 92.3% specific. Ultimately, the combination of whole blood QFT-GIT with pleural ADA improved both the specificity and positive predictive value to 100%. Thus, QFT-GIT is not superior to pleural ADA in the differential diagnosis of TPE and MPE. Combined whole blood QFT-GIT and pleural ADA detection can improve the diagnosis of TPE.

  5. Clinical characteristics and the usefulness of the QuantiFERON-TB Gold In-Tube test in hematologic patients with hepatic or splenic lesions.

    PubMed

    Kwon, Jae-Cheol; Kim, Si-Hyun; Park, Sun Hee; Choi, Su-Mi; Lee, Dong-Gun; Choi, Jung-Hyun; Yoo, Jin-Hong; Kim, Yoo-Jin; Lee, Seok; Kim, Hee-Je; Cho, Seok-Goo; Lee, Jong-Wook; Min, Woo-Sung

    2013-03-01

    Hepatic or splenic lesions in hematologic patients are not defined well because they are not easy to evaluate due to limitations of invasive procedures. Management typically depends on the clinical diagnosis with few microbiological data. We reviewed the medical records of consecutive hematologic patients with hepatic or splenic lesions in the infectious diseases unit from April 2009 to December 2010 at the Catholic Hematopoietic Stem Cell Transplantation Center in Korea. Twenty-six patients were identified. Their mean age was 46.0 ± 14.7 years, and 16 (61.5%) were male. Underlying diseases were acute myelogenous leukemia (n = 15, 57.7%) and myelodysplastic syndrome (n = 6, 23.1%). Among the nine nontuberculous infectious lesions, two bacterial, six fungal, and one combined infection were identified. The numbers of confirmed, probable, and possible tuberculosis (TB) cases were one, three, and four, respectively. Two patients had concurrent pulmonary TB. QuantiFERON-TB Gold In-Tube (QFT-GIT, Cellestis Ltd.) was positive in seven cases, among which six were diagnosed with TB. The sensitivity and specificity of QFT-GIT were 75% and 81.3%. Nine (34.6%) were defined as noninfectious causes. Causes of hepatic or splenic lesion in hematologic patients were diverse including TB, non-TB organisms, and noninfectious origins. TB should be considered for patients not responding to antibacterial or antifungal drugs, even in the absence of direct microbiological evidence. QFT-GIT may be useful for a differential diagnosis of hepatosplenic lesions in hematologic patients.

  6. Effect of 90° counterclockwise rotation of the endotracheal tube on its advancement through the larynx during nasal fiberoptic intubation in children: a randomized and blinded study.

    PubMed

    Choudhry, Dinesh K; Brenn, B Randall; Lutwin-Kawalec, Malgorzata; Sacks, Karen; Nesargi, Susmita; He, Zhaoping

    2016-04-01

    Resistance to the passage of the endotracheal tube (ETT) is frequently encountered in children as it is advanced over the fiberoptic scope for placement into the trachea because it gets hung up at the laryngeal inlet. Literature in adults indicates that a 90° counterclockwise rotation (CCR) of the ETT before advancing results in smooth passage. We found no literature in children. Our aim was to study if a 90° counterclockwise rotation (CCR) of the ETT before advancement leads to smooth passage of the ETT into the larynx in children. Following IRB approval, we performed this study in two parts: Part 1: An unblinded, observational, pilot study on 20 children scheduled for oral rehabilitation where we concurrently used a fiberoptic scope nasally and GlideScope orally. We visualized the ETT path and observed that 90° CCR allowed smooth passage without hang up. Part 2: A blinded and randomized study on 40 children to confirm if 90° CCR from the outset would improve passage of the ETT during nasal intubation with a fiberoptic scope in children. All children were divided into two groups: group S, ETT bevel facing left; group R, ETT bevel facing down. In Part 1, we observed that the ETT got hung up in 57% of children with standard bevel direction (facing left) and in 0% of children when prerotated. In Part 2, efficacy of prerotation was confirmed; the ETT got hung up in 50% of children in group S but in only 10.5% of children in group R. A change in ETT tip orientation from bevel facing left to facing down by 90° CCR, leads to a significantly higher first-attempt success rate by nasal approach in children. We believe the ETT should be rotated before insertion into the nostril to ensure that full 90° CCR of the tip has been accomplished. © 2016 John Wiley & Sons Ltd.

  7. Selective and sentivive method based on capillary liquid chromatography with in-tube solid phase microextraction for determination of monochloramine in water.

    PubMed

    Pla-Tolós, J; Moliner-Martínez, Y; Molins-Legua, C; Herráez-Hernández, R; Verdú-Andrés, J; Campíns-Falcó, P

    2015-04-03

    Due to the difficulties of working with chloramines, a critical examination of monochloramine standard preparation has been performed in order to select the best synthesis conditions. The analyte has been determined by in-tube solid phase extraction coupled to capillary liquid chromatography with UV detection (IT-SPME Capillary LC DAD). Potential factors affecting the response of monochloramine such as the pH of mobile phase and the volume of sample processed by IT-SPME Capillary LC DAD have been investigated and optimized. According to the results of the study, 0.1 mL or 4.0 mL of sample at neutral pH were loaded in the chromatographic system. A sensitive and selective method has been developed for the determination of monochloramine in water. Validation of the method has been performed. The linear range was 0.09-5mg/L with linear regression coefficients (R(2)) greater than 0.995. Method reproducibility expressed as relative standard deviation (RSD, %), was lower than 15%. The limits of detection (LODs) were 0.029 and 0.01 mg/L by processing 0.100mL or 4 mL of the samples, respectively, being below the maximum residues levels allowed for this compound. The sensitivity achieved by the developed method was better than that obtained by the reference method. The developed method was applied to water samples (tap and swimming pool water). Copyright © 2015 Elsevier B.V. All rights reserved.

  8. Fluctuating Behavior and Influential Factors in the Performance of the QuantiFERON-TB Gold In-Tube Assay in the Diagnosis of Tuberculosis.

    PubMed

    Bao, Lei; Li, Tao; Diao, Ni; Shen, Yaojie; Shao, Lingyun; Zhang, Ying; Lu, Shuihua; Zhang, Wenhong

    2015-01-01

    The QuantiFERON-TB Gold In-Tube (QFT-GIT) is a newly developed but widely used interferon-γ release assay for diagnosing tuberculosis (TB). However, research has not determined whether age or the use of an immune suppressive or anti-TB treatment influences this assay's ability to detect TB. We assessed the QFT-GIT diagnostic performance for active tuberculosis (ATB) in children and adults in an endemic country and explored the effects of glucocorticoids and anti-TB therapy on the diagnostic value of the QFT-GIT. A total of 60 children and 212 adults with suspected ATB were evaluated with the QFT-GIT. The association between the QFT-GIT diagnostic value and pretreatment factors was qualitatively and quantitatively assessed. The sensitivity of the QFT-GIT was 83.9% (95% CI 66.3%-94.6%) in children, and 73.7% (95% CI 57.8%-85.2%) in adults. Glucocorticoids affected the mitogen-stimulated response in both children and adults. In subjects undergoing glucocorticoid pretreatment, 25.0% of the children presented with false-negative QFT-GIT results, 28.6% of adults presented with indeterminate results. For subjects pre-treated with anti-TB drugs, 44.4% presented with false-negative QFT-GIT results. The QFT-GIT has higher sensitivity and specificity in children than adults. Glucocorticoid treatment negatively impacts the diagnostic value of the QFT-GIT in all age groups. Anti-TB treatment decreases the sensitivity of the QFT-GIT. Therefore, we recommend that the QFT-GIT assay be performed before TB-specific treatment is initiated and the test should not be used on people undergoing immunosuppression treatment, regardless of their age. A quantitative analysis of the QFT-GIT could be useful for assessing and monitoring TB-specific and non-specific immunity during conversion of the disease.

  9. Endotracheal intubation

    MedlinePlus

    ... RF, McGill JW, Clinton JE. Tracheal intubation. In: Roberts JR, ed. Roberts and Hedges' Clinical Procedures in Emergency Medicine . 6th ... commercial use must be authorized in writing by ADAM Health Solutions. About MedlinePlus Site Map FAQs Customer ...

  10. Tracheal intubation in patients with anticipated difficult airway using Boedeker intubation forceps and McGrath videolaryngoscope.

    PubMed

    Strøm, C; Barnung, S; Kristensen, M S; Bøttger, M; Tvede, M F; Rasmussen, L S

    2015-10-01

    Videolaryngoscopes with sharp angulated blades improve the view of the vocal cords but this does not necessarily result in higher success rates of intubation The aim of this study was to evaluate the efficacy of using Boedeker intubation forceps in conjunction with McGrath Series 5 Videolaryngoscope (MVL) in patients with predictors for difficult intubation. The study was conducted at the Department of Anaesthesia, Copenhagen University Hospital from September to December 2013. Patients with one or more predictors of difficult intubation scheduled for general anaesthesia were assessed for eligibility. Patients were intubated using Boedeker intubation forceps and MVL. The primary endpoint was time to intubation. The secondary endpoints were intubation success rate, number of intubation attempts, intubation conditions and post-operative hoarseness. Thirty-three patients were assessed for eligibility, and 25 patients were included in the study with a median SARI score of 3 (IQR 3-4). Twenty-two (88%, 95% confidence interval [74-100%]) of the patients were successfully intubated by the method with a median time to intubation of 115 s (IQR 78-247). Steering and advancement of the tube were reported as acceptable in 21 (84%) and 22 cases (88%), respectively, and excellent in 10 cases (45%) for both measures. Ten cases (40%) were intubated on the first attempt. There were three cases (12%) of failed intubation; in these cases, successful intubation was obtained by using a styletted tube. Most patients with anticipated difficult intubation can be successfully intubated with Boedeker intubation forceps and MVL. However, endotracheal tube placement failed in 3/25 patients despite a good laryngeal view. © 2015 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  11. Enhanced rat sciatic nerve regeneration through silicon tubes filled with pyrroloquinoline quinone.

    PubMed

    Liu, Shiqing; Li, Haohuan; Ou Yang, Jingping; Peng, Hao; Wu, Ke; Liu, Yongming; Yang, Jingwei

    2005-01-01

    Pyrroloquinoline quinone (PQQ) is an antioxidant that also stimulates nerve growth factor (NGF) synthesis and secretion. In an earlier pilot study in our laboratory, Schwann cell growth was accelerated, and NGF mRNA expression and NGF secretion were promoted. The present study was designed to explore the possible nerve-inducing effect of PQQ on a nerve tube model over a 1-cm segmental deficit. An 8-mm sciatic nerve deficit was created in a rat model and bridged by a 1-cm silicone tube. Then,10 mul of 0.03 mmol/l PQQ were perfused into the silicone chamber in the PQQ group. The same volume of normal saline was delivered in the control group. Each animal underwent functional observation (SFI) at 2-week intervals and electrophysiological studies at 4-week intervals for 12 weeks. Histological and morphometrical analyses were performed at the end of the experiment, 12 weeks after tube implantation. Using a digital image-analysis system, thickness of the myelin sheath was measured, and total numbers of regenerated axons were counted. There was a significant difference in SFI, electrophysiological index (motor-nerve conduct velocity and amplitude of activity potential), and morphometrical results (regenerated axon number and thickness of myelin sheath) in nerve regeneration between the PQQ group and controls (P < 0.05). More mature, high-density, newly regenerated nerve was observed in the PQQ group. We conclude that PQQ is a potent enhancer for the regeneration of peripheral nerves.

  12. Gastric intubation: assessment and intervention.

    PubMed

    Cottrell, Damon B; Asturi, Elizabeth

    2004-12-01

    When gastric intubation is the chosen method of providing enteral nutrition, a variety of factors must be considered. To choose the proper tube, whether it resides in the gastric area or is postpyloric, it is important to consider the patient's level of consciousness, the duration of feeding, and the patient's overall status. Proper assessment, confirmation of tube placement, and nursing vigilance greatly reduce the likelihood of complications.

  13. Intentional esophageal intubation to improve visualization during emergent endotracheal intubation in the context of massive vomiting: a case report.

    PubMed

    Sorour, Khaled; Donovan, Lucas

    2015-03-01

    Impaired visualization during intubation due to vomitus of gastric contents is a potential cause of failed intubation. An 82-year-old woman was intubated emergently for respiratory distress secondary to aspiration of gastric contents. Her intubation was hindered by the presence of a massive amount of ongoing vomitus that impaired visualization and overwhelmed all suction capabilities. Intentional blind intubation of the esophagus with an endotracheal tube was performed with successful diversion of ongoing vomitus away from the airway. Thereafter, after brief suctioning, the larynx was quickly visualized and the patient was successfully intubated. Copyright © 2014 Elsevier Inc. All rights reserved.

  14. Analysis of urinary 8-isoprostane as an oxidative stress biomarker by stable isotope dilution using automated online in-tube solid-phase microextraction coupled with liquid chromatography-tandem mass spectrometry.

    PubMed

    Mizuno, Keisuke; Kataoka, Hiroyuki

    2015-08-10

    We have developed a simple and sensitive method for the determination of the oxidative stress biomarker 8-isoprostane (8-IP) in human urine by automated online in-tube solid-phase microextraction (SPME) coupled with liquid chromatography-tandem mass spectrometry (LC-MS/MS) using a Zorbax Eclipse XDB-8 column and 0.1% formic acid/methanol (25/75, v/v) as a mobile phase. Electrospray MS/MS for 8-IP was performed on an API 4000 triple quadruple mass spectrometer in negative ion mode. The optimum in-tube SPME conditions were 20 draw/eject cycles with a sample size of 40 μL using a Carboxen 1006 PLOT capillary column for the extraction. The extracted compounds were easily desorbed from the capillary by passage of the mobile phase, and no carryover was observed. Total analysis time of this method including online extraction and analysis was about 30 min for each sample. The in-tube SPME LC-MS/MS method showed good linearity in the concentration range of 20-1000 pg/mL with a correlation coefficient r = 0.9999 for 8-IP using a stable isotope-labeled internal standard, 8-IP-d4. The detection limit of 8-IP was 3.3 pg/mL and the proposed method showed 42-fold higher sensitivity than the direct injection method. The intra-day and inter-day precisions (relative standard deviations) were below 5.0% and 8.5% (n = 5), respectively. This method was applied successfully to the analysis of urine samples without pretreatment or interference peaks. The recovery rates of 8-IP spiked into urine samples were above 92%. This method is useful for assessing the effects of oxidative stress and antioxidant intake.

  15. Glucose oxidation in a dual hollow fiber bioreactor with a silicone tube oxygenator.

    PubMed

    Chang, H N; Kyung, Y S; Chung, B H

    1987-04-01

    A dual hollow fiber bioreactor, consisting of an outer silicone membrane for oxygen supply and an inner polyamide membrane for substrate permeation, was used as an immobilized enzyme reactor to carry out enzymatic glucose oxidation. Attaching a silicone tube oxygenator to provide an additional oxygen supply improved the conversion in glucose oxidation when the oxygen supply was rate-limiting. The reactor was operated in both diffusion and ultrafiltration modes. In the latter case, the conversion was much higher, but the stability of the immobilized enzyme was better maintained in the diffusion mode. As the inlet glucose concentration increased from 10mM to 500mM, the conversion decreased from 70 to 20%.

  16. Agreement between QuantiFERON®-TB Gold In-Tube and the tuberculin skin test and predictors of positive test results in Warao Amerindian pediatric tuberculosis contacts.

    PubMed

    Verhagen, Lilly M; Maes, Mailis; Villalba, Julian A; d'Alessandro, Adriana; Rodriguez, Lazaro Perez; España, Mercedes F; Hermans, Peter W M; de Waard, Jacobus H

    2014-07-11

    Interferon-gamma release assays have emerged as a more specific alternative to the tuberculin skin test (TST) for detection of tuberculosis (TB) infection, especially in Bacille Calmette-Guérin (BCG) vaccinated people. We determined the prevalence of Mycobacterium tuberculosis infection by TST and QuantiFERON®-TB Gold In-Tube (QFT-GIT) and assessed agreement between the two test methods and factors associated with positivity in either test in Warao Amerindian children in Venezuela. Furthermore, progression to active TB disease was evaluated for up to 12 months. 163 HIV-negative childhood household contacts under 16 years of age were enrolled for TST, QFT-GIT and chest X-ray (CXR). Follow-up was performed at six and 12 months. Factors associated with TST and QFT-GIT positivity were studied using generalized estimation equations logistic regression models. At baseline, the proportion of TST positive children was similar to the proportion of children with a positive QFT-GIT (47% vs. 42%, p = 0.12). Overall concordance between QFT-GIT and TST was substantial (kappa 0.76, 95% CI 0.46-1.06). Previous BCG vaccination was not associated with significantly increased positivity in either test (OR 0.68, 95% CI 0.32-1.5 for TST and OR 0.51, 95% CI 0.14-1.9 for QFT-GIT). Eleven children were diagnosed with active TB at baseline. QFT-GIT had a higher sensitivity for active TB (88%, 95% CI 47-98%) than TST (55%, 95% CI 24-83%) while specificities were similar (respectively 58% and 55%). Five initially asymptomatic childhood contacts progressed to active TB disease during follow-up. Replacement of TST by the QFT-GIT for detection of M. tuberculosis infection is not recommended in this resource-constrained setting as test results showed substantial concordance and TST positivity was not affected by previous BCG vaccination. The QFT-GIT had a higher sensitivity than the TST for the detection of TB disease. However, the value of the QFT-GIT as an adjunct in diagnosing TB disease is

  17. Agreement between QuantiFERON®-TB Gold In-Tube and the tuberculin skin test and predictors of positive test results in Warao Amerindian pediatric tuberculosis contacts

    PubMed Central

    2014-01-01

    Background Interferon-gamma release assays have emerged as a more specific alternative to the tuberculin skin test (TST) for detection of tuberculosis (TB) infection, especially in Bacille Calmette-Guérin (BCG) vaccinated people. We determined the prevalence of Mycobacterium tuberculosis infection by TST and QuantiFERON®-TB Gold In-Tube (QFT-GIT) and assessed agreement between the two test methods and factors associated with positivity in either test in Warao Amerindian children in Venezuela. Furthermore, progression to active TB disease was evaluated for up to 12 months. Methods 163 HIV-negative childhood household contacts under 16 years of age were enrolled for TST, QFT-GIT and chest X-ray (CXR). Follow-up was performed at six and 12 months. Factors associated with TST and QFT-GIT positivity were studied using generalized estimation equations logistic regression models. Results At baseline, the proportion of TST positive children was similar to the proportion of children with a positive QFT-GIT (47% vs. 42%, p = 0.12). Overall concordance between QFT-GIT and TST was substantial (kappa 0.76, 95% CI 0.46-1.06). Previous BCG vaccination was not associated with significantly increased positivity in either test (OR 0.68, 95% CI 0.32-1.5 for TST and OR 0.51, 95% CI 0.14-1.9 for QFT-GIT). Eleven children were diagnosed with active TB at baseline. QFT-GIT had a higher sensitivity for active TB (88%, 95% CI 47-98%) than TST (55%, 95% CI 24-83%) while specificities were similar (respectively 58% and 55%). Five initially asymptomatic childhood contacts progressed to active TB disease during follow-up. Conclusion Replacement of TST by the QFT-GIT for detection of M. tuberculosis infection is not recommended in this resource-constrained setting as test results showed substantial concordance and TST positivity was not affected by previous BCG vaccination. The QFT-GIT had a higher sensitivity than the TST for the detection of TB disease. However, the value of the QFT

  18. Comparison of the QuantiFERON-TB Gold In-Tube test with the tuberculin skin test for detecting latent tuberculosis infection prior to hematopoietic stem cell transplantation.

    PubMed

    Moon, S M; Lee, S-O; Choi, S-H; Kim, Y S; Woo, J H; Yoon, D H; Suh, C; Kim, D-Y; Lee, J-H; Lee, Je-H; Lee, K-H; Kim, S-H

    2013-02-01

    A total of 244 patients including 100 (41%) autologous hematopoietic stem cell transplant (HCT) recipients and 144 (59%) allogeneic HCT recipients were enrolled over a 28-month period. During the study period, no prophylaxis for latent tuberculosis (TB) infection was administrated. Of these, 201 (82%) had Bacillus Calmette-Guérin (BCG) scars or prior histories of BCG vaccination. The tuberculin skin test (TST) and the QuantiFERON-TB Gold In-Tube (QFT-GIT) test were performed simultaneously in all 244 patients. TST indurations were ≥ 5 mm in 39 of these patients (15%), and in 25 (10%) indurations were ≥ 10 mm. In addition, 40 (16%) had positive QFT-GIT outcomes, and 34 (14%) indeterminate outcomes. If the 34 patients with indeterminate QFT-GIT results were excluded from the overall agreement analysis, the agreement between the TST results (induration size ≥ 5 mm) and the QFT-GIT results in the 210 patients with clear QFT results was poor (κ = 0.08, 95% confidence interval [CI] -0.06 to 0.24), as it was for the patients with indurations ≥ 10 mm (κ = 0.15, 95% CI -0.004 to 0.31). During follow up, 2 patients developed TB after HCT. The incidence of TB in the patients with positive QFT-GIT outcomes was 2.80 per 100 person-years (95% CI 0.07-15.81), whereas among those with positive TST (≥ 5 mm) results, it was 0 per 100 person-years (95% CI 0-8.00). However, this finding should be cautiously interpreted because of the relatively short follow up and the fact that the sample size of the study cohort did not have adequate power. In conclusion, our data show that, although the frequencies of positive outcomes in the 2 TB screening tests were similar, the overall agreement between the TST and the QFT-GIT test was poor, regardless of BCG vaccination history.

  19. Use of the QuantiFERON-TB Gold In-Tube Test in the Diagnosis and Monitoring of Treatment Efficacy in Active Pulmonary Tuberculosis

    PubMed Central

    Chang, Ping-Chin; Wang, Pin-Hui; Chen, Kow-Tong

    2017-01-01

    The value of QuantiFERON in the diagnosis of tuberculosis disease and in the monitoring of the response to anti-tuberculosis treatment is unclear. The aims of this study were to evaluate the accuracy of the QuantiFERON-TB Gold In-Tube (QFT-GIT) test in the diagnosis of tuberculosis and in the monitoring of the response to anti-tuberculosis treatment in patients with active pulmonary tuberculosis (PTB). Between January 2013 and December 2015, 133 cases with active PTB and 133 controls with no mycobacterial infection, matched by age (within 3 years) and by the week that they visited Tainan Chest Hospital, were enrolled in the study. Serial testing by QFT-GIT at baseline and after 2 and 6 months of treatment was performed. At these time points, a comparison of the performance of QFT-GIT with that of sputum culture status among study subjects was conducted. Compared to baseline, 116 (87.2%) cases showed a decreased response, whereas 17 (12.8%) showed persistent or stronger interferon-gamma (IFN-γ) responses at 2 months. PTB patients IFN-γ responses declined significantly from baseline to 2 months (median, 6.32 vs. 4.12; p < 0.005). The sensitivity values of the QFT-GIT test for the detection of pulmonary tuberculosis at cut-off points of 0.35 IU/mL, 0.20 IU/mL, and 0.10 IU/mL were 74.4%, 78.2%, and 80.5%, respectively. The specificity values at cut-off points of 0.35 IU/mL, 0.20 IU/mL, and 0.10 IU/mL were 66.2%, 63.9%, and 57.1%, respectively. Our results support the QFT-GIT assay as a potential tool for diagnosing tuberculosis and for monitoring the efficacy of anti-tuberculosis treatment. PMID:28264462

  20. Diagnostic Values of the QuantiFERON-TB Gold In-Tube Assay Carried out in China for Diagnosing Pulmonary Tuberculosis

    PubMed Central

    Li, Fabin; Longuet, Christophe; Vernet, Guy; Goletti, Delia; Zhao, Yanlin; Lagrange, Philippe H.

    2015-01-01

    Background Interferon-release assays (IGRAs) for diagnosing active pulmonary tuberculosis (PTB) are not yet fully validated, particularly in high TB-endemic areas as the People's Republic of China (PRC). The aim of this report was to assess the performance of the QuantiFERON-TB Gold In-tube (QFT-GIT) and tuberculin skin test (TST), in addition to microbiological results, as contributors for diagnosing active PTB in the PRC. Methods/Principal Findings A total of 300 PTB patients, 41 disease controls (DC) and 59 healthy community controls (HCC) were included prospectively between May 2010 and April 2011 from two provinces of the PRC (Heilongjiang and Zhejiang). The QFT-GIT and TST yielded an overall sensitivity for active TB of 80.9% and 86.2%, and a specificity of 36.6% and 26.8%, respectively. The province of origin and smear microscopy status did not significantly impact the diagnostic values for PTB. However, using the TST with a 10 mm cut-off point, a significantly higher proportion of LTBI was observed in the DC than the HCC (p=0.01). Discordant results between the QFT-GIT and TST were found among 1/3 of the PTB, HCC and DC. Two-thirds of the individuals presented TST-positive/QFT-GIT-negative discordant results. The TST-negative/QFT-GIT-positive result was not associated with age or bacillary load. Cumulative QFT-GIT and TST positive results increased the overall sensitivity (95.9%), but it was associated with a dramatic decrease of the overall specificity (24.8%) leading to a suboptimal PPV (80.1%) and a low NPV (61.1%). Conclusions/Significance The usefulness of the QFT-GIT to diagnose active TB in high TB-endemic countries remains doubtful because like the TST, the QFT-GIT cannot distinguish between LTBI and active TB. Used as single stand-alone tests, both the QFT-GIT and TST have very limited roles in the diagnosis of active PTB. However, the combined use of SM, the TST and QFT-GIT may allow for the exclusion of ATB. PMID:25867946

  1. Cost analysis of tuberculin skin test and the QuantiFERON-TB Gold In-tube test for tuberculosis screening in a correctional setting in Dallas, Texas, USA.

    PubMed

    Nijhawan, Ank E; Iroh, Princess A; Brown, Larry S; Winetsky, Daniel; Porsa, Esmaeil

    2016-10-12

    Tuberculosis (TB) disproportionately affects immigrants, HIV-infected individuals, and those living in crowded settings such as homeless shelters and correctional facilities. Although the majority of jails and prisons use a tuberculin skin test (TST) for latent tuberculosis infection (LTBI) screening, limited data exist on the clinical performance and costs of the TST compared to interferon gamma release assays (IGRAs) in this setting. A prospective pilot study comparing cost between TST and an IGRA (QuantiFERON Gold In-tube, QFT-GIT) for the detection of LTBI in a convenience sample of inmates entering the Dallas County Jail (DCJ) was conducted June-October 2014. Participants completed a risk questionnaire, TST placement, QFT-GIT testing, and were offered opt-out HIV-Ab testing. LTBI prevalence based on TST and QFT-GIT results, an evaluation of discordant results and a cost analysis are presented. A total of 529 subjects were enrolled. The majority were male (75 %), and 46 % were Black, 29 % White, and 24 % Hispanic. Most (85 %) had been previously incarcerated. Over 28 % of participants were released prior to TST reading, with paired QFT-GIT and TST results available for 351 subjects. Of these, nine (2.6 %) tested positive by TST and 47 (13.4 %) tested positive by QFT-GIT. It costs $23.27 more per inmate per year to screen with QFT-GIT than TST in this population, though the cost per LTBI case detected was nearly three times higher for TST than QFT-GIT ($1247 v $460). We found a substantially higher rate of QFT-GIT positivity compared to TST in this sample of individuals entering the Dallas County Jail. Although no gold standard exists, this finding may indicate under-recognized LTBI in this setting. QFT-GIT as an initial screening tool was more time-efficient, had four-fold fewer labor costs and provided results on more individuals when compared with the TST. The overall cost of QFT-GIT was $23.27 more per inmate per year, though the cost per LTBI case

  2. [Application of low damage endotracheal intubation in patients undergoing extra long-term endotracheal intubation: a case report].

    PubMed

    Wang, Hao; Ding, Baochun

    2017-07-01

    To approach the effect of low damage endotracheal intubation on reducing the occurrence of cuff-related intubation complication and prolonging the intubation time. On January 7th, 2015, 1 patient with respiratory failure after subarachnoid hemorrhage were admitted to Huludao Central Hospital. Immediate endotracheal intubation and ventilator assisted ventilation were performed. When the trachea was difficult to be removed in a short time, and tracheotomy was refused, a low damage endotracheal intubation was used for a long term. On the basis of the original high volume low pressure cuff, this tube was designed for inner cuff, the hole was allowed in the inner cuff to connect with the tube. During the period of ventilation, the cuff pressure changed with airway pressure automatically, therefore it would reduce the compression injury of tracheal mucosa, improve the tolerance of the patients, and prolong the intubation time. The patient was removed from the tube on October 12th, 2015 with an intubation day of 279, the intubation-related complications and severe aspiration pneumonia had not been observed during the application of low damage endotracheal intubation. Design of this intubation ensured the cuff pressure changes with airway pressure, therefore, it could effectively avoid the cuff pressure become too high, and reduce the occurrence of intubation-related complication. This low damage endotracheal had an evident superiority in the aspects of cuff management. It has a better practical significance, especially for patients with long intubation time.

  3. Validation of the new intubation detector device: a manikin study.

    PubMed

    Umesh, Goneppanavar; Jasvinder, Kaur; Tim, Thomas Joseph

    2012-12-01

    This study was done to validate the utility of Umesh's intubation detector in detection of tracheal or oesophageal intubation in manikin using volunteers with different levels of experience in tracheal intubation (including novices). The Sim Man II, (Laerdal Medical AS, Norway) manikin was used. Two cuffed tracheal tubes of size 6.5 mm ID were used. One was passed into the trachea and the other into oesophagus. The device was connected to one of the two tubes as per randomisation table and three high quality chest compressions were performed. Each volunteer participated in the study twice. Their opinion regarding the tube position (in trachea or oesophagus or could not determine) was noted. A total of 50 volunteers participated in the study. Eleven of them had not observed intubation (novice), 29 had either only observed or had experience of <10 tracheal intubations (less experienced) and 10 had experience of >10 intubations or >1 year experience in tracheal intubation (experienced). Out of a total 100 performances, 99 were correctly identified. On one instance, a tube placed in trachea was incorrectly interpreted to be in the oesophagus by a novice. Umesh's intubation detector helps in rapid and reliable confirmation of tracheal intubation in manikin irrespective of the experience level of the assessor in tracheal intubation.

  4. Umesh's intubation detector (UID) for rapid and reliable identification of tracheal intubation by novices in anaesthetised, paralysed adult patients.

    PubMed

    Umesh, Goneppanavar; Tim, Thomas Joseph; Prabhu, Manjunath; Prasad, Krishnamurthy N; Jasvinder, Kaur

    2013-10-01

    Oesophageal intubation can lead to life threatening complications if left undetected. Several devices and techniques are available to confirm tracheal intubation and for early detection of oesophageal intubation. This study was carried out to evaluate the utility of the Umesh's intubation detector device for rapid and reliable differentiation of tracheal from oesophageal intubation by novice users. In this prospective, double blind and randomised study, 100 healthy patients undergoing general anaesthesia with endotracheal intubation received two identical size endotracheal tubes; one inserted into trachea and the other into the oesophagus. The Umesh's intubation detector was connected to one of the tubes randomly and a novice was asked to observe for inflation of the reservoir bag of the device while two chest compressions of approximately one inch each were given to the patient. Out of the total 100 tracheal intubations, 96 were correctly identified while the observers could not clearly conclude whether the tube was in trachea or oesophagus in the other four patients. Out of the total 100 oesophageal intubations, 99 were correctly identified. There were no complications related to the study. Umesh's intubation detector device can be used by novices for rapid and reliable differentiation of tracheal from oesophageal intubation in healthy adult patients.

  5. The Kepler intubation system.

    PubMed

    Hemmerling, Thomas M; Wehbe, Mohamad; Zaouter, Cedrick; Taddei, Riccardo; Morse, Joshua

    2012-03-01

    Our goal in this study was to develop a robotic intubation system and to conduct a feasibility pilot study on the use of a robotic intubation system for endotracheal intubations. The Kepler Intubation System was developed, consisting of a remote control center (joystick and intubation cockpit) linked to a standard videolaryngoscope via a robotic arm. Ninety intubations were performed by the Kepler Intubation System on an airway trainer mannequin by a single operator. The first group of 30 intubations was performed with the operator in direct view of the mannequin (direct view group). The second group of 30 intubations was performed with the operator unable to see the mannequin (indirect view group). Thirty semiautomated intubations were also performed during which the robotic system replayed a trace of a previously recorded intubation maneuver (semiautomated group). First-attempt success rates and intubation times for each trial were recorded. Trends were analyzed using linear regression. Data are presented as mean (SD). All intubations were successful at first attempt. The mean intubation times were 46 (18) seconds, 51 (19) seconds, and 41 (1) seconds for the direct view, indirect view, and semiautomated group, respectively. Both the direct and indirect view groups had a negative slope, denoting that each successive trial required less time. The semiautomated group had a slope of 0 and a low SD of 1 second, illustrating the high reproducibility of automated intubations. We concluded that a robotic intubation system has been developed that can allow remote intubations within 40 to 60 seconds.

  6. Submandibular intubation in awake patient of panfacial trauma

    PubMed Central

    Kamra, SK; Khandavilli, HK; Banerjee, P

    2016-01-01

    Maxillofacial trauma patients present with airway problems. Submandibular intubation is an effective means of intubation to avoid tracheostomy for operative procedures. Airway is secured with oral endotracheal intubation in paralyzed patient and tube is then transplaced in sub mental or submandibular region. However there may be instances when paralyzing such trauma patients is not safe and short term tracheostomy is the only airway channel available for conduction of anesthesia. We report a case of submandibular intubation in awake patient of maxillofacial trauma with anticipated intubation problems. PMID:27833492

  7. Formation of silicon oxide nanowires in nanomaterial synthesis experiments based on the usage of tube furnace

    NASA Astrophysics Data System (ADS)

    Li, Chunfei; Solomon, Virgil; Moro, Marjan; Welsh, Chad; McCauley, Tyler; Bauer, Michael; Cupo, Joseph

    2013-08-01

    In an effort to synthesize doped ZnO nanowires, SiO x nanowires were obtained accidently. In the experiment, mixed powders containing chemicals such as ZnO, graphite, Ga2O3, and In2O3 were placed in the center of a tube furnace, where the temperature was set to 1200 °C and the vacuum was approximately 27 Pa. Silicon wafers were placed around the vicinity of the furnace exit to collect the expected nanomaterials. After prolonged heating, grey layers were found on top of one wafer located inside the furnace. The layer showed no adhesion to the substrate. Characterization by using Scanning Electron Microscope (SEM), Transmission Electron Microscope (TEM), and Energy Dispersive X-ray Spectroscopy (EDS) revealed that this layer consisted of SiO x nanowires. Formation of Si-containing liquid drop and the subsequent growth of SiO x nanowires out of it are suggested as the growth mechanism.

  8. Submental Intubation in Patients with Complex Maxillofacial Injuries

    PubMed Central

    Cheong, Yuseon; Kang, Seong Sik; Kim, Minsoo; Son, Hee Jeong; Park, Jaewoo; Kim, Jeong-Mo

    2016-01-01

    Airway management in patients with complex maxillofacial injuries is a challenge to anesthesiologists. Submental intubation is a useful technique that is less invasive than tracheostomy in securing the airways where orotracheal and nasotracheal intubation cannot be performed. This procedure avoids the use of tracheostomy and bypasses its associated morbidities. A flexible and kink-resistant reinforced endotracheal tube with detachable universal connector is commonly used for submental intubation. Herein, we report cases involving submental intubation using a reinforced endotracheal tube with a non-detachable universal connector in patients with complex maxillofacial injuries. PMID:27924286

  9. Proof of feasibility of the Vacuum Silicon PhotoMultiplier Tube (VSiPMT)

    NASA Astrophysics Data System (ADS)

    Barbarino, G.; Campajola, L.; de Asmundis, R.; De Rosa, G.; Fiorillo, G.; Migliozzi, P.; Barbato, F. C. T.; Mollo, C. M.; Russo, A.; Vivolo, D.

    2013-04-01

    The Vacuum Silicon PhotoMultiplier Tube (VSiPMT) is an innovative design we propose for a modern hybrid photodetector based on the combination of a Silicon PhotoMultiplier (SiPM) with a hemispherical vacuum glass PMT standard envelope. The basic idea is to replace the classical dynode chain of a PMT with a SiPM, which acts as an electron multiplying detector. Such a solution will match the goal of a large photocathode sensitive area with the performances of a SiPM. This will lead to many advantages such as lower power consumption, mild sensitivity to magnetic fields and high quantum efficiency. The feasibility of this idea has been throughly studied both from a theoretical and experimental point of view. As a first step we performed the full characterization of a special non-windowed Hamamatsu MPPC with a laser source. The response of the SiPM to an electron beam was studied as a function of the energy and of the incident angle by means of a Geant4-based simulation. In this paper we present the preliminary results of the characterization of the SiPM with an electron source and we discuss how the development of next generation SiPMs will overcome the main weaknesses of VSiPMT, such as relatively low PDE and high photocathode voltage.

  10. Corrosion resistant coatings for silicon carbide heat exchanger tubes -- Volume 3. Final report

    SciTech Connect

    Boss, D.E.

    1996-06-07

    The development of a silicon carbide (SiC) heat exchanger is a critical step in the development of the Externally-Fired Combined Cycle (EFCC) power system. SiC is the only material that provides the necessary combination of resistance to creep, thermal shock, and oxidation. While the SiC structure materials provide the thermomechanical and thermophysical properties needed for an efficient system, the mechanical properties of the SiC tubes are severely degraded through corrosion by the coal combustion products. To obtain the necessary service life of thousands of hours at temperature, a protective coating is needed that is stable with both the SiC tube and the coal combustion products, resists erosion from the particle laden gas stream, is thermal shock resistant, adheres to SiC during repeated thermal shocks (start-up, process upsets, shut-down), and allows the EFCC system to be cost competitive. This demanding set of technical performance and cost drivers was used in reviewing and selecting candidate protective materials. After a review of open literature, discussion with leading researchers in materials for coal combustion environments, and preliminary thermodynamic studies, a total of ten materials were identified for future study that were grouped into three categories: alumina-based materials, materials stable with SiO{sub 2}, and low expansion materials.

  11. Enhanced rat sciatic nerve regeneration through silicon tubes implanted with valproic acid.

    PubMed

    Wu, Fei; Xing, Danmou; Peng, Zhengren; Rao, Ting

    2008-05-01

    Valproic acid (VPA) is an effective antiepileptic drug and mood stabilizer. It has recently been demonstrated that VPA could promote neurite outgrowth, activate the extracellular signal-regulated kinase pathway, and increase B-cell lymphoma/leukemia-2 (bcl-2)and growth cone-associated protein 43 (GAP-43) levels in spinal cord. We hypothesized that VPA could enhance axonal regeneration in the rat. In the present research, we demonstrate the effect of VPA on peripheral nerve regeneration and recovery of motor function through a silicon tube implanted with VPA. The left sciatic nerves were exposed through dorsal-splitting incisions, and 8-mm nerve sections were excised at the middle of the thigh. Then, a 1.0-cm-long silicone tube (internal diameter,1.0 mm; exterior diameter, 2.0 mm) was used to bridge the nerve deficit, anchored to the proximal and distal terminals of the excised deficit of sciatic nerves with 9-0 nylon epineural suture. Sterile petroleum jelly was used to seal the ends of the tubes to avoid leakage. The rats in the VPA group and control group were locally delivered 10 muL VPA injection (400 mg/5 mL) and normal saline, respectively, after the operation. The sciatic nerve index (SFI) was observed in each animal at 2-week intervals and electrophysiology was studied at 4-week intervals for 12 weeks. Histological and morphometrical analyses were performed at the end of the experiment (12 weeks after the operation). Using the digital image-analysis system, the thickness of the myelin sheath was measured, and total numbers of regenerated axons were counted. There was a significant difference in SFI, electrophysiological index (motor-nerve conduct velocity, amplitude of activity potential), and morphometrical results (regenerated axon number and thickness of myelin sheath) in nerve regeneration between the VPA group and controls ( P < 0.05). The results demonstrated that VPA is able to enhance sciatic nerve regeneration in rats, suggesting the potential

  12. Serial T-SPOT.TB and quantiFERON-TB-Gold In-Tube assays to monitor response to antitubercular treatment in Italian children with active or latent tuberculosis infection.

    PubMed

    Chiappini, Elena; Bonsignori, Francesca; Mangone, Giusi; Galli, Luisa; Mazzantini, Rachele; Sollai, Sara; Azzari, Chiara; de Martino, Maurizio

    2012-09-01

    We performed a prospective study to investigate T-SPOT.TB and QuantiFERON-TB Gold In-Tube (QFT-G-IT) dynamics during antitubercular treatment in active tuberculosis (TB) or latent TB. Eighteen children with latent TB and 26 with TB were enrolled. At 6 months of follow-up reversion rate was 5.88% (95% CI:0-13.79) for QFT-G-IT; 9.09% (95% CI:0.59-17.58) for T-SPOT.TB (P=0.921) in TB cases. Significant decline in quantitative response was observed exclusively in TB cases. Our results suggest that serial IGRA have limited use in children receiving antitubercular treatment.

  13. In vivo monitoring of quantum dots in the extracellular space using push-pull perfusion sampling, online in-tube solid phase extraction, and inductively coupled plasma mass spectrometry.

    PubMed

    Su, C K; Huang, C W; Yang, C S; Wang, Y J; Sun, Y C

    2010-09-01

    To monitor the dynamic changes of extracellular quantum dots (QDs) in vivo in the livers of anesthetized rats, we developed an automatic online analytical system comprising push-pull perfusion (PPP) sampling, the established in-tube solid phase extraction (SPE) procedure, and inductively coupled plasma mass spectrometry (ICPMS). The method takes advantage of the retention of QDs onto the interior surface of a polytetrafluoroethylene (PTFE) tube as a means of extracting the QDs from complicated push-pull perfusates. For the injected QDs present in the liver extracellular fluid (ECF) at low picomolar levels, a temporal resolution of 10 min was required to collect sufficient amounts of QDs to meet the sensitivity requirements of the ICPMS system. To the best of our knowledge, this study is the first to exploit the PPP technique for the collection of QDs from living animals and PTFE tubing as a SPE adsorbent for the online extraction of QDs and the removal of biological matrix prior to ICPMS analysis of cadmium-containing inorganic nanocrystal. We confirmed the analytical reliability of this method from measurements of the spike recoveries of saline samples; in addition, we demonstrated the systems' applicability through in vivo monitoring of the time-dependent concentration profile of liver extracellular QDs in living rats after intravenous administration.

  14. Novel solvent-free microwave-assisted extraction coupled with low-density solvent-based in-tube ultrasound-assisted emulsification microextraction for the fast analysis of organophosphorus pesticides in soils.

    PubMed

    Su, Yi-Song; Yan, Cheing-Tong; Ponnusamy, Vinoth Kumar; Jen, Jen-Fon

    2013-07-01

    A novel and rapid solventless microwave-assisted extraction coupled with low-density solvent-based in-tube ultrasound-assisted emulsification microextraction has been developed for the efficient determination of nine organophosphorus pesticides in soils by GC analysis with microelectron capture detection. A specially designed, homemade glass tube inbuilt with a scaled capillary tube was used as an extraction device to collect and measure the separated extractant phase easily. Parameters affecting the efficiencies of the developed method were thoroughly investigated. From experimental results, the following conditions were selected for the extraction of organophosphorus pesticides from 1.0 g of soil sample to 5 mL of aqueous solution under 226 W of microwave irradiation for 2.5 min followed by ultrasound-assisted emulsification microextraction with 20 μL toluene for 30 s and then centrifugation at 3200 rpm for 3 min. Detections were linear in the range of 0.25-10 ng/g with detection limits between 0.04 and 0.13 ng/g for all target analytes. The applicability of the method to real samples was assessed on agricultural contaminated soils and the recoveries ranged between 91.4 and 101.3%. Compared to other methods, the present method was shown to be highly competitive in terms of sensitivity, cost, eco-friendly nature, and analysis speed.

  15. In-tube solid-phase microextraction based on NH2-MIL-53(Al)-polymer monolithic column for online coupling with high-performance liquid chromatography for directly sensitive analysis of estrogens in human urine.

    PubMed

    Luo, Xialin; Li, Gongke; Hu, Yufei

    2017-04-01

    In this work, a novel NH2-MIL-53(Al) incorporated poly(styrene-divinylbenzene-methacrylic acid) (poly(St-DVB-MAA)) monolith was prepared via chemical fabrication. Moreover, it has been efficiently applied to the in-tube solid-phase microextraction (SPME) for online coupling with high-performance liquid chromatography (HPLC) to the direct determination of five estrogens in human urine samples. The NH2-MIL-53(Al)-polymer monolith was suitable for in-tube SPME owing to its good permeability, high extraction efficiency, chemical stability, good reproducibility and long lifetime. The extraction conditions including extraction solvent, pH of sample solution, flow rate of extraction and desorption, and desorption volume were investigated. Under the optimum conditions, the enrichment factors were 180-304 and saturated amounts of extraction were 2326-21393 pmol for estriol, 17β-estradiol, estrone, ethinyl estradiol and progesterone, respectively. The adsorption mechanism was also explored which contributed to its strong extraction to target compounds. The proposed method had low limit of detection (2.0-40ng/L) and good linearity (with R(2) between 0.9908 and 0.9978). Four endogenous estrogens were detected in urine samples and the recoveries of all five analytes were ranged from 75.1-120% with relative standard deviations (RSDs) less than 8.7%. The results showed that the proposed online SPME-HPLC method based on NH2-MIL-53(Al)-polymer monolithic column was highly sensitive for directly monitoring trace amount of estrogens in human urine sample.

  16. Incidence and predictors of difficult nasotracheal intubation with airway scope.

    PubMed

    Ono, Koyu; Goto, Tomoko; Nakai, Daishi; Ueki, Shuhei; Takenaka, Seiichiro; Moriya, Tomomi

    2014-10-01

    The airway scope (AWS) improves views of the larynx during orotracheal intubation. However, the role of the AWS in routine nasotracheal intubation has not been studied adequately. One hundred and three patients undergoing dental and maxillofacial surgery that required general anesthesia and nasotracheal intubation were enrolled. The study was approved by our Institution Review Board, and written informed consent was obtained from all patients. We evaluated the success rate of AWS intubation and the incidence of difficult nasotracheal intubation using a modified intubation difficulty scale (IDS) to examine preoperative characteristics and intubation profiles. Categories were difficult intubation (IDS ≥5), mildly difficult (IDS = 1-4), and intubation without difficulty (IDS = 0). We also assessed the incidence of the use of Magill forceps or cuff inflation (the cuff of endotracheal tube is inflated with 10-15 ml air) to guide the endotracheal tube into the glottis. AWS nasotracheal intubation was 100% successful. The cuff inflation technique was used in 37 patients. Neither Magill forceps nor other devices were needed for any patient during AWS use. The incidence of difficult nasotracheal intubation was 10% (n = 10). Of the patients, 61% (n = 63) had mildly difficult intubation and 29% (n = 30) had no difficulty. Patients with difficult intubation were more likely to be male and to have a larger tongue and a higher Cormack grade than in the other two groups. Complications, involving minor soft tissue injury, were observed in only 1 patient (1%). The AWS achieves a high success rate for nasotracheal intubation with cuff inflation in patients undergoing dental and maxillofacial surgery.

  17. Radiation grafting of N-vinylpyrrolidone into silicone tubes. Synthesis of polymers with improved hemocompatibility and implantation tests in lambs

    NASA Astrophysics Data System (ADS)

    Chapiro, A.; Domurado, D.; Foëx-Milléquant, M.; Jendrychowska-Bonamour, A.-M.

    NVP was grafted onto silicone 2 mm I.D. tubes by the "direct" radiation method. Homogeneous bulk grafting was carried in toluene solutions, the best results were obtained in 70% monomer solution, so it was choosen for preparing the samples for the implantations (in vivo tests). In 7 days implantation test the significant improvement of blood-compatibility correspond to grafting ratios higher than 40%. Surface limited grafting is realized in dilute aqueous solutions of NVP. The thickness of the grafted layer inside and outside the tubes is measured after colouration and observation with a microscope. the surface grafting ratio determined by multiple reflection I.R. analysis.

  18. Mesoporous titanium oxide with high-specific surface area as a coating for in-tube solid-phase microextraction combined with high-performance liquid chromatography for the analysis of polycyclic aromatic hydrocarbons.

    PubMed

    Wang, Xiuqin; Feng, Juanjuan; Bu, Yanan; Tian, Yu; Luo, Chuannan; Sun, Min

    2017-06-01

    Stainless-steel wires coated with mesoporous titanium oxide were placed into a polyether ether ketone tube for in-tube solid-phase microextraction, and the coating sorbent was characterized by X-ray diffraction and scanning electron microscopy. It was combined with high-performance liquid chromatography to build an online system. Using eight polycyclic aromatic hydrocarbons as the analytes, some conditions including sample flow rate, sample volume, organic solvent content, and desorption time were investigated. Under optimum conditions, an online analysis method was established and provided good linearity (0.03-30 μg/L), low detection limits (0.01-0.10 μg/L), and high enrichment factors (77.6-678). The method was applied to determine target analytes in river water and water sample of coal ash, and the recoveries are in the range of 80.6-106.6 and 80.9-103.5%, respectively. Compared with estrogens and plasticizers, extraction coating shows better extraction efficiency for polycyclic aromatic hydrocarbons. © 2017 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  19. [Light-guided tracheal intubation using a Trachlight: causes of difficulty and skill acquisition].

    PubMed

    Yamamoto, T; Aoyama, K; Takenaka, I; Kadoya, T; Uehara, H

    1999-06-01

    We studied the reasons why tracheal intubation using a lighted stylet (Trachlight) was sometimes difficult for unexperienced intubators. We also examined light-guided intubation skill acquisition in inexperienced anesthesiologists. Two anesthesiologists, with no prior experience in using a Trachlight, performed orotracheal intubation using a Trachlight in 60 anesthetized patients (30 patients each). During intubation, an assistant observed the advancement of the tracheal tube using a fiberscope passed nasally and recorded the reason for difficulty in intubation. The time to successful intubation was also measured. Data were divided into epochs of 10 cases, and the intubation time and the incidence of difficult cases were compared between the groups. Tracheal intubation was successful using the Trachlight in 59 of 60 patients. The incidence of difficult cases, defined as cases requiring two or more attempts, was 31.7%. Fiberscopy showed that when the tube tip was located in the vallecula or in the esophagus, it was sometimes difficult to determine the position of the tube tip by transillumination of the soft tissues of the neck, and this results in the need for multiple attempts. Both the intubation time and the incidence of difficult cases decreased significantly between the first and last epoch. The present study confirms that light-guided intubation is sometimes difficult when the tube tip is advanced to the vallecula or to the esophagus. An acceptable level of skill in light-guided intubation is achieved within 30 uses.

  20. Prosthodontic Approach in Management of Prolonged Neonatal Intubation

    PubMed Central

    Shah, Shital K; Rathod, Vishnu B; Ambadkar, Priyanka S; Patil, Charudutt N

    2016-01-01

    Intubation is a routine intervention in the Neonatal Intensive Care Unit (NICU) for preterm neonates with respiratory distress, inadequate gag reflex, poor sucking and swallowing. Prolonged intubation in neonates can be done by nasal or oral route. Although naso-tracheal intubation may reduce movement of the tube, it may contribute to airway obstruction, possible hypoxia, and occlusion of the nasal aperture during a crucial period of development further contributing to laboured breathing. Being obligate nasal breathers, oro-tracheal route is the preferred method of intubation in premature infants as oral mucosa is less susceptible to damage than nasal mucosa. Ineffective stabilization of the tubes is a frequent problem often resulting in accidental extubation and displacement of orotracheal and orogastric tube. Hence, these tubes must be stabilized against displacement from tongue and jaw movements to prevent discomfort and subsequent tissue trauma. Complications of prolonged endotracheal intubation include palatal groove formation by pressure against the hard palate, infection, accidental extubation, malposition, laryngeal or tracheal edema and ulceration, tracheal stenosis, vocal cord injury. Various oral appliances are used for infants to stabilize the tubes and prevent complications associated with long term intubation. This case report describes a prosthodontic approach in management of prolonged neonatal intubation. PMID:28050517

  1. Prosthodontic Approach in Management of Prolonged Neonatal Intubation.

    PubMed

    Kamble, Vikas B; Shah, Shital K; Rathod, Vishnu B; Ambadkar, Priyanka S; Patil, Charudutt N

    2016-11-01

    Intubation is a routine intervention in the Neonatal Intensive Care Unit (NICU) for preterm neonates with respiratory distress, inadequate gag reflex, poor sucking and swallowing. Prolonged intubation in neonates can be done by nasal or oral route. Although naso-tracheal intubation may reduce movement of the tube, it may contribute to airway obstruction, possible hypoxia, and occlusion of the nasal aperture during a crucial period of development further contributing to laboured breathing. Being obligate nasal breathers, oro-tracheal route is the preferred method of intubation in premature infants as oral mucosa is less susceptible to damage than nasal mucosa. Ineffective stabilization of the tubes is a frequent problem often resulting in accidental extubation and displacement of orotracheal and orogastric tube. Hence, these tubes must be stabilized against displacement from tongue and jaw movements to prevent discomfort and subsequent tissue trauma. Complications of prolonged endotracheal intubation include palatal groove formation by pressure against the hard palate, infection, accidental extubation, malposition, laryngeal or tracheal edema and ulceration, tracheal stenosis, vocal cord injury. Various oral appliances are used for infants to stabilize the tubes and prevent complications associated with long term intubation. This case report describes a prosthodontic approach in management of prolonged neonatal intubation.

  2. Endotracheal intubation in swine.

    PubMed

    Chum, Helen; Pacharinsak, Cholawat

    2012-11-01

    Swine are commonly used as research models for cardiovascular surgery and disease, gastrointestinal disease, organ transplantation and intra-renal surgery. These surgical models require anesthesia and, consequently, endotracheal intubation in order to protect the airway; prevent aspiration of saliva, blood and foreign materials; and maintain positive pressure ventilation of the animal. Successful intubation is vital to the stable maintenance of swine under inhalational anesthesia. Here we discuss key features of swine anatomy that make intubation challenging, equipment necessary for successful intubation and techniques for endotracheal intubation in swine.

  3. Palliative intubation for malignant strictures of the oesophagus

    PubMed Central

    Leverment, J. N.; Milne, D. Mearns

    1974-01-01

    Leverment, J. N. and Mearns Milne, D. (1974).Thorax, 29, 228-231. Palliative intubation for malignant strictures of the oesophagus. Over a 16-year period the Mousseau-Barbin tube was used for palliation in 50 patients suffering from malignant stricture of the oesophagus. In only two cases was the Souttar tube used. Thirty-seven cases were intubated as a primary method of treatment—21 cases without preliminary exploration, 13 cases following exploration, and three cases as a `delayed' procedure. Twelve cases were secondarily intubated as a result of recurrence of malignancy following an earlier oesophagogastrectomy. In three cases perforation of the oesophagus was recognized at the time of intubation, following which palliative oesophagogastrectomies were attempted. Intubation remains one method of relieving the patient's most distressing symptom, but in the majority of cases prolongation of life was seldom for more than three months. The hazards of this form of treatment are discussed. PMID:4133968

  4. Optimisation of stir bar sorptive extraction and in-tube derivatisation-thermal desorption-gas chromatography-mass spectrometry for the determination of several endocrine disruptor compounds in environmental water samples.

    PubMed

    Iparraguirre, Arantza; Prieto, Ailette; Navarro, Patricia; Olivares, Maitane; Fernández, Luis-Ángel; Zuloaga, Olatz

    2011-07-01

    The analysis of organic pollutants in environmental water samples requires a pre-concentration step. Pre-concentration techniques such as stir bar sorptive extraction (SBSE) have gained popularity since they minimise the use of toxic organic solvents and can be considered as green analytical techniques. Similar to other pre-concentration techniques, one of the problems when SBSE is used is the matrix effect, which often occurs during the analysis of environmental water samples such as estuarine or wastewater samples. The present work studied the matrix effect during SBSE coupled to in-tube derivatisation-thermal desorption (TD)-gas chromatography-mass spectrometry for the determination of several endocrine disruptor compounds, such as alkylphenols, bisphenol A, estrogens and sterols, in environmental water samples, after optimisation of the major variables affecting the determination. Variables such as the addition of methanol or an inert salt to the donor phase, the extraction temperature, the volume of the donor phase, the stirring rate and the extraction time were studied during the SBSE optimisation. In the case of the in-tube derivatisation and TD step, the volume of the derivatisation reagent (N,O-bis(trimethylsilyl)triufloroacetamide with 1% of trimethylchlorosilane (BSTFA + 1% TMCS)) and the cryo-focusing temperature were fixed (2 μL and -50 °C, respectively) according to a consensus between maximum signal and optimal operation conditions. Good apparent recovery values (78-124%) were obtained for most of the analytes in Milli-Q water, except for 4-tert-octylphenol (4-tOP), which showed apparent recovery values exceeding 100%. Precision (n = 4) was in the 2-27%, and method detection limits were in the low nanogrammes per litre level for most of the analytes studied. The matrix effect was studied using two different approaches. On the one hand, Milli-Q water samples were spiked with humic acids, and apparent recovery values were studied with and

  5. Contribution of a heparin-binding haemagglutinin interferon-gamma release assay to the detection of Mycobacterium tuberculosis infection in HIV-infected patients: comparison with the tuberculin skin test and the QuantiFERON-TB Gold In-tube.

    PubMed

    Wyndham-Thomas, Chloé; Dirix, Violette; Schepers, Kinda; Martin, Charlotte; Hildebrand, Marc; Goffard, Jean-Christophe; Domont, Fanny; Libin, Myriam; Loyens, Marc; Locht, Camille; Van Vooren, Jean-Paul; Mascart, Françoise

    2015-02-14

    The screening and treatment of latent tuberculosis (TB) infection reduces the risk of progression to active disease and is currently recommended for HIV-infected patients. The aim of this study is to evaluate, in a low TB incidence setting, the potential contribution of an interferon-gamma release assay in response to the mycobacterial latency antigen Heparin-Binding Haemagglutinin (HBHA-IGRA), to the detection of Mycobacterium tuberculosis infection in HIV-infected patients. Treatment-naïve HIV-infected adults were recruited from 4 Brussels-based hospitals. Subjects underwent screening for latent TB using the HBHA-IGRA in parallel to a classical method consisting of medical history, chest X-ray, tuberculin skin test (TST) and QuantiFERON-TB Gold In-Tube (QFT-GIT). Prospective clinical and biological follow-up ensued, with repeated testing with HBHA-IGRA. A group of HIV-infected patients with clinical suspicion of active TB was also recruited and tested with the HBHA-IGRA. Multiplex analysis was performed on the culture supernatants of this in-house assay to identify test read-outs alternative to interferon-gamma that could increase the sensitivity of the test. Among 48 candidates enrolled for screening, 9 were identified with latent TB by TST and/or QFT-GIT results. Four of these 9 patients and an additional 3 screened positive with the HBHA-IGRA. This in-house assay identified all the patients that were positive for the TST and showed the best concordance with the presence of a M. tuberculosis exposure risk. During follow-up (median 14 months) no case of active TB was reported and HBHA-IGRA results remained globally constant. Fourteen HIV-infected patients with clinical suspicion of active TB were recruited. Active TB was confirmed for 6 of them among which 3 were HBHA-IGRA positive, each with very high interferon-gamma concentrations. All patients for whom active TB was finally excluded, including 2 non-tubercular mycobacterial infections, had negative HBHA

  6. Silicone Tubes - Simple and Effective Tools for Gas Extraction and Monitoring in the Course of Hydrate Dissociation

    NASA Astrophysics Data System (ADS)

    Strauch, B.; Schicks, J. M.; Zimmer, M.

    2015-12-01

    The in situ dissociation of gas hydrate is prerequisite for the commercial recovery of natural gas from hydrate deposits. We examined different methods such as depressurization, thermal stimulation and distortion of the chemical equilibrium by carbon dioxide sequestration for methane gas production from hydrates within our Large Scale reservoir simulator LARS in a pilot plant scale. Within this setup, thin-walled (0.8 mm) silicon tubes are utilized for in situ gas capture. They function as membranes for the extraction of methane gas, leaving sediment and brine behind. The gas capture via silicone tube membranes is, due to their robust nature, reliably applicable in remote and rough areas. First tests show that, driven by the transmembrane pressure difference, the methane flux through these membranes is about 1 mL per minute per cm² membrane surface at a reservoir pressure of about 20 MPa. This is in good agreement with values reported in the literature [e.g. 2]. The operation of the membranes as a simple capture tool for the released methane from a hydrate deposit is therefore considered as feasible. Furthermore, silicone tube membranes are suitable for the quantification of free and dissolved gas volumes. For the monitoring of spatial and temporal gas distribution, LARS has been equipped with several silicone membranes at various locations. They have been utilized to monitor the progress of hydrate formation and decomposition and show that inhomogeneous gas distributions within the reservoir are detectable and terminable. The quantification of carbon dioxide/methane gas ratios during exchange experiments, however, is due to differences in water solubility and permeation rates of the gas species challenging. The study assesses the capability and limits of silicone tubes as membranes for gas extraction and as a tool to monitor gas distribution and composition in the course of hydrate dissociation experiments. [1] Merkel, T.C.; Bodnar, V.I.; Nagai, K.; Freeman, B

  7. Characterization of mechanical properties of hydroxyapatite-silicon-multi walled carbon nano tubes composite coatings synthesized by EPD on NiTi alloys for biomedical application.

    PubMed

    Khalili, Vida; Khalil-Allafi, Jafar; Sengstock, Christina; Motemani, Yahya; Paulsen, Alexander; Frenzel, Jan; Eggeler, Gunther; Köller, Manfred

    2016-06-01

    Release of Ni(1+) ions from NiTi alloy into tissue environment, biological response on the surface of NiTi and the allergic reaction of atopic people towards Ni are challengeable issues for biomedical application. In this study, composite coatings of hydroxyapatite-silicon multi walled carbon nano-tubes with 20wt% Silicon and 1wt% multi walled carbon nano-tubes of HA were deposited on a NiTi substrate using electrophoretic methods. The SEM images of coated samples exhibit a continuous and compact morphology for hydroxyapatite-silicon and hydroxyapatite-silicon-multi walled carbon nano-tubes coatings. Nano-indentation analysis on different locations of coatings represents the highest elastic modulus (45.8GPa) for HA-Si-MWCNTs which is between the elastic modulus of NiTi substrate (66.5GPa) and bone tissue (≈30GPa). This results in decrease of stress gradient on coating-substrate-bone interfaces during performance. The results of nano-scratch analysis show the highest critical distance of delamination (2.5mm) and normal load before failure (837mN) as well as highest critical contact pressure for hydroxyapatite-silicon-multi walled carbon nano-tubes coating. The cell culture results show that human mesenchymal stem cells are able to adhere and proliferate on the pure hydroxyapatite and composite coatings. The presence of both silicon and multi walled carbon nano-tubes (CS3) in the hydroxyapatite coating induce more adherence of viable human mesenchymal stem cells in contrast to the HA coated samples with only silicon (CS2). These results make hydroxyapatite-silicon-multi walled carbon nano-tubes a promising composite coating for future bone implant application.

  8. Assessment of intubation in croup and epiglottitis.

    PubMed

    Zulliger, J J; Schuller, D E; Beach, T P; Garvin, J P; Birck, H G; Frank, J E

    1982-01-01

    Nasotracheal intubation for the management of airway obstruction in acute epiglottitis has become a well-received practice. However, the same technique has not received widespread support in laryngotracheobronchitis. The purpose of this study was to update the series of nasotracheal intubations in croup and epiglottitis from Columbus Children's Hospital with the specific intent to evaluate its effectiveness. All patients were evaluated for any immediate and delayed complications. Delayed complications were evaluated using parent interviews and measuring expiratory flow rates. This study of 45 children intubated for epiglottitis and 83 intubations for croup reconfirms the earlier report from this institution about its safety in both conditions. However, it has identified a subset of the croup patients who are definitely at risk to develop complications of the technique. In those children under 1 year of age, a disturbingly high incidence of subglottic stenosis was identified and this appeared to be related to the patient's age, tube size, serial intubations (dilatations), and duration of intubation. Suggested guidelines for airway management in the light of the new information are presented.

  9. Substantial reduction of the heat losses to ambient air by natural convection from horizontal in-tube flows: impact of an axial bundle of passive baffles

    NASA Astrophysics Data System (ADS)

    Campo, A.; Cortés, C.

    This paper is concerned with a distinct and effective technique to insulate horizontal tubes carrying hot fluids without using the variety of insulating materials traditionally utilized in industry. The tubes transport hot fluids and are exposed to a natural convection environment of air at standard atmospheric temperature and pressure. Essentially, an ``equivalent quantity of insulation'' is provided by an envelope of straight symmetric baffles made from a low conductivity material that is affixed to the outer surface of the horizontal tubes. A simple 1-D lumped model of comparable precision to the customary 2-D differential model serves to regulate the thermal interaction between the two perpendicular fluid streams, one horizontal due to internal forced convection and the other vertical due to external natural convection in air. All computations are algebraic and lead to a rapid determination of the two quantities that are indispensable to design engineers: the mean bulk temperatures of the internal hot fluid moving either laminarly or turbulently, together with the degraded levels of heat transfer rates.

  10. Ischemic subglottic damage following a short-time intubation.

    PubMed

    Silva, Marta João; Aparício, José; Mota, Teresa; Spratley, Jorge; Ribeiro, Augusto

    2008-12-01

    The objective of this study is to report a case of ischemic subglottic damage after a short-time intubation with a large, overinflated endotracheal tube cuff in a child. The study uses individual case report. A 6-year-old boy was admitted to the pediatric intensive care unit after a head trauma intubated with a 5.5-mm inner diameter cuffed endotracheal tube overinflated with 16 ml of air that produced a pressure of more than 120 cm H2O. The endotracheal tube cuff pressure produced by inflation was reduced after 4 h. The child presented postextubation stridor with subglottic edema. Inappropriate handling of tracheal intubation without accurate measurement of endotracheal tube size and intracuff pressures of endotracheal tubes, can cause airway trauma and place patients at risk.

  11. Comparison of the tuberculin skin test and Quanti-FERON-TB Gold In-Tube (QFT-G) test for the diagnosis of latent tuberculosis infection in dialysis patients.

    PubMed

    Al Jahdali, Hamdan; Ahmed, Anwar E; Balkhy, Hanan H; Baharoon, Salim; Al Hejaili, Fayez F; Hajeer, Ali; Memish, Ziad; Binsalih, Salih; Al Sayyari, Abdullah A

    2013-06-01

    Dialysis patients are more likely than the general population to develop active tuberculosis (TB). In these patients, the availability of a highly sensitive and specific test to diagnose latent TB will ensure earlier treatment and decreased progression to active disease. In the current study, the Quanti-FERON-TB Gold In-Tube (QFT-G) test was compared with the tuberculin skin test (TST) for the diagnosis of latent tuberculosis infection (LTBI) among 200 hemodialysis patients and 15 confirmed TB disease cases in a tertiary care center in Saudi Arabia. Among the LTBI cases, 26 (13%) were TST positive, and 65 (32.5%) were positive by the QTF-G test, with an overall agreement between the 2 tests of 75.5% (k=0.34) being observed. Among the confirmed tuberculosis disease cases, none were positive by TST, and 10 (66.7%) were positive by the QTF-G test, resulting in an overall agreement of 33.3% (k=0). A comparison between the TST and the QTF-G test was performed based on the sensitivity, specificity, and area under the curve (AUC) obtained for the tests. The QTF-G test was more sensitive and less specific than the TST in predicting the confirmed TB disease cases. When we tested the correspondence of the AUC values between the 2 diagnostic modalities, the obtained p-value was 0.0003. In conclusion, the AUCs of the examined diagnostic modalities are significantly different in predicting LTBI and tuberculosis.

  12. Online coupling of in-tube solid-phase microextraction with direct analysis in real time mass spectrometry for rapid determination of triazine herbicides in water using carbon-nanotubes-incorporated polymer monolith.

    PubMed

    Wang, Xin; Li, Xianjiang; Li, Ze; Zhang, Yiding; Bai, Yu; Liu, Huwei

    2014-05-20

    Online coupling of in-tube solid phase microextraction (IT-SPME) with direct analysis in real time mass spectrometry (DART-MS) was realized for the first time and applied in the analysis of triazine herbicides in lake water and orange juice. We incorporated single-wall carbon nanotubes (SWNTs) into a polymer monolith containing methacrylic acid (MAA) and ethylene dimethacrylate (EDMA) to form a novel poly(methacrylic acid-co-ethylene dimethacrylate-co-single wall carbon nanotubes) (poly(MAA-EDMA-SWNT)) monolith, which was then used in IT-SPME for enrichment of six triazine herbicides from water samples. With the online combination of IT-SPME with DART-MS, the analytes desorbed from the monolith were directly ionized by DART and transferred into MS for detection, thus rapid determination was achieved. Compared with regular DART-MS method, this online IT-SPME-DART-MS method was more sensitive and reproducible, because of the IT-SPME procedures and the isotope-labeled internal standard used in the experiment. Six triazine herbicides were determined simultaneously using this method with good linearity (R(2) > 0.998). The limit of quantification (signal-to-noise ratio of S/N = 10) of the six herbicides were only 0.06-0.46 ng/mL. The proposed method has been applied to determine triazine herbicides in lake water and orange juice, showing satisfactory recovery (85%-106%) and reproducibility (relative standard deviation of RSD = 3.1%-10.9%).

  13. Rapid determination of triclosan in personal care products using new in-tube based ultrasound-assisted salt-induced liquid-liquid microextraction coupled with high performance liquid chromatography-ultraviolet detection.

    PubMed

    Chen, Ming-Jen; Liu, Ya-Ting; Lin, Chiao-Wen; Ponnusamy, Vinoth Kumar; Jen, Jen-Fon

    2013-03-12

    This paper describes the development of a novel, simple and efficient in-tube based ultrasound-assisted salt-induced liquid-liquid microextraction (IT-USA-SI-LLME) technique for the rapid determination of triclosan (TCS) in personal care products by high performance liquid chromatography-ultraviolet (HPLC-UV) detection. IT-USA-SI-LLME method is based on the rapid phase separation of water-miscible organic solvent from the aqueous phase in the presence of high concentration of salt (salting-out phenomena) under ultrasonication. In the present work, an indigenously fabricated home-made glass extraction device (8-mL glass tube inbuilt with a self-scaled capillary tip) was utilized as the phase separation device for USA-SI-LLME. After the extraction, the upper extractant layer was narrowed into the self-scaled capillary tip by pushing the plunger plug; thus, the collection and measurement of the upper organic solvent layer was simple and convenient. The effects of various parameters on the extraction efficiency were thoroughly evaluated and optimized. Under optimal conditions, detection was linear in the concentration range of 0.4-100ngmL(-1) with correlation coefficient of 0.9968. The limit of detection was 0.09ngmL(-1) and the relative standard deviations ranged between 0.8 and 5.3% (n=5). The applicability of the developed method was demonstrated for the analysis of TCS in different commercial personal care products and the relative recoveries ranged from 90.4 to 98.5%. The present method was proven to be a simple, sensitive, less organic solvent consuming, inexpensive and rapid procedure for analysis of TCS in a variety of commercially available personal care products or cosmetic preparations.

  14. [BONFILS retromolar intubation fiberscope VS styletscope for oro-tracheal intubation].

    PubMed

    Maeyama, Akihiko; Kodaka, Mitsuharu; Miyao, Hideki

    2009-10-01

    Battery-powered BONFILS Retromolar Intubation Fiberscope (B-scope) is a nonflexible fiberscope having the same curvature as the Macintosh laryngoscope. Battery-powered StyletScope (S-scope) has a flexible apex whose direction was controlled by grasping a handle. We assessed the operational performance of the two scopes. Fifty patients were randomly allocated in the two groups :25 patients were in the B group (B-scope) and 25 were S group (S-scope) after obtaining written informed consent. We evaluated Mallampati class classification, size of tracheal tube, and intubation time. There are no significance differences between the two groups in Mallampati class, demographic date and intubation time (23 +/-15 sec in B-group and 26 +/-14 sec in S-group). Both scopes were good in operational performance. BONFILS Retromolar Intubation Fiberscope and StyletScope are both good in the operational performance.

  15. Product technology and market assessment for silicon carbide whisker reinforced alumina heat-exchanger tubes. Final report

    SciTech Connect

    Loutfy, R.O.; Withers, J.C.; Chakravarti, D.

    1993-10-01

    This report describes a study designed to develop an assessment of key performance features, desirable technical specifications and market potential for silicon carbide whisker-reinforced alumina (henceforth SCWRA) tubes for heat exchanger applications in a number of industries. The results of the first stage of a Delphi study conducted in the US market are presented. The second phase of the study is in progress. The first stage results suggest that there is a small market for SCWRA tubes in heat exchanger applications. The market is expected to grow steadily during the 1990`s. With appropriate performance specifications and competitive pricing, growth should come from (a) new applications that permit recovery in cases that were previously infeasible and (b) selective, partial substitution and replacement of current ceramics and metal/ceramic composites in existing applications. We identify key performance factors and detailed specifications needed in six designated industries (primary metals, fabricated metals, chemicals, glass, utility and incinerators). Reliability, durability and low maintenance costs emerge as critical performance factors across these industries. The data show that although ceramics are recognized as having better properties, enhancing reliability and durability and thus improving maintenance cost performance is a key priority. Such improvements, reflected in the objectives for SCWRA tubes, should facilitate adoption in both new and existing applications. At this time, we are unable to assess market size directly. However, expert judgment provided indices tracking the projected market for heat exchanger tubes from 1990 to 2005.

  16. Nanoporous silicon tubes: the role of geometry in nanostructure formation and application to light emitting diodes

    NASA Astrophysics Data System (ADS)

    Vukajlović Pleština, Jelena; Đerek, Vedran; Francaviglia, Luca; Amaduzzi, Francesca; Potts, Heidi; Ivanda, Mile; Morral, Anna Fontcuberta i.

    2017-07-01

    Obtaining light emission from silicon has been the holy grail of optoelectronics over the last few decades. One of the most common methods for obtaining light emission from silicon is to reduce it to a nanoscale structure, for example by producing porous silicon. Here, we present a method for the large-area fabrication of porous silicon microtubes by the stain etching of silicon micropillar arrays. We explain and model how the formation of the microtubes is influenced by the morphology of the substrate, especially the concave or convex character of the 3D features. Light emission is demonstrated at the micro- and nanoscale respectively by photo- and cathodoluminescence. Finally, we demonstrate a 0.55 cm2 device that can work as a photodetector with 2.3% conversion efficiency under one sun illumination, and also as a broadband light emitting diode, illustrating the applicability of our results for optoelectronic applications.

  17. Neonatal airway: challenging endotracheal intubation in infants with tracheal malformations at birth.

    PubMed

    Agarwal, Arpan; Nakao, Masakazu; Rajadurai, Victor Samuel; Chandran, Suresh

    2017-04-13

    Intubating newborn infants can be exacting. We describe two cases of endotracheal intubations in infants born with tracheal malformations. A male infant aged 30 weeks required intubation at birth for respiratory distress. Repeated attempts at intubation failed to achieve an optimal endotracheal tube position as the tube could not advance beyond the vocal cords. Hence ventilation continued with suboptimal air entry in the lungs. Bronchoscopy and CT scan confirmed tracheal stenosis. Slide tracheoplasty was successfully executed on day 78 of life. A female infant aged 33 weeks was intubated at birth for perinatal depression. Attempts at intubation were unsuccessful due to non-visualisation of the laryngeal inlet. Oesophagus was intubated and attempts to inflate showed air entry in the lungs, suggesting a fistulous communication between oesophagus and airway. A contrast oesophagogram showed a fistula connecting oesophagus and carina. With airway patency in question and associated major anomalies, parents were counselled and support was withdrawn.

  18. A novel fatty-acid-based in-tube dispersive liquid-liquid microextraction technique for the rapid determination of nonylphenol and 4-tert-octylphenol in aqueous samples using high-performance liquid chromatography-ultraviolet detection.

    PubMed

    Shih, Hou-Kuang; Shu, Ting-Yun; Ponnusamy, Vinoth Kumar; Jen, Jen-Fon

    2015-01-07

    In this study, a novel fatty-acid-based in-tube dispersive liquid-liquid microextraction (FA-IT-DLLME) technique is proposed for the first time and is developed as a simple, rapid and eco-friendly sample extraction method for the determination of alkylphenols in aqueous samples using high-performance liquid chromatography-ultraviolet detection (HPLC-UV). In this extraction method, medium-chain saturated fatty acids were investigated as a pH-dependent phase because they acted as either anionic surfactants or neutral extraction solvents based on the acid-base reaction caused solely by the adjustment of the pH of the solution. A specially designed home-made glass extraction tube with a built-in scaled capillary tube was utilized as the phase-separation device for the FA-IT-DLLME to collect and measure the separated extractant phase for analysis. Nonylphenol (NP) and 4-tert-octylphenol (4-tOP) were chosen as model analytes. The parameters influencing the FA-IT-DLLME were thoroughly investigated and optimized. Under the optimal conditions, the detector responses of NP and 4-tOP were linear in the concentration ranges of 5-4000 μg L(-1), with correlation coefficients of 0.9990 and 0.9996 for NP and 4-tOP, respectively. The limits of detection based on a signal-to-noise ratio of 3 were 0.7 and 0.5 μg L(-1), and the enrichment factors were 195 and 143 for NP and 4-tOP, respectively. The applicability of the developed method was demonstrated for the analysis of alkylphenols in environmental wastewater samples, and the recoveries ranged from 92.9 to 107.1%. The extraction process required less than 4 min and utilized only acids, alkalis, and fatty acids to achieve the extraction. The results demonstrated that the presented FA-IT-DLLME approach is highly cost-effective, simple, rapid and environmentally friendly in its sample preparation.

  19. Bicanalicular double silicone stenting in endoscopic dacryocystorhinostomy with lacrimal trephination in distal or common canalicular obstruction.

    PubMed

    Paik, Ji-Sun; Cho, Won-Kyung; Yang, Suk-Woo

    2012-06-01

    The purpose of the study was to evaluate the clinical effects of bicanalicular double silicone stents in endoscopic transnasal dacryocystorhinostomy with lacrimal trephinized canaliculoplasty for monocanalicular and common canalicular obstruction. Bicanalicular double silicone intubation in endoscopic transnasal dacryocystorhinostomy with lacrimal trephination was performed in 58 eyes of 54 patients (5 men, 49 women; mean age: 55.9 ± 14.9 years) with epiphora due to monocanalicular and common canalicular obstruction between November 2007 and August 2010. We reviewed the records of subjects who had undergone the same surgery with a bicanalicular single intubation for same disease between March 2004 and October 2007 as controls (56 eyes of 50 patients). We evaluated age, gender, the operative side, the site of canalicular obstruction, and the effects of double silicone intubation. Complications relating to the silicone tube were also investigated. The double-stent group showed higher anatomical success rates (91.4%) and functional success rates (82.8%) than the single-stent group (75.0 and 69.6%, respectively) (p = 0.034 and p = 0.103, respectively). Bicanalicular double silicone stenting in endoscopic transnasal dacryocystorhinostomy with lacrimal trephinized canaliculoplasty may be an effective treatment for monocanalicular and common canalicular obstructions. This may also reduce more invasive surgery including Jones tube insertion (p = 0.038).

  20. Evaluation of Superparamagnetic Silica Nanoparticles for Extraction of Triazines in Magnetic in-Tube Solid Phase Microextraction Coupled to Capillary Liquid Chromatography.

    PubMed

    González-Fuenzalida, R A; Moliner-Martínez, Y; Prima-Garcia, Helena; Ribera, Antonio; Campins-Falcó, P; Zaragozá, Ramon J

    2014-04-02

    The use of magnetic nanomaterials for analytical applications has increased in the recent years. In particular, magnetic nanomaterials have shown great potential as adsorbent phase in several extraction procedures due to the significant advantages over the conventional methods. In the present work, the influence of magnetic forces over the extraction efficiency of triazines using superparamagnetic silica nanoparticles (NPs) in magnetic in tube solid phase microextraction (Magnetic-IT-SPME) coupled to CapLC has been evaluated. Atrazine, terbutylazine and simazine has been selected as target analytes. The superparamagnetic silica nanomaterial (SiO₂-Fe₃O₄) deposited onto the surface of a capillary column gave rise to a magnetic extraction phase for IT-SPME that provided a enhancemment of the extraction efficiency for triazines. This improvement is based on two phenomena, the superparamegnetic behavior of Fe₃O₄ NPs and the diamagnetic repulsions that take place in a microfluidic device such a capillary column. A systematic study of analytes adsorption and desorption was conducted as function of the magnetic field and the relationship with triazines magnetic susceptibility. The positive influence of magnetism on the extraction procedure was demonstrated. The analytical characteristics of the optimized procedure were established and the method was applied to the determination of the target analytes in water samples with satisfactory results. When coupling Magnetic-IT-SPME with CapLC, improved adsorption efficiencies (60%-63%) were achieved compared with conventional adsorption materials (0.8%-3%).

  1. Evaluation of Superparamagnetic Silica Nanoparticles for Extraction of Triazines in Magnetic in-Tube Solid Phase Microextraction Coupled to Capillary Liquid Chromatography

    PubMed Central

    González-Fuenzalida, R. A.; Moliner-Martínez, Y.; Prima-Garcia, Helena; Ribera, Antonio; Campins-Falcó, P.; Zaragozá, Ramon J.

    2014-01-01

    The use of magnetic nanomaterials for analytical applications has increased in the recent years. In particular, magnetic nanomaterials have shown great potential as adsorbent phase in several extraction procedures due to the significant advantages over the conventional methods. In the present work, the influence of magnetic forces over the extraction efficiency of triazines using superparamagnetic silica nanoparticles (NPs) in magnetic in tube solid phase microextraction (Magnetic-IT-SPME) coupled to CapLC has been evaluated. Atrazine, terbutylazine and simazine has been selected as target analytes. The superparamagnetic silica nanomaterial (SiO2-Fe3O4) deposited onto the surface of a capillary column gave rise to a magnetic extraction phase for IT-SPME that provided a enhancemment of the extraction efficiency for triazines. This improvement is based on two phenomena, the superparamegnetic behavior of Fe3O4 NPs and the diamagnetic repulsions that take place in a microfluidic device such a capillary column. A systematic study of analytes adsorption and desorption was conducted as function of the magnetic field and the relationship with triazines magnetic susceptibility. The positive influence of magnetism on the extraction procedure was demonstrated. The analytical characteristics of the optimized procedure were established and the method was applied to the determination of the target analytes in water samples with satisfactory results. When coupling Magnetic-IT-SPME with CapLC, improved adsorption efficiencies (60%–63%) were achieved compared with conventional adsorption materials (0.8%–3%).

  2. Influence of Alumina Reaction Tube Impurities on the Oxidation of Chemically-Vapor-Deposited Silicon Carbide

    NASA Technical Reports Server (NTRS)

    Opila, Elizabeth

    1995-01-01

    Pure coupons of chemically vapor deposited (CVD) SiC were oxidized for 100 h in dry flowing oxygen at 1300 C. The oxidation kinetics were monitored using thermogravimetry (TGA). The experiments were first performed using high-purity alumina reaction tubes. The experiments were then repeated using fused quartz reaction tubes. Differences in oxidation kinetics, scale composition, and scale morphology were observed. These differences were attributed to impurities in the alumina tubes. Investigators interested in high-temperature oxidation of silica formers should be aware that high-purity alumina can have significant effects on experiment results.

  3. Intubation without use of stylet for McGrath videolaryngoscopy in patients with expected normal airway

    PubMed Central

    Kwak, Hyun Jeong; Lee, Sook Young; Lee, Su Youn; Kim, Yong Beom; Kim, Jong Yeop

    2016-01-01

    Abstract Background: During McGrath videolaryngoscope (VL) intubation, a styletted endotracheal tube maintaining an upward distal tip angle is recommended by some manufacturers. However, a styletted endotracheal tube can elicit rare but potentially serious complications. The purpose of this study was to demonstrate that a nonstyletted tube with exaggerated curvature would be noninferior to a styletted tube for orotracheal intubation using McGrath VL in patients with expected normal airway, by comparing the time to intubation and ease of intubation. Methods: One hundred forty patients, ages 19 to 70 years (American Society of Anesthesiologists physical status I–II), undergoing tracheal intubation for elective surgery were randomly allocated to the nonstylet group (n = 70) or the stylet group (n = 70). Anesthesia induction consisted of propofol, remifentanil, and rocuronium. The primary outcome was time to intubation assessed by a blind observer. Cormack and Lehane glottic grade, easy of intubation, and intubation difficulty score (IDS) were also assessed. Results: Median time to intubation [interquartile range] was not different between the nonstylet group and the stylet group (26 [24–32.5] s vs 27 [25–31] s, P = 0.937). There was no significant in median IDS between the nonstylet group and the stylet group (P = 0.695). Conclusion: This study shows that a nonstyletted endotracheal tube with exaggerated curvature has a similar performance to a styletted tube with a hockey-stick curvature during intubation using McGrath VL regarding time taken to successful intubation and easiness of intubation. PMID:27902612

  4. Typing and subtyping of 83 clinical isolates purified from surgically implanted silicone feeding tubes by random amplified polymorphic DNA amplification.

    PubMed

    Dautle, Melanie P; Ulrich, Ricky L; Hughes, Thomas A

    2002-02-01

    In this study, 83 clinical isolates purified from biofilms colonizing 18 silicone gastrostomy devices (12 "buttons" and six tubes converted to skin level devices) were selected for subtype characterization utilizing genetic analysis. The tubes, previously used for feeding, remained in place for 3 to 47 months (mean, 20.0 months) in children ranging in age from 6 months to 17 years. Classification of specific microbes using random amplified polymorphic DNA (RAPD) analysis revealed genetic similarities and differences among isolates belonging to the same genus. Both gram-positive and -negative bacteria were investigated, including 2 isolates of Bacillus brevis, 4 isolates of Bacillus licheniformis, 2 isolates of Bacillus pumilus, 3 isolates of Enterococcus durans, 19 isolates of Enterococcus faecalis, 8 isolates of Enterococcus faecium, 2 isolates of Enterococcus hirae, 7 isolates of Escherichia coli, 8 isolates of Lactobacillus plantarum, 19 isolates of Staphylococcus aureus, 2 isolates of Staphylococcus epidermidis, and 7 isolates of Staphylococcus saprophyticus. Amplified DNA fragments (amplicons) provided species-specific fingerprints for comparison by agarose gel electrophoresis. A total of 62 distinct RAPD types were categorized from the five genera studied. Typing analysis suggested cross acquisition of E. coli, E. faecalis, and S. aureus in three patient pairs. Genomic polymorphism detection proved efficient and reliable for classifying bacterial subtypes isolated from biofilms adhering to various portions of commonly employed enteral access tubes.

  5. Performance of QuantiFERON-TB Gold In-Tube test and Tuberculin Skin Test for diagnosis of latent tuberculosis infection in BCG vaccinated health care workers

    PubMed Central

    Babayigit, Cenk; Ozer, Burcin; Inandi, Tacettin; Ozer, Cahit; Duran, Nizami; Gocmen, Orhan

    2014-01-01

    Background Tuberculin skin test (TST) has been used for years as an aid in diagnosing latent tuberculosis infection (LTBI) but it suffers from a number of well-documented performance and logistic problems. Quantiferon-TB Gold In Tube test (QFT-GIT) has been reported to have better sensitivity and specifity than TST. In this study, it was aimed to compare the performance of a commercial IFN-γ release assay (QFT-GIT) with TST in the diagnosis of HCWs at risk for latent TB infection in BCG vaccinated population. Material/Methods Hundred healthy volunteer health care workers were enrolled. All were subjected to TST and QFT-GIT. Results were compared among Health Care Workers (HCWs) groups in terms of profession, workplace, working duration. Results TST is affected by previous BCG vaccinations and number of cases with QFT-GIT positivity is increased in accordance with the TST induration diameter range. QFT-GIT result was negative in 17 of 32 TST positive (≥15 mm) cases and positive in 4 of 61 cases whose TST diameters are between 6–14 mm, that is attritutable to previous BCG vaccination(s). It was negative in all cases with TST diameters between 0–5 mm. HCWs with positive QFT-GIT results were significantly older than the ones with negative results. Furthermore duration of work was significantly longer in QFT-GIT positive than in negative HCWs. Conclusions There was a moderate concordance between QFT-GIT and TST, when TST result was defined as positive with a ≥15 mm diameter of induration. We suggest that QFT-GIT can be used as an alternative to TST for detection of LTBI, especially in groups with high risk of LTBI and in population with routine BCG vaccination program. PMID:24681806

  6. Ion-pair in-tube solid-phase microextraction and capillary liquid chromatography using a titania-based column: application to the specific lauralkonium chloride determination in water.

    PubMed

    Prieto-Blanco, M C; Moliner-Martínez, Y; López-Mahía, P; Campíns-Falcó, P

    2012-07-27

    A quick, miniaturized and on-line method has been developed for the determination in water of the predominant homologue of benzalkonium chloride, dodecyl dimethyl benzyl ammonium chloride or lauralkonium chloride (C(12)-BAK). The method is based on the formation of an ion-pair in both in-tube solid-phase microextraction (IT-SPME) and capillary liquid chromatography. The IT-SPME optimization required the study of the length and nature of the stationary phase of capillary and the processed sample volume. Because to the surfactant character of the analyte both, the extracting and replacing solvents, have played a decisive role in the IT-SPME optimized procedure. Conditioning the capillary with the mobile phase which contains the counter ion (acetate), using an organic additive (tetrabutylammonium chloride) added to the sample and a mixture water/methanol as replacing solvent (processed just before the valve is switched to the inject position), allowed to obtain good precision of the retention time and a narrow peak for C(12)-BAK. A reversed-phase capillary based TiO(2) column and a mobile phase containing ammonium acetate at pH 5.0 for controlling the interactions of cationic surfactant with titania surface were proposed. The optimized procedure provided adequate linearity, accuracy and precision at the concentrations interval of 1.5-300 μg L(-1) .The limit of detection (LOD) was 0.5 μg L(-1) using diode array detection (DAD). The applicability of proposed IT-SPME-capillary LC method has been assessed in several water samples.

  7. Tuberculosis screening by tuberculosis skin test or QuantiFERON-TB Gold In-Tube Assay among an immigrant population with a high prevalence of tuberculosis and BCG vaccination.

    PubMed

    Painter, John A; Graviss, Edward A; Hai, Hoang Hoa; Nhung, Duong Thi Cam; Nga, Tran Thi Thanh; Ha, Ngan P; Wall, Kirsten; Loan, Le Thien Huong; Parker, Matt; Manangan, Lilia; O'Brien, Rick; Maloney, Susan A; Hoekstra, R M; Reves, Randall

    2013-01-01

    Each year 1 million persons acquire permanent U.S. residency visas after tuberculosis (TB) screening. Most applicants undergo a 2-stage screening with tuberculin skin test (TST) followed by CXR only if TST-positive at > 5 mm. Due to cross reaction with bacillus Calmette-Guérin (BCG), TST may yield false positive results in BCG-vaccinated persons. Interferon gamma release assays exclude antigens found in BCG. In Vietnam, like most high TB-prevalence countries, there is universal BCG vaccination at birth. 1. Compare the sensitivity of QuantiFERON-TB Gold In-Tube Assay (QFT) and TST for culture-positive pulmonary TB. 2. Compare the age-specific and overall prevalence of positive TST and QFT among applicants with normal and abnormal CXR. We obtained TST and QFT results on 996 applicants with abnormal CXR, of whom 132 had TB, and 479 with normal CXR. The sensitivity for tuberculosis was 86.4% for QFT; 89.4%, 81.1%, and 52.3% for TST at 5, 10, and 15 mm. The estimated prevalence of positive results at age 15-19 years was 22% and 42% for QFT and TST at 10 mm, respectively. The prevalence increased thereafter by 0.7% year of age for TST and 2.1% for QFT, the latter being more consistent with the increase in TB among applicants. During 2-stage screening, QFT is as sensitive as TST in detecting TB with fewer requiring CXR and being diagnosed with LTBI. These data support the use of QFT over TST in this population.

  8. Influence of age and nutritional status on the performance of the tuberculin skin test and QuantiFERON-TB gold in-tube in young children evaluated for tuberculosis in Southern India.

    PubMed

    Jenum, Synne; Selvam, Sumithra; Mahelai, Diana; Jesuraj, Nelson; Cárdenas, Vicky; Kenneth, John; Hesseling, Anneke C; Doherty, Timothy Mark; Vaz, Mario; Grewal, Harleen M S

    2014-10-01

    Reliable identification of Mycobacterium tuberculosis infection or tuberculosis (TB) disease in young children is vital to assure adequate preventive and curative treatment. The tuberculin skin test (TST) and IFNγ-release assays may supplement the diagnosis of pediatric TB as cases are typically bacteriologically unconfirmed. However, it is unclear to what extent the performance of TST and QuantiFERON-TB Gold In-Tube (QFT; Cellestis' IFNγ-release assay test) depends on the demographic, clinical and nutritional characteristics of children in whom they are tested. During a 2-year prospective observational study of 4382 neonates in Southern India, children with suspected TB were investigated and classified by a standard TB diagnostic algorithm. Clinical TB was diagnosed in 13 of 705 children referred for case verification with suspected TB. TST and QFT had a susceptibility for clinical TB of 31% and 23%, respectively, in this group. Children <2 years were more likely to test QFT indeterminate. A height-for-age Z score within the lowest quartile increased the odds ratio (OR) for a positive or indeterminate QFT result [OR 2.46 (1.19-5.06), OR 3.08 (1.10-8.58)], whereas the OR for a positive TST was reduced with a weight-for-height Z score within the lowest quartile [OR 0.17 (0.06-0.47)]. The sensitivities of the TST and QFT for clinical TB in children <3 years of age were equally poor in this population. Stunted children were more susceptible to Mycobacterium tuberculosis infection and more prone to indeterminate QFT results. TST was less reliable in children with wasting.

  9. Mycobacterium Tuberculosis Infection, Immigration Status, and Diagnostic Discordance: A Comparison of Tuberculin Skin Test and QuantiFERON-TB Gold In-Tube Test Among Immigrants to the U.S.

    PubMed

    Wilson, Fernando A; Miller, Thaddeus L; Stimpson, Jim P

    2016-01-01

    We used a recent source of nationally representative population data on tuberculosis (TB) infection to characterize concordance between the tuberculin skin test (TST) and the QuantiFERON-TB Gold In-Tube (QFT-GIT) blood test for immigrants in the United States. We used TB screening data from the 2011-2012 National Health and Nutrition Examination Survey to examine concordance between the TST and QFT-GIT--an interferon-gamma release assay (IGRA) blood test--for 7,097 U.S. natives, naturalized citizens, and noncitizens. Consistent with prior findings, one in five immigrants in the survey was identified with latent TB infection (LTBI), a rate 14 times higher than for U.S. natives. We also found higher rates of discordant TST/IGRA results among immigrants than among U.S. natives. Unadjusted discordance between TST and IGRA was 3% among U.S. natives (weighted N=5,684,274 of 191,179,213) but ranged up to 19% for noncitizens (weighted N=3,722,960 of 19,377,147). Adjusting for age, sex, and race/ethnicity, noncitizens had more than nine times the odds of having a positive TST result but negative QFT-GIT result compared with U.S. natives. Our findings suggest that whether and how either of these tests should be deployed is highly context sensitive. Significant discordance in test results when used among immigrants raises the possibility of missed opportunities for harm reduction in this already at-risk population. However, we found little distinction between the tests in terms of diagnostic outcome when used in a U.S. native population, suggesting little benefit to the adoption and use of the QFT-GIT test in place of TST on the basis of test performance alone for this population.

  10. Impact of tuberculosis treatment and antiretroviral therapy on serial RD-1-specific quantitative T-cell readouts (QuantiFERON-TB Gold In-Tube), and relationship to treatment-related outcomes and bacterial burden.

    PubMed

    Mthiyane, Thuli; Rustomjee, Roxana; Pym, Alex; Connolly, Cathy; Onyebujoh, Philip; Theron, Grant; Dheda, Keertan

    2015-07-01

    The impact of anti-tuberculosis treatment with and without antiretroviral therapy (ART) on standardized interferon gamma release assay (IGRA) readouts has been studied inadequately in high-burden countries. The QuantiFERON-TB Gold In-Tube (QFT-GIT) test was used to evaluate interferon gamma (IFN-γ) responses longitudinally (0, 3, 6, and 12 months post initiation of tuberculosis (TB)-HIV co-treatment or ART alone) in 82 HIV-infected patients. Of the 65 evaluable participants, 30 were co-infected on ART, 17 were co-infected but not on ART, and 18 were HIV-infected alone and on ART. In HIV-infected and HIV-TB-infected patients on ART, IFN-γ responses increased, whilst they decreased in those not on ART. However, baseline, month 3, and month 6 IFN-γ responses, irrespective of ART, did not differ in TB-HIV co-infected patients who culture-converted compared to those who did not (1.25 vs. 1.05, p=0.5 at baseline; 3.76 vs. 1.15, p=0.2 for month 3; 0.06 vs. 0.7, p=0.3 for month 6). IFN-γ levels did not correlate with the magnitude of sputum bacillary load, smear status, or liquid culture time-to-positivity. As IGRAs do not correlate with 2- or 6-month culture conversion or with markers of bacillary burden, they are unlikely to be useful for the prognostication of treatment outcome in co-infected patients. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

  11. [Comparative study of concordance and costs between tuberculin skin test and QuantiFERON(®)-TB Gold In-Tube in the diagnosis of latent tuberculosis infection among contacts of patients with pulmonary tuberculosis].

    PubMed

    Martinez Lacasa, Xavier; Canals Font, Roser; Jaen Manzanera, Angels; Cuchi Burgos, Eva; Lite Lite, Josep

    2015-11-20

    Recently diagnosis of latent tuberculosis infection (LTBI) can be made using the tuberculin skin test (TST) or by techniques known as interferon-γ release assays (IGRAS), being QuantiFERON(®)-TB Gold In-Tube (QF-G-IT) the most used. The IGRAS avoid some drawbacks of the TST, especially cross-reaction with bacillus Calmette-Guérin (BCG) vaccine, but also present some problems such as those arising from cost and the need of having an adequate infrastructure and experience. There is no clear consensus on which technique should be preferentially used for the diagnosis of LTBI. This is a comparative study between the TST and QT-G-IT in a cohort of contacts of patients with pulmonary tuberculosis during the study period. An analysis of global agreement and groups was performed according to whether the contacts were vaccinated with BCG or not. A study of costs of both techniques and diagnostic strategies based on these techniques was performed. The agreement between TST and QF-G-IT was acceptable in the whole sample yet it was very good in the unvaccinated group. Few cases of indeterminate values were recorded. The cost study showed that TST was cheaper than QF-G-IT; however when we analyzed the cost of the strategies according to each technique, the QF-G-IT showed a better cost-benefit. We suggest considering QF-G-IT as the only preferred technique for the diagnosis of LTBI in household contacts, based on good overall agreement between the 2 techniques (even if we eliminate the effect of the vaccine) and a cost analysis favorable to QF-G-IT. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

  12. Screening for latent tuberculosis infection in psoriasis and psoriatic arthritis patients in a tuberculosis-endemic country: a comparison of the QuantiFERON®-TB Gold In-Tube test and tuberculin skin test.

    PubMed

    Duman, Nilay; Ersoy-Evans, Sibel; Karadağ, Omer; Aşçıoğlu, Sibel; Sener, Burçin; Kiraz, Sedat; Sahin, Sedef

    2014-10-01

    Since the introduction of biologic therapies for tuberculosis (TB), screening for latent TB infection has increased in importance, especially in countries in which TB is endemic. The aim of this study was to evaluate the effect of psoriasis on tuberculin skin test (TST) results and to compare two TB screening tests, the TST and QuantiFERON(®)-TB Gold In-Tube (QFT-GIT) test, in psoriasis and psoriatic arthritis (PA) patients living in a TB-endemic country (Turkey). This prospective study included 61 psoriasis and 40 PA patients, and 58 healthy controls. Demographic data, medical history, human immunodeficiency virus (HIV) status, level of education, smoking status, exposure to TB, personal and family histories of TB, and bacillus Calmette-Guérin (BCG) vaccination status were recorded for all participants. The TST and QFT-GIT were performed in all participants. The mean ± standard deviation TST indurations in the patient and control groups were 12.6 ± 6.4 mm and 10.2 ± 6.5 mm, respectively (P = 0.051). The TST positivity rate was higher in patients than in controls (86.1% vs. 37.9%; P < 0.001), whereas QFT-GIT positivity did not differ significantly (patients: 20.8%; controls: 17.2%; P = 0.737). False positive results can lead to unnecessary prophylactic TB treatment; therefore, the cut-off point for TST positivity in psoriasis and PA patients should be re-evaluated, or other tests, such as the QFT-GIT, should be used.

  13. Comparison of QuantiFERON-TB Gold In-Tube (QFT-GIT) and tuberculin skin test (TST) for diagnosis of latent tuberculosis in haemodialysis (HD) patients: a meta-analysis of κ estimates.

    PubMed

    Ayubi, E; Doosti-Irani, A; Sanjari Moghaddam, A; Khazaei, S; Mansori, K; Safiri, S; Sani, M; Mostafavi, E

    2017-03-02

    Diagnosis of latent tuberculosis infection (LTBI) is a concern in haemodialysis (HD) patients. Many studies have compared QuantiFERON-TB Gold In-Tube (QFT-GIT) and tuberculin skin test (TST) for detecting LTBI and reported the κ statistic of agreement between QFT-GIT and TST in HD patients. The present study aimed to systematically review this literature and conduct meta-analysis of individual studies that estimated the κ between QFT-GIT with TST among HD patients. All relevant published studies that were available as full-text were obtained by searching Medline (1950), Web of Sciences (1945), Scopus (1973) through May 2016. The κ was re-estimated from the individual studies and pooled using random effect meta-analysis. Subgroup analysis and meta-regression were applied to evaluate the effect of Bacillus Calmette-Guérin (BCG) vaccination, TST cut-off points, quality of studies, sample size and age on variation of κ estimate. Eight studies involving 901 HD patients were included in meta-analysis. The pooled κ estimate was 0·28 (I 2 = 18·4%, P = 0·239, 95% confidence intervals 0·22-0·34). The discordance of TST-/QFT-GIT+ was more than TST+/QFT-GIT-. History of BCG vaccination, TST cut-off points and age are related to variation of κ estimates. TST and QFT-GIT are not comparable in detecting LTBI in HD patients. The higher TST-/QFT-GIT+ ratio compared with TST+/QFT-GIT- ratio, may indicate the superiority of QFT-GIT over TST for detection LTBI in HD patients.

  14. Improved hemocompatibility of silicone rubber extracorporeal tubing via solvent swelling-impregnation of S-nitroso-N-acetylpenicillamine (SNAP) and evaluation in rabbit thrombogenicity model.

    PubMed

    Brisbois, Elizabeth J; Major, Terry C; Goudie, Marcus J; Bartlett, Robert H; Meyerhoff, Mark E; Handa, Hitesh

    2016-06-01

    Blood-contacting devices, including extracorporeal circulation (ECC) circuits, can suffer from complications due to platelet activation and thrombus formation. Development of nitric oxide (NO) releasing polymers is one method to improve hemocompatibility, taking advantage of the ability of low levels of NO to prevent platelet activation/adhesion. In this study a novel solvent swelling method is used to load the walls of silicone rubber tubing with the NO donor S-nitroso-N-acetylpenicillamine (SNAP). This SNAP-silicone rubber tubing exhibits an NO flux of ca. 1×10(-10)molcm(-2)min(-1), which mimics the range of NO release from the normal endothelium, which is stable for at least 4h. Images of the tubing before and after swelling, obtained via scanning electron microscopy, demonstrate that this swelling method has little effect on the surface properties of the tubing. The SNAP-loaded silicone rubber and silicone rubber control tubing are used to fabricate ECC circuits that are evaluated in a rabbit model of thrombogenicity. After 4h of blood flow, the SNAP-loaded silicone rubber circuits were able to preserve the blood platelet count at 64% of baseline (vs. 12% for silicone rubber control). A 67% reduction in the degree of thrombus formation within the thrombogenicity chamber was also observed. This study demonstrates the ability to improve the hemocompatibility of existing/commercial silicone rubber tubing via a simple solvent swelling-impregnation technique, which may also be applicable to other silicone-based blood-contacting devices. Localized nitric oxide (NO) release can be achieved from biomedical grade polymers doped with S-nitroso-N-acetylpenicillamine (SNAP). Despite the promising in vitro and in vivo biocompatibility results reported for these NO releasing polymers, many of these materials may face challenges in being translated to clinical applications, especially in the areas of polymer processing and manufacturing. In this study, we report a solvent

  15. Predictors of Difficult Intubation with the Bonfils Rigid Fiberscope.

    PubMed

    Nowakowski, Michal; Williams, Stephan; Gallant, Jason; Ruel, Monique; Robitaille, Arnaud

    2016-06-01

    Endotracheal intubation is commonly performed via direct laryngoscopy (DL). However, in certain patients, DL may be difficult or impossible. The Bonfils Rigid Fiberscope® (BRF) is an alternative intubation device, the design of which raises the question of whether factors that predict difficult DL also predict difficult BRF. We undertook this study to determine which demographic, morphologic, and morphometric factors predict difficult intubation with the BRF. Four hundred adult patients scheduled for elective surgery were recruited. Patients were excluded if awake intubation, rapid sequence induction, or induction without neuromuscular blocking agents was planned. Data were recorded, including age, sex, weight, height, American Society of Anesthesiologist classification, history of snoring and sleep apnea, Mallampati class, upper lip bite test score, interincisor, thyromental and sternothyroid distances, manubriomental distances in flexion and extension, neck circumference, maximal neck flexion and extension, neck skinfold thickness at the cricoid cartilage, and Cormack and Lehane grade obtained via DL after paralysis was confirmed. Quality of glottic visualization (good or poor), as well as the number of intubation attempts and time to successful intubation with the BRF, was noted. Univariate analyses were performed to evaluate the association between patient characteristics and time required for intubation. Variables that exhibited a significant correlation were included in a multivariate analysis using a standard least squares model. A P < 0.05 was considered significant. Glottic visualization with the BRF was good in 396 of 400 (99%) cases. On the first attempt, 390 patients were successfully intubated with the BRF; 6 patients required >1 attempt; 4 patients could not be intubated by using the BRF alone. These 4 patients were intubated by using a combination of DL and BRF (2 patients), DL and a Frova bougie (1 patient), and DL and an endotracheal tube shaped

  16. Intubation Biomechanics: Laryngoscope force and cervical spine motion during intubation with Macintosh and Airtraq laryngoscopes

    PubMed Central

    Hindman, Bradley J.; Santoni, Brandon G.; Puttlitz, Christian M.; From, Robert P.; Todd, Michael M.

    2014-01-01

    Introduction Laryngoscopy and endotracheal intubation in the presence of cervical spine instability may put patients at risk of cervical cord injury. Nevertheless, the biomechanics of intubation (cervical spine motion as a function of applied force) have not been characterized. This study characterized and compared the relationship between laryngoscope force and cervical spine motion using two laryngoscopes hypothesized to differ in force. Methods Fourteen adults undergoing elective surgery were intubated twice (Macintosh, Airtraq). During each intubation, laryngoscope force, cervical spine motion, and glottic view were recorded. Force and motion were referenced to a pre-intubation baseline (stage 1) and were characterized at three stages: stage 2 (laryngoscope introduction); stage 3 (best glottic view); stage 4 (endotracheal tube in trachea). Results Maximal force and motion occurred at stage 3, and differed between the Macintosh and Airtraq: 1) Force: 48.8±15.8 vs. 10.4±2.8 N, respectively; P=0.0001; 2) occiput-C5 extension: 29.5±8.5 vs. 19.1±8.7 degrees, respectively; P=0.0023. Between stages -2 and -3, the motion/force ratio differed between Macintosh and Airtraq: 0.5±0.2 vs. 2.0±1.4 degrees/N, respectively; P=0.0006. Discussion The relationship between laryngoscope force and cervical spine motion is: 1) non-linear and 2) differs between laryngoscopes. Differences between laryngoscopes in motion/force relationships are likely due to: 1) laryngoscope-specific cervical extension needed for intubation, 2) laryngoscope-specific airway displacement/deformation needed for intubation, and 3) cervical spine and airway tissue viscoelastic properties. Cervical spine motion during endotracheal intubation is not directly proportional to force. Low force laryngoscopes cannot be assumed to result in proportionally low cervical spine motion. PMID:24739996

  17. Determination of the voltage applied to x-ray tubes from the bremsstrahlung spectrum obtained with a silicon PIN photodiode.

    PubMed

    Silva, M C; Herdade, S B; Lammoglia, P; Costa, P R; Terini, R A

    2000-11-01

    This work describes a methodology for the obtainment of the electron accelerating potential (kVp) applied to an x-ray tube, through the determination of the end point of the energy spectrum of the radiation emitted by the tube. The measurements have been performed utilizing alternatively two silicon PIN photodiodes, directly irradiated by the x-ray beam. Both were operated at room temperature, with low bias, so avoiding the drawbacks presented by photomultiplier tubes and germanium detectors. The energy calibration of the system was performed with X- and gamma-emitter radioactive sources, which makes the method absolute. Each kVp value was determined by means of a linear regression in the end of the spectrum, to give, simultaneously, a good fit of the straight line to the experimental data and a low standard deviation for the kVp value. Results of the measurements carried out with an x-ray tube connected to a three-phase generator, using additional filtration between 1.5 and 4.0 mm of Cu, are presented. This filtration was used in order to minimize the contribution of low energy photons and to reduce pulse pile-up. Errors determined for the values of kVp are between 0.06 and 0.16 kV, in the potential range from 50 to 100 kV. As an example, the methodology has been applied in the verification of the secondary calibration of a voltage divider, utilized, by its turn, in the tertiary calibration of noninvasive kVp meters. All intrinsic sources of errors involved in the process are discussed and evaluated.

  18. Front-end circuit for position sensitive silicon and vacuum tube photomultipliers with gain control and depth of interaction measurement

    NASA Astrophysics Data System (ADS)

    Herrero, Vicente; Colom, Ricardo; Gadea, Rafael; Lerche, Christoph W.; Cerdá, Joaquín; Sebastiá, Ángel; Benlloch, José M.

    2007-06-01

    Silicon Photomultipliers, though still under development for mass production, may be an alternative to traditional Vacuum Photomultipliers Tubes (VPMT). As a consequence, electronic front-ends initially designed for VPMT will need to be modified. In this simulation, an improved architecture is presented which is able to obtain impact position and depth of interaction of a gamma ray within a continuous scintillation crystal, using either kind of PM. A current sensitive preamplifier stage with individual gain adjustment interfaces the multi-anode PM outputs with a current division resistor network. The preamplifier stage allows to improve front-end processing delay and temporal resolution behavior as well as to increase impact position calculation resolution. Depth of interaction (DOI) is calculated from the width of the scintillation light distribution, which is related to the sum of voltages in resistor network input nodes. This operation is done by means of a high-speed current mode scheme.

  19. Numerical simulation of capacitively coupled RF plasma flowing through a tube for the synthesis of silicon nanocrystals

    NASA Astrophysics Data System (ADS)

    Le Picard, Romain; Song, Sang-Heon; Porter, David; Kushner, Mark; Girshick, Steven

    2014-10-01

    Silicon nanocrystals (SiNCs) are of interest for applications in the photonics, electronics, and biomedical areas. Nonthermal plasmas offer several potential advantages for synthesizing SiNCs. In this work, we have developed a numerical model of a capacitively coupled RF plasma used for the synthesis of SiNCs. The plasma, consisting of silane diluted in argon at a total pressure of about 2 Torr, flows through a narrow quartz tube with two ring electrodes. The numerical model is 2D, assuming axisymmetry. An aerosol sectional model is added to the Hybrid Plasma Equipment Model developed by Kushner and coworkers. The aerosol module solves for aerosol size distributions and size-dependent charge distributions. A detailed chemical kinetic mechanism considering silicon hydride species containing up to 5 Si atoms is used to model particle nucleation and surface growth. The sectional model calculates coagulation, particle transport by electric force, neutral drag and ion drag, and particle charging using orbital motion limited theory. Simulation results are presented for selected operating conditions, and are compared to experimental results. This work was partially supported by the US Dept. of Energy Office of Fusion Energy Science (DE-SC0001939), the US National Science Foundation (CHE-124752), and the Minnesota Supercomputing Institute.

  20. Isolation, structural determination, synthesis and quantitative determination of impurities in Intron-A, leached from a silicone tubing.

    PubMed

    Chan, Tze-Ming; Pramanik, Birendra; Aslanian, Robert; Gullo, Vincent; Patel, Mahesh; Cronin, Bart; Boyce, Chris; McCormick, Kevin; Berlin, Mike; Zhu, Xiaohong; Buevich, Alexei; Heimark, Larry; Bartner, Peter; Chen, Guodong; Pu, Haiyan; Hegde, Vinod

    2009-02-20

    Investigation of unexpected levels of impurities in Intron product has revealed the presence of low levels of impurities leached from the silicone tubing (Rehau RAU-SIK) on the Bosch filling line. In order to investigate the effect of these compounds (1a, 1b and 2) on humans, they were isolated identified and synthesized. They were extracted from the tubing by stirring in Intron placebo at room temperature for 72 h and were enriched on a reverse phase CHP-20P column, eluting with gradient aqueous ACN and were separated by HPLC. Structural elucidation of 1a, 1b and 2 by MS and NMR studies demonstrated them to be halogenated biphenyl carboxylic acids. The structures were confirmed by independent synthesis. Levels of extractable impurities in first filled vials of actual production are estimated to be in the range of 0.01-0.55 microg/vial for each leached impurity. Potential toxicity of these extractables does not represent a risk for patients under the conditions of clinical use.

  1. Bicanalicular versus monocanalicular intubation after failed probing in congenital nasolacrimal duct obstruction

    PubMed Central

    Rajabi, Mohammad Taher; Zavarzadeh, Najmeh; Mahmoudi, Alireza; Johari, Mohammad Karim; Hosseini, Seyedeh Simindokht; Abrishami, Yalda; Rajabi, Mohammad Bagher

    2016-01-01

    AIM To investigate the clinical outcomes of different intubation techniques in the cases of failed primary probing. METHODS This retrospective study was performed on 338 patients with the diagnosis of congenital nasolacrimal duct obstruction with age 1-4y that had failed primary probing. Intubation was performed under light sedation in operating room and the stent was left 3mo in place. Clinical outcome was investigated 3mo after tube removal. RESULTS Bicanalicular intubation method had higher complete and relative success rates compared to monocanalicular intubation (P=0.00). In addition, Monoka intubation had better outcomes compared to Masterka technique (P=0.046). No difference was found between genders but the higher the age, the better the outcomes with bicanalicular technique rather than monocanalicular. CONCLUSION Overall success rate of bicanalicular intubation is superior to monocanalicular technique especially in older ages. Also, based upon our clinical outcomes, Masterka intubation is not recommended in cases of failed probing. PMID:27803865

  2. Alternative Methods for Nasotracheal Intubation and Extubation in a Patient With Apert Syndrome

    PubMed Central

    Tsukamoto, Masanori; Yokoyama, Takeshi

    2015-01-01

    Apert syndrome is a rare autosomal dominant disorder characterized by craniofacial abnormalities, craniosynostosis and syndactyly. Nasotracheal intubation for a patient with Apert syndrome can be a challenge because of abnormal facial anatomy. We experienced the anesthetic management of a patient with Apert syndrome who underwent partial resection of mandible and cleft palate repair with nasotracheal intubation. Nasotracheal intubation using a gastric tube and extubation using an airway exchange catheter proved useful in this case of airway compromise. PMID:26398130

  3. Alternative Methods for Nasotracheal Intubation and Extubation in a Patient With Apert Syndrome.

    PubMed

    Tsukamoto, Masanori; Yokoyama, Takeshi

    2015-01-01

    Apert syndrome is a rare autosomal dominant disorder characterized by craniofacial abnormalities, craniosynostosis and syndactyly. Nasotracheal intubation for a patient with Apert syndrome can be a challenge because of abnormal facial anatomy. We experienced the anesthetic management of a patient with Apert syndrome who underwent partial resection of mandible and cleft palate repair with nasotracheal intubation. Nasotracheal intubation using a gastric tube and extubation using an airway exchange catheter proved useful in this case of airway compromise.

  4. Identifying the more suitable nostril for nasotracheal intubation using radiographs.

    PubMed

    Chi, Seong In; Park, Sookyung; Joo, Li-Ah; Shin, Teo Jeon; Kim, Hyun Jeong; Seo, Kwang-Suk

    2016-06-01

    One nostril must be selected for nasotracheal intubation. In some cases, structural anomalies within the nasal cavity hinder the insertion of the tube or complications, such as epistaxis, develop. This study examined the possibility of using radiography to select the nostril that would induce fewer complications. Four hundred and five patients who underwent nasotracheal intubation under general anesthesia were studied. A 7.0-mm internal diameter nasal right angle endotracheal (RAE) tube and 6.5-mm internal diameter nasal RAE tube were inserted into men and women, respectively. Complications were considered to have developed in cases in which insertion of the tube into the nasal cavity failed or epistaxis occurred. The tube was inserted into the other nostril for insertion failures and hemostasis was performed in cases of epistaxis. The degree of nasal septal deviation was determined from posteroanterior skull radiographs or panoramic radiographs; the incidence of complications was compared depending on the direction of the septal deviation and the intubated nostril. The radiographs of 390 patients were readable; 94 had nasal septum deviation. The incidence of complications for cases without nasal septum deviation was 16.9%, that for cases in which the tube was inserted into the nostril on the opposite side of the deviation was 18.5%, and that for cases in which the tube was inserted into the nostril with the deviation was 35.0%, showing a high incidence of complications when intubation is performed through the nostril with septum deviation (chi-square test, P < 0.05 ). Although there were no differences in the incidence rates of complications between intubation through the left nostril and that through the right nostril, radiological findings indicated that incidence of complications significantly increased when the tube was inserted into the nostril with the septum deviation.

  5. Intubation biomechanics: laryngoscope force and cervical spine motion during intubation with Macintosh and Airtraq laryngoscopes.

    PubMed

    Hindman, Bradley J; Santoni, Brandon G; Puttlitz, Christian M; From, Robert P; Todd, Michael M

    2014-08-01

    Laryngoscopy and endotracheal intubation in the presence of cervical spine instability may put patients at risk of cervical cord injury. Nevertheless, the biomechanics of intubation (cervical spine motion as a function of applied force) have not been characterized. This study characterized and compared the relationship between laryngoscope force and cervical spine motion using two laryngoscopes hypothesized to differ in force. Fourteen adults undergoing elective surgery were intubated twice (Macintosh, Airtraq). During each intubation, laryngoscope force, cervical spine motion, and glottic view were recorded. Force and motion were referenced to a preintubation baseline (stage 1) and were characterized at three stages: stage 2 (laryngoscope introduction); stage 3 (best glottic view); and stage 4 (endotracheal tube in trachea). Maximal force and motion occurred at stage 3 and differed between the Macintosh and Airtraq: (1) force: 48.8 ± 15.8 versus 10.4 ± 2.8 N, respectively, P = 0.0001; (2) occiput-C5 extension: 29.5 ± 8.5 versus 19.1 ± 8.7 degrees, respectively, P = 0.0023. Between stages 2 and 3, the motion/force ratio differed between Macintosh and Airtraq: 0.5 ± 0.2 versus 2.0 ± 1.4 degrees/N, respectively; P = 0.0006. The relationship between laryngoscope force and cervical spine motion is: (1) nonlinear and (2) differs between laryngoscopes. Differences between laryngoscopes in motion/force relationships are likely due to: (1) laryngoscope-specific cervical extension needed for intubation, (2) laryngoscope-specific airway displacement/deformation needed for intubation, and (3) cervical spine and airway tissue viscoelastic properties. Cervical spine motion during endotracheal intubation is not directly proportional to force. Low-force laryngoscopes cannot be assumed to result in proportionally low cervical spine motion.

  6. [The transillumination technique. An alternative to conventional intubation?].

    PubMed

    Lipp, M; de Rossi, L; Daubländer, M; Thierbach, A

    1996-10-01

    The technique of light-guided intubation is based on the principle that a source of light brought into the trachea results in clearly visible and defined transcutaneous illumination, while no illumination can be observed with the light source in the oesophagus (Fig. 1-7). The Trachlight is a reintroduced instrument for this alternative intubation technique. The essential developments are: a length-adjustable stylet with a removable internal metal wire, a brighter light source, a stable handle with tight fixation of the endotracheal tube, and a time-dependent warning device to avoid extended intubations. One hundred twenty patients (Mallampati I. ASA I-III) were included in the study (conventional intubation [group KL, n = 60]. Trachlight intubation [group TT, n = 60]. The goals of the investigation were to examine the handling, application, problems, limitations, and possible indications of the method. The recorded parameters were: number of intubation attempts: course and duration of intubation; complications; and difficulties. In 40 patients (20 in each group) the indication for invasive blood pressure measurement was given due to the surgical procedure, and circulatory parameters were recorded at defined moments during the intubation course. In group KL 55 patients were intubated in the attempt, 4 on the second, and 1 on the third (mean duration 23.6 +/- 10.4 s, range 12-60 s). Complications were: unilateral intubation (3 patients), bradycardia (2), asystole (1) and soft-tissue injury (1). Of the 60 patients in group TT. 54 were intubated successfully, the mean time needed being 29.9 +/- 14.8 s (range: 6-61 s). The remaining 6 were then intubated by the conventional method. Positive results in group TT included: easy handling and application, no injury to soft tissues or teeth, and invariably correct placement of the tube. Problems included: sufficient transillumination was achieved only after (entire) dimming of the room, insufficient control over the distal

  7. A National Emergency Airway Registry for children: landscape of tracheal intubation in 15 PICUs.

    PubMed

    Nishisaki, Akira; Turner, David A; Brown, Calvin A; Walls, Ron M; Nadkarni, Vinay M

    2013-03-01

    To characterize the landscape of process of care and safety outcomes for tracheal intubation across pediatric intensive care units Procedural process of care and safety outcomes of tracheal intubation across pediatric intensive care units has not been described. We hypothesize that the novel National Emergency Airway Registry for Children registry is a feasible tool to capture tracheal intubation process of care and outcomes. Prospective, descriptive. Fifteen academic PICUs in North America. Critically ill children requiring tracheal intubation in PICUs. Tracheal intubation quality improvement data were prospectively collected for all initial tracheal intubation in 15 PICUs from July 2010 to December 2011 using the National Emergency Airway Registry for Children tool with explicit site-specific compliance plans and operational definitions including adverse tracheal intubation associated events. One thousand seven hundred fifteen tracheal intubation encounters were reported (averaging 1/3.4 days, or 1/86 bed days). Ninety-eight percent of primary tracheal intubation were successful; 86% were successful with less than or equal to two attempts. First attempt was by pediatric residents in 23%, pediatric critical care fellows in 41%, and critical care attending physicians in 13%: first attempt success rate was 62%, first provider success rate was 79%. The first method was oral intubation in 1,659 (98%) and nasal in 55 (2%). Direct laryngoscopy was used in 96%. Ninety percent of tracheal intubation were with cuffed tracheal tubes. Adverse tracheal intubation associated events were reported in 20% of intubations (n = 372), with severe tracheal intubation associated events in 6% (n = 115). Esophageal intubation with immediate recognition was the most common tracheal intubation associated events (n = 167, 9%). History of difficult airway, diagnostic category, unstable hemodynamics, and resident provider as first airway provider were associated with occurrence of tracheal

  8. Delayed detection of subcutaneous emphysema following routine endotracheal intubation -A case report-

    PubMed Central

    Jo, Youn Yi; Park, Woo Young; Choi, Eunkyeong; Koo, Bon Nyeo

    2010-01-01

    A tracheal intubation-related tracheobronchial rupture is a relatively rare complication. We report a case of tracheobronchial rupture after single lumen endotracheal intubation. Twenty four hours after extubation of an endotracheal tube, subcutaneous emphysema developed on the patient's neck. A pneumomediastinum was also detected by computerized tomography (CT). The patient recovered uneventfully after conservative management. PMID:20877710

  9. Fibre-optic intubation in oncological head and neck emergencies.

    PubMed

    Varghese, Bipin Thomas; Balakrishnan, Mallika; Kuriakose, Renju

    2005-08-01

    Although fibre-optic bronchoscopic intubation is well recognized as the most valuable adjunct for elective management of the difficult airway its precise role in oncological head and neck emergencies has not been evaluated. The objective of this study was to evaluate the role of fibre-optic intubation in such emergencies. This was a consecutive case series study by a single surgeon (the otolaryngologist) and anaesthetist team, taking place in a regional tertiary-referral head and neck surgical oncology centre. A series of 17 consecutive oncological head and neck emergency patients underwent fibre-optic intubation with a Portex endotracheal tube of inner diameter > or =7 mm, with the aid of a 6-mm (EB-1830T2) Pentax fibre-optic video bronchoscope. The study assessed occurrence of: avoidance of tracheostomy in bleeding emergencies; a well placed, uncomplicated tracheostomy in airway obstruction; and successful intubation. Two cases were decannulated completely. All cases were successfully intubated and a tracheostomy was avoided in all cases in which emergency intubation was required and the patient was bleeding. We conclude that fibre-optic bronchoscopic intubation is a viable option in head and neck oncological emergencies due to upper airway obstruction and tumour bleeding. Clinical and endoscopic judgement and operator experience are the key factors determining success.

  10. Comparative Performance of the Photomultiplier Tube and the Silicon Avalanche Photodiode When Used as Detectors in Angular Scattering Measurements

    NASA Astrophysics Data System (ADS)

    Kroner, D. O.; Nelson, R. M.; Boryta, M. D.; Hapke, B. W.; Manatt, K.; Smythe, W. D.

    2014-12-01

    We report the results of a comparative study of two types of photometric detectors that are commonly used for, spacecraft, ground-based telescope, and laboratory observations in support of precise angular scattering investigations of the type described in a companion paper (Nelson et al., this meeting). The performance of the state of the art Hamamatsu C12703-01 Silicon Avalanche photodiode (SAD) was compared to that of the Hamamatsu R928 Photomultiplier tube (PMT). The Hamamatsu R928 evolved from a sequence of photometric detectors with a long history of use in support of laboratory and remote sensing studies, tracing backwards to include the RCA 1P21 and the RCA 931A. Two newly acquired SADs were bench tested along with a new R928 photomultiplier tube that was thermoelectrically cooled to -10 deg C. The SAD's employed electronic thermal compensation supplied by the manufacturer. The SADs and PMT measured electromagnetic radiation from solid-state lasers of wavelength 635 nm after the radiation was reflected from diffusely-scattering surfaces of varying albedos. The SADs were housed on tripods that were co-aligned with the PMT and laser. The photometric detectors were placed 4.3 meters from a reflecting disk. The disk was rotated to reduce the effect of laser speckle. All detectors in the experiment were equipped with notch filters that transmit light only of the wavelength emitted by the laser. Three SR830 DSP Lock-in Amplifiers were connected to the detectors and various setting configurations were compared in order to optimize signal to noise. Neutral Density filters (ND 0,3 and ND 0,9) were placed in the light path to determine the linearity in the response function of the detectors. We conclude that in this application SADs and PMTs produce comparable photometric precision and fidelity. SADs offer greater convenience because thermal compensation circuitry is integrated with the detector. This work was partially supported by NASA's Cassini Science

  11. Retromolar fibreoptic orotracheal intubation in a patient with severe trismus undergoing nasal surgery.

    PubMed

    Truong, Angela; Truong, Dam-Thuy

    2011-05-01

    A considerable challenge arises when passage of an endotracheal tube between the teeth is impossible because of severe trismus and the presence of concomitant contraindications to nasotracheal intubation. We report a novel technique to circumvent the need for tracheostomy by using the retromolar space for oral fibreoptic intubation. A 50-yr-old female with a history of pharyngeal cancers treated with surgery and radiotherapy presented for right dacryocystorhinostomy. She had undergone left dacryocystorhinostomy after nasotracheal intubation one week earlier. This time, orotracheal intubation was requested since surgery would involve the right nostril and left nasal intubation might dislodge the recently placed nasolacrimal tube. Due to severe trismus, the patient's interincisor distance was only 9 mm, and it was impossible to pass a 6.0 mm endotracheal tube through that gap. A flexible bronchoscope loaded with a 6.0 mm tracheal tube was inserted through the retromolar space into the pharynx and maneuvered through the vocal cords for endotracheal intubation. The retromolar space is located between the last molar and the ascending ramus of the mandible. Even with complete mandibular occlusion, it is usually able to accommodate a 7.0 mm endotracheal tube. Despite its hidden location, it can be used successfully for orotracheal fibreoptic intubation. With practice, the expertise achieved in performing this technique will confer a much needed option for securing the airway in this challenging situation.

  12. Method and apparatus for stable silicon dioxide layers on silicon grown in silicon nitride ambient

    NASA Technical Reports Server (NTRS)

    Cohen, R. A.; Wheeler, R. K. (Inventor)

    1974-01-01

    A method and apparatus for thermally growing stable silicon dioxide layers on silicon is disclosed. A previously etched and baked silicon nitride tube placed in a furnace is used to grow the silicon dioxide. First, pure oxygen is allowed to flow through the tube to initially coat the inside surface of the tube with a thin layer of silicon dioxide. After the tube is coated with the thin layer of silicon dioxide, the silicon is oxidized thermally in a normal fashion. If the tube becomes contaminated, the silicon dioxide is etched off thereby exposing clean silicon nitride and then the inside of the tube is recoated with silicon dioxide. As is disclosed, the silicon nitride tube can also be used as the ambient for the pyrolytic decomposition of silane and ammonia to form thin layers of clean silicon nitride.

  13. Tracheal intubation and sore throat: a mechanical explanation.

    PubMed

    Chandler, M

    2002-02-01

    Although tracheal intubation remains a valuable tool, it may result in pressure trauma and sore throat. The evidence for an association between these sequelae is not conclusive and sore throat may be caused at the time of intubation. This hypothesis was tested in a mechanical model and the results from tracheal intubation compared with those from insertion of a laryngeal mask airway, which is associated with a lower incidence of sore throat. Use of the model suggests that the tracheal tube and laryngeal mask airway impinge on the pharyngeal wall in different manners and involve different mechanisms for their conformation to the upper airway, but that in a static situation, the forces exerted on the pharyngeal wall are low with both devices. It also suggests that the incidence of sore throat should be lower for softer and smaller tracheal tubes and that the standard 'Magill' curve (radius of curvature 140 +/- 20 mm) is about optimum for the average airway.

  14. Image Shutters: Gated Proximity-Focused Microchannel-Plate (MCP) Wafer Tubes Versus Gated Silicon Intensified Target (SIT) Vidicons

    NASA Astrophysics Data System (ADS)

    Yates, G. J.; King, N. S. P.; Jaramillo, S. A.; Ogle, J. W.; Noel, B. W.; Thayer, N. N.

    1983-03-01

    The imaging characteristics of two fast image shutters used for recording the spatial and temporal evolution of transient optical events in the nanosecond range have been studied. Emphasis is on the comparative performances of each shutter type under similar conditions. Response data, including gating speed, gain, dynamic range, shuttering efficiency, and resolution for 18 and 25-mm-diam proximity-focused microchannel-plate (MCP) intensifiers are com-pared with similar data for a prototype electrostatically-focused 25-mm-diam gated silicon-intensified-target (SIT) vidicon currently under development for Los Alamos National Laboratory. Several key parameters critical to optical gating speed have been varied in both tube types in order to determine the optimum performance attainable from each design. These include conductive substrate material and thickness used to reduce photocathode resistivity, spacing between gating electrodes to minimize interelectrode capacitance, the use of con-ductive grids on the photocathode substrate to permit rapid propagation of the electrical gate pulse to all areas of the photocathode, and different package geometries to provide a more effective interface with external biasing and gating circuitry. For comparable spatial resolution, most 18-mm-diam MCPs require gate times > 2.5 ns while the fastest SIT has demonstrated sub-nanosecond optical gates as short as r 400 ± 50 ps for full shuttering of the 25-mm-diam input window.

  15. Image shutters: Gated proximity-focused Microchannel Plate (MCP) wafer tubes versus gated Silicon Intensified Target (SIT) vidicons

    NASA Astrophysics Data System (ADS)

    Yates, G. J.; King, N. S. P.; Jaramillo, S. A.; Ogle, J. W.; Noel, B. W.; Thayer, N. N.

    Response data, including gating speed, gain, dynamic range, shuttering efficiency, and resolution for 18- and 25-mm-diam proximity-focused microchannel-plate (MCP) intensifiers are compared with similar data for a prototype electrostatically-focused 25-mm-diam gated silicon-intensified-target (SIT) vidicon. Conductive substrate material and thickness used to reduce photocathode resistivity, spacing between gating electrodes to minimize inter-electrode capacitance, the use of conductive grids on the photocathode substrate to permit rapid propagation of the electrical gate pulse to all areas of the photocathode, and different package geometries to provide a more effective interface with external biasing and gating circuitry were varied in both tube types to determine optimal performance from each design. For comparable spatial resolution, most 18-mm-diam MCPs require gate times 2.5 ns while the fastest SIT has demonstrated sub-nanosecond optical gates as short as approximately 400 + or - 50 ps for full shuttering of the 25-mm-diam input window.

  16. Unstable endobronchial intubation in a cat undergoing tracheal laceration repair.

    PubMed

    Kästner, Sabine B R; Grundmann, Stefan; Bettschart-Wolfensberger, Regula

    2004-07-01

    A peri-carinal tracheal laceration was produced in a 11-year-old cat during tracheal intubation. Before reconstructive surgery began, the leak was bypassed with an endobronchial tube positioned using endoscopy and direct vision. However, single-lung ventilation could not be sustained because the tube became dislodged and could not be repositioned. Consequently, surgery was completed with periods of intermittent apnoea interspersed with manually controlled hyperventilation. Cardiovascular variables were stable during anaesthesia and no signs of hypoxia were detected. The difficulties in maintaining endobronchial tube position resulted from the animal's small size relative to the dimensions of the endotracheal tube.

  17. Bioactivity and electrochemical behavior of hydroxyapatite-silicon-multi walled carbon nano-tubes composite coatings synthesized by EPD on NiTi alloys in simulated body fluid.

    PubMed

    Khalili, V; Khalil-Allafi, J; Frenzel, J; Eggeler, G

    2017-02-01

    In order to improve the surface bioactivity of NiTi bone implant and corrosion resistance, hydroxyapatite coating with addition of 20wt% silicon, 1wt% multi walled carbon nano-tubes and both of them were deposited on a NiTi substrate using a cathodic electrophoretic method. The apatite formation ability was estimated using immersion test in the simulated body fluid for 10days. The SEM images of the surface of coatings after immersion in simulated body fluid show that the presence of silicon in the hydroxyapatite coatings accelerates in vitro growth of apatite layer on the coatings. The Open-circuit potential and electrochemical impedance spectroscopy were measured to evaluate the electrochemical behavior of the coatings in the simulated body fluid at 37°C. The results indicate that the compact structure of hydroxyapatite-20wt% silicon and hydroxyapatite-20wt% silicon-1wt% multi walled carbon nano-tubes coatings could efficiently increase the corrosion resistance of NiTi substrate.

  18. Endotracheal intubation: ultrasound-guided versus fiberscope in patients with cervical spine immobilization.

    PubMed

    Moustafa, Moustafa Abdelaziz; Arida, Emad A; Zanaty, Ola M; El-Tamboly, Sameh Fathy

    2017-09-21

    Ultrasound has growing applications in airway management during anesthesia. The aim of the present study was to evaluate the feasibility of real-time ultrasound-guided tracheal intubation in patients with cervical spine immobilization relative to fiberscope-guided tracheal intubation. This randomized controlled study was carried out on 266 adult patients who have a rigid neck collar in place for cervical spine immobilization and were randomly allocated into two equal groups. All patients were subjected to the same anesthetic protocol. After full neuromuscular blockade, neck collar was removed and tracheal intubation was done in the neutral position. In group A, the trachea was intubated guided by a 5-12-MHz linear ultrasound probe attached to a Sonoscape A5 ultrasound machine. In group B, the trachea was intubated by an endotracheal tube mounted over a fiberscope (Karl Storz, working length 65 cm, distal tip diameter 5.6 mm). Hemodynamic measurements and oxygen saturation were recorded. Tracheal intubation criteria for both groups including duration of the intubation procedure, number of intubation attempts, success rate at each attempt, and the lowest oxygen saturation recorded during tracheal intubation were recorded. Ultrasound and fiberscope achieved comparable time for tracheal intubation (57 ± 12 vs. 55 ± 10 s), respectively. Success rate of tracheal intubation at the first attempt was higher in the fiberscope group than the ultrasound group, with a P value of 0.032. The overall success rate was not significantly different between the two groups. Ultrasound-guided tracheal intubation showed a lower first attempt success rate in patients with cervical spine immobilization compared to fiberscope-guided tracheal intubation but the overall success rates were comparable. Ultrasound can be an alternative technique for guiding tracheal intubation in patients with cervical spine immobilization. PACTR201602001476292.

  19. Difficult paediatric intubation when fibreoptic laryngoscopy fails.

    PubMed

    Ng, Agnes; Vas, Lakshmi; Goel, Sunita

    2002-11-01

    We report an unusual problem with fibreoptic bronchoscopy in an 8-year-old girl with Negar syndrome. She had a history of difficult airway since birth, and had undergone mandibular distraction for severe obstructive sleep apnoea when she was aged 2 years. Nagar syndrome is a Treacher-Collins like syndrome with normal intelligence, conductive bone deafness and problems with articulation. The patients have malar hypoplasia with down slanting palpebral fissures, high nasal bridge, micrognathia, absence of lower eyelashes, low set posteriorly rotated ears, preauricular tags, atresia of external ear canal, cleft palate, hypoplasia of thumb, with or without radius, and limited elbow extension. Protracted attempts with a fibreoptic bronchoscope failed to visualize the glottis, and this was only possible when the tube was guided to the larynx by blind nasal intubation. Apparently, the healing of the wounds for the mandibular distraction in the mandibular space on the inside of the rami of the mandible had caused differential fibrosis on either side of the hyoid, leading to a triplane distortion of the larynx with a left shift, clockwise rotation to a 2-8 o'clock direction and a slight tilt towards the left pharyngeal wall. The large epiglottis overlying this had precluded a view of the larynx. Finally, the older technique of breathguided intubation facilitated fibreoptic bronchoscopy to achieve tracheal intubation.

  20. New laser tracheal tube

    NASA Astrophysics Data System (ADS)

    Ungemach, Josef; Foth, Hans-Jochen; Hoermann, Karl; Preponis, E.

    1996-09-01

    The complication of a laser induced tube fire during surgery was first published in 1979. The protection of tracheal tubes against ignition is necessary to enable a safe laser surgery of the upper airway. in an experimental study a new compound tube was tested: this tube had a higher laser resistance than a pure metal tube. The damage threshold of this tube was tested against the emission of various lasers as CO2. The metal tube was damaged within seconds at CO2 laser power densities of 103 W/cm2 whereas the damage threshold of the compound tube was 3.106 W/cm2. We compared the compound laser tube to the so far used metal tube in a prospective clinical trial in our department of ENT in patients undergoing CO2-laser surgery of the upper airway. 66 patients were included into the study: 33 received the compound tube, 33 the metal tube. During endotracheal intubation the handling of the compound tube was better. During laser surgery high airway pressures occured more often with the metal tube. Whereas kinking was the problem of the compound tubes. Destruction of cuffs occured in both groups but did not cause any complications. No tube or cuff fire was noticed.

  1. [A clinical evaluation of blind orotracheal intubation using Trachlight in 511 patients].

    PubMed

    Tsutsui, T; Setoyama, K

    2001-08-01

    We used Trachlight for blind orotracheal intubation (ordinary tracheal tube or Portex Blueline in 305 cases, and reinforced tube or Mallinckrodt Safety-Flex in 206 cases) for general anesthetic procedures, and evaluated its technical features along with related complications. With ordinary tubes, 93% of the patients could be intubated successfully at the first attempt. Unsuccessful intubation even at the third attempt occurred in 3 patients (1%). One patient was complicated with a long epiglottis and the cause was unknown in the other patients. With reinforced tubes, 83% of the patients could be intubated at the first attempt but 8 patients (4%) could not. Of them, four patients received too large reinforced tubes straightening the bending of the stylet. Each of the three patients had a narrow larynx, mandibular retraction or obese neck making transillumination difficult. In the remaining one patient, the cause was unknown. Complication found in 30% of the patients was sore throat that seemed severer than that caused by laryngoscope. One patient developed minor tracheal bleeding probably due to injury of the mucosa. The elevation of the blood pressure at intubation with this device was not as high as that by direct laryngoscopy. We conclude that Trachlight leads to intubation with a high success rate, and that care should be taken not to damage the tracheal mucosa by blind insertion.

  2. Swallowing dysfunction following endotracheal intubation

    PubMed Central

    Tsai, Min-Hsuan; Ku, Shih-Chi; Wang, Tyng-Guey; Hsiao, Tzu-Yu; Lee, Jang-Jaer; Chan, Ding-Cheng; Huang, Guan-Hua; Chen, Cheryl Chia-Hui

    2016-01-01

    Abstract To evaluate postextubation swallowing dysfunction (PSD) 21 days after endotracheal extubation and to examine whether PSD is time-limited and whether age matters. For this prospective cohort study, we evaluated 151 adult critical care patients (≥20 years) who were intubated for at least 48 hours and had no pre-existing neuromuscular disease or swallowing dysfunction. Participants were assessed for time (days) to pass bedside swallow evaluations (swallow 50 mL of water without difficulty) and to resume total oral intake. Outcomes were compared between younger (20–64 years) and older participants (≥65 years). PSD, defined as inability to swallow 50 mL of water within 48 hours after extubation, affected 92 participants (61.7% of our sample). At 21 days postextubation, 17 participants (15.5%) still failed to resume total oral intake and were feeding-tube dependent. We found that older participants had higher PSD rates at 7, 14, and 21 days postextubation, and took significantly longer to pass the bedside swallow evaluations (5.0 vs 3.0 days; P = 0.006) and to resume total oral intake (5.0 vs 3.0 days; P = 0.003) than their younger counterparts. Older participants also had significantly higher rates of subsequent feeding-tube dependence than younger patients (24.1 vs 5.8%; P = 0.008). Excluding patients with pre-existing neuromuscular dysfunction, PSD is common and prolonged. Age matters in the time needed to recover. Swallowing and oral intake should be monitored and interventions made, if needed, in the first 7 to 14 days postextubation, particularly for older patients. PMID:27310972

  3. Blind Intubation through Self-pressurized, Disposable Supraglottic Airway Laryngeal Intubation Masks: An International, Multicenter, Prospective Cohort Study.

    PubMed

    Ruetzler, Kurt; Guzzella, Sandra Esther; Tscholl, David Werner; Restin, Tanja; Cribari, Marco; Turan, Alparslan; You, Jing; Sessler, Daniel I; Seifert, Burkhardt; Gaszynski, Tomasz; Ganter, Michael T; Spahn, Donat R

    2017-08-01

    Supraglottic airway devices commonly are used for securing the airway during general anesthesia. Occasionally, intubation with an endotracheal tube through a supraglottic airway is indicated. Reported success rates for blind intubation range from 15 to 97%. The authors thus investigated as their primary outcome the fraction of patients who could be intubated blindly with an Air-Qsp supraglottic airway device (Mercury Medical, USA). Second, the authors investigated the influence of muscle relaxation on air leakage pressure, predictors for failed blind intubation, and associated complications of using the supraglottic airway device. The authors enrolled 1,000 adults having elective surgery with endotracheal intubation. After routine induction of general anesthesia, a supraglottic airway device was inserted and patients were ventilated intermittently. Air leak pressure was measured before and after full muscle relaxation. Up to two blind intubation attempts were performed. The supraglottic airway provided adequate ventilation and oxygenation in 99% of cases. Blind intubation succeeded in 78% of all patients (95% CI, 75 to 81%). However, the success rate was inconsistent among the three centers (P < 0.001): 80% (95% CI, 75 to 85%) at the Institute of Anesthesia and Pain Therapy, Kantonsspital Winterthur, Winterthur, Switzerland; 41% (95% CI, 29 to 53%) at the Department of Anesthesiology and Intensive Therapy, Medical University of Lodz, Lodz, Poland; and 84% (95% CI, 80 to 88%) at the Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland. Leak pressure before relaxation correlated reasonably well with air leak pressure after relaxation. The supraglottic airway device reliably provided a good airway and allowed blind intubation in nearly 80% of patients. It is thus a reasonable initial approach to airway control. Muscle relaxation can be used safely when unparalyzed leak pressure is adequate.

  4. Morbid obesity and tracheal intubation.

    PubMed

    Brodsky, Jay B; Lemmens, Harry J M; Brock-Utne, John G; Vierra, Mark; Saidman, Lawrence J

    2002-03-01

    The tracheas of obese patients may be more difficult to intubate than those of normal-weight patients. We studied 100 morbidly obese patients (body mass index >40 kg/m(2)) to identify which factors complicate direct laryngoscopy and tracheal intubation. Preoperative measurements (height, weight, neck circumference, width of mouth opening, sternomental distance, and thyromental distance) and Mallampati score were recorded. The view during direct laryngoscopy was graded, and the number of attempts at tracheal intubation was recorded. Neither absolute obesity nor body mass index was associated with intubation difficulties. Large neck circumference and high Mallampati score were the only predictors of potential intubation problems. Because in all but one patient the trachea was intubated successfully by direct laryngoscopy, the neck circumference that requires an intervention such as fiberoptic bronchoscopy to establish an airway remains unknown. We conclude that obesity alone is not predictive of tracheal intubation difficulties. In 100 morbidly obese patients, neither obesity nor body mass index predicted problems with tracheal intubation. However, a high Mallampati score (greater-than-or-equal to 3) and large neck circumference may increase the potential for difficult laryngoscopy and intubation.

  5. Successful Management of Rabbit Anesthesia Through the Use of Nasotracheal Intubation

    PubMed Central

    2009-01-01

    Although nasotracheal intubation in the rabbit has been briefly described, scientific assessment of the procedure has not been reported. In this report we describe nasotracheal intubation performed in 38 male New Zealand White rabbits (3.0 to 5.5 kg) used for a vascular patch study. The rabbits were placed under general anesthesia twice, with 2 mo between the initial and final intubations. Rabbits were intubated by the oral or nasotracheal route and compared. Previous literature dismissed nasotracheal intubation, citing the possibility of introducing pathogens into the lungs and the necessity of high oxygen flow rates (presumably greater than 3 L/min). However, no clinical signs of respiratory disease were noted among the study animals, nor were high oxygen flow rates necessary. Several key points collectively facilitated a successful procedure. Total relaxation was essential, modification of the classic blind approach eased placement, a correct approach was necessary, and our development of a unique method of securing the tube improved tube management. The findings suggest that nasotracheal intubation can be used as an easy, less traumatic method of rabbit intubation when compared with orotracheal intubation. PMID:19383213

  6. Palatopharyngeal wall perforation during Glidescope intubation.

    PubMed

    Leong, W L; Lim, Y; Sia, A T H

    2008-11-01

    We report a case of palatopharyngeal wall perforation during intubation with a GlideScope laryngoscope. The likely mechanism was advancing and rotating the endotracheal tube against a taut palatopharyngeal fold. This was missed during the initial laryngoscopy, because there is a potential blind-spot in the oropharynx when attention is focused on the GlideScope" monitor Fortunately, there were no sequelae other than minor bleeding and a mild sore throat and no surgical intervention was necessary. The use of unnecessary force during the endotracheal tube insertion, the use of too large a laryngoscope blade and the use of a rigid stylet could possibly also have been contributory factors to this complication.

  7. Surface modification of silicone tubes by functional carboxyl and amine, but not peroxide groups followed by collagen immobilization improves endothelial cell stability and functionality.

    PubMed

    Salehi-Nik, Nasim; Amoabediny, Ghassem; Shokrgozar, Mohammad Ali; Mottaghy, Khosrow; Klein-Nulend, Jenneke; Zandieh-Doulabi, Behrouz

    2015-03-02

    Surface modification by functional groups promotes endothelialization in biohybrid artificial lungs, but whether it affects endothelial cell stability under fluid shear stress, and the release of anti-thrombotic factors, e.g. nitric oxide (NO), is unknown. We aimed to test whether surface-modified silicone tubes containing different functional groups, but similar wettability, improve collagen immobilization, endothelialization, cell stability and cell-mediated NO-release. Peroxide, carboxyl, and amine-groups increased collagen immobilization (41-76%). Only amine-groups increased ultimate tensile strength (2-fold). Peroxide and amine enhanced (1.5-2.5 fold), but carboxyl-groups decreased (2.9-fold) endothelial cell number after 6 d. After collagen immobilization, cell numbers were enhanced by all group-modifications (2.8-3.8 fold). Cells were stable under 1 h-fluid shear stress on amine, but not carboxyl or peroxide-group-modified silicone (>50% cell detachment), while cells were also stable on carboxyl-group-modified silicone with immobilized collagen. NO-release was increased by peroxide and amine (1.1-1.7 fold), but decreased by carboxyl-group-modification (9.8-fold), while it increased by all group-modifications after collagen immobilization (1.8-2.8 fold). Only the amine-group-modification changed silicone stiffness and transparency. In conclusion, silicone-surface modification of blood-contacting parts of artificial lungs with carboxyl and amine, but not peroxide-groups followed by collagen immobilization allows the formation of a stable functional endothelial cell layer. Amine-group-modification seems undesirable since it affected silicone's physical properties.

  8. Dental trauma prevention during endotracheal intubation--review of literature.

    PubMed

    Mańka-Malara, Katarzyna; Gawlak, Dominika; Hovhannisyan, Anahit; Klikowska, Marta; Kostrzewa-Janicka, Jolanta

    2015-01-01

    Endotracheal intubation is a procedure performed during general anaesthesia with the use of an endotracheal tube in order to maintain a patent airway. This routinely used procedure is connected with a risk of complications within the region of the masticatory system. Trauma of teeth, their surrounding structures and the soft tissue of the oral cavity is observed in app. 1.38 per 1000 procedures. The main causes of this damage are the surgical skills and experience of the surgeon, the anatomical conditions present and the mode of conducting the procedure. In order to reduce the risk of postoperative complications, patients with a high risk of sustaining an injury during endotracheal intubation should be equipped with elastic mouthguards, which reduces the possibility of damage. The scoring in a scale of endotracheal intubation difficulty should be used for qualification for the use of such mouthguards.

  9. Flow-through polymerase chain reaction inside a seamless 3D helical microreactor fabricated utilizing a silicone tube and a paraffin mold.

    PubMed

    Wu, Wenming; Trinh, Kieu The Loan; Lee, Nae Yoon

    2015-03-07

    We introduce a new strategy for fabricating a seamless three-dimensional (3D) helical microreactor utilizing a silicone tube and a paraffin mold. With this method, various shapes and sizes of 3D helical microreactors were fabricated, and a complicated and laborious photolithographic process, or 3D printing, was eliminated. With dramatically enhanced portability at a significantly reduced fabrication cost, such a device can be considered to be the simplest microreactor, developed to date, for performing the flow-through polymerase chain reaction (PCR).

  10. [Difficult fiberoptic tracheal intubation in 1 month-old infant with Treacher Collins Syndrome].

    PubMed

    Fuentes, Ricardo; De la Cuadra, Juan Carlos; Lacassie, Hector; González, Alejandro

    2016-09-27

    Neonates and small infants with craniofacial malformation may be very difficult or impossible to mask ventilate or intubate. We would like to report the fiberoptic intubation of a small infant with Treacher Collins Syndrome using the technique described by Ellis et al. An one month-old infant with Treacher Collins Syndrome was scheduled for mandibular surgery under general endotracheal anesthesia. Direct laryngoscopy for oral intubation failed to reveal the glottis. Fiberoptic intubation using nasal approach and using oral approach through a 1.5 size laryngeal mask airway were performed; however, both approach failed because the fiberscope loaded with a one 3.5mm ID uncuffed tube was stuck inside the nasal cavity or inside the laryngeal mask airway respectively. Therefore, the laryngeal mask airway was keep in place and the fiberoptic intubation technique described by Ellis et al. was planned: the tracheal tube with the 15mm adapter removed was loaded proximally over the fiberscope; the fiberscope was advanced under video-screen visualization into the trachea; the laryngeal mask airway was removed, leaving the fiberscope in place; the tracheal tube was passed completely through the laryngeal mask airway and advanced down over the fiberscope into the trachea; the fiberscope was removed and the 15mm adapter was reattached to the tracheal tube. the fiberoptic intubation method through a laryngeal mask airway described by Ellis et al. can be successfully used in small infants with Treacher Collins Syndrome. Copyright © 2015 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  11. Prevalence and prediction of difficult intubation in maxillofacial surgery patients.

    PubMed

    Tuzuner-Oncul, Aysegul Mine; Kucukyavuz, Zuhal

    2008-08-01

    The failure to maintain a patent airway after the induction of general anesthesia is a major concern for anesthesiologists. For securing the airway, tracheal intubation using direct laryngoscopy remains the method of choice in most cases. However, direct laryngoscopic intubation is difficult in 1% to 4%, and impossible in 0.05% to 0.35%, of patients who have seemingly normal airways. This study sought to determine the prevalence of difficult intubation in maxillofacial surgery patients, and to evaluate the usefulness of various predictive tests for difficult intubation. This study was conducted on 208 patients undergoing maxillofacial surgery. During the preoperative visit, patients were examined in terms of the test of Mallampati et al (Can Anaesth Soc J 32:429, 1985), thyromental distance, sternomental distance, and interincisal distance. Direct laryngoscopic grading, as defined by Cormack and Lehane (Anesthesia 39:1105, 1984), was recorded for each patient. An intubation of "no difficulty" was noted when the tube was inserted into the fully visualized larynx with little effort on the first attempt. Intubation was possible in all patients. Combinations of different predictive tests resulted in higher sensitivity. Among all test types, that of Cormack and Lahene was thought to exhibit the highest sensitivity and positive predictive values when used alone. The prevalence of difficult intubation in our group of maxillofacial surgery patients was 15.4%. It may be concluded that a combination of predictive variables can be used to improve sensitivity. We demonstrated that combining the Mallampati test with other instruments of measurement resulted in higher sensitivity than when either test was used alone.

  12. TIVA-A Promising Approach to Anaesthetic Management of Montgomery T-tube Insertion

    PubMed Central

    Kurdi, Madhuri S.; Sindhupriya

    2015-01-01

    One of the treatment modalities for tracheal stenosis is tracheal dilatation and stenting using silicone Montgomery T-tube. Various techniques have been reported for this procedure. For safe anaesthetic management, anaesthesiologist must be aware of the surgical procedure, limitations of T-tube, likelihood of compromised airway besides the inherent problems of sharing the airway with surgeons. Total intravenous anaesthesia (TIVA) is a technique which has become very popular and possible now a days for various surgical procedures owing to its advantages. The anaesthetic technique should be based on the provider’s experience and severity of tracheal stenosis. We present here the anaesthetic management using TIVA technique with propofol and atracurium for the insertion of Montgomery T-tube in a case of post intubation tracheal stenosis. PMID:26436024

  13. Determinants of Success and Failure in Prehospital Endotracheal Intubation.

    PubMed

    Myers, Lucas A; Gallet, Charles G; Kolb, Logan J; Lohse, Christine M; Russi, Christopher S

    2016-09-01

    This study aimed to identify factors associated with successful endotracheal intubation (ETI) by a multisite emergency medical services (EMS) agency. We collected data from the electronic prehospital record for all ETI attempts made from January through May 2010 by paramedics and other EMS crew members at a single multistate agency. If documentation was incomplete, the study team contacted the paramedic. Paramedics use the current National Association of EMS Physicians definition of an ETI attempt (laryngoscope blade entering the mouth). We analyzed patient and EMS factors affecting ETI. During 12,527 emergent ambulance responses, 200 intubation attempts were made in 150 patients. Intubation was successful in 113 (75%). A crew with paramedics was more than three times as likely to achieve successful intubation as a paramedic/emergency medical technician-Basic crew (odds ratio [OR], 3.30; p=0.03). A small tube (≤7.0 inches) was associated with a more than 4-fold increased likelihood of successful ETI compared with a large tube (≥7.5 inches) (OR, 4.25; p=0.01). After adjustment for these features, compared with little or no view of the glottis, a partial or entire view of the glottis was associated with a nearly 13-fold (OR, 12.98; p=0.001) and a nearly 40-fold (OR, 39.78; p<0.001) increased likelihood of successful intubation, respectively. Successful ETI was more likely to be accomplished when a paramedic was partnered with another paramedic, when some or all of the glottis was visible and when a smaller endotracheal tube was used.

  14. Determinants of Success and Failure in Prehospital Endotracheal Intubation

    PubMed Central

    Myers, Lucas A.; Gallet, Charles G.; Kolb, Logan J.; Lohse, Christine M.; Russi, Christopher S.

    2016-01-01

    Introduction This study aimed to identify factors associated with successful endotracheal intubation (ETI) by a multisite emergency medical services (EMS) agency. Methods We collected data from the electronic prehospital record for all ETI attempts made from January through May 2010 by paramedics and other EMS crew members at a single multistate agency. If documentation was incomplete, the study team contacted the paramedic. Paramedics use the current National Association of EMS Physicians definition of an ETI attempt (laryngoscope blade entering the mouth). We analyzed patient and EMS factors affecting ETI. Results During 12,527 emergent ambulance responses, 200 intubation attempts were made in 150 patients. Intubation was successful in 113 (75%). A crew with paramedics was more than three times as likely to achieve successful intubation as a paramedic/emergency medical technician-Basic crew (odds ratio [OR], 3.30; p=0.03). A small tube (≤7.0 inches) was associated with a more than 4-fold increased likelihood of successful ETI compared with a large tube (≥7.5 inches) (OR, 4.25; p=0.01). After adjustment for these features, compared with little or no view of the glottis, a partial or entire view of the glottis was associated with a nearly 13-fold (OR, 12.98; p=0.001) and a nearly 40-fold (OR, 39.78; p<0.001) increased likelihood of successful intubation, respectively. Conclusion Successful ETI was more likely to be accomplished when a paramedic was partnered with another paramedic, when some or all of the glottis was visible and when a smaller endotracheal tube was used. PMID:27625734

  15. Orotracheal Intubation Using the Retromolar Space: A Reliable Alternative Intubation Approach to Prevent Dental Injury

    PubMed Central

    Thakar, Sudip D.; Truong, Angela T.; Truong, Dam-Thuy

    2016-01-01

    Despite recent advances in airway management, perianesthetic dental injury remains one of the most common anesthesia-related adverse events and cause for malpractice litigation against anesthesia providers. Recommended precautions for prevention of dental damage may not always be effective because these techniques involve contact and pressure exerted on vulnerable teeth. We describe a novel approach using the retromolar space to insert a flexible fiberscope for tracheal tube placement as a reliable method to achieve atraumatic tracheal intubation. Written consent for publication has been obtained from the patient. PMID:28116174

  16. Video-assisted thoracoscopic surgery segmentectomy by non-intubated or intubated anesthesia: a comparative analysis of short-term outcome

    PubMed Central

    Guo, Zhihua; Yin, Weiqiang; Pan, Hui; Zhang, Xin; Xu, Xin; Shao, Wenlong; Chen, Hanzhang

    2016-01-01

    Background The aim of this study was to reveal the short-term outcomes of video-assisted thoracoscopic surgery (VATS) segmentectomy without tracheal intubation compared with intubated general anesthesia with one-lung ventilation (OLV). Methods We performed a retrospective review of our institutional database of consecutive 140 patients undergoing VATS anatomical segmentectomy from July 2011 to June 2015. Among them, 48 patients were treated without tracheal intubation using a combination of thoracic epidural anesthesia (TEA), intrathoracic vagal blockade, and sedation (non-intubated group). The other 92 patients were treated with intubated general anesthesia (intubated group). Safety and feasibility was evaluated by comparing the perioperative profiles and short-term outcomes of these two groups. Results Two groups had comparable surgical durations, intraoperative blood loss, postoperative chest tube drainage volume, and numbers of dissected lymph nodes (P>0.05). Patients who underwent non-intubated segmentectomy had higher peak end-tidal carbon dioxide (EtCO2) during operation (44.81 vs. 33.15 mmHg, P<0.001), less white blood cell changes before and after surgery (△WBC) (6.08×109 vs. 7.75×109, P=0.004), earlier resumption of oral intake (6.76 vs. 17.58 hours, P<0.001), shorter duration of postoperative chest tube drainage (2.25 vs. 3.16 days, P=0.047), less cost of anesthesia (¥5,757.19 vs. ¥7,401.85, P<0.001), and a trend toward shorter postoperative hospital stay (6.04 vs. 7.83 days, P=0.057). One patient (2.1%) in the non-intubated group required conversion to intubated OLV since a significant mediastinal movement. In the intubated group, there was one patient (1.1%) required conversion to thoracotomy due to uncontrolled bleeding. The incidence difference of postoperative complications between groups was not significant (P=0.248). There was no in-hospital death in either group. Conclusions Compared with intubated general anesthesia, non-intubated

  17. Transient unilateral combined paresis of the hypoglossal nerve and lingual nerve following intubation anesthesia.

    PubMed

    Ulusoy, Hulya; Besir, Ahmet; Cekic, Bahanur; Kosucu, Muge; Geze, Sukran

    2014-01-01

    Nerve damage may occur in the pharyngolaryngeal region during general anesthesia. The most frequently injured nerves are the hypoglossal, lingual and recurrent laryngeal. These injuries may arise in association with several factors, such as laryngoscopy, endotracheal intubation and tube insertion, cuff pressure, mask ventilation, the triple airway maneuver, the oropharyngeal airway, manner of intubation tube insertion, head and neck position and aspiration. Nerve injuries in this region may take the form of an isolated single nerve or of paresis of two nerves together in the form of hypoglossal and recurrent laryngeal nerve palsy (Tapia's syndrome). However, combined injury of the lingual and hypoglossal nerves following intubation anesthesia is a much rarer condition. The risk of this damage can be reduced with precautionary measures. We describe a case of combined unilateral nervus hypoglossus and nervus lingualis paresis developing after intubation anesthesia.

  18. Endotracheal intubation in the ICU.

    PubMed

    Lapinsky, Stephen E

    2015-06-17

    Endotracheal intubation in the ICU is a high-risk procedure, resulting in significant morbidity and mortality. Up to 40% of cases are associated with marked hypoxemia or hypotension. The ICU patient is physiologically very different from the usual patient who undergoes intubation in the operating room, and different intubation techniques should be considered. The common operating room practice of sedation and neuromuscular blockade to facilitate intubation may carry significant risk in the ICU patient with a marked oxygenation abnormality, particularly when performed by the non-expert. Preoxygenation is largely ineffective in these patients and oxygen desaturation occurs rapidly on induction of anesthesia, limiting the time available to secure the airway. The ICU environment is less favorable for complex airway management than the operating room, given the frequent lack of availability of additional equipment or additional expert staff. ICU intubations are frequently carried out by trainees, with a lesser degree of airway experience. Even in the presence of a non-concerning airway assessment, these patients are optimally managed as a difficult airway, utilizing an awake approach. Endotracheal intubation may be achieved by awake direct laryngoscopy in the sick ICU patient whose level of consciousness may be reduced by sepsis, hypercapnia or hypoxemia. As the patient's spontaneous respiratory efforts are not depressed by the administration of drugs, additional time is available to obtain equipment and expertise in the event of failure to secure the airway. ICU intubation complications should be tracked as part of the ICU quality improvement process.

  19. [Temporary replacement of the common biliary duct by a silicone tube as an urgent repair of iatrogenic injury. Experimental study in pigs].

    PubMed

    Napolitano, Daniel A; Rodríguez Bertola, Xavier; Sambuelli, Gabriela M; Vial, Luis H; Torrecillas, Daniel A

    2015-03-01

    Surgery of the biliary tract is complex, and its volume has increased with iatrogenic injuries and living donor transplantation. The aim of this study was to analyze if the common duct can be temporarily replaced. We used nine 18-20 kg pigs. They were operated on, and their bile duct was replaced by a 100% silicone tube. All pigs underwent laboratory tests, magnetic resonance imaging, intraoperative ultrasound, cholangiography and biliar manometry with pathological biopsy examination within 60 days from the initial surgery. All pigs survived the first surgery over 60 days without laboratory evidence of evident cholestasis. Nine pigs were re-operated on at 60 days showing dilated common bile duct and hepatic ducts doubling its original size without dilating the intrahepatic bile ducts. There were no clinical, relevant laboratory or biopsy signs showing cholestasis. This experience represents the initial intention to find an optimal situation and prosthesis for replacement of the thin biliary tract, in surgical emergencies or palliative situations. The silicon tube, is a positive answer that remains permeable. A non-fibrotic reaction was found that allows a posterior definitive procedure, maintaining a good nutritional status.

  20. Nasotracheal intubation: an unusual cause of palatal perforation in an insulin dependent diabetes mellitus patient.

    PubMed

    Bhowate, Rahul; Dubey, Alok

    2004-01-01

    A case of palatal perforation occurring in 7-year-old girl with IDDM due to nasotracheal intubation is reported. The child, who was not previously diagnosed of IDDM, was brought to hospital in comatose stage and was put on nasotracheal tube for maintaining respiration. This paper highlights the link between IDDM and palatal perforation communicating the nasal cavity due to naso-tracheal intubation.

  1. Intubation methods by novice intubators in a manikin model.

    PubMed

    O'Carroll, Darragh C; Barnes, Robert L; Aratani, Ashley K; Lee, Dane C; Lau, Christopher A; Morton, Paul N; Yamamoto, Loren G; Berg, Benjamin W

    2013-10-01

    Tracheal Intubation is an important yet difficult skill to learn with many possible methods and techniques. Direct laryngoscopy is the standard method of tracheal intubation, but several instruments have been shown to be less difficult and have better performance characteristics than the traditional direct method. We compared 4 different intubation methods performed by novice intubators on manikins: conventional direct laryngoscopy, video laryngoscopy, Airtraq® laryngoscopy, and fiberoptic laryngoscopy. In addition, we attempted to find a correlation between playing videogames and intubation times in novice intubators. Video laryngoscopy had the best results for both our normal and difficult airway (cervical spine immobilization) manikin scenarios. When video was compared to direct in the normal airway scenario, it had a significantly higher success rate (100% vs 83% P=.02) and shorter intubation times (29.1 ± 27.4 sec vs 45.9 ± 39.5 sec, P=.03). In the difficult airway scenario video laryngoscopy maintained a significantly higher success rate (91% vs 71% P=0.04) and likelihood of success (3.2 ± 1.0 95%CI [2.9-3.5] vs 2.4 ± 0.9 95%CI [2.1-2.7]) when compared to direct laryngoscopy. Participants also reported significantly higher rates of self-confidence (3.5 ± 0.6 95%CI [3.3-3.7]) and ease of use (1.5 ± 0.7 95%CI [1.3-1.8]) with video laryngoscopy compared to all other methods. We found no correlation between videogame playing and intubation methods.

  2. Short-term effects of endotracheal intubation on voice.

    PubMed

    Hamdan, Abdul-Latif; Sibai, Abla; Rameh, Charbel; Kanazeh, Ghassan

    2007-11-01

    The objective of this study was to examine the vocal symptoms and acoustic changes perceived in the short period after endotracheal intubation, and to find the association between these changes and the endotracheal tube parameters. A total of 35 subjects were included. They were examined preoperatively, and 2 and 24 hours postoperatively. The vocal symptoms of hoarseness, vocal fatigue, loss of voice, throat clearing, globus pharyngeus, throat pain, and the acoustic variables mainly average fundamental frequency, relative average perturbation, shimmer, noise to harmony ratio, voice turbulence index, habitual pitch, and maximum phonation time (MPT) were assessed as such and in relation to the following endotracheal tube parameters: duration of anesthesia, number of intubation attempts, size of the tube, cuff volume, cuff mean pressure, and the emergence. The association between anesthesia parameters with incidence of vocal complaints and changes in acoustic parameters were examined using logistic and linear regression. Vocal fatigue was associated significantly with the increase in cuff volume and the number of intubation attempts. Throat clearing was associated significantly with the increase in cuff mean pressure. Only the increase in habitual pitch was associated significantly with the increase in cuff volume. The acute short-term effect of endotracheal intubation on voice is significant. The most important endotracheal tube parameters that affect the vocal changes are the cuff mean pressure and volume. The laryngeal contribution to these vocal changes seems to be minimal. All vocal symptoms increased significantly except for globus pharyngeus at 2 hours postoperatively. The acoustic parameters did not change significantly except for a decrease in MPT. At 24 hours postoperatively, all vocal symptoms subsided with no significant difference to baseline value. The habitual pitch increased significantly, and the rest of the parameters remained comparable to baseline

  3. Measurement of insulation integrity of IUE camera tube facsimiles by partial discharges method and diffusion of gases through various silicone rubbers

    NASA Technical Reports Server (NTRS)

    Bever, R. S.

    1977-01-01

    Several dummy tubes imitating the IUE Camera System design were encapsulated with Solithane 2, Conathane EN-11, Green and Black Hysols and SMRD 432. Various flaws were purposefully placed in some of these. Partial discharge testing in vacuum under direct voltage conditions was carried once a week for 12 weeks, 15 kv dc being applied during normal working hours for 40 hours duration per week. None of the units showed much damage during this time judging by the P.D. energy histograms. A more complete mathematical presentation is given on diffusion and permeation than previously. Measurements of diffusion constants for various silicone rubbers are carried out by the Time-Lag method and compared to other determinations in the literature. Calculations of the time required for diffusion through a thick wall are demonstrated in the long time approximation and for dimensions pertaining to void and wall sizes of a delamination problem in the LANDSAT-C vidicon tubes. An actual delaminated LANDSAT-C tube and some facsimiles are immersed in vacuum for long periods and tested for catastrophic breakdown due to diffusion of gas, by application of high voltage.

  4. A rare complication of tracheal intubation

    PubMed Central

    Shukeri, Wan Fadzlina Wan Muhd; Hassan, Wan Mohd Nazaruddin Wan; Nadarajan, Chandran

    2016-01-01

    Accidental endobronchial intubation is a frequent complication in critically ill patients requiring tracheal intubation (TI). If such complication occurs, it is more often the right main bronchus that is intubated due to anatomical reasons. Left main bronchus (LMB) intubation is rare. Here, we report a case with auscultatory, bronchoscopic, and radiographic evidence of accidental LMB intubation in a pregnant woman with dengue shock syndrome. We highlight this case to increase awareness about this possible-but-rare complication of TI. PMID:27275080

  5. Comparison of blind intubation through supraglottic devices and direct laryngoscopy by novices: a simulation manikin study

    PubMed Central

    Kim, Young Yong; Kang, Gu Hyun; Kim, Won Hee; Choi, Hyun Young; Jang, Yong Soo; Lee, Young Jae; Kim, Jae Guk; Kim, Hyeongtae; Kim, Gyoung Yong

    2016-01-01

    Objective This study aimed to compare intubation performance between blind intubation through supraglottic airway devices and direct laryngoscopy by novices under manikin simulation. We hypothesized that the intubation time by novices using supraglottic airway devices was superior to that with the Macintosh laryngoscope (MCL). Methods A prospective, randomized crossover study was conducted with 95 participants, to evaluate i-gel, air-Q, LMA Fastrach, and MCL devices. Primary outcomes were the intubation time and the success rate for intubation. Results The i-gel showed the shortest insertion and tube passing time among the four devices; the i-gel and air-Q also showed the shortest total intubation time (all P<0.0083; i-gel vs. air-Q, P=0.03). The i-gel and MCL showed the highest cumulative success rate (all P<0.0083; i-gel vs. MCL, P=0.12). Conclusion Blind intubation through the i-gel showed almost equal intubation performance compared to direct laryngoscopy. PMID:27752621

  6. [Effectiveness of gum elastic bougie for tracheal intubation with Airtraq optical laryngoscope].

    PubMed

    Matsuyama, Kaoru; Shibata, Mari; Fujinaka, Waso; Takatori, Makoto; Tada, Keiichi

    2012-01-01

    Although Airtraq (ATQ) is well accepted as a useful device for tracheal intubation especially in cases of difficult airway management, we sometimes encounter difficulty in insertion of a tracheal tube along the blade of ATQ across the vocal cord in spite of ATQ assistance. Gum Elastic Bougie (GEB) is well known as a practical device for intubation assistance with Macintosh laryngoscope. We studied the efficacy of GEB for intubation with ATQ. One-hundred-forty one patients scheduled for general anesthesia, ASA physical status 1 or 2, were allocated into two groups randomly; patients intubated with ATQ without GEB (n = 70), and those with ATQ with GEB (n = 71). Twenty anesthegiologists were assinged to them evenly according to their experience. We measured the time they needed for intubation. The combinational advantage of ATQ and GEB was not significantly proved among board certified anesthesiologist. However, among non-board-certified anesthesiologist group, the time needed for successful intubation was significantly shorter with combined use of ATQ and GEB. For the people with less experience of intubation, GEB is useful assistance for intubation with ATQ. It was concluded that the combined use of ATQ and GEB is a simple and effective process for ordinary doctors or paramedics.

  7. Making endotracheal intubation easy and successful, particularly in unexpected difficult airway

    PubMed Central

    Abdulla, Susanne; Abdulla, Sina; Schwemm, Karl-Peter; Eckhardt, Regina; Abdulla, Walied

    2014-01-01

    Background: Difficult intubation, most often due to poor view of the vocal cords on laryngoscopy is an intermittent and often challenging problem for clinically practicing anesthesiologists, maxillofacial surgeons, ear nose, and throat (ENT), emergency, and critical care physicians. Purpose: We present a new approach for facilitating difficult intubation and evaluate its efficacy in a retrospective observational study. Settings and Design: Operating room, emergency department, intensive care unit (ICU), retrospective observational study. Materials and Methods: A semirigid 5.6 Rüsch tracheal tube introducer (bougie) with its soft tip protruding at least 6 cm (=4 digits) beyond the distal end of the tube was used. After its insertion through the larynx under laryngoscopy, the tube was gently advanced upon rotation at 360° clockwise. Statistical Analysis: Descriptive. Results: Anesthesia services were analyzed on 10,363 patients over 12 months. In 2453 patients (23.7%) (Group A) intubated in the usual way, difficulties were encountered in 63 patients (2.6%). They were managed either with tube rotation technique (n = 60) or Bonfils endoscope (n = 3). In contrast, 2807 patients (27.1%) (Group B) were intubated using tube rotation technique with introducer. Difficult intubations occurred only in three patients (0.11%) who could be managed with tube rotation by experienced consultant anesthesiologists. Conclusions: The tube rotation technique for intubation was introduced during the Gulf War and has been practiced for the past 19 years without any obvious damage to the trachea in Germany. However, it should be used only by physicians being well familiar with this technique. In addition, well designed controlled studies are needed. PMID:24741494

  8. Endotracheal intubation in the dog.

    PubMed

    Brown, Cyndi

    2007-02-01

    In dogs, endotracheal intubation is often necessary for surgery, dental prophylaxis, or other procedures that require gas anesthesia or ventilation. Following a few simple guidelines can help ensure that the procedure is done safely and effectively.

  9. Cervical Spinal Motion During Intubation.

    DTIC Science & Technology

    2000-01-01

    Ten fresh human cadavers were intubated while recording cervical motion using a cinefluoroscopic technique. Segmental cervical motion from the...performed using no external stabilization, Gardner-Wells traction and manual in-line cervical immobilization. The data are currently being analyzed. A...paper entitled Segmental cervical spine motion during orotracheal intubation of the intact and injured spine with and without external stabilization was published in the Journal of Neurosurgery.

  10. Pulmonary Delivery of Vancomycin Dry Powder Aerosol to Intubated Rabbits.

    PubMed

    Sullivan, Bradley P; El-Gendy, Nashwa; Kuehl, Christopher; Berkland, Cory

    2015-08-03

    Antibiotic multiresistant pneumonia is a risk associated with long-term mechanical ventilation. Vancomycin is commonly prescribed for methicillin-resistant Staphylococcus aureus infections; however, current formulations of vancomycin are only given intravenously. High doses of vancomycin have been associated with severe renal toxicity. In this study, we characterized dry powder vancomyin as a potential inhaled therapeutic aerosol and compared pharmacokinetic profiles of iv and pulmonary administered vancomycin in intubated rabbits through an endotracheal tube system. Cascade impaction studies indicated that using an endotracheal tube, which bypasses deposition in the mouth and throat, increased the amount of drug entering the lung. Bypassing the endotracheal tube with a catheter further enhanced drug deposition in the lung. Interestingly, intubated rabbits administered 1 mg/kg vancomycin via inhalation had similar AUC to rabbits that were administered 1 mg/kg vancomycin via a single bolus iv infusion; however, inhalation of vancomycin reduced Cmax and increased Tmax, indicating that inhaled vancomycin resulted in more sustained pulmonary levels of vancomycin. Collectively, these results suggested that dry powder vancomycin can successfully be delivered by pulmonary inhalation in intubated patients. Furthermore, as inhaled vancomycin is delivered locally to the site of pulmonary infection, this delivery route could reduce the total dose required for therapeutic efficacy and simultaneously reduce the risk of renal toxicity by eliminating the high levels of systemic drug exposure required to push the pulmonary dose to therapeutic thresholds during iv administration.

  11. In situ silicone tube microextraction: a new method for undisturbed sampling of root-exuded thiophenes from marigold (Tagetes erecta L.) in soil.

    PubMed

    Mohney, Brian K; Matz, Tricia; Lamoreaux, Jessica; Wilcox, David S; Gimsing, Anne Louise; Mayer, Philipp; Weidenhamer, Jeffrey D

    2009-11-01

    The difficulties of monitoring allelochemical concentrations in soil and their dynamics over time have been a major barrier to testing hypotheses of allelopathic effects. Here, we evaluate three diffusive sampling strategies that employ polydimethylsiloxane (PDMS) sorbents to map the spatial distribution and temporal dynamics of root-exuded thiophenes from the African marigold, Tagetes erecta. Solid phase root zone extraction (SPRE) probes constructed by inserting stainless steel wire into PDMS tubing were used to monitor thiophene concentrations at various depths beneath marigolds growing in PVC pipes. PDMS sheets were used to map the distribution of thiophenes beneath marigolds grown in thin glass boxes. Concentrations of the two major marigold thiophenes measured by these two methods were extremely variable in both space and time. Dissection and analysis of roots indicated that distribution of thiophenes in marigold roots also was quite variable. A third approach used 1 m lengths of PDMS microtubing placed in marigold soil for repeated sampling of soil without disturbance of the roots. The two ends of the tubing remained out of the soil so that solvent could be washed through the tubing to collect samples for HPLC analysis. Unlike the other two methods, initial experiments with this approach show more uniformity of response, and suggest that soil concentrations of marigold thiophenes are affected greatly even by minimal disturbance of the soil. Silicone tube microextraction gave a linear response for alpha-terthienyl when maintained in soils spiked with 0-10 ppm of this thiophene. This method, which is experimentally simple and uses inexpensive materials, should be broadly applicable to the measurement of non-polar root exudates, and thus provides a means to test hypotheses about the role of root exudates in plant-plant and other interactions.

  12. Antimicrobial activity of silica coated silicon nano-tubes (SCSNT) and silica coated silicon nano-particles (SCSNP) synthesized by gas phase condensation.

    PubMed

    Tank, Chiti; Raman, Sujatha; Karan, Sujoy; Gosavi, Suresh; Lalla, Niranjan P; Sathe, Vasant; Berndt, Richard; Gade, W N; Bhoraskar, S V; Mathe, Vikas L

    2013-06-01

    Silica-coated, silicon nanotubes (SCSNTs) and silica-coated, silicon nanoparticles (SCSNPs) have been synthesized by catalyst-free single-step gas phase condensation using the arc plasma process. Transmission electron microscopy and scanning tunneling microscopy showed that SCSNTs exhibited a wall thickness of less than 1 nm, with an average diameter of 14 nm and a length of several 100 nm. Both nano-structures had a high specific surface area. The present study has demonstrated cheaper, resistance-free and effective antibacterial activity in silica-coated silicon nano-structures, each for two Gram-positive and Gram-negative bacteria. The minimum inhibitory concentration (MIC) was estimated, using the optical densitometric technique, and by determining colony-forming units. The MIC was found to range in the order of micrograms, which is comparable to the reported MIC of metal oxides for these bacteria. SCSNTs were found to be more effective in limiting the growth of multidrug-resistant Staphylococcus aureus over SCSNPs at 10 μg/ml (IC 50 = 100 μg/ml).

  13. The temporary effect of short-term endotracheal intubation on vocal function.

    PubMed

    Paulauskiene, Iveta; Lesinskas, Eugenijus; Petrulionis, Mindaugas

    2013-01-01

    The objective of the study was to assess and perceive the vocal and pharyngeal symptoms and acoustic changes of voice after short-term endotracheal intubation and to evaluate the relation between these changes and the endotracheal tube parameters, number of intubation attempts, duration of anaesthesia, experience of anaesthesiologist. A total of 108 patients were evaluated preoperatively, 1-2 and 24 h after extubation. The vocal and pharyngeal symptoms, voice acoustic characteristics and maximum phonation time (MPT) were evaluated to find the relationship with endotracheal tube parameters, number of intubation attempts, duration of anaesthesia, experience of anaesthesiologist. All vocal and pharyngeal symptoms increased significantly at 24 h and remained significantly increased at 24 h after general anaesthesia. The vocal acoustic parameters changed significantly at 1-2 h: decrease of MPT and increase relative average perturbation were recorded. The day after the short-term intubation: only noise to harmony ratio and habitual pitch remains significantly changed. The most important endotracheal tube parameters that affect significantly (P value <0.05) the vocal function were the size of tube, cuff volume and number of intubation attempts. In relation to the anaesthesia, the changes of the acoustic parameters did not associate significantly with the anaesthesia-related parameters. No statistically significant relationship between experience of an anaesthesiologist and changes of the voice after anaesthesia was detected. Though being short-term, endotracheal anaesthesia is an invasive procedure, and its temporary influence on vocal function is important.

  14. A canine model of tracheal stenosis induced by cuffed endotracheal intubation

    PubMed Central

    Su, Zhuquan; Li, Shiyue; Zhou, Ziqing; Chen, Xiaobo; Gu, Yingying; Chen, Yu; Zhong, Changhao; Zhong, Minglu; Zhong, Nanshan

    2017-01-01

    Postintubation tracheal stenosis is a complication of endotracheal intubation. The pathological mechanism and risk factors for endotracheal intubation-induced tracheal stenosis remain not fully understood. We aimed to establish an animal model and to investigate risk factors for postintubation tracheal stenosis. Beagles were intubated with 4 sized tubes (internal diameter 6.5 to 8.0 mm) and cuff pressures of 100 to 200 mmHg for 24 hr. The status of tracheal wall was evaluated by bronchoscopic and histological examinations. The model was successfully established by cuffed endotracheal intubation using an 8.0 mm tube and an intra-cuff pressure of 200 mmHg for 24 hr. When the intra-cuff pressures were kept constant, a larger sized tube would induce a larger tracheal wall pressure and more severe injury to the tracheal wall. The degree of tracheal stenosis ranged from 78% to 91% at 2 weeks postextubation. Histological examination demonstrated submucosal infiltration of inflammatory cells, hyperplasia of granulation tissue and collapse of tracheal cartilage. In summary, a novel animal model of tracheal stenosis was established by cuffed endotracheal intubation, whose histopathological feathers are similar to those of clinical cases of postintubation tracheal stenosis. Excessive cuff pressure and over-sized tube are the risk factors for postintubation tracheal stenosis. PMID:28349955

  15. Air-Q intubating laryngeal airway: A study of the second generation supraglottic airway device

    PubMed Central

    Attarde, Viren Bhaskar; Kotekar, Nalini; Shetty, Sarika M

    2016-01-01

    Background and Aims: Air-Q intubating laryngeal mask airway (ILA) is used as a supraglottic airway device and as a conduit for endotracheal intubation. This study aims to assess the efficacy of the Air-Q ILA regarding ease of insertion, adequacy of ventilation, rate of successful intubation, haemodynamic response and airway morbidity. Methods: Sixty patients presenting for elective surgery at our Medical College Hospital were selected. Following adequate premedication, baseline vital parameters, pulse rate and blood pressure were recorded. Air-Q size 3.5 for patients 50-70 kg and size 4.5 for 70-100 kg was selected. After achieving adequate intubating conditions, Air-Q ILA was introduced. Confirming adequate ventilation, appropriate sized endotracheal tube was advanced through the Air-Q blindly to intubate the trachea. Placement of the endotracheal tube in trachea was confirmed. Results: Air-Q ILA was successfully inserted in 88.3% of patients in first attempt and 11.7% patients in second attempt. Ventilation was adequate in 100% of patients. Intubation was successful in 76.7% of patients with Air-Q ILA. 23.3% of patients were intubated by direct laryngoscopy following failure with two attempts using Air-Q ILA. Post-intubation the change in heart rate was statistically significant (P < 0.0001). 10% of patients were noted to have a sore throat and 5% of patients had mild airway trauma. Conclusion: Air-Q ILA is a reliable device as a supraglottic airway ensuring adequate ventilation as well as a conduit for endotracheal intubation. It benefits the patient by avoiding the stress of direct laryngoscopy and is also superior alternative device for use in a difficult airway. PMID:27212722

  16. Teaching fibreoptic intubation in anaesthetised patients.

    PubMed

    Schaefer, H G; Marsch, S C; Keller, H L; Strebel, S; Anselmi, L; Drewe, J

    1994-04-01

    One hundred ASA grade 1 and 2 patients requiring orotracheal intubation for various general surgical procedures were randomly assigned to receive either expert rigid laryngoscopic or novice fibreoptic orotracheal intubation under total intravenous anaesthesia. Five anaesthesia residents in the 4th year, with no prior experience in fibreoptic laryngoscopy, participated in a fibreoptic training course, viewing two instructional videos and practising on the intubation manikin. Each resident intubated 20 patients in a randomised fashion either as an expert laryngoscopist or as a fibreoptic novice. The time (SEM) to achieve successful intubation was statistically different for fibreoptic and rigid intubation (77.2 (5.1) s vs 17.7 (1.6) s, p < 0.01). The time to achieve successful rigid laryngoscopic intubation remained constant over the ten intubations, whereas time required for fibreoptic intubation decreases significantly (p < 0.01). The learning objectives (fibreoptic intubation times in 60 s or less and with 90% or greater success rate on the first intubation attempt) were met by all residents. The haemodynamic profile was similar for fibreoptically intubated and conventionally intubated patients and there was no difference between the first two or the last two fibreoptic or rigid intubations. The study was designed to detect a difference of 10% in means (assuming alpha = 0.05 and beta < or = 0.2). The incidence of postoperative sore throat, dysphagia or hoarseness was similar in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)

  17. Smartphone technology enhances newborn intubation knowledge and performance amongst paediatric trainees.

    PubMed

    Hawkes, Colin Patrick; Walsh, Brian Henry; Ryan, C Anthony; Dempsey, Eugene Michael

    2013-02-01

    Smartphones are widely used by physicians, but their effectiveness in improving teaching of clinical skills is not known. The aim of this study was to determine if pre procedural use of a smartphone neonatal intubation instructional application (NeoTube) improves trainee knowledge and enhances procedural skills performance in newborn intubation. Neonatal Resuscitation Program certified trainees in paediatrics and neonatology completed a knowledge based questionnaire on neonatal intubation, and were recorded intubating a term newborn manikin model. They then used the NeoTube iPhone application for 15 min, before completing the questionnaire and intubation again. Video recordings were later reviewed by two independent assessors, blinded to whether it was pre or post NeoTube use. 20 paediatric trainees (12 fellows and 8 residents) participated in this study. Comparing pre and post-viewing of the application, Questionnaire Scores (median (range)) increased from 18.5 (8-28) to 31 (24-35) (P<0.001), with calculation scores increasing from 6 (0-11) to 11 (6-12) (P<0.001), Skill Scores increased from 11 (9-15) to 12.5 (9-16) (P=0.016), and the duration of intubation attempt decreased from 39 to 31 s (P=0.044) following utilisation of the application. There was a significant positive correlation with duration of specialist training for procedure performance post viewing, but not pre viewing of the application. Bedside use of smartphones can enhance both knowledge of newborn intubation and improves procedural performance, including reducing the time to successfully intubate. Smartphones may have a useful role in bringing procedural skills training closer to the bedside. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  18. Endotracheal intubation with intubating laryngeal mask airway (ILMA), C-Trach, and Cobra PLA in simulated cervical spine injury patients: a comparative study.

    PubMed

    Mathew, Deepak G; Ramachandran, Rashmi; Rewari, Vimi; Trikha, Anjan; Chandralekha

    2014-10-01

    The aim of our study was to evaluate the success rate of fiberoptic-guided endotracheal intubation through an Intubating Laryngeal Mask Airway (ILMA), a Cobra Perilaryngeal Airway (Cobra PLA), and a C-Trach Laryngeal Mask Airway (C-Trach) in patients whose necks are stabilized in a hard cervical collar. One hundred and eighty ASA I-II patients were randomized to undergo endotracheal intubation after general anesthesia via an ILMA (group ILMA), a C-Trach (group C-Trach) or a Cobra PLA (group CPLA) with the application of an appropriately-sized hard cervical collar. A fiberoptic bronchoscope was used for intubation via the ILMA and Cobra PLA. Rate of successful insertion of an endotracheal tube through the three devices was the primary aim. Other parameters compared were time taken for device insertion, endotracheal intubation, hemodynamic changes, incidence of hypoxia, and mucosal injury during the procedure. The incidence of postoperative sore throat was also compared between the three groups. The success rates of intubation in the ILMA, C-Trach, and CPLA groups were 100, 100, and 98% respectively. The first-attempt success rate was significantly better with the C-Trach compared to Cobra PLA (100 vs. 85%, p < 0.05). The time taken for device insertion was significantly more with the Cobra PLA as compared to that taken with an ILMA or a C-Trach (35.7 vs. 30.3 and 27.5 s, respectively). Intubation through a C-Trach took the least amount of time (84.4 s) as compared to an ILMA (117.9 s) or a Cobra PLA (139.2 s). The incidence of hypoxia and airway morbidity was similar between the groups. The success rates of fiberoptic-guided endotracheal intubation through an ILMA and a Cobra PLA are similar to the success rate of intubation using a C-Trach in patients whose cervical spines are immobilized with a hard cervical collar.

  19. Sonographic detection of tracheal or esophageal intubation: A cadaver study

    PubMed Central

    Tejesh, CA; Manjunath, AC; Shivakumar, S; Vinayak, PS; Yatish, B; Geetha, CR

    2016-01-01

    Background: The correct position of the endotracheal tube is confirmed by various modalities, most of which are not entirely reliable. Ultrasound is now increasingly available to anesthesiologists in the operating theater and is an attractive alternative. To investigate the usefulness of sonography in identifying the correct tracheal tube position in human cadavers. Materials and Methods: Endotracheal tubes placed randomly into trachea or esophagus was identified with a linear ultrasound probe placed transversely just above the suprasternal notch by a single anesthesiologist. Results: Of the 100 intubations performed at random, 99 were correctly identified to give a sensitivity of 100% and a specificity of 97.9%. Conclusion: Sonography is a useful technique to identify correct position of the tracheal tube. PMID:27375387

  20. Mask versus nasal tube for stabilization of preterm infants at birth: a randomized controlled trial.

    PubMed

    Kamlin, C Omar F; Schilleman, Kim; Dawson, Jennifer A; Lopriore, Enrico; Donath, Susan M; Schmölzer, Georg M; Walther, Frans J; Davis, Peter G; Te Pas, Arjan B

    2013-08-01

    Positive-pressure ventilation (PPV) using a manual ventilation device and a face mask is recommended for compromised newborn infants in the delivery room (DR). Mask ventilation is associated with airway obstruction and leak. A nasal tube is an alternative interface, but its safety and efficacy have not been tested in extremely preterm infants. An unblinded randomized controlled trial was conducted in Australia, and the Netherlands. Infants were stratified by gestational age (24-25/26-29 weeks) and center. Immediately before birth infants were randomly assigned to receive PPV and/or continuous positive airway pressure with either a nasal tube or a size 00 soft, round silicone mask. Resuscitation protocols were standardized; respiratory support was provided using a T-piece device commencing in room air. Criteria for intubation included need for cardiac compressions, apnea, continuous positive airway pressure >7 cm H2O, and fraction of inspired oxygen >0.4. Primary outcome was endotracheal intubation in the first 24 hours from birth. Three hundred sixty-three infants were randomly assigned; the study terminated early on the grounds of futility. Baseline variables were similar between groups. Intubation rates in the first 24 hours were 54% and 55% in the nasal tube and face mask groups, respectively (odds ratio: 0.97; 95% confidence interval: 0.63-1.50). There were no important differences in any of the secondary outcomes within the whole cohort or between the 2 gestational age subgroups. In infants at <30 weeks' gestation receiving PPV in the DR, there were no differences in short-term outcomes using the nasal tube compared with the face mask.

  1. Gargling with povidone-iodine reduces the transport of bacteria during oral intubation.

    PubMed

    Ogata, Junichi; Minami, Kouichiro; Miyamoto, Hiroshi; Horishita, Takafumi; Ogawa, Midori; Sata, Takeyoshi; Taniguchi, Hatsumi

    2004-11-01

    Nosocomial pneumonia remains a common complication in patients undergoing endotracheal intubation. This study examined the transport of bacteria into the trachea during endotracheal intubation, and evaluated the effects of gargling with povidone-iodine on bacterial contamination of the tip of the intubation tube. In the gargling group, patients gargled with 25 mL of povidone-iodine (2.5 mg.mL(-1)). In the control group, patients gargled with 25 mL of tap water. Before tracheal intubation, microorganisms were obtained from the posterior wall of the patient's pharynx using sterile cotton swabs. After anesthesia, all patients were extubated and bacteria contaminating the tip of the tracheal tube were sampled and cultured. Before orotracheal intubation, all 19 patients who gargled with tap water (control group) had bacterial colonization on the posterior walls of the pharynx. This group included five patients who had methicillin-resistant staphylococcus aureus (MRSA) in their nasal cavity preoperatively and MRSA was also detected in the pharynx of four patients. Bacterial colonization was observed in all 19 patients who gargled with povidone-iodine (gargling group) and four patients carried MRSA in their nasal cavity, although no MRSA was detected in the pharynx. In the control group, all the patients had bacterial colonization at the tip of the tube after extubation. Additionally, MRSA was detected in two of the four patients. In the gargling group, povidone-iodine eradicated general bacteria and MRSA colonies in the pharynx before intubation and at the tip of the tube after extubation. Gargling with povidone-iodine before oral intubation reduces the transport of bacteria into the trachea.

  2. Long term intubation and successful weaning in two children with Guillain-Barre syndrome.

    PubMed

    Javed, H; Nair, M P; Koul, R L; Chacko, A; Fazalullah, M

    2000-07-01

    No definite criteria exists in Guillian-Barre syndrome in children regarding prolonged ventilation through an endo-tracheal tube without tracheostomy and successful weaning using a T-piece. Here we report two such cases of Guillian-Barre syndrome requiring prolonged intubation for 56 days and ventilation for 30 days and ultimately successfully weaning them using the T-piece. Both the children eventually made a complete recovery, highlighting the point that in children prolonged intubation and ventilation using the portex tube is equally good, if not, better than tracheostomy with its attendant risks.

  3. Nasogastric tube placement in the rabbit.

    PubMed

    Brown, Cyndi

    2010-01-01

    If a rabbit is ill or will be undergoing certain types of surgery, it may need to be fed using a nasogastric tube. Nasogastric intubation is easy and is an effective means of delivering nutrition and fluids when other feeding methods are not feasible. This column describes how to place a nasogastric tube in a rabbit.

  4. Stylet angulation for routine endotracheal intubation with McGrath videolaryngoscope

    PubMed Central

    Lee, Jiyoung; Kim, Jong Yeop; Kang, Se Yoon; Kwak, Hyun Jeong; Lee, Dongchul; Lee, Sook Young

    2017-01-01

    Abstract Background: The McGrath videolaryngoscope (VL) provides excellent laryngoscopic views, but directing an endotracheal tube can be difficult, and thus the routine use of a stylet is recommended. The goal of this study is to determine the appropriate angle (60° vs 90°) of the stylet when using the McGrath VL by comparing the time to intubation (TTI). Methods: One hundred and forty patients aged 19 to 70 years (American Society of Anesthesiologists classification I or II) who required tracheal intubation for elective surgery were randomly allocated to 1 of 2 groups, at the 60° angle (n = 70) or the 90° angle (n = 70). Anesthesia was induced with propofol, fentanyl, and rocuronium. The primary outcome was TTI assessed by a blind observer. Glottic grade, use of optimal external laryngeal manipulation, failed intubation at first attempt, ease of intubation, and severity of oropharyngeal bleeding were also recorded. Results: The mean TTI was significantly shorter in the 60° group than in the 90° group (29.3 ± 6.4 vs 32.5 ± 9.4 s, P = 0.022). The glottic grade and degree of intubation difficulty were not significantly different between the 2 groups. Conclusions: When intubating the patients with the McGrath videolaryngoscope, the 60° angled stylet allowed for faster orotracheal intubation than did the 90° angled stylet. PMID:28207549

  5. Stylet angulation for routine endotracheal intubation with McGrath videolaryngoscope.

    PubMed

    Lee, Jiyoung; Kim, Jong Yeop; Kang, Se Yoon; Kwak, Hyun Jeong; Lee, Dongchul; Lee, Sook Young

    2017-02-01

    The McGrath videolaryngoscope (VL) provides excellent laryngoscopic views, but directing an endotracheal tube can be difficult, and thus the routine use of a stylet is recommended. The goal of this study is to determine the appropriate angle (60° vs 90°) of the stylet when using the McGrath VL by comparing the time to intubation (TTI). One hundred and forty patients aged 19 to 70 years (American Society of Anesthesiologists classification I or II) who required tracheal intubation for elective surgery were randomly allocated to 1 of 2 groups, at the 60° angle (n = 70) or the 90° angle (n = 70). Anesthesia was induced with propofol, fentanyl, and rocuronium. The primary outcome was TTI assessed by a blind observer. Glottic grade, use of optimal external laryngeal manipulation, failed intubation at first attempt, ease of intubation, and severity of oropharyngeal bleeding were also recorded. The mean TTI was significantly shorter in the 60° group than in the 90° group (29.3 ± 6.4 vs 32.5 ± 9.4 s, P = 0.022). The glottic grade and degree of intubation difficulty were not significantly different between the 2 groups. When intubating the patients with the McGrath videolaryngoscope, the 60° angled stylet allowed for faster orotracheal intubation than did the 90° angled stylet.

  6. Fiberoptic bronchoscopy-assisted endotracheal intubation in a patient with a large tracheal tumor.

    PubMed

    Pang, Lei; Feng, Yan-Hua; Ma, Hai-Chun; Dong, Su

    2015-04-01

    In the event of a high degree of airway obstruction, endotracheal intubation can be impossible and even dangerous, because it can cause complete airway obstruction, especially in patients with high tracheal lesions. However, a smaller endotracheal tube under the guidance of a bronchoscope can be insinuated past obstructive tumor in most noncircumferential cases. Here we report a case of successful fiberoptic bronchoscopy-assisted endotracheal intubation in a patient undergoing surgical resection of a large, high tracheal tumor causing severe tracheal stenosis. A 42-year-old Chinese man presented with dyspnea, intermittent irritable cough, and sleep deprivation for one and a half years. X-rays and computed tomography scan of the chest revealed an irregular pedunculated soft tissue mass within the tracheal lumen. The mass occupied over 90% of the lumen and caused severe tracheal stenosis. Endotracheal intubation was done to perform tracheal tumor resection under general anesthesia. After several failed conventional endotracheal intubation attempts, fiberoptic bronchoscopy-assisted intubation was successful. The patient received mechanical ventilation and then underwent tumor resection and a permanent tracheostomy. This case provides evidence of the usefulness of the fiberoptic bronchoscopy-assisted intubation technique in management of an anticipated difficult airway and suggests that tracheal intubation can be performed directly in patients with a tracheal tumor who can sleep in the supine position, even if they have occasional sleep deprivation and severe tracheal obstruction as revealed by imaging techniques.

  7. Retrograde nasal intubation via the cleft in Pierre-Robin Sequence neonates: a case series.

    PubMed

    Portnoy, Joel E; Tatum, Sherard

    2009-12-01

    Pierre-Robin Sequence, the triad of glossoptosis, micrognathia and cleft palate, provides a challenge in airway management both in and out of the operating room. Transnasal intubation is greatly preferred during its surgical intervention for maximum oral exposure in these very small patients without the added encumbrance of an oral endotracheal tube. From 2001 to 2009, three neonates with Pierre-Robin Sequence who underwent surgery to improve their airway had a novel method of securing a transnasal airway performed in the operating theater. After successful placement of a laryngeal mask airway (LMA) and subsequent endotracheal intubation via the LMA, this technique was used to convert from an oral to a nasal intubation. After the LMA is removed, a smaller endotracheal tube is placed into the nose and out of the mouth via the cleft in each of these patients. This smaller tube is then telescoped into the larger one and secured with suture. Both tubes are subsequently backed out of the nose in a retrograde fashion and disarticulated so that the now transnasal endotracheal tube can be re-connected to the anesthesia circuit. This case series highlights a rapid technique utilizing the patient's congenital defect for securing a transnasal airway alternative to that of transnasal fiberoptic intubation in Pierre-Robin Sequence neonates.

  8. Safe intubation in Morquio-Brailsford syndrome: A challenge for the anesthesiologist.

    PubMed

    Chaudhuri, Souvik; Duggappa, Arun Kumar Handigodu; Mathew, Shaji; Venkatesh, Sandeep

    2013-04-01

    Morquio-Brailsford syndrome is a type of mucopolysaccharidoses. It is a rare disease with features of short stature, atlantoaxial instability with risk of cord damage, odontoid hypoplasia, pectus carinatum, spine deformities, hepatomegaly, and restrictive lung disease. Neck movements during intubation are associated with the risk of quadriparesis due to cervical instability. This, along with the distortion of the airway anatomy due to deposition of mucopolysaccharides makes airway management arduous. We present our experience in management of difficult airway in a 3-year-old girl with Morquio-Brailsford syndrome posted for magnetic resonance imaging and computerized tomography scan of a suspected unstable cervical spine. As utmost sagacity during intubation is required, the child was intubated inside operation theatre in the presence of experienced anesthesiologists and then shifted to the peripheral location. Intubation was done with an endotracheal tube railroaded over a pediatric fibreoptic bronchoscope passed through the lumen of a classic laryngeal mask airway, keeping head in neutral position.

  9. An active simulator for neonatal intubation: Design, development and assessment.

    PubMed

    Baldoli, Ilaria; Tognarelli, Selene; Vangi, Ferdinando; Panizza, Davide; Scaramuzzo, Rosa T; Cuttano, Armando; Laschi, Cecilia; Menciassi, Arianna

    2017-01-01

    This study describes the technical realization and the pre-clinical validation of a instrumented neonatal intubation skill trainer able to provide objective feedback for the improvement of clinical competences required for such a delicate procedure. The Laerdal(®) Neonatal Intubation Trainer was modified by applying pressure sensors on areas that are mainly subject to stress and potential injuries. Punctual Force Sensing Resistors (FSRs) were characterized and fixed on the external side of the airway structure on the dental arches and epiglottis. A custom silicone tongue was designed and developed to integrate a matrix textile sensor for mapping the pressure applied on its whole surface. The assessment of the developed tool was performed by nine clinical experts who were asked to practice three intubation procedures apiece. Median and maximum forces, over threshold events (i.e. 2N for gingival arch sensors and 7N for epiglottis and tongue sensors respectively) and execution time were measured for each trainee. Data analysis from training sessions revealed that the epiglottis is the point mainly stressed during an intubation procedure (maximum value: 16.69N, median value: 3.11N), while the analysis carried out on the pressure distribution on the instrumented tongue provided information on both force values and distribution, according to clinicians' performance. The debriefing phase was used to enhance the clinicians' awareness of applied force and gestures performed, confirming that the present study is an adequate starting point for achieving and optimizing neonatal intubation skills for both residents and expert clinicians. Copyright © 2016 IPEM. Published by Elsevier Ltd. All rights reserved.

  10. Preparing hydroxyapatite-silicon composite suspensions with homogeneous distribution of multi-walled carbon nano-tubes for electrophoretic coating of NiTi bone implant and their effect on the surface morphology

    NASA Astrophysics Data System (ADS)

    Khalili, Vida; Khalil-Allafi, Jafar; Xia, Wei; Parsa, Alireza B.; Frenzel, Jan; Somsen, Christoph; Eggeler, Gunther

    2016-03-01

    Preparing a stable suspension is a main step towards the electrophoretically depositing of homogeneous and dense composite coatings on NiTi for its biomedical application. In the present study, different composite suspensions of hydroxyapatite, silicon and multi-walled carbon nano-tubes were prepared using n-butanol and triethanolamine as media and dispersing agent, respectively. Multi-walled carbon nanotubes were first functionalized in the nitric acid vapor for 15 h at 175 °C, and then mixed into suspensions. Thermal desorption spectroscopy profiles indicate the formation of functional groups on multi-walled carbon nano-tubes. An excellent suspension stability can be achieved for different amounts of triethanolamine. The amount of triethanolamine can be increased by adding a second component to a stable hydroxyapatite suspension due to an electrostatic interaction between components in suspension. The stability of composite suspension is less than that of the hydroxyapatite suspension, due to density differences, which under the gravitational force promote the demixing. The scanning electron microscopy images of the coatings surface show that more dense coatings are developed on NiTi substrate using electrophoretic deposition and sintering at 850 °C in the simultaneous presence of silicon and multi-walled carbon nanotubes in the hydroxyapatite coatings. The atomic force microscopy results of the coatings surface represent that composite coatings of hydroxyapatite-20 wt.% silicon and hydroxyapatite-20 wt.% silicon-1 wt.% multi-walled carbon nano-tubes with low zeta potential have rougher surfaces.

  11. Orotracheal intubation in infants performed with a stylet versus without a stylet.

    PubMed

    O'Shea, Joyce E; O'Gorman, Jennifer; Gupta, Aakriti; Sinhal, Sanjay; Foster, Jann P; O'Connell, Liam Af; Kamlin, C Omar F; Davis, Peter G

    2017-06-22

    .47). Success rates did not differ between groups in subgroup analyses by provider level of training and infant weight. Results showed no differences in secondary review outcomes, including duration of intubation, number of attempts, participant instability during the procedure, and local airway trauma. Only 25% of all intubations took less than 30 seconds to perform. Study authors did not report neonatal morbidity nor mortality. We considered the quality of evidence as low on GRADE analysis, given that we identified only one unblinded study. Current available evidence suggests that use of a stylet during neonatal orotracheal intubation does not significantly improve the success rate among paediatric trainees. However, only one brand of stylet and one brand of endotracheal tube have been tested, and researchers performed all intubations on infants in a hospital setting. Therefore, our results cannot be generalised beyond these limitations.

  12. Clinical significance of differentiating post-intubation and post-tracheostomy tracheal stenosis.

    PubMed

    Shin, Beomsu; Kim, Kang; Jeong, Byeong-Ho; Eom, Jung Seop; Song, Won Jun; Kang, Hyung Koo; Kim, Hojoong

    2017-04-01

    Post-intubation tracheal stenosis (PITS) and post-tracheostomy tracheal stenosis (PTTS) are serious complications in mechanically ventilated patients. Although the aetiologies and mechanisms of PITS and PTTS are quite different, little is known about the clinical impact of differentiating one from the other. We retrospectively conducted a chart review of 117 patients with PITS and 88 patients with PTTS who were treated with interventional bronchoscopy at Samsung Medical Center between January 2004 and December 2013. Compared to patients with PITS, patients with PTTS had a lower BMI, poorer performance status and more frequent neurological aetiologies, mid-to-lower tracheal lesions, total obstruction and mixed stenosis types. Although there were no differences in the number of patients who received silicone stents between the two groups, Montgomery T-tubes were more frequently used in the PTTS group than in the PITS group. The final success rate without surgery, mortality or tracheostomy in situ was higher in the PITS group than in the PTTS group (76.9% vs 63.6%, P = 0.043). Additionally, airway prosthesis removal was achieved in 46.2% of patients in the PITS group and in 33.0% of the PTTS group (P = 0.063). There were significant differences between PITS and PTTS in terms of patient and stenosis characteristics, treatment modalities and clinical outcomes. Therefore, PITS and PTTS should be considered two different entities. © 2016 Asian Pacific Society of Respirology.

  13. Hypoglossal neuropraxia following endotracheal intubation.

    PubMed

    Venkatesh, B; Walker, D

    1997-12-01

    A case of hypoglossal nerve neuropraxia following elective drainage of bilateral chronic subdural haematomas is described. We postulate that the cause of neuropraxia was inadvertent extubation of the trachea with the cuff inflated, leading to compression and stretch of the nerve against the greater horn of the hyoid bone. The literature on cranial nerve palsies following endotracheal intubation is reviewed.

  14. Predictors of postoperative sore throat in intubated children.

    PubMed

    Calder, Alyson; Hegarty, Mary; Erb, Thomas O; von Ungern-Sternberg, Britta S

    2012-03-01

    The incidence of postoperative sore throat (POST) following intubation is not well defined in the pediatric population. The etiology is multifactorial and includes impairment of subglottic mucosal perfusion and edema as a result of the pressures exerted by cuffed or uncuffed tubes. To determine the incidence of, and risk factors for, POST in intubated children undergoing elective day-case surgery. Five hundred patients aged 3-16 years were studied prospectively. Endotracheal tube (ETT) choice (cuffed or uncuffed) was left to the anesthetist. The cuff was inflated either until loss of audible leak or to a determined pressure using a cuff manometer. The research team then measured the cuff pressure (CP). POST incidence and intensity was determined by interviewing patients prior to discharge from the same day procedure unit. Chi-square testing and stepwise logistic regression were used to determine the predictors of POST. Of the 111 (22%) children developed a sore throat, 19 (3.8%) a sore neck, and 5 (1%) a sore jaw. 19% of patients with cuffed ETTs complained of sore throat compared with 37% of those intubated with an uncuffed ETT. The incidence of POST increased with CP; 0-10% at 0 cmH(2)O, 4% at 11-20 cmH(2)O, 20% at 21-30 cmH(2)O, 68% at CP 31-40 cmH(2)O, and 96% at CP >40 cmH(2)O. The ETT CP and use of uncuffed ETTs were univariate predictors of POST. Children intubated with uncuffed ETTs are more likely to have POST. ETT CP is positively correlated with the incidence of POST. When using cuffed ETTs, CP should be routinely measured intraoperatively. © 2011 Blackwell Publishing Ltd.

  15. Pentax-airway scope for tracheal intubation breaks through the limitation of neck motion in an ankylosing spondylitis patient wearing halo vest--a case report.

    PubMed

    Cheng, Wei-Chun; Jimmy-Ong; Lee, Chia-Ling; Lan, Cing-Hong; Chen, Tsung-Ying; Lai, Hsien-Yong

    2010-12-01

    The Airway Scope (AWS) provides better glottic view than the conventional direct laryngoscopy in tracheal intubation. With it, the endotracheal tube can be more easily inserted into the tracheal lumen easily. We hereby presented a 24-year-old ankylosing spondylitis (AS) patient wearing a halo vest who was successfully intubated for undergoing cervical spine surgery involving C1 and C2 under general anesthesia. Pre-operative airway assessment revealed that he was a case of difficult intubation. An AWS was used for oral tracheal intubation which was achieved smoothly in the first attempt. AWS can be an alternative device for airway management in a patient wearing halo vest.

  16. [The Use of a Tracheal Tube for Guiding Nasogastric Tube Insertion].

    PubMed

    Saima, Shunsuke; Asai, Takashi; Okuda, Yasuhisa

    2016-04-01

    An obese patient was scheduled for shoulder joint surgery under general anesthesia. After induction of anesthesia and tracheal intubation, insertion of a gastric tube was difficult. A new tracheal tube was prepared, the connecter was removed, and the tube was cut longitudinally. The tube was inserted orally into the esophagus. A gastric tube was passed through the nose, and its tip was taken out of the mouth. The tip of the gastric tube was passed through the tracheal tube, and its correct position in the stomach was confirmed by auscultation of the epigastrium. The tracheal tube was carefully taken out from the esophagus leaving the gastric tube in the stomach. The cut tracheal tube was peeled off from the gastric tube. Correct positioning of the gastric tube was re-confirmed.

  17. Knotting of nasogastric tube around a nasotracheal tube: An unusual cause of hypercapnia in a 3-month-old infant.

    PubMed

    Melki, Imad; Matar, Nayla; Maalouf, Sabine; Rassi, Simon

    2010-03-01

    A 3-month-old boy was admitted to the intensive care unit because of septic shock; he required immediate intubation and placement of a nasogastric tube. A confirmatory chest radiograph showed that the nasogastric tube was looping in the hypopharynx and needed to be repositioned. During removal of the nasogastric tube, the infant experienced hypercapnia and respiratory distress. These complications were due to looping and knotting of the nasogastric tube around the nasotracheal tube.

  18. Comparison of two interferon-gamma release assays (QuantiFERON-TB Gold In-Tube and T-SPOT.TB) in testing for latent tuberculosis infection among HIV-infected adults.

    PubMed

    Sultan, B; Benn, P; Mahungu, T; Young, M; Mercey, D; Morris-Jones, S; Miller, R F

    2013-10-01

    There is currently no 'gold standard' for diagnosis of latent tuberculosis infection (LTBI), and both the tuberculin skin test and interferon-gamma release assays (IGRAs) are used for diagnosis; the latter have a higher sensitivity than tuberculin skin tests for diagnosis of LTBI in HIV-infected individuals with lower CD4 counts. No evidence base exists for selection of IGRA methodology to identify LTBI among human immunodeficiency virus-infected patients in the UK. We prospectively evaluated two commercially available IGRA methods (QuantiFERON-TB Gold In Tube [QFG] and T-SPOT.TB) for testing LTBI among HIV-infected patients potentially nosocomially exposed to an HIV-infected patient with 'smear-positive' pulmonary tuberculosis. Among the exposed patients median CD4 count was 550 cells/µL; 105 (90%) of 117 were receiving antiretroviral therapy, of who 104 (99%) had an undetectable plasma HIV load. IGRAs were positive in 12 patients (10.3%); QFG positive in 11 (9.4%) and T-SPOT.TB positive in six (5.1%); both IGRAs were positive in five patients (4.3%). There was one indeterminate QFG and one borderline T-SPOT.TB result. Concordance between the two IGRAs was moderate (κ = 0.56, 95% confidence interval = 0.27-0.85). IGRAs were positive in only 4 (29%) of 14 patients with previous culture-proven tuberculosis. No patient developed tuberculosis during 20 months of follow-up.

  19. A Prospective Evaluation of Transverse Tracheal Sonography During Emergent Intubation by Emergency Medicine Resident Physicians.

    PubMed

    Lahham, Shadi; Baydoun, Jamie; Bailey, James; Sandoval, Sandra; Wilson, Sean P; Fox, John C; Slattery, David E

    2017-10-01

    Establishing a definitive airway is often the first step in emergency department treatment of critically ill patients. Currently, there is no agreed upon consensus as to the most efficacious method of airway confirmation. Our objective was to determine the diagnostic accuracy of real-time sonography performed by resident physicians to confirm placement of the endotracheal tube during emergent intubation. We performed a prospective cohort study of adult patients in the emergency department undergoing emergent endotracheal intubation. Thirty emergency medicine residents, who were blinded to end-tidal carbon dioxide detection results, performed real-time transverse tracheal sonography during intubation to evaluate correct endotracheal tube placement. Seventy-two patients were enrolled in the study. Sixty-eight instances (94.4%) were interpreted as correct placement in the trachea; 4 (5.6%) were interpreted as esophageal, of which 1 was a false-negative finding, therefore conferring sensitivity of 98.5% (95% confidence interval, 92.1%-99.9%) and specificity of 75.0% (95% confidence interval, 19.4%-99.4%) for correct placement. There was no significant difference in accuracy among resident sonographers with different levels of residency training. A simple transverse tracheal sonographic examination performed by emergency medicine resident physicians can be used as an adjunct to help confirm correct endotracheal tube placement during intubation. In our cohort, the level of training did not appear to affect the ability of residents to correctly identify the endotracheal tube position. © 2017 by the American Institute of Ultrasound in Medicine.

  20. [Use of a gum elastic bougie for tracheal intubation with Pentax-AWS airway scope].

    PubMed

    Ueshima, Hironobu; Asai, Takashi; Shingu, Koh; Inoue, Hisashi; Hashimoto, Yuichi; Enomoto, Yoshiro; Okuda, Yasuhisa

    2008-01-01

    Pentax-AWS laryngoscope (Pentax, Tokyo, Japan) consists of a disposable anatomically shaped blade, a 12-cm cable with a charge-coupled device (CCD) camera and a 2.4-inch liquid crystal device (LCD) color monitor display. A tracheal tube can be attached to the right side of the blade. The device may be useful in patients with difficult airways. One limitation of the device is that intubation may be difficult if it is difficult to position the glottis to the target symbol on the monitor display. We experienced such a difficulty in four patients, and the use of a gum elastic bougie enabled intubation. In a 57-year-old woman with a difficult airway, tracheal intubation using either a Macintosh laryngoscope or a fiberscope had failed. By inserting the AWS laryngoscope, the glottis was easily seen on the monitor display. Nevertheless, it was difficult to position the glottis to the target symbol, and advancing a tracheal tube collided with the tissue around the glottis. A bougie was passed through the tracheal tube, and it became possible to insert the bougie into the trachea by adjusting the angle of its tip. The tracheal tube was then easily passed over the bougie into the trachea. We successfully used the same technique in other three patients. We believe that the gum elastic bougie can be useful for tracheal intubation using the Pentax-AWS laryngoscope.

  1. Comparison of the C-MAC video laryngoscope to a flexible fiberoptic scope for intubation with cervical spine immobilization.

    PubMed

    Yumul, Roya; Elvir-Lazo, Ofelia L; White, Paul F; Durra, Omar; Ternian, Alen; Tamman, Richard; Naruse, Robert; Ebba, Hailu; Yusufali, Taizoon; Wong, Robert; Hernandez Conte, Antonio; Farnad, Shahbaz; Pham, Christine; Wender, Ronald H

    2016-06-01

    To compare the C-MAC video laryngoscope to the standard flexible fiberoptic scope (FFS) with an eye piece (but without a camera or a video screen) for intubation of patients undergoing cervical spine surgery with manual inline stabilization. The primary end point was the time to achieve successful tracheal intubation. Secondary end points included glottic view at intubation and number of intubation attempts. Prospective, randomized, single-blinded study. Cedars Sinai Medical Center in Los Angeles, CA. One hundred forty patients (American Society of Anaesthesiologists physical status I-III), aged 18 to 80years undergoing elective cervical spine surgery. Patients were prospectively randomized to undergo tracheal intubation using either an FFS (n=70) or the C-MAC video laryngoscope (n=70). After performing a preoperative airway evaluation, patients underwent a standardized induction sequence. The glottic view was assessed at the time of tracheal tube placement using the Cormack-Lehane and percentage of glottic opening scoring systems. In addition, the time required for successful insertion of the tracheal tube, number of intubation attempts to secure the airway, the need for adjuvant airway devices, hemodynamic changes, adverse events, and any airway-related trauma were recorded. The glottic view at the time of intubation did not differ significantly with the 2 devices; however, the C-MAC facilitated more rapid tracheal intubation compared with the FFS (P=.001). The peak heart rate response following insertion of the tracheal tube was also reduced (P=.004) in the C-MAC (vs FFS) group. The C-MAC may offer an advantage over the FFS with respect to the time required to obtain glottic view and successful placement of the tracheal tube in patients requiring cervical spine immobilization. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

  2. [A child with Klippel-Feil syndrome in whom GlideScope was effective for tracheal intubation].

    PubMed

    Arai, Takero; Hashimoto, Yuichi; Saito, Tomoyuki; Ogata, Tokiko; Chiba, Ayako; Sato, Hiromi; Enomoto, Sumie; Shimazaki, Mutsuhisa; Okuda, Yasuhisa

    2013-06-01

    GlideScope videolaryngoscope (GlideScope, herein-after referred to as "GS", Verathon Medical, Bothell, WA, USA), with a high-resolution camera positioned on a blade, enables operators to confirm the position of the larynx and a tube through clear view, thereby conducting intubation safely in a patient whose neck is difficult to be bent back. As the blade is slim, GS is indicated for use in children whose oral cavity is narrow. We herein report safe and smooth intubation with GS in a child with Klippel-Feil syndrome in whom difficult intubation was predicted.

  3. Nasogastric tube placement with video-guided laryngoscope: A manikin simulator study.

    PubMed

    Lee, Xiao-Lun; Yeh, Li-Chun; Jin, Yau-Dung; Chen, Chun-Chih; Lee, Ming-Ho; Huang, Ping-Wun

    2017-08-01

    This study aimed to investigate video-guided laryngoscopy for nasogastric tube placement. This was an observational comparative study performed in a hospital. The participants included volunteers from the medical staff (physicians and nurses) experienced with nasogastric intubation, and non-medical staff (medical students, pharmacists and emergent medical technicians) with knowledge of nasogastric intubation but lacking procedural experience. Medical and non-medical hospital staff performed manual, laryngoscope-assisted and video-guided laryngoscope nasogastric intubation both in the presence and in the absence of an endotracheal tube, using a manikin. Nasogastric intubation times were compared between groups and methods. Using the video-guided laryngoscope resulted in a significantly shorter intubation time compared to the other 2 methods, both with and without an endotracheal tube, for the medical and non-medical staff alike (all p < 0.05). For the medical staff, mean nasogastric intubation time was significantly shorter using video-guided laryngoscope without endotracheal intubation, direct laryngoscope with endotracheal intubation and video-guided laryngoscope with endotracheal intubation compared to manual intubation without endotracheal intubation (0.49, 0.63 and 0.72 vs. 5.63, respectively, p ≤ 0.008). For non-medical staff, nasogastric intubation time was significantly shorter using video-guided laryngoscope without endotracheal intubation, direct laryngoscope with endotracheal intubation and video-guided laryngoscope with endotracheal intubation compared to manual intubation without endotracheal intubation (1.67, 1.58 and 0.95 vs. 6.9, respectively, p ≤ 0.002). And mean nasogastric intubation time for video-guided laryngoscope endotracheal intubation was significantly shorter for medical staff than for non-medical staff (0.49 vs. 1.67 min, respectively, p = 0.041). Video-guided laryngoscope reduces nasogastric intubation time compared to

  4. I-gel Laryngeal Mask Airway Combined with Tracheal Intubation Attenuate Systemic Stress Response in Patients Undergoing Posterior Fossa Surgery

    PubMed Central

    Tang, Chaoliang; Chai, Xiaoqing; Kang, Fang; Huang, Xiang; Hou, Tao; Tang, Fei; Li, Juan

    2015-01-01

    Background. The adverse events induced by intubation and extubation may cause intracranial hemorrhage and increase of intracranial pressure, especially in posterior fossa surgery patients. In this study, we proposed that I-gel combined with tracheal intubation could reduce the stress response of posterior fossa surgery patients. Methods. Sixty-six posterior fossa surgery patients were randomly allocated to receive either tracheal tube intubation (Group TT) or I-gel facilitated endotracheal tube intubation (Group TI). Hemodynamic and respiratory variables, stress and inflammatory response, oxidative stress, anesthesia recovery parameters, and adverse events during emergence were compared. Results. Mean arterial pressure and heart rate were lower in Group TI during intubation and extubation (P < 0.05 versus Group TT). Respiratory variables including peak airway pressure and end-tidal carbon dioxide tension were similar intraoperative, while plasma β-endorphin, cortisol, interleukin-6, tumor necrosis factor-alpha, malondialdehyde concentrations, and blood glucose were significantly lower in Group TI during emergence relative to Group TT. Postoperative bucking and serious hypertensions were seen in Group TT but not in Group TI. Conclusion. Utilization of I-gel combined with endotracheal tube in posterior fossa surgery patients is safe which can yield more stable hemodynamic profile during intubation and emergence and lower inflammatory and oxidative response, leading to uneventful recovery. PMID:26273146

  5. Pulmonary delivery of vancomycin dry powder aerosol to intubated rabbits

    PubMed Central

    Sullivan, Bradley P.; El-Gendy, Nashwa; Kuehl, Christopher; Berkland, Cory

    2016-01-01

    Antibiotic multi-resistant pneumonia is a risk associated with long term mechanical ventilation. Vancomycin is commonly prescribed for methicillin-resistant staphylococcus aureus infections; however, current formulations of vancomycin are only given intravenously. High doses of vancomycin have been associated with severe renal toxicity. In this study we characterized dry powder vancomyin as a potential inhaled therapeutic aerosol and compared pharmacokinetic profiles of i.v. and pulmonary administered vancomycin in intubated rabbits using a novel endotracheal tube catheter system. Cascade Impaction studies indicated that using an endotracheal tube, which bypasses deposition the mouth and throat, increased the amount of drug entering the lung. Drug deposition in the lung was further enhanced by using an endotracheal tube catheter, which did not alter the aerosol fine particle fraction. Interestingly, intubated rabbits administered 1 mg/kg vancomycin via inhalation had similar AUC to rabbits that were administered 1 mg/kg vancomycin via a single bolus i.v. infusion; however, inhalation of vancomycin reduced Cmax and increased Tmax, suggesting that inhaled vancomycin resulted in more sustained pulmonary levels of vancomycin. Collectively, these results suggested that dry powder vancomycin can successfully be delivered by pulmonary inhalation in intubated patients. Furthermore, as inhaled vancomycin is delivered locally to the site of pulmonary infection, this delivery route could reduce the total dose required for therapeutic efficacy and simultaneously reduce the risk of renal toxicity by eliminating the high levels of systemic drug exposure required to push the pulmonary dose to therapeutic thresholds during i.v. administration. PMID:25915095

  6. Electron tube

    DOEpatents

    Suyama, Motohiro [Hamamatsu, JP; Fukasawa, Atsuhito [Hamamatsu, JP; Arisaka, Katsushi [Los Angeles, CA; Wang, Hanguo [North Hills, CA

    2011-12-20

    An electron tube of the present invention includes: a vacuum vessel including a face plate portion made of synthetic silica and having a surface on which a photoelectric surface is provided, a stem portion arranged facing the photoelectric surface and made of synthetic silica, and a side tube portion having one end connected to the face plate portion and the other end connected to the stem portion and made of synthetic silica; a projection portion arranged in the vacuum vessel, extending from the stem portion toward the photoelectric surface, and made of synthetic silica; and an electron detector arranged on the projection portion, for detecting electrons from the photoelectric surface, and made of silicon.

  7. Is it safe to use frova airway intubating device during tracheal intubation in difficult airway patient with multiple and chest trauma?

    PubMed

    Hajjar, Waseem M; Alsubaie, Nourah; Nouh, Thamer A; Al-Nassar, Sami A

    2016-01-01

    Traumatic chest injury is one of the leading causes of death in motor vehicle accident (MVA). A complete tracheobronchial injury occurred in 1% of trauma cases and most of the cases died before arrival to the emergency department. We report a 37-year-old female involved in MVA presented to the emergency room (ER) with normal vital signs. Ten minutes later, her saturation dropped to 75%, which required ventilation; however, two attempts for endotracheal intubation failed. The third time frova airway intubating introducer used and succeeded. Immediately after tracheal intubation, the patient started to have extensive subcutaneous emphysema and severe hypoxia; chest X-ray showed right side tension pneumothorax which was not relieved by a chest tube insertion. Bronchoscopy confirmed total transection of the right main bronchus and lower tracheal laceration and injury. Emergency thoracotomy and repair of both trachea and the right main bronchus were successful.

  8. Airway management using a supraglottic airway device without endotracheal intubation for positive ventilation of anaesthetized rats.

    PubMed

    Cheong, S H; Lee, J H; Kim, M H; Cho, K R; Lim, S H; Lee, K M; Park, M Y; Yang, Y I; Kim, D K; Choi, C S

    2013-04-01

    Endotracheal intubation is often necessary for positive pressure ventilation of rats during open thoracic surgery. Since endotracheal intubation in rats is technically difficult and is associated with numerous complications, many techniques using various devices have been described in the scientific literature. In this study, we compared the effectiveness of airway management of a home-made supraglottic airway device (SAD), which is cheap to fabricate and easy to place with that of an endotracheal intubation tube in enflurane-anaesthetized rats. Twenty male Sprague-Dawley rats (200-300 g) were randomly assigned to two equal groups for positive pressure mechanical ventilation using either the SAD or an endotracheal intubation tube. The carotid artery of each rat was cannulated for continuous blood pressure measurements and obtaining blood samples for determination of oxygen tension, carbon dioxide tension, and blood acidity before, during and after SAD placement or endotracheal intubation. Proper placement of the SAD was confirmed by observing chest wall movements that coincided with the operation of the mechanical ventilator. No complications and adverse events were encountered in the rats in which the SAD was placed, during SAD placement and immediate removal, during their mechanical ventilation through the SAD, and one week after SAD removal. From the results of blood gas analyses, we conclude that anaesthetized rats can be successfully ventilated using an SAD for open thoracic surgery.

  9. [Application of the fibreoptic intubating laryngeal mask airway CTrach in face and neck scar contracture patients].

    PubMed

    Yang, Dong; Deng, Xiao-Ming; Tong, Shi-Yi; Liu, Ju-Hui; Sui, Jing-Hu; Zhang, Yan-Ming; Liu, Jian-Hua; Wei, Ling-Xin; Xu, Kun-Lin

    2009-02-01

    To evaluate the feasibility of the fibreoptic intubating laryngeal mask airway (LMA) CTrach (CTrach) in anticipated difficult airway caused by face and neck scar contracture. Totally 33 patients undergoing selective face and neck scar plastic surgery and requiring general anesthesia were enrolled in our study. After anesthesia induction, the CTrach was inserted and the viewer was attached, which allowed fibreoptic visualization of the larynx before and during passage of the tracheal tube through the vocal cords. The duration and the success rates of CTrach insertion, tracheal intubation, and CTrach removal were recorded. The view of glottis on viewer and the adjusting maneuvers for improving the laryngeal view were recorded. Noninvasive blood pressures and heart rates were recorded before and after anesthesia induction and at CTrach insertion, tracheal intubation, and CTrach removal. The CTrach was successfully inserted in all patients, among whom 4 patients succeeded at the second attempt. The full view of glottis were shown in 10 patients, while partial view and no view of glottis were shown in 8 and 15 patients, respectively. The good view of glottis was achieved by adjusting manoeuvres. Tracheal intubation via the CTrach was successful in 27 patients at the first attempt and in 6 patients at the second attempt. Hemodynamic changes during the performance with the CTrach were minimal. The CTrach can be easily inserted, with clear view and high success rate of tracheal intubation. Therefore, it is an effective way to resolve difficulty intubation caused by face and neck scar contracture.

  10. A comparison of various supraglottic airway devices for fiberoptical guided tracheal intubation.

    PubMed

    Metterlein, Thomas; Dintenfelder, Anna; Plank, Christoph; Graf, Bernhard; Roth, Gabriel

    Fiberoptical assisted intubation via placed supraglottic airway devices has been described as safe and easy procedure to manage difficult airways. However visualization of the glottis aperture is essential for fiberoptical assisted intubation. Various different supraglottic airway devices are commercially available and might offer different conditions for fiberoptical assisted intubation. The aim of this study was to compare the best obtainable view of the glottic aperture using different supraglottic airway devices. With approval of the local ethics committee 52 adult patients undergoing elective anesthesia were randomly assigned to a supraglottic airway device (Laryngeal Tube, Laryngeal Mask Airway I-Gel, Laryngeal Mask Airway Unique, Laryngeal Mask Airway Supreme, Laryngeal Mask Airway Aura-once). After standardized induction of anesthesia the supraglottic airway device was placed according to the manufacturers recommendations. After successful ventilation the position of the supraglottic airway device in regard to the glottic opening was examined with a flexible fiberscope. A fully or partially visible glottic aperture was considered as suitable for fiberoptical assisted intubation. Suitability for fiberoptical assisted intubation was compared between the groups (H-test, U-test; p<0.05). Demographic data was not different between the groups. Placement of the supraglottic airway device and adequate ventilation was successful in all attempts. Glottic view suitable for fiberoptical assisted intubation differed between the devices ranging from 40% for the laringeal tube (LT), 66% for the laryngeal mask airway Supreme, 70% for the Laryngeal Mask Airway I-Gel and 90% for both the Laryngeal Mask Airway Unique and the Laryngeal Mask Airway Aura-once. None of the used supraglottic airway devices offered a full or partial glottic view in all cases. However the Laryngeal Mask Airway Unique and the Laryngeal Mask Airway Aura-once seem to be more suitable for fiberoptical

  11. [A comparison of various supraglottic airway devices for fiberoptical guided tracheal intubation].

    PubMed

    Metterlein, Thomas; Dintenfelder, Anna; Plank, Christoph; Graf, Bernhard; Roth, Gabriel

    Fiberoptical assisted intubation via placed supraglottic airway devices has been described as safe and easy procedure to manage difficult airways. However visualization of the glottis aperture is essential for fiberoptical assisted intubation. Various different supraglottic airway devices are commercially available and might offer different conditions for fiberoptical assisted intubation. The aim of this study was to compare the best obtainable view of the glottic aperture using different supraglottic airway devices. With approval of the local ethics committee 52 adult patients undergoing elective anesthesia were randomly assigned to a supraglottic airway device (Laryngeal Tube, Laryngeal Mask Airway I-Gel, Laryngeal Mask Airway Unique, Laryngeal Mask Airway Supreme, Laryngeal Mask Airway Aura-once). After standardized induction of anaesthesia the supraglottic airway device was placed according to the manufacturers recommendations. After successful ventilation the position of the supraglottic airway device in regard to the glottic opening was examined with a flexible fiberscope. A fully or partially visible glottic aperture was considered as suitable for fiberoptical assisted intubation. Suitability for fiberoptical assisted intubation was compared between the groups (H-test, U-test; p<0.05). Demographic data was not different between the groups. Placement of the supraglottic airway device and adequate ventilation was successful in all attempts. Glottic view suitable for fiberoptical assisted intubation differed between the devices ranging from 40% for the laringeal tube (LT), 66% for the laryngeal mask airway Supreme, 70% for the Laryngeal Mask Airway I-Gel and 90% for both the Laryngeal Mask Airway Unique and the Laryngeal Mask Airway Aura-once. None of the used supraglottic airway devices offered a full or partial glottic view in all cases. However the Laryngeal Mask Airway Unique and the Laryngeal Mask Airway Aura-once seem to be more suitable for fiberoptical

  12. Extubation force: tape versus endotracheal tube holders.

    PubMed

    Carlson, Jestin; Mayrose, James; Krause, Richard; Jehle, Dietrich

    2007-12-01

    Tape is the standard method for securing endotracheal tubes to prevent extubation. This study examines the force required to extubate endotracheal tubes from cadavers with either tape or one of 4 commercially available endotracheal tube holders. Newly deceased, unembalmed cadavers were intubated with standard tracheal intubation techniques. The endotracheal tube was secured with either tape or one of 4 commercially available endotracheal tube holders. The endotracheal tube was then connected to a force-measuring device and pulled until the cuff was removed from the trachea. The largest force recorded on the device was then marked as the "extubation force" for that trial. When tape was used to secure the endotracheal tube, it required a significantly larger force to extubate than 3 of 4 off-the-shelf endotracheal tube holders. Only the Thomas Tube Holder secured the endotracheal tube better than tape. Although the Thomas Tube Holder had the greatest holding force in this study, tape was shown to be the least expensive and outperformed 3 other commercially available devices used to secure endotracheal tubes.

  13. A prospective, randomised, cross-over trial comparing two standard polyvinyl chloride tracheal tubes. Are all the tubes the same?

    PubMed

    Serna, M B; Valdivia, A; Dosset, C; Ivars, C; Martin-Pacetti, M A

    2016-01-01

    A randomised study was conducted on the number of attempts made during the conventional endotracheal intubation of a mannequin using two polyvinyl (PVC) tracheal tubes, apparently similar but from different manufactures: INTERSURGICAL (IS; Intersurgical S.L., Madrid, Spain) and Mallinckrodt (ML; Mallinkrodt Medical S.A., Madrid, Spain). A total of 26 anaesthesiologists, in randomly established order (generated by Epidat 3.1) intubated a mannequin twice using a different tube each time. The tubes were masked by painting them to prevent recognition. The main outcome of the study was to compare the number of attempts needed to complete the manoeuvre for each tube. Data on intubation time and failed intubations were also collected. The number of attempts with the ML tube was significantly lower than with the IS tube. Intubation was completed on the first attempt with the ML tube in 93.3% of cases, while using the IS tube the percentage fell to 30.8% (Fisher exact test, P<.001). The time required to complete the manoeuvre was greater with the IS tube (median 10.8seconds, interquartile range 6-22) than with the ML tube (median 4.4seconds, interquartile range 3.5 to 6.3). The PVC tube from the ML manufacturer was superior when compared with the IS, the latter was also associated with a larger number of attempts to complete intubation using a conventional Macintosh blade. Copyright © 2015 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  14. Airway management using submental intubation in head and neck surgery.

    PubMed

    Szantyr, Aleksandra; Szuta, Mariusz; Zapała, Jan

    2016-01-01

    In 1995 the first tracheosubmental intubation (TSI) in Poland was performed in the Clinic and De- partment of Cranio-Maxillofacial Surgery at Jagiellonian University Medical College in Kraków. Our 20 years of experience with using TSI in the eld of cranio-maxillofacial surgery, with 316 successfully performed intubations, resulted in one of the largest bodies of material analysed in the literature so far. The aim of this study was to evaluate the eficacy and complications of TSI in the field of cranio-maxillofacial surgery in patients where orotracheal or nasotracheal intubation is contraindicated and tracheostomy can be avoided. To fulfil this objective we present our own experience with the use of TSI in the field of cranio-maxillofacial surgery. This retrospective study included 316 patients who were operated on with general anaesthesia via TSI in the Department of Cranio-Maxillofacial Surgery, Jagiellonian University Medical College, Kraków, from 1995 to 2014 (20 years). Indications for TSI were as follows: multifragmentaric fractures of the bones of mid- and lower face in 262 patients (82.9%), simultaneous osteotomies of the maxilla and mandible due to mandibular prognathism with maxillary compression in 62 patients (19.6%), extensive facial cancer infiltrating both the nose and lips in 4 patients (1.2%) and posttraumatic deformities of the nose and jaws in 4 patients (1.2%). In all 316 patients TSI was successfully performed and proved to be the optimal method of airway management, providing a comfortable surgical approach with the operating field free from an intubation tube. Complications were observed in 12 patients (3.8%) and included wound infection in 7 patients (2.21%), transitory salivary fistula in 3 patients (0.95%), and hypertrophic scarring in 2 patients (0.63%). TSI is considered to be a safe and simple technique of intubation, which makes it possible to to avoid tracheotomy complications when it is difficult or impossible to perform

  15. Cervical Spinal Motion During Orotacheal Intubation

    DTIC Science & Technology

    1999-01-01

    cervical spines and were evaluated under fluoroscopy and found to have a normal range of motion prior to intubation. Each subject was placed supine on...4 ’.* AD Contract Number DAMD17-97-C-7006 TITLE: Cervical Spinal Motion During Orotacheal Intubation PRINCIPAL INVESTIGATOR: Vincent C... Cervical Spinal Motion During Orotachea.l Intubation 6. AUTHOR(S) Vincent C. TrayneJis, M.D. 7. PERFORMING ORGANIZATION NAWIE(S

  16. Tracheal intubation with a flexible intubation scope versus other intubation techniques for obese patients requiring general anaesthesia.

    PubMed

    Nicholson, Amanda; Smith, Andrew F; Lewis, Sharon R; Cook, Tim M

    2014-01-17

    The prevalence of obesity (body mass index (BMI) > 30 kg/m(2)) is increasing in both developed and developing countries, leading to a rise in the numbers of obese patients requiring general anaesthesia. Obese patients are at increased risk of anaesthetic complications, and tracheal intubation can be more difficult. Flexible intubation scopes (FISs) are recommended as an alternative method of intubation in these patients. Intubation with an FIS is considered an advanced method, requiring training and experience; therefore it may be underused in clinical practice. Patient outcomes following intubation with these scopes compared with other devices have not been systematically reviewed. We wished to compare the safety and effectiveness of a flexible intubation scope (FIS) used for tracheal intubation in obese patients (BMI > 30 kg/m(2)) with other methods of intubation, including conventional direct laryngoscopy, non-standard laryngoscopy and the use of intubating supraglottic airway devices. We aimed to compare the frequency of complications, as well as process indicators, such as time taken for intubation and the proportion of first attempts that were successful, between groups using the different methods of intubation. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and two trial registers on 18 January 2013, and performed reference checking and citation searching and contacted study authors to identify additional studies. We included randomized controlled trials (RCTs) of participants aged 16 years and older with a BMI > 30 kg/m(2) that had compared the use of an FIS for tracheal intubation with any one of three comparison groups: direct laryngoscopy; non-standard laryngoscopy (including indirect laryngoscopy using a videolaryngoscope (VLS) or a rigid or semi-rigid stylet); or intubation of supraglottic airway devices (SADs). We used standard methodological approaches expected by The Cochrane Collaboration, including

  17. Heat Transfer from High-Temperature Surfaces to Fluids. III - Correlation of Heat-Transfer Data for Air Flowing in Silicon Carbide Tube with Rounded Entrance, Inside Diameter of 3/4 Inch, and Effective Length of 12 Inches. Part 3; Correlation of Heat-Transfer Data for Air Flowing in Silicon Carbide Tube with Rounded Entrance, Inside Diameter of 3/4 Inch, and Effective Length of 12 Inches

    NASA Technical Reports Server (NTRS)

    Sams, Eldon W.; Desmon, Leland G.

    1949-01-01

    A heat-transfer investigation was conducted with air flowing through an electrically heated silicon carbide tube with a rounded entrance, an inside diameter of 3/4 inch, and an effective heat-transfer length of 12 inches over a range of Reynolds numbers up to 300,000 and a range of average inside-tube-wall temperature up to 2500 R. The highest corresponding local outside-tube-wall temperature was 3010 R. Correlation of the heat-transfer data using the conventional Nueselt relation wherein physical properties of the fluid were evaluated at average bulk temperature resulted in a separation of data with tube-wall-temperature level. A satisfactory correlation of the heat-transfer data was obtained, however, by the use of modified correlation parameters wherein the mass velocity G (or product of average air density and velocity evaluated at bulk temperature P(sub b)V(sub b)) in the Reynolds number was replaced by the product of average air velocity evaluated at the bulk temperature and density evaluated at either the average inside-tube-wall temperature or the average film temperature; in addition, all the physical properties of air were correspondingly evaluated at either the average inside-tube-wall temperature or the average film temperature.

  18. [Use of fiberoptic bronchoscope for difficult intubation in maxillofacial surgery].

    PubMed

    Kalfon, F; Dubost, J

    1993-01-01

    This retrospective study analyzed the cases of difficult intubations carried out with a fiberoptic bronchoscope between March 1984 and May 1989. During this period, 222 such procedures were attempted in 131 male and 68 female patients. All cases were diagnosed at the preoperative visit. A fiberoptic bronchoscope was used as a guide under topical nasal and laryngeal anaesthesia, together with appropriate benzodiazanalgesia, in order to maintain spontaneous breathing. The nasotracheal route was used in 218 cases. Successful intubation was achieved in 219 cases (98.6%), 209 of them (95.4%) within fifteen minutes. Of the three failures, only one was unpredictable (inability to withdraw the fiberoptic bronchoscope from the endotracheal tube). In the two others, the technique was subsequently found to have been wrongly indicated: major nasopharyngeal secretions occluded the fiberoptic device in the first one, and an anatomically compromised airway led to apnoea under sedation in the other. A narrow nasotracheal passage, spreading oedema, bloody secretions or coughing gave rise to technical difficulties in 39 cases (17.5%). There was one case of regurgitation without any drawback. Benzodiazanalgesia was responsible for two cases of respiratory depression. This technique was otherwise very satisfactory, patients being cooperative and frequently having amnesia of intubation. The indications for the use of a fiberoptic bronchoscope were: insufficient oral opening, orofacial obstacles to laryngoscopy, and cases where laryngoscopy had to be avoided. The main drawbacks of this technique were the cost and fragility of fiberoptic device as well as operator efficiency. The anaesthesiologists involved in the present series performed ten easy intubations each with the fiberoptic bronchoscope, and routinely used the teaching eye-piece.(ABSTRACT TRUNCATED AT 250 WORDS)

  19. Inadvertent Endobronchial Intubation in a Patient With a Short Neck Length.

    PubMed

    Cornelius, Bryant; Sakai, Tetsuro

    2015-01-01

    Inadvertent placement of the endotracheal tube into the right bronchus during intubation for general anesthesia is a fairly common occurrence. Many precautions should be taken by the anesthesia provider in order to minimize the incidence of endobronchial intubation, including bilateral auscultation of the lungs, use of the 21/23 rule, and palpation of the inflated endotracheal cuff at the sternal notch. These provisions, however, are not foolproof; anesthesia providers should realize that endobronchial intubation may occur from time to time because of variations in patient anatomy, changes in patient positioning, and cephalad pressures exerted during surgery. A 58-year-old man with chronic obstructive pulmonary disease received general endotracheal anesthesia for a laparoscopic cholecystectomy. His height was 165 cm (5 ft, 5 in) and the endotracheal tube was secured at his incisors at 21 cm after placement with a rigid laryngoscope. Bilateral breath sounds were confirmed with auscultation, although they were distant because of his chronic obstructive pulmonary disease. After radiographic examination in the postanesthesia care unit, a right main-stem intubation was revealed to have taken place, resulting in complete atelectasis of the left lung. After repositioning of the endotracheal tube, radiography confirmed that the patient had an anatomically short tracheal length.

  20. Nasogastric tube syndrome induced by an indwelling long intestinal tube.

    PubMed

    Sano, Naoki; Yamamoto, Masayoshi; Nagai, Kentaro; Yamada, Keiichi; Ohkohchi, Nobuhiro

    2016-04-21

    The nasogastric tube (NGT) has become a frequently used device to alleviate gastrointestinal symptoms. Nasogastric tube syndrome (NTS) is an uncommon but potentially life-threatening complication of an indwelling NGT. NTS is characterized by acute upper airway obstruction due to bilateral vocal cord paralysis. We report a case of a 76-year-old man with NTS, induced by an indwelling long intestinal tube. He was admitted to our hospital for treatment of sigmoid colon cancer. He underwent sigmoidectomy to release a bowel obstruction, and had a long intestinal tube inserted to decompress the intestinal tract. He presented acute dyspnea following prolonged intestinal intubation, and bronchoscopy showed bilateral vocal cord paralysis. The NGT was removed immediately, and tracheotomy was performed. The patient was finally discharged in a fully recovered state. NTS be considered in patients complaining of acute upper airway obstruction, not only with a NGT inserted but also with a long intestinal tube.

  1. Nasogastric tube syndrome induced by an indwelling long intestinal tube

    PubMed Central

    Sano, Naoki; Yamamoto, Masayoshi; Nagai, Kentaro; Yamada, Keiichi; Ohkohchi, Nobuhiro

    2016-01-01

    The nasogastric tube (NGT) has become a frequently used device to alleviate gastrointestinal symptoms. Nasogastric tube syndrome (NTS) is an uncommon but potentially life-threatening complication of an indwelling NGT. NTS is characterized by acute upper airway obstruction due to bilateral vocal cord paralysis. We report a case of a 76-year-old man with NTS, induced by an indwelling long intestinal tube. He was admitted to our hospital for treatment of sigmoid colon cancer. He underwent sigmoidectomy to release a bowel obstruction, and had a long intestinal tube inserted to decompress the intestinal tract. He presented acute dyspnea following prolonged intestinal intubation, and bronchoscopy showed bilateral vocal cord paralysis. The NGT was removed immediately, and tracheotomy was performed. The patient was finally discharged in a fully recovered state. NTS be considered in patients complaining of acute upper airway obstruction, not only with a NGT inserted but also with a long intestinal tube. PMID:27099450

  2. The Intubating Laryngeal Mask Airway Facilitates Tracheal Intubation in the Lateral Position

    PubMed Central

    Komatsu, Ryu; Nagata, Osamu; Sessler, Daniel I.; Ozaki, Makoto

    2005-01-01

    Although the difficulty of tracheal intubation in the lateral position has not been systematically evaluated, airway loss during surgery in a laterally positioned patient may have hazardous consequences. We explored whether the intubating laryngeal mask airway (ILMA) facilitates tracheal intubation in patients with normal airway anatomy, i.e., Mallampati grade ≤ 3 and thyromental distance ≥ 5 cm, positioned in the lateral position. And we evaluated whether this technique can be used as a rescue when the airway is lost mid-case in laterally positioned patients with respect to success rate and intubation time. Anesthesia was induced with propofol, fentanyl, and vecuronium in 50 patients undergoing spine surgery for lumbar disk herniation (Lateral) and 50 undergoing other surgical procedures (Supine). Patients having disk surgery (Lateral) were positioned on their right or left sides before induction of general anesthesia, and intubation was performed in that position. Patients in control group (Supine) were anesthetized in supine position, and intubation was performed in that position. Intubation was performed blindly via an ILMA in both groups. The time required for intubation and number and types of adjusting maneuvers employed were recorded. Data were compared by Mann-Whitney U, Fisher’s exact, chi-square, or unpaired t-tests, as appropriate. Data presented as mean (SD). Demographic and airway measures were similar in the two groups, except for mouth opening which was slightly wider in patients in the lateral position: 5.1 (0.9) vs. 4.6 (0.7) cm. The time required for intubation was similar in each group (≈25 s), as was intubation success (96%). We conclude that blind intubation via an ILMA offers a frequent success rate and a clinically acceptable intubation time (< one min) even in the lateral position. Summary Blind intubation via the intubating laryngeal mask airway (ILMA) offers a high success rate and a clinically acceptable intubation time even in

  3. Transient nerve damage following intubation for trans-sphenoidal hypophysectomy.

    PubMed

    Evers, K A; Eindhoven, G B; Wierda, J M

    1999-12-01

    To describe a case of transient lingual and hypoglossal nerve damage following intubation for a trans-sphenoidal hypophysectomy. A 56-yr-old acromegalic man was scheduled for trans-sphenoidal hypophysectomy. He had been treated with octreotide six months previously which had reduced the swelling of the tongue to an acceptable degree to the patient. During the anesthetic procedure there were no problems. The intubation was performed without any difficulty, no force had been used to place the endotracheal tube, a throat pack was inserted and, before extubation, an oro-gastric tube was inserted. Three days after surgery the patient complained of numbness and swelling of the left side of the tongue, he had difficulty in moving the tongue, speaking difficulties and problems in swallowing food were noted. Also taste was lost on this side of the tongue. Left lingual and hypoglossal nerve damage was diagnosed, which was confirmed by the neurologist. After four months of intensive physiotherapy and speech therapy, the symptoms disappeared. This is a report of a very rare complication of lingual and hypoglossal nerve damage in an acromegalic patient. This incident suggests forceful laryngoscopy, hyperextension of the head and the throat pack (tightly packed in the oropharynx) can result in injury of the lingual and the hypoglossal nerves.

  4. Is retrograde intubation more successful than direct laryngoscopic technique in difficult endotracheal intubation?

    PubMed

    Sanguanwit, Pitsucha; Trainarongsakul, Thavinee; Kaewsawang, Noppanan; Sawanyawisuth, Kittisak; Sitthichanbuncha, Yuwares

    2016-12-01

    Difficult airway intubation is an emergency condition both at the emergency department (ED) and in out-of-hospital situations. Retrograde intubation (RI) is another option for difficult airway management. There are limited data regarding the successful rate of RI compared with direct laryngoscopy (DL) intubation, the commonly used method in the ED. This study was a randomized, controlled trial. Participants were randomly assigned to either the RI or the DL technique to attempt intubation on a difficult airway mannequin (Cormack and Lehane grades 3-4). First, all participants received the training on the RI or DL, and then attempted intubation. After the training, the participants had 2 chances to intubate. The outcomes of this study included numbers of participants who successfully intubated and times of successful intubation. There were 100 participants in this study, with 50 participants in each group (RI and DL). There was no significant difference between the groups in terms of experience at the ED or DL. The successful rate of intubation was significantly higher in the RI group than in the DL group (74% vs 12%; P = .001), as was the rate of successful intubation on the first attempt (34% vs 8%; P = .026). There were no statistical differences between physicians and medical students in any of the 3 outcomes in either the DL or RI group. The RI technique had a higher success rate in difficult airway intubation than the DL technique, regardless of experience. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Endotracheal intubation - A life saving procedure, still potential hazardous to upper airway: A case report.

    PubMed

    Afreen, Mahrukh; Ansari, Murtaza Ahsan

    2015-12-01

    Endotracheal intubation plays a key role in the management of upper airway obstruction in emergency situations. It is non-invasive and easily learned technique by medical professionals as compared to other more skilled, surgical procedures, e.g., tracheostomy and cricothyrotomies etc. But prolonged intubation may result in numerous complications, most notorious being tracheoesophageal fistula and narrowing of subglottic area. We report a profile of a patient who had been diagnosed as case of Guillian-Barre Syndrome, had difficulty in breathing due to paralysis of respiratory muscles. The patient was admitted in Medical Intensive Care Unit (MICU) for 40 days and was kept on artificial breathing through endotracheal intubation, which remained in place for 19 days. Later tracheostomy was performed. Patient ultimately developed severe subglottic stenosis and became dependent on tracheostomy tube.

  6. Foreign Body Obstruction Preventing Blind Nasal Intubation

    PubMed Central

    Prior, Simon

    2006-01-01

    A healthy young male patient was scheduled for dental care under nasotracheal intubated general anesthesia. The presence of a plastic calculator key complicated the intubation. This case report describes the event and reviews some possible techniques for coping with an airway that becomes obstructed by a foreign object. PMID:16863390

  7. Palliative pulsion intubation in oesophageal carcinoma.

    PubMed Central

    Angorn, I. B.; Hegarty, M. M.

    1979-01-01

    Peroral pulsion intubation for the palliation of dysphagia due to oesophageal carcinoma was performed on 652 patients. The mortality was 16%, failure rate 3%, and hospital stay 3 days. Advanced disease and the presence of oesophagorespiratory fistula is not a contraindication to intubation. Images FIG. 1 FIG. 2 PMID:90475

  8. Tube support

    DOEpatents

    Mullinax, Jerry L.

    1988-01-01

    A tube support for supporting horizontal tubes from an inclined vertical support tube passing between the horizontal tubes. A support button is welded to the vertical support tube. Two clamping bars or plates, the lower edges of one bearing on the support button, are removably bolted to the inclined vertical tube. The clamping bars provide upper and lower surface support for the horizontal tubes.

  9. A Note regarding Problems with Interaction and Varying Block Sizes in a Comparison of Endotracheal Tubes

    PubMed Central

    Einsporn, Richard L.

    2014-01-01

    A randomized clinical experiment to compare two types of endotracheal tubes utilized a block design where each of the six participating anesthesiologists performed tube insertions for an equal number of patients for each type of tube. Five anesthesiologists intubated at least three patients with each tube type, but one anesthesiologist intubated only one patient per tube type. Overall, one type of tube outperformed the other on all three effectiveness measures. However, analysis of the data using an interaction model gave conflicting and misleading results, making the tube with the better performance appear to perform worse. This surprising result was caused by the undue influence of the data for the anesthesiologist who intubated only two patients. We therefore urge caution in interpreting results from interaction models with designs containing small blocks. PMID:25132863

  10. Effective Bolus Dose of Sufentanil to Attenuate Cardiovascular Responses in Laryngoscopic Double-Lumen Endobronchial Intubation

    PubMed Central

    Choi, Byung-Hee; Lee, Yong-Cheol

    2016-01-01

    Background Sufentanil is a potent opioid analgesic frequently used in clinical anesthesia. Double-lumen endobronchial intubation induces profound cardiovascular responses in comparison with ordinary endotracheal intubation because of the larger tube diameter and direct irritation of the carina. Objectives The purpose of this study was to determine the effective bolus dose of sufentanil to attenuate hemodynamic changes in response to laryngoscopic double-lumen endobronchial intubation. Patients and Methods We randomly assigned 72 patients aged 18 - 65 years and with an American Society of Anesthesiologists physical status of 1 or 2 to one of four sufentanil dose groups: NS, S0.1, S0.2, or S0.3. The respective doses for the groups were as follows: normal saline, 0.1 mcg/kg of sufentanil, 0.2 mcg/kg of sufentanil, and 0.3 mcg/kg of sufentanil. Blood pressure and heart rate were recorded during the pre-anesthesia period at baseline, pre-intubation, immediate post-intubation, and every minute during 5 minutes after intubation. Results Baseline mean arterial pressures in the NS, S0.1, S0.2, and S0.3 groups were 89.8 ± 12.1, 89.2 ± 10.9, 88.8 ± 13.6, and 90.7 ± 11.1, respectively. At immediate post-intubation, the mean arterial pressures in the NS, S0.1, S0.2, and S0.3 groups were 129.7 ± 14.7, 120.7 ± 14.2, 120.8 ± 17.2, and 96.7 ± 10.4, respectively. At immediate post-intubation, the mean arterial pressure in the NS, S0.1, and S0.2 groups significantly increased from baseline (P < 0.001), but the S0.3 group showed no difference. In the time point comparison at immediate post- intubation, the S0.3 group had a significantly lower mean arterial pressure than did the NS, S0.1, and S0.2 groups (P < 0.001). Conclusions We found that 0.3 mcg/kg of sufentanil attenuates cardiovascular responses to double-lumen endobronchial intubation without adverse effects. PMID:27252903

  11. Duration of oral endotracheal intubation is associated with dysphagia symptoms in acute lung injury patients.

    PubMed

    Brodsky, Martin B; Gellar, Jonathan E; Dinglas, Victor D; Colantuoni, Elizabeth; Mendez-Tellez, Pedro A; Shanholtz, Carl; Palmer, Jeffrey B; Needham, Dale M

    2014-08-01

    The purpose of this study is to evaluate demographic and clinical factors associated with self-reported dysphagia after oral endotracheal intubation and mechanical ventilation in patients with acute lung injury (ALI). This is a prospective cohort study of 132 ALI patients who had received mechanical ventilation via oral endotracheal tube. The primary outcome was binary, whether clinically important symptoms of dysphagia at hospital discharge were reported by patients, using the Sydney Swallowing Questionnaire score 200 or more. Of 132 patients, 29% reported clinically important symptoms of dysphagia. Of 18 relevant demographic and clinical variables, only 2 were found to be independently associated with clinically important symptoms of dysphagia in a multivariable logistic regression model: upper gastrointestinal comorbidity (odds ratio, 2.82; 95% confidence interval, 1.09-7.26) and duration of oral endotracheal intubation (odds ratio, 1.79; [95% confidence interval, 1.15-2.79] per day for first 6 days, after which additional days of intubation were not associated with a further increase in the odds of dysphagia). In ALI survivors, patient-reported, postexubation dysphagia at hospital discharge was significantly associated with upper gastrointestinal comorbidity and a longer duration of oral endotracheal intubation during the first 6 days of intubation. Copyright © 2014 Elsevier Inc. All rights reserved.

  12. Visible, Safe and Certain Endotracheal Intubation Using Endoscope System and Inhalation Anesthesia for Rats

    PubMed Central

    KONNO, Kenjiro; SHIOTANI, Yumi; ITANO, Naoki; OGAWA, Teppei; HATAKEYAMA, Mika; SHIOYA, Kyoko; KASAI, Noriyuki

    2014-01-01

    ABSTRACT Anesthesia strongly influences laboratory animals, and it can also greatly affect the experimental data. Rats rank only second to mice in the number used in research fields, such as organ transplantation, regenerative medicine and imaging. Therefore, appropriate and effective anesthesia, including the protocol of the endotracheal intubation and inhalation anesthesia, is crucial. Hence, we evaluated these methods in this study. Twelve Wistar rats were intraperitoneally injected with M/M/B: 0.3/4/5, comprising of medetomidine, midazolam and butorphanol at a dose of 0.3 mg/kg + 4.0 mg/kg + 5.0 mg/kg body weight/rat, respectively. An endotracheal tube was then intubated into the trachea. After intubation, the rats were connected to the inhalation anesthesia circuit using isoflurane, and vital signs were measured until 30 min after connection. All intubations were successfully finished within 1 min, and the values of the vital signs were normal and stable. In addition, histopathological observation of the trachea and lungs showed no trauma. These results suggest that this visible endotracheal intubation method is simple, reliable, safe and favorable with regard to the rats’ welfare. PMID:25030602

  13. Nonradiographic assessment of enteral feeding tube position.

    PubMed

    Harrison, A M; Clay, B; Grant, M J; Sanders, S V; Webster, H F; Reading, J C; Dean, J M; Witte, M K

    1997-12-01

    To determine whether a clinical, nonradiographic criterion can be used to predict when the tip of a blindly placed feeding tube is in the small intestine. Prospective sample. Pediatric intensive care unit at a tertiary care children's hospital. Critically ill children requiring transpyloric feeding. The small bowel was intubated, using a blind, bedside transpyloric feeding tube placement protocol. The feeding tube was considered to be in the small bowel when <2 mL of a 10- mL aliquot of insufflated air could be aspirated from the feeding tube. This clinical criterion was confirmed with an abdominal radiograph. Patient age ranged from 1 month to 19 yrs (median 6 months). Weight ranged from 2.2 to 60 kg (median 4.9). Median time to feeding tube placement was 10 mins (range 5 to 60). Eighty-nine percent of the patients were mechanically ventilated, while 28% of these patients were pharmacologically paralyzed. Seventy-five feeding tubes were inserted. There were no known complications. Ninety-nine (74/75) percent of the feeding tubes were positioned in the small bowel. The inability to aspirate insufflated air correctly predicted small bowel intubation with 99% certainty (Sequential Probability Ratio Test, p = .05 and power = .80). This test incorrectly predicted the position of only one feeding tube, the 26th, which was in the stomach. Of the 74 feeding tubes positioned in the small bowel, 13 feeding tubes were in the duodenum and 61 were in the jejunum. The inability to aspirate insufflated air confirms the transpyloric position of a feeding tube. Other clinical criteria did not successfully predict small bowel intubation. Use of this single test may obviate confirmatory abdominal radiographs in carefully selected patients and may lead to more cost-effective and timely initiation of enteral feedings.

  14. First robotic tracheal intubations in humans using the Kepler intubation system.

    PubMed

    Hemmerling, T M; Taddei, R; Wehbe, M; Zaouter, C; Cyr, S; Morse, J

    2012-06-01

    Intubation is one of the most important anaesthetic skills. We developed a robotic intubation system (Kepler intubation system, KIS) for oral tracheal intubation. In this pilot study, 12 patients were enrolled after approval of the local Ethics board and written informed consent. The KIS consists of four main components: a ThrustMaster T.Flight Hotas X joystick (Guillemot Inc., New York, NY, USA), a JACO robotic arm (Kinova Rehab, Montreal, QC, Canada), a Pentax AWS video laryngoscope (Ambu A/S, Ballerup, Denmark), and a software control system. The joystick allows simulation of the wrist or arm movements of a human operator. The success rate of intubation and intubation times were measured. Eleven men and one woman aged 66 yr were included in this study. Intubation was successful in all but one patient using KIS at a total time of [median (inter-quartile range; range)] 93 (87, 109; 76, 153) s; in one patient, fogging of the video laryngoscope prevented intubation using KIS. We present the first human testing of a robotic intubation system for oral tracheal intubation. The success rate was high at 91%. Future studies are needed to assess the performance and safety of such a system.

  15. Multivariate predictors of failed prehospital endotracheal intubation.

    PubMed

    Wang, Henry E; Kupas, Douglas F; Paris, Paul M; Bates, Robyn R; Costantino, Joseph P; Yealy, Donald M

    2003-07-01

    Conventionally trained out-of-hospital rescuers (such as paramedics) often fail to accomplish endotracheal intubation (ETI) in patients requiring invasive airway management. Previous studies have identified univariate variables associated with failed out-of-hospital ETI but have not examined the interaction between the numerous factors impacting ETI success. This study sought to use multivariate logistic regression to identify a set of factors associated with failed adult out-of-hospital ETI. The authors obtained clinical and demographic data from the Prehospital Airway Collaborative Evaluation, a prospective, multicentered observational study involving advanced life support (ALS) emergency medical services (EMS) systems in the Commonwealth of Pennsylvania. Providers used standard forms to report details of attempted ETI, including system and patient demographics, methods used, difficulties encountered, and initial outcomes. The authors excluded data from sedation-facilitated and neuromuscular blockade-assisted intubations. The main outcome measure was ETI failure, defined as failure to successfully place an endotracheal tube on the last out-of-hospital laryngoscopy attempt. Logistic regression was performed to develop a multivariate model identifying factors associated with failed ETI. Data were used from 45 ALS systems on 663 adult ETIs attempted during the period June 1, 2001, to November 30, 2001. There were 89 cases of failed ETI (failure rate 13.4%). Of 61 factors potentially related to ETI failure, multivariate logistic regression revealed the following significant covariates associated with ETI failure (odds ratio; 95% confidence interval; likelihood ratio p-value): presence of clenched jaw/trismus (9.718; 95% CI = 4.594 to 20.558; p < 0.0001); inability to pass the endotracheal tube through the vocal cords (7.653; 95% CI = 3.561 to 16.447; p < 0.0001); inability to visualize the vocal cords (7.638; 95% CI = 3.966 to 14.707; p < 0.0001); intact gag reflex

  16. Predicting Which Patients will Likely Benefit from Subglottic Secretion Drainage Endotracheal Tubes: A Retrospective Study.

    PubMed

    Mareiniss, Darren P; Xu, Tim; Pham, Julius Cuong; Hsieh, Yu-Hsiang; Zhao, Jiawei; Nguyen, Christopher; Nguyen, Michael; Winters, Bradford

    2016-03-01

    Subglottic secretion drainage endotracheal tubes (SSD ETTs) have been shown to decrease ventilator-associated pneumonia and are recommended for patients intubated > 48 h or 72 h. However, it is difficult to determine which patients will be intubated > 48 h or 72 h at the time of intubation. We attempted to determine which patient characteristics were associated with intubations ≥ 48 h or 72 h in order to guide proper placement of SSD ETTs. The medical records of 2,159 ventilated patients at a single institution were retrospectively reviewed for intubation duration, age, sex, race, body mass index, weight, intubation reason, whether the intubation was emergent, operative status, intensive care unit (ICU) diagnosis, intubation location, ICU location, comorbidities (e.g., congestive heart failure, chronic obstructive pulmonary disorder, coronary artery disease, dementia, and liver disease), acute kidney injury (AKI), and chronic renal injury. A multivariate regression analysis was then performed with all reliable data. The following were associated with intubation ≥ 48 h: neuroscience critical care unit (NCCU) admission (risk ratio [RR] = 1.85; 95% confidence interval [CI] 1.34-2.56), emergent intubation (RR = 1.97; 95% 1.28-3.03), comorbid dementia (RR = 2.31; 95% 1.28-4.18), nonoperative intubation (RR = 1.77; 95% 1.28-4.18), and AKI (RR = 3.32; 95% 2.56-4.3). The following were independently associated with intubation ≥ 72 h: NCCU admission (RR = 2.2; 95 CI 1.57-3.08), nonoperative intubation (RR = 3.38; 95% CI 2.63-4.35), comorbid dementia (RR = 3.03; 95% CI 1.67-5.48), and AKI (RR = 3.11; 95% CI 2.38-4.07). Nonoperative intubation, emergent intubation, history of dementia, admission to NCCU and AKI all appear to be independently associated with increased RRs for either ≥ 48 h or 72 h of ventilation. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Comparing ease of intubation in obese and lean patients using intubation difficulty scale

    PubMed Central

    Shailaja, S.; Nichelle, S. M.; Shetty, A. Kishan; Hegde, B. Radhesh

    2014-01-01

    Background: Difficult tracheal intubation contributes to significant morbidity and mortality during induction of anesthesia. There are divided opinions regarding ease of intubation in obese patients. Moreover, the definition of difficult intubation is not uniform; hence we have use the Intubation Difficulty Scale (IDS) to find the incidence of difficult intubation in obese patients. Aims: The primary aim of the following study is to find out the incidence of difficult intubation in obese and lean patients using IDS and secondary aim is to assess the performance of bedside screening tests to predict difficult intubation, mask ventilation and laryngoscopy in obese and lean patients. Materials and Methods: A prospective, observational cohort study of 200 patients requiring general anesthesia were categorized into 100 each based on body mass index (BMI) into lean (BMI <25 kg/m2) and obese (BMI ≥25 kg/m2) groups. IDS score ≥5 was termed as difficult intubation. Pre-operative airway assessment included Mallampati score, mouth opening, neck circumference (NC), upper lip bite test, thyromental distance, sternomental distance (SMD) and head neck mobility. Patients having difficulty in mask ventilation and laryngoscopy was recorded. Results: Over all in 200 patients the incidence of difficult intubation was 9%. Obese patients were slightly more difficult to intubate than lean (11% vs. 7%, P = 0.049). Age >40 years, NC >35 cm, SMD <12.5 cm and restricted head neck mobility were factors which were associated with IDS ≥5. Multivariate analysis revealed SMD <12.5 cm to predict difficult intubation in obese patients. Obese patients were difficult to mask ventilate (6% vs. 1%, P = 0.043). There was no difference regarding grading of laryngoscopy between the two groups. Conclusion: Obese patients are difficult to mask ventilate and intubate. During intubation of obese patients who is more than 40 years age and SMD <12.5 cm, it is preferable to have a second skilled

  18. Inverse intubation in entrapped trauma casualties: a simulator based, randomised cross-over comparison of direct, indirect and video laryngoscopy.

    PubMed

    Schober, Patrick; Krage, Ralf; van Groeningen, Dick; Loer, Stephan A; Schwarte, Lothar A

    2014-12-01

    Airway management in entrapped casualties with restricted access to the head is challenging. If tracheal intubation is required and conventional laryngoscopy is not possible, intubation must be attempted in a face-to-face approach. Traditionally, this is performed with a standard laryngoscope held in the right hand with the blade facing upward. Recently, alternative methods have been developed to facilitate difficult intubations, and we hypothesised that such techniques are also useful for face-to-face intubations. 24 (trainee) anaesthesiologists attempted tracheal intubation in a patient simulator (SimMan, Laerdal, Norway) using three techniques in random order: (1) direct laryngoscopy (Macintosh blade #3), (2) indirect optical laryngoscopy (Airtraq, Prodol, Spain) and (3) video laryngoscopy (McGrath, Aircraft Medical, UK). The manikin was sitting with the neck immobilised and only accessible from the left anterolateral side. Success rate (percentage (95% CI)) and tube insertion time (median (IQR)) were recorded. Success rate did not differ significantly (Airtraq and McGrath 100% (84% to 100%), direct laryngoscopy 88% (68% to 96%)). Intubation was faster with Airtraq (25 s (22-34), p<0.001) and direct laryngoscopy (34 s (22-48), p<0.05) compared with the McGrath technique (55 s (37-96)). All three techniques have a high success rate, but the usefulness of the video laryngoscope is limited due to longer intubation duration. Inverse direct laryngoscopy showed reasonable intubation times and, given the widespread availability of Macintosh laryngoscopes, seems a useful technique. Intubation was always successful and tended to be fastest with the Airtraq device, suggesting that this technique may be a promising alternative. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  19. Hybrid endotracheal tubes

    NASA Astrophysics Data System (ADS)

    Sakezles, Christopher Thomas

    Intubation involves the placement of a tube into the tracheal lumen and is prescribed in any setting in which the airway must be stabilized or the patient anesthetized. The purpose of the endotracheal tube in these procedures is to maintain a viable airway, facilitate mechanical ventilation, allow the administration of anesthetics, and prevent the reflux of vomitus into the lungs. In order to satisfy these requirements a nearly airtight seal must be maintained between the tube and the tracheal lining. Most conventional endotracheal tubes provide this seal by employing a cuff that is inflated once the tube is in place. However, the design of this cuff and properties of the material are a source of irritation and injury to the tracheal tissues. In fact, the complication rate for endotracheal intubation is reported to be between 10 and 60%, with manifestations ranging from severe sore throat to erosion through the tracheal wall. These complications are caused by a combination of the materials employed and the forces exerted by the cuff on the tracheal tissues. In particular, the abrasive action of the cuff shears cells from the lining, epithelium adhering to the cuff is removed during extubation, and normal forces exerted on the basement tissues disrupt the blood supply and cause pressure necrosis. The complications associated with tracheal intubation may be reduced or eliminated by employing airway devices constructed from hydrogel materials. Hydrogels are a class of crosslinked polymers which swell in the presence of moisture, and may contain more than 95% water by weight. For the current study, several prototype airway devices were constructed from hydrogel materials including poly(vinyl alcohol), poly(hydroxyethyl methacrylate), and poly(vinyl pyrrolidone). The raw hydrogel materials from this group were subjected to tensile, swelling, and biocompatibility testing, while the finished devices were subjected to extensive mechanical simulation and animal trials

  20. Predictors of intubation in children.

    PubMed

    Nikhar, Sapna A; Grover, Vinod K; Mathew, Preethy Joseph

    2010-12-01

    To estimate the relation of mentohyoid, thyromental and sternomental distances to height, weight and age of children with normal airway. We carried out a prospective, double blind pilot study in 400 children posted for elective surgery to measure mentohyoid, thyromental and sternomental distances pre-operatively followed by intra-op evaluation of intubation using Cormack and Lehane grading. On assessing the contribution of age, height and weight to predict mentohyoid, thyromental and sternomental distances in children, the best predictor was found to be height (p=0.001)followed by age (p=0.04)of the patient. We have derived simple formulae to predict mentohyoid, thyromental and sternomental distances relevant to airway based on height and age of children.

  1. Silicones in medical electronics.

    PubMed

    Bruner, Stephen

    2008-01-01

    The use of silicones, although already extensive, is set to grow in medical electronics. Silicones used in medical device applications as tubing or moulded parts should also be considered for electronic applications in the same device. This article outlines the potential reduction in complexity that this solution offers. Benefits include eliminating negative materials interactions and avoiding bonding problems.

  2. Combined use of a McGrath® MAC video laryngoscope and Frova Intubating Introducer in a patient with Pierre Robin syndrome: a case report

    PubMed Central

    Kim, Yongsuk; Kim, Jeong Eun; Jeong, Da Hye

    2014-01-01

    Patients with Pierre Robin syndrome are characterized by micrognathia, retrognathia, glossoptosis, and respiratory obstruction and are prone to have a difficult-to-intubate airway. The McGrath® MAC video laryngoscope provides a better view of the glottis than a Macintosh laryngoscope, but it is not easy to insert an endotracheal tube through the vocal cords because a video laryngoscope has a much greater curvature than that of a conventional direct laryngoscope and an endotracheal tube has a different curvature. The Frova Intubating Introducer is used as a railroad for an endotracheal tube in cases of a difficult airway. We thought that a combination of these two devices would make it easy to insert an endotracheal tube through the vocal cords, as a McGrath® MAC video laryngoscope provides a better glottic view and the Frova Intubating Introducer is a useful device for placing an endotracheal tube through the glottis. We report a successful endotracheal intubation with use of the McGrath® MAC video laryngoscope and Frova Intubating Introducer in a patient with Pierre Robin syndrome. PMID:24851168

  3. Ear Tubes

    MedlinePlus

    ... ENTCareers Marketplace Find an ENT Doctor Near You Ear Tubes Ear Tubes Patient Health Information News media ... and throat specialist) may be considered. What are ear tubes? Ear tubes are tiny cylinders placed through ...

  4. Assessment and confirmation of tracheal intubation when capnography fails: a novel use for an USB camera.

    PubMed

    Karippacheril, John George; Umesh, Goneppanavar; Nanda, Shetty

    2013-10-01

    A 62 year old male with a right pyriform fossa lesion extending to the right arytenoid and obscuring the glottic inlet was planned for laser assisted excision. Direct laryngoscopic assessment after topicalization of the airway, showed a Cormack Lehane grade 3 view. We report a case where, in the absence of a fiberscope, a novel inexpensive Universal Serial Bus camera was used to obtain an optimal laryngoscopic view. This provided direct visual confirmation of tracheal intubation with a Laser Flex tube, when capnography failed to show any trace. Capnography may not be reliable as a sole indicator of confirmation of correct endotracheal tube placement. Video laryngoscopy may provide additional confirmation of endotracheal intubation.

  5. [Assessment of the practice of endotracheal intubation by levering Laryngoscope in teaching of undergraduate medical students].

    PubMed

    Higashizawa, T; Bito, H; Nishiyama, T; Sakai, T; Konishi, A

    1997-09-01

    Twenty-nine inexperienced medical students tried to intubate endotracheal tubes using both levering laryngoscope (McCoy laryngoscope) and Macintosh laryngoscope in adult mannikin the Cormack and Lehane Grade 2. The number of successful intubations by McCoy type was close to those by Macintosh type. Improvement in time necessary from insertion of the laryngoscope to confirmation of placement of the endotracheal tube McCoy type was also close to that by Macintosh type. But the grade of handling difficulty of McCoy type was significantly higher than that of Macintosh type, because Macintosh type was simpler to handle than McCoy type. It was suggested that Macintosh laryngoscope was more useful than McCoy laryngoscope for teaching of inexperienced medical students.

  6. Placement of nasoenteral feeding tubes using magnetic guidance: retesting a new technique.

    PubMed

    Ozdemir, B; Frost, M; Hayes, J; Sullivan, D H

    2000-08-01

    To study a new technique of intubating the small bowel using a newly developed nasoenteral feeding tube fitted with a magnet in its tip and guided for placement with an external magnet. The study was performed in medical and surgical wards of a university-affiliated Department of Veterans Affairs hospital on 42 patients referred by their attending physicians for tube placement. The newly designed feeding tube was inserted per nares into the stomach using traditional technique. As the tube was advanced, movement of the hand-held steering magnet was designed to guide the tip of the magnetic nasoenteral tube along the lesser curvature of the stomach, through the pyloric sphincter, and into the duodenum. Portable abdominal radiography confirmed the anatomic location of the tube tip. Fifty-one intubations were performed on 42 subjects. In 45 intubations (88%), tubes passed into the duodenum. Twenty-seven (53%) met criteria for optimal placement in the second portion of the duodenum or distally. Six of 11 tubes (55%) that were not optimally placed were advanced to the distal duodenum on repositioning. Median procedure time for the initial intubations was 30 minutes (interquartile range 15-40). Median procedure time for last 10 intubations improved to 13 minutes (interquartile range 5-20). No complications were related to the procedure. Enteral feeding tube placement using external magnetic guidance is a promising, novel technique which is deserving of further study.

  7. Risk Factors Assessment of the Difficult Intubation using Intubation Difficulty Scale (IDS)

    PubMed Central

    K. Nasa, Vaibhav

    2014-01-01

    Background: The major responsibility of anaesthesiologist is to maintain adequate gas exchange in his patients in all circumstances and this require that patency of upper airway is constantly maintained. Problems with upper airway management are among the most frequent causes of anaesthetic mishaps. Using intubation difficulty scale (IDS) we made an attempt to objectively assess the predictors of difficult intubation. We assessed classical bedside tests such as modified Mallampati test, Thyromental distance test and also neck extension test. Methods: We prospectively observed 400 patients undergoing general anaesthesia with endotracheal intubation, for each patient intubation difficulty score was recorded during intubation. Risk factors assessment of difficult intubation done using IDS. Risk factor assessed includes modified mallampati class III and IV, thyromental distance ≤ 6cm and neck extension < 5cm. Patients were categorised as Easy intubation (IDS, 0 to 2), slightly difficult intubation (IDS, 3 to 4) and difficult intubation (IDS 5). Preoperative airway assessment was done by thyromental distance measurement, neck extension measurement and modified mallampati test. Data was analysed using Receiver operating characteristic curve (ROC) and area under curve (AUC) for each test computed. p<0.05 was considered significant. Results: The incidence of difficult intubation was 8% and there were no failure to intubate the trachea. The AUC were as follows: modified Mallampati test 0.473 (p<0.005), Thyromental distance test 0.753 (p<0.005) and neck extension test 0.768 (p<0.005). Conclusion: The results indicate that neck extension test is strongest predictor of difficult intubation (IDS≥5) in comparison to Thyromental test and modified mallampati test. PMID:25177576

  8. Risk Factors Assessment of the Difficult Intubation using Intubation Difficulty Scale (IDS).

    PubMed

    K Nasa, Vaibhav; S Kamath, Shaila

    2014-07-01

    The major responsibility of anaesthesiologist is to maintain adequate gas exchange in his patients in all circumstances and this require that patency of upper airway is constantly maintained. Problems with upper airway management are among the most frequent causes of anaesthetic mishaps. Using intubation difficulty scale (IDS) we made an attempt to objectively assess the predictors of difficult intubation. We assessed classical bedside tests such as modified Mallampati test, Thyromental distance test and also neck extension test. We prospectively observed 400 patients undergoing general anaesthesia with endotracheal intubation, for each patient intubation difficulty score was recorded during intubation. Risk factors assessment of difficult intubation done using IDS. Risk factor assessed includes modified mallampati class III and IV, thyromental distance ≤ 6cm and neck extension < 5cm. Patients were categorised as Easy intubation (IDS, 0 to 2), slightly difficult intubation (IDS, 3 to 4) and difficult intubation (IDS 5). Preoperative airway assessment was done by thyromental distance measurement, neck extension measurement and modified mallampati test. Data was analysed using Receiver operating characteristic curve (ROC) and area under curve (AUC) for each test computed. p<0.05 was considered significant. The incidence of difficult intubation was 8% and there were no failure to intubate the trachea. The AUC were as follows: modified Mallampati test 0.473 (p<0.005), Thyromental distance test 0.753 (p<0.005) and neck extension test 0.768 (p<0.005). The results indicate that neck extension test is strongest predictor of difficult intubation (IDS≥5) in comparison to Thyromental test and modified mallampati test.

  9. Videolaryngoscopic endotracheal intubation (GlideScope) of morbidly obese patients in semi-erect position: a comparison with rapid sequence induction in supine position.

    PubMed

    Gupta, Deepak; Rusin, Konstantin

    2012-10-01

    In regards to peri-anesthetic morbidity considerations, morbidly obese patients often have full stomach for extended periods secondary to delayed gastric emptying. Additionally, they may have difficulty lying supine because of multiple reasons. The purpose of the study was to compare endotracheal intubation of morbidly obese patients placed in semi-erect position with the rapid sequence induction in the supine position using GlideScope video laryngoscopy. A prospective randomized study was conducted in ASA I-III patients aged 18-65 years who were scheduled for bariatric surgery. Group A (Study Group): General anesthesia was induced in the semi-erect position, and endotracheal intubation was performed by the investigator positioned in front of the patient. The GlideScope blade was held in the right hand of the investigator during intubation and endotracheal tube with rigid stylet was inserted using the left hand. Group B (Control Group): General anesthesia was induced and patient's trachea intubated in the standard supine position. 39 patients underwent endotracheal intubation in semi-erect position (Study Group) and 37 patients underwent endotracheal intubation in supine position (Control Group). No differences were observed in the intubation parameters or patient safety. Intubation times required to secure patients' airways were not significantly insignificant (p = 0.42) between the two groups; desaturation episodes occurred 50% less frequently (though insignificant p = 0.42) in the semierect group. This is the first prospective study demonstrating endotracheal intubation with GlideScope in the semi-erect position as comparable to standard supine position intubation. Moreover, gravity-directed and aligned biomechanics in the semi-erect position may be ergonomically more efficient for intubating morbidly obese patients.

  10. A Randomized Comparison Simulating Face to Face Endotracheal Intubation of Pentax Airway Scope, C-MAC Video Laryngoscope, Glidescope Video Laryngoscope, and Macintosh Laryngoscope.

    PubMed

    Choi, Hyun Young; Oh, Young Min; Kang, Gu Hyun; Kang, Hyunggoo; Jang, Yong Soo; Kim, Wonhee; Kim, Euichung; Cho, Young Soon; Choi, Hyukjoong; Kim, Hyunjong; Kim, Gyoung Yong

    2015-01-01

    Early airway management is very important for severely ill patients. This study aimed to investigate the efficacy of face to face intubation in four different types of laryngoscopes (Macintosh laryngoscope, Pentax airway scope (AWS), Glidescope video laryngoscope (GVL), and C-MAC video laryngoscope (C-MAC)). Ninety-five nurses and emergency medical technicians were trained to use the AWS, C-MAC, GVL and Macintosh laryngoscope with standard airway trainer manikin and face to face intubation. We compared VCET (vocal cord exposure time), tube pass time, 1st ventilation time, VCET to tube pass time, tube pass time to 1st ventilation time, and POGO (percentage of glottis opening) score. In addition, we compared success rate according to the number of attempts and complications. VCET was similar among all laryngoscopes and POGO score was higher in AWS. AWS and Macintosh blade were faster than GVL and C-MAC in total intubation time. Face to face intubation success rate was lower in GVL than other laryngoscopes. AWS and Macintosh were favorable laryngoscopes in face to face intubation. GVL had disadvantage performing face to face intubation.

  11. A Randomized Comparison Simulating Face to Face Endotracheal Intubation of Pentax Airway Scope, C-MAC Video Laryngoscope, Glidescope Video Laryngoscope, and Macintosh Laryngoscope

    PubMed Central

    Choi, Hyun Young; Oh, Young Min; Kang, Gu Hyun; Kang, Hyunggoo; Jang, Yong Soo; Kim, Wonhee; Kim, Euichung; Cho, Young Soon; Choi, Hyukjoong; Kim, Hyunjong; Kim, Gyoung Yong

    2015-01-01

    Objectives. Early airway management is very important for severely ill patients. This study aimed to investigate the efficacy of face to face intubation in four different types of laryngoscopes (Macintosh laryngoscope, Pentax airway scope (AWS), Glidescope video laryngoscope (GVL), and C-MAC video laryngoscope (C-MAC)). Method. Ninety-five nurses and emergency medical technicians were trained to use the AWS, C-MAC, GVL and Macintosh laryngoscope with standard airway trainer manikin and face to face intubation. We compared VCET (vocal cord exposure time), tube pass time, 1st ventilation time, VCET to tube pass time, tube pass time to 1st ventilation time, and POGO (percentage of glottis opening) score. In addition, we compared success rate according to the number of attempts and complications. Result. VCET was similar among all laryngoscopes and POGO score was higher in AWS. AWS and Macintosh blade were faster than GVL and C-MAC in total intubation time. Face to face intubation success rate was lower in GVL than other laryngoscopes. Conclusion. AWS and Macintosh were favorable laryngoscopes in face to face intubation. GVL had disadvantage performing face to face intubation. PMID:26161424

  12. [Comparison of effectiveness of intubation by way of "Gum Elastic Bougie" and "Intubating Laryngeal Mask Airway" in endotracheal intubation of patients with simulated cervical trauma].

    PubMed

    Sut, Esra Yildiz; Gunal, Solmaz; Yazar, Mehmet Akif; Dikmen, Bayazit

    In this study, we evaluated the effectiveness of intubations by way of "Gum Elastic Bougie" and "Intubating Laryngeal Mask Airway" in endotracheal intubation of patients with simulated cervical trauma. 134 patients were included in the study. All patients were placed cervical collar for a simulated cervical trauma. Patients were allocated randomly into three groups: Group NI (n=45) intubation with Macintosh laryngoscopy, Group GEB (n=45) intubation with Gum Elastic Bougie, and Group ILMA (n=44) intubation with Intubating Laryngeal Mask Airway. The number of intubation attempts, success of intubation, duration of complete visualization of the larynx, duration of intubation, user's performance score, hemodynamic changes and the observed complications were recorded. Success of intubation in the first attempt was highest in Group GEB while it was lowest in Group ILMA. Regarding the intubation success, rates of successful intubation were 95.6%, 84.4% and 65.9% in Groups GEB, NI, and ILMA, respectively. Durations of visualization of larynx and intubation were shorter in Groups NI and GEB than in Group ILMA. This difference was statistically significant (p<0.05) while there was no significant difference between Groups NI and GEB. The number of patients with "good" intubation performance was significantly higher in Group GEB while the number of patients with "poor" intubation performance was significantly higher in Group ILMA (p<0.05). We conclude that GEB, which is cheap and easily accessible, should be an advantageous choice in cervical trauma patients for both the easeness of intubation and patient morbidity and mortality. Copyright © 2016 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  13. [Video laryngoscopic tracheal intubation under sedation].

    PubMed

    Masquère, P; Lonjaret, L; Fourcade, O; Minville, V

    2013-05-01

    We report a video laryngoscopic tracheal intubation under sedation in a patient with a hip fracture. Preoperative assessment revealed signs of difficult airway management linked to a cervical spine immobilization. Here we describe an alternative method to awake fiber optic flexible intubation. Copyright © 2013 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier SAS. All rights reserved.

  14. Cervical Spinal Motion During Orotracheal Intubation.

    DTIC Science & Technology

    1998-01-01

    Sixteen fresh human cadavers were intubated while recording cervical motion using a cine fluoroscopic technique. Segmental cervical motion from the...intubation was performed using no external stabilization, Gardner-Wells traction and manual in-line cervical immobilization. The cadaveric spine motion...immobilization reduced motion at the destabilize C4-5 level. Four patients without significant cervical pathology and normal motion of flexion

  15. Prehospital Endotracheal Intubation in Warm Climates: Caution is Required.

    PubMed

    Daniel, Yann; Habas, Sébastien; Cruc, Maximilien

    2016-09-01

    Out-of-hospital endotracheal intubation is a frequent procedure for trauma care. Nevertheless, in warm climates, sunlight and heat can interfere with the flow of the usual procedure. They can affect the equipment and hinder the operator. There are few data on this issue. The presentation of this case highlights three common complications that may occur when intubating under a hot and bright sun. A 23-year-old man had a car accident in Djibouti, at 11:00 a.m., in broad sunlight. The heat was scorching. Due to a severe head trauma, with a Glasgow Coma Scale score of 8, it was decided to perform an endotracheal intubation. The operator faced three problems: the difficulty of seeing inside the mouth in the bright sunlight, the softening of the tube under the influence of the heat, and the inefficiency of colorimetric CO2 detectors in the warm atmosphere in confirming the proper endotracheal tube placement. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Solutions are simple, but must be known and planned ahead, prior to beginning the procedure: Putting a jacket over his head while doing the laryngoscopy would solve the problem of dazzle; adjuncts like a stylet or gum elastic bougie have to be used at the outset to fix the softening problem; alternative methods to exhaled CO2 detection, such as the syringe aspiration technique, to confirm the proper tube placement, should be available. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Comparison of haemodynamic responses to intubation: Flexible fibreoptic bronchoscope versus bonfils rigid intubation endoscope

    PubMed Central

    Gupta, Kapil; Girdhar, Kiran Kumar; Anand, Raktima; Majgi, Sumanth Mallikarjuna; Gupta, Surinder Pal; Gupta, Payal Bansal

    2012-01-01

    Background: The flexible fibreoptic bronchoscope and bonfils rigid intubation endoscope are being widely used for difficult intubations. Methods: The haemodynamic response to intubation under general anaesthesia was studied in 60 adult female patients who were intubated using either flexible fibreoptic bronchoscope or bonfils rigid intubation endoscope (30 in each group). Non-invasive blood pressure and heart rate (HR) was recorded before induction of anaesthesia, immediately after induction, at the time of intubation and, thereafter, every minute for the next 5 min. The product of HR and systolic blood pressure (rate pressure product) at every point of time was also calculated. Statistical Analyses: Graph pad prism, 5.0 statistical software, independent t test and repeated measure ANOVA test were used. Results: Both bonfils rigid intubation endoscope and flexible fibreoptic bronchoscope required a similar time (less than 1 min) for orotracheal intubation. After intubation, there was a significant increase in HR, blood pressure and rate pressure product (P<0.001) in both the groups compared with the baseline and post-induction values. There was no significant difference in HR, blood pressure and rate pressure product at any of the measuring points or in their maximum values during observation between the two groups. The time required for recovery of systolic blood pressure and HR to post-induction value (±10%) was not significantly different between the two groups (more than 2 min). Conclusion: In female adults under general anaesthesia, bonfils rigid intubation endoscope and flexible fibreoptic bronchoscope require a similar time for successful orotracheal intubation and cause a similar magnitude of haemodynamic response. PMID:23087457

  17. Telepresent intubation supervision is as effective as in-person supervision of procedurally naive operators.

    PubMed

    Prescher, Hannes; Grover, Emily; Mosier, Jarrod; Stolz, Uwe; Biffar, David E; Hamilton, Allan J; Sakles, John C

    2015-03-01

    Telepresence is emerging in clinical and educational settings as a potential modality to provide expert guidance during remote airway management. This study aimed to compare the effectiveness of telepresent versus in-person supervision of tracheal intubation. A randomized, crossover study was performed in a university medical simulation center with 48 first- and second-year medical students with no formal procedural training in tracheal intubation. Each participant was assigned to receive each of four study arms in random sequence: (1) direct laryngoscopy (DL) with in-person supervision, (2) DL with telepresent supervision, (3) videolaryngoscopy (VL) with in-person supervision, and (4) VL with telepresent supervision. Telepresence was established with a smartphone (Apple [Cupertino, CA] iPhone(®)) via FaceTime(®) connection. The primary outcome measure was the time to successful intubation. Secondary outcome measures included first pass success rate and the number of blade and tube attempts. There was no significant difference between in-person and telepresent supervision for any of the outcomes. The median difference (in-person versus telepresent) for time to intubation was -3 s (95% confidence interval [CI], -20 to 14 s). The odds ratio for first attempt success was 0.7 (95% CI, 0.3-1.3), and the rate ratio for extra number of blade attempts (i.e., attempts in addition to first) was 1.1 (95% CI, 0.7-1.7) and 1.4 (95% CI, 0.9-2.2) for extra number of tube attempts. In this study population of procedurally naive medical students, telepresent supervision was as effective as in-person supervision for tracheal intubation.

  18. Innate Immune Response of the Pig Laryngeal Mucosa to Endotracheal Intubation.

    PubMed

    Hughes, Owain R; Ayling, Sarah M; Birchall, Martin A

    2016-01-01

    The aim of this study was to measure the effects of endotracheal intubation on innate immune response within the pig laryngeal mucosa. Prospective controlled basic science study. The animal experiments and analyses were conducted at the University of Bristol. Eighteen pigs, matched at the major histocompatibility complex (MHC), were used in the study. The pigs were divided into 9 pairs. One of each pair (9 pigs in total) was intubated with an endotracheal tube under general anesthesia for 90 minutes. Two days later, pinch biopsies were taken from the supraglottis (specifically the false cords) and subglottis of both pigs. The experiment was repeated 8 more times. Based on quantitative immunohistochemistry, percentage areas of positive staining for CD172a, CD163, MHC class II, CD14, and CD16 were calculated separately for the epithelium and lamina propria of each biopsy. Total areas of laryngeal mucosa (epithelium and lamina propria) expressing CD172a and coexpressing CD163 and CD172a were significantly reduced at 2 days following endotracheal intubation (P = .039 and P = .037, respectively). MHC class II expression and MHC class II coexpression with CD172a were similarly reduced following intubation (P = .003 and P = .005, respectively). In the supraglottis, MHC class II coexpression with CD16 and CD14 was also reduced following endotracheal intubation (P = .037). Our results indicate that endotracheal intubation reduces the number of innate immune cells within the upper airway mucosa. This may be an important first step in a cascade leading to chronic wound and scar formation causing airway stenosis. © American Academy of Otolaryngology-Head and Neck Surgery Foundation 2015.

  19. Shock-tube studies of atomic silicon emission in the spectral range 180 to 300 nm. [environment simulation for Jupiter probes

    NASA Technical Reports Server (NTRS)

    Prakash, S. G.; Park, C.

    1978-01-01

    Emission spectroscopy of shock-heated atomic silicon was performed in the spectral range 180 to 300 nm, in an environment simulating the ablation layer expected around a Jovian entry probe with a silica heat shield. From the spectra obtained at temperatures from 6000 to 10,000 K and electron number densities from 1 quadrillion to 100 quadrillion per cu cm, the Lorentzian line-widths were determined. The results showed that silicon lines are broadened significantly by both electrons (Stark broadening) and hydrogen atoms (Van der Waals broadening), and the combined line-widths are much larger than previously assumed. From the data, the Stark and the Van der Waals line-widths were determined for 34 silicon lines. Radiative transport through a typical shock layer was computed using the new line-width data. The computations showed that silicon emission in the hot region is large, but it is mostly absorbed in the colder region adjacent to the wall.

  20. [Post-intubation laryngeal granuloma: a rare complication of tracheal intubation in pediatrics. Case report].

    PubMed

    Cuestas, Giselle; Rodríguez, Verónica; Doormann, Flavia; Bellia Munzón, Patricio; Bellia Munzón, Gastón

    2017-10-01

    Laryngeal granulomas are benign lesions located in the posterior third of the glottis, mainly at the level of the vocal apophysis of the arytenoid cartilage. They are typically associated with three etiological factors: endotracheal intubation, inappropriate voice use and/or gastroesophageal reflux. The formation of a post-intubation laryngeal granuloma is a late complication related to intubation injury. It is uncommon in the child, especially if the period of intubation is short. It is usually unilateral and produces dysphonia, pharyngeal foreign body sensation and cough. Treatment consists of surgical removal when the lesion is pediculated or causes respiratory compromise. We present a 14-year-old girl who developed a pediculated laryngeal granuloma after orotracheal intubation of less than 24 hours, which was evidenced 3 months after cardiac surgery. We describe the pathogenesis, clinical manifestations, diagnosis and treatment of this pathology. Sociedad Argentina de Pediatría.

  1. Variables Associated with Successful Intubation Attempts Using Video Laryngoscopy: A Preliminary Report in a Helicopter Emergency Medical Service

    PubMed Central

    Carlson, Jestin N.; Quintero, Jorge; Guyette, Francis X.; Callaway, Clifton W.; Menegazzi, James J.

    2013-01-01

    Background Multiple studies have demonstrated varying rates of successful endotracheal intubation (ETI). Until the application of video laryngoscopy, little information regarding prehospital intubation could be analyzed objectively by individuals other than the provider performing the ETI. Objective To evaluate the association of variables recorded during video laryngoscopy and successful ETI attempts, defined as placing the endotracheal tube in the trachea. Methods We retrospectively reviewed intubations performed by a single helicopter emergency medical service (HEMS) using a video larygoscope from March 1, 2010, to October 1, 2010. All videos were de-identified and analyzed by a single researcher. Time intervals (e.g., attempt time) and intubation process variables (e.g., Cormack-Lehane [C-L] view) were abstracted from all videos. Time intervals were begun when the laryngoscope blade passed the lips and entered the oral cavity (entry). We describe variables using means and standard deviations (continuous), medians with interquartile ranges (ordinal), and percentages with 95% confidence intervals (categorical). We then looked at univariate associations between these variables and ETI success using logistic regression. Results We recorded 116 intubations during the study period. Twenty-nine recordings were either incomplete (n = 26) or of insufficient quality for analysis (n = 3). The remaining 87 videos represented 87 different patients with a total of 102 attempts at laryngoscopy. Thirty-six providers performed 64 cases, with the majority of providers (n = 21) performing only one intubation. The first-pass success rate in this series was 76% (n = 66), with 98% success within three attempts. Successful ETI attempts had lower entry–to–percentage of glottic opening (POGO) times (16.6 sec vs. 32.1 sec, p = 0.013), entry–to–first view of the endotracheal tube or entry-to-tube times (17.6 sec vs. 27.4 sec, p = 0.04), higher POGO scores (76 vs. 39, p < 0

  2. Tracheal intubation in an urban emergency department in Scotland: a prospective, observational study of 3738 intubations.

    PubMed

    Kerslake, Dean; Oglesby, Angela J; Di Rollo, Nicola; James, Ed; McKeown, Dermot W; Ray, David C

    2015-04-01

    The emergency department (ED) is an area where major airway difficulties can occur, often as complications of rapid sequence induction (RSI). We undertook a prospective, observational study of tracheal intubation performed in a large, urban UK ED to study this further. We reviewed data on every intubation attempt made in our ED between January 1999 and December 2011. We recorded techniques and drugs used, intubator details, success rate, and associated complications. Tracheal intubation in our ED is managed jointly by emergency physicians and anaesthetists; an anaesthetist is contacted to attend to support ED staff when RSI is being performed. We included 3738 intubations in analysis. 2749 (74%) were RSIs, 361 (10%) were other drug combinations, and 628 (17%) received no drugs. Emergency physicians performed 78% and anaesthetists 22% of intubations. Tracheal intubation was successful in 3724 patients (99.6%). First time success rate was 85%; 98% of patients were successfully intubated with two or fewer attempts, and three patients (0.1%) had more than three attempts. Intubation failed in 14 patients; five (0.13%) had a surgical airway performed. Associated complications occurred in 286 (8%) patients. The incidence of complications was associated with the number of attempts made; 7% in one attempt, 15% in two attempts, and 32% in three attempts (p<0.001). A collaborative approach between emergency physicians and anaesthetists contributed to a high rate of successful intubation and a low rate of complications. Close collaboration in training and delivery of service models is essential to maintain these high standards and achieve further improvement where possible. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  3. Microbiology of endotracheal aspirates in intubated pediatric intensive care unit patients: correlations with radiographic findings.

    PubMed

    Golden, S E; Shehab, Z M; Bjelland, J C; Ryan, K J; Ray, C G

    1987-07-01

    We studied the utility of Gram-stained smears and semiquantitative cultures of endotracheal aspirates (ETAs) in diagnosing pneumonia in intubated patients in a pediatric intensive care unit. The chest radiographs of 35 intubated patients were independently reviewed by a pediatric radiologist and classified into probable, possible and unlikely pneumonias. Concomitant bacteriologic and radiographic information was available in 15 episodes of probable and 13 of possible pneumonia. These findings were compared with the ETAs obtained during the study from patients with no radiographic evidence of pneumonia (N = 21). There was a good correlation between ETA findings and radiographic evidence of pneumonia when ETAs were obtained within 60 minutes of initial intubation. Only a growth of greater than or equal to 3+ of a pathogen was associated with probable pneumonia when ETAs were obtained more than 60 minutes from initial intubation. There was a poor correlation between the microbiologic findings from ETAs and the results of blood cultures and postmortem examinations. Moreover 5 of 10 pairs of ETAs obtained within 18 hours of each other demonstrated discordant results. The ETAs from patients with indwelling endotracheal tubes correlated poorly with radiographic findings and are of questionable value in diagnosing the presence of pneumonia or its etiology in this group. They must be cautiously interpreted in critically ill patients.

  4. Ketorolac Tromethamine Spray Prevents Postendotracheal-Intubation-Induced Sore Throat after General Anesthesia

    PubMed Central

    Yang, H. L.; Tsai, S. C.; Tsay, P. K.; Lin, H. T.

    2016-01-01

    Background. Postoperative sore throat is one of the major complaints of general anesthesia in the postanesthesia care unit. This prospective study investigated the preventive effect of ketorolac tromethamine spray in postendotracheal-intubation-induced sore throat after general anesthesia. Methods. Surgical patients undergoing general anesthesia with endotracheal intubation were recruited from a medical center. Patients were randomly assigned to group K (treated with 5% ketorolac tromethamine spray) or group D (treated with distilled water spray). Before intubation, each endotracheal tube was sprayed with the appropriate solution by physicians over the 20 cm length of the cuff. Each group comprised 95 patients fitting the inclusion and exclusion criteria for whom complete data sets were collected. The intensity of the sore throat was measured at 1, 3, 6, and 24 h after surgery, and data were compared. Results. The two groups had similar characteristics. Postoperative sore throat was significantly less frequent in group K than in group D (p < 0.001) and the pain intensity was significantly lower in group K than in group D at each time point (all p < 0.001). Conclusions. This study demonstrated that preanesthesia 5% ketorolac tromethamine spray could effectively decrease postendotracheal-intubation-induced sore throat in patients undergoing general anesthesia. PMID:28025646

  5. [Secondary lung diseases in patients with nasotracheal intubation. Role of nosocomial sinusitis].

    PubMed

    Meyer, P; Guérin, J M; Habib, Y; Lévy, C

    1988-01-01

    Nosocomial pneumonia is a frequent infectious complication in ICU patients. All the patients with prolonged nasotracheal intubation presenting with nosocomial pneumonia according to Salata's criteria were examined for sinusitis in the prospective study. Diagnosis was confirmed via CT-scan views and transnasal sinus puncture. In eleven nasally intubated patients, CT-scan views showed air fluid levels and multiple sinus involvement. Bacteriological studies isolated the same gram negative bacilli in both sinus and bronchial aspirates. In four cases, a polymicrobial sinusitis was found with a single organism predominant. This predominant germ was always found in bronchial aspirate. Recovery from pneumonia was obtained only after sinus drainage. Treatment included removing the nasal tubes, or performing tracheostomy and systemic antibiotics. One patient required surgical maxillary sinus drainage after failure of medical management. The occurrence of nosocomial pneumonia in nasotracheally intubated patients should lead physicians to explore the paranasal sinuses. Sinus CT-scan views should be routinely obtained in the assessment of pulmonary sepsis in patients with prolonged nasotracheal intubation. Persistent or ignored nosocomial sinusitis in such circumstances could be a major source of treatment failure.

  6. Modeling water vapor and heat transfer in the normal and the intubated airways.

    PubMed

    Tawhai, Merryn H; Hunter, Peter J

    2004-04-01

    Intubation of the artificially ventilated patient with an endotracheal tube bypasses the usual conditioning regions of the nose and mouth. In this situation any deficit in heat or moisture in the air is compensated for by evaporation and thermal transfer from the pulmonary airway walls. To study the dynamics of heat and water transport in the intubated airway, a coupled system of nonlinear equations is solved in airway models with symmetric geometry and anatomically based geometry. Radial distribution of heat, water vapor, and velocity in the airway are described by power-law equations. Solution of the time-dependent system of equations yields dynamic airstream and mucosal temperatures and air humidity. Comparison of model results with two independent experimental studies in the normal and intubated airway shows a close correlation over a wide range of minute ventilation. Using the anatomically based model a range of spatially distributed temperature paths is demonstrated, which highlights the model's ability to predict thermal behavior in airway regions currently inaccessible to measurement. Accurate representation of conducting airway geometry is shown to be necessary for simulating mouth-breathing at rates between 15 and 100 l x min(-1), but symmetric geometry is adequate for the low minute ventilation and warm inspired air conditions that are generally supplied to the intubated patient.

  7. Laryngeal complications by orotracheal intubation: Literature review

    PubMed Central

    Mota, Luiz Alberto Alves; de Cavalho, Glauber Barbosa; Brito, Valeska Almeida

    2012-01-01

    Sumamry Introduction: The injuries caused for the orotracheal intubation are common in our way and widely told by literature. Generally the pipe rank of or consequence of its permanence in the aerial ways of the patient is caused by accidents in. It has diverse types of larynx injuries, caused for multiple mechanisms. Objective: To verify, in literature, the main causes of laryngeal complications after- orotracheal intubation and its mechanisms of injury. Revision of Literature: The searched databases had been LILACS, BIREME and SCIELO. Were updated, books and theses had been used, delimiting itself the period enters 1953 the 2009. The keywords used for the search of articles had been: complications, injuries, larynx, intubation, endotracheal, orotracheal, granulomas, stenosis. 59 references had been selected. The used criteria of inclusion for the choice of articles had been the ones that had shown to the diverse types of injuries caused for the orotracheal intubation and its pathophysiology. Final Considerations: This revision of literature was motivated by the comment in the practical clinic of a great number of laryngeal sequels in patients submitted to the orotracheal intubation. Of that is ahead important the knowledge, for the professionals of the area of health, the types of complications and its causes, with intention to prevent them, adopting measured of prevention of these injuries. PMID:25991942

  8. Circular Scan Streak Tube Development

    NASA Technical Reports Server (NTRS)

    Nevin, S.

    1980-01-01

    A streak tube having circular scan was designed, built and tested. Continuous circular scan, easily derived from out of phase sine waves applied to the conventional deflection plates, permits the timing of pulses traveling long baselines. At the tube's output a circular array of 720 elements is scanned to provide 30 to 40 picosecond resolution. Initial difficulties with electron bombarded silicon arrays were circumvented by using microchannel plates within the streak tube to provide the needed electronic amplification and digital sensitivity and coupling the 720 element arrays to the electron beam by means of a phosphor on a fiber optics. Two ceramic body tubes with S-20 photocathodes were tested and delivered.

  9. Air-Q laryngeal airway for rescue and tracheal intubation.

    PubMed

    Ads, Ayman; Auerbach, Frederic; Ryan, Kelly; El-Ganzouri, Abdel R

    2016-08-01

    We report the successful use of the Air-Q laryngeal airway (Air-Q LA) as a ventilatory device and a conduit for tracheal intubation to rescue the airway in a patient with difficult airway and tracheal stenosis. This is the first case report of the device to secure the airway after two episodes of hypoxemia in the operating room and intensive care unit. Consent for submission of this case report was obtained from our institution's human studies institutional review board given that the patient died a few months after his discharge from the hospital before his personal consent could be obtained and before preparation of this report. All personal identifiers that could lead to his identification have been removed from this report. A 59-year-old man was scheduled for a flexible and rigid bronchoscopy with possible laser excision of tracheal stenosis. He had a history of hypertension, atrial fibrillation, and diabetes. Assessment of airway revealed a thyromental distance of 6.5 cm, Mallampati class II, and body weight of 110 kg. He had hoarseness and audible inspiratory/expiratory stridor with Spo2 90% breathing room air. After induction and muscle relaxation, tracheal intubation and flexible bronchoscopy were achieved without incident. The patient was then extubated and a rigid bronchoscopy was attempted but failed with Spo2 dropping to 92%; rocuronium 60 mg was given, and reintubation was accomplished with a 7.5-mm endotracheal tube. A second rigid bronchoscopy attempt failed, with Spo2 dropping to 63%. Subsequent direct laryngoscopy revealed a bloody hypopharynx. A size 4.5 Air-Q LA was placed successfully and confirmed with capnography, and Spo2 returned to 100%. The airway was suctioned through the Air-Q LA device, and the airway was secured using a fiberoptic bronchoscope to place an endotracheal tube of 7.5-mm internal diameter. The case was canceled because of edema of the upper airway from multiple attempts with rigid bronchoscopy. The patient was transported

  10. TUBE TESTER

    DOEpatents

    Gittings, H.T. Jr.; Kalbach, J.F.

    1958-01-14

    This patent relates to tube testing, and in particular describes a tube tester for automatic testing of a number of vacuum tubes while in service and as frequently as may be desired. In it broadest aspects the tube tester compares a particular tube with a standard tube tarough a difference amplifier. An unbalanced condition in the circuit of the latter produced by excessive deviation of the tube in its characteristics from standard actuates a switch mechanism stopping the testing cycle and indicating the defective tube.

  11. Out-of-Hospital Endotracheal Intubation Experience and Patient Outcomes

    PubMed Central

    Wang, Henry E.; Balasubramani, G. K.; Cook, Lawrence J.; Lave, Judith R.; Yealy, Donald M.

    2011-01-01

    Study objective Previous studies suggest improved patient outcomes for providers who perform high volumes of complex medical procedures. Out-of-hospital tracheal intubation is a difficult procedure. We seek to determine the association between rescuer procedural experience and patient survival after out-of-hospital tracheal intubation. Methods We analyzed probabilistically linked Pennsylvania statewide emergency medicine services, hospital discharge, and death data of patients receiving out-of-hospital tracheal intubation. We defined tracheal intubation experience as cumulative tracheal intubation during 2000 to 2005; low=1 to 10 tracheal intubations, medium=11 to 25 tracheal intubations, high=26 to 50 tracheal intubations, and very high=greater than 50 tracheal intubations. We identified survival on hospital discharge of patients intubated during 2003 to 2005. Using generalized estimating equations, we evaluated the association between patient survival and out-of-hospital rescuer cumulative tracheal intubation experience, adjusted for clinical covariates. Results During 2003 to 2005, 4,846 rescuers performed tracheal intubation. These individuals performed tracheal intubation on 33,117 patients during 2003 to 2005 and 62,586 patients during 2000 to 2005. Among 21,753 cardiac arrests, adjusted odds of survival was higher for patients intubated by rescuers with very high tracheal intubation experience; adjusted odds ratio (OR) versus low tracheal intubation experience: very high 1.48 (95% confidence interval [CI] 1.15 to 1.89), high 1.13 (95% CI 0.98 to 1.31), and medium 1.02 (95% CI 0.91 to 1.15). Among 8,162 medical nonarrests, adjusted odds of survival were higher for patients intubated by rescuers with high and very high tracheal intubation experience; adjusted OR versus low tracheal intubation experience: very high 1.55 (95% CI 1.08 to 2.22), high 1.29 (95% CI 1.04 to 1.59), and medium 1.16 (95% CI 0.97 to 1.38). Among 3,202 trauma nonarrests, survival was not

  12. Mechanisms of pneumothorax following tracheal intubation.

    PubMed

    Berg, L F; Mafee, M F; Campos, M; Applebaum, E L

    1988-01-01

    To investigate the mechanism by which pneumothorax may occur as a complication of tracheal intubation, we submitted four cats to tracheotomy and three to tracheal intubation. To simulate the dissection of air along fascial planes following tracheotomy, we placed catheters in either the pretracheal or subcutaneous plane and applied positive pressure to the catheters. The cats undergoing tracheal intubation were ventilated with excessive positive pressure. Computed tomography was used to document the progression of pneumothorax. High positive pressures during mechanical ventilation led to pneumothorax and pneumomediastinum, and the mechanism was primarily the dissection of air along the perivascular sheaths of the pulmonary arteries, presumably due to rupture of perivascular alveoli. Dissection of air along the pretracheal fascia following tracheotomy produced pneumomediastinum but not pneumothorax. This suggests that pneumothorax occurring clinically is more likely a complication of assisted ventilation than a complication of tracheotomy surgery.

  13. Tube supports

    SciTech Connect

    Cannon, K.A.

    1989-01-10

    This patent describes an apparatus consisting of parallel tubes arranged in the form of a tube bundle having a first plurality of parallel tube rows with lanes between adjacent rows and a second plurality of parallel tube rows with lanes between adjacent rows and support structure for supporting the tubes. The support structure consists of at least a first baffle and a second baffle, wherein each baffle comprises an outer ring surrounding the tube bundle and at least one slat attached to the outer ring as a chord and extending through the tube bundle between adjacent rows in one of the parallel tube rows. At least one slat is characterized by corrugations or folds extending along its length for point contact with the tubes of the bundle, the slat in the first baffle extending in lanes between the first plurality of parallel tube rows, and the slat in the second baffle extending in lanes between the second plurality of parallel tube rows.

  14. Bilobar atelectasis after difficult tracheal intubation.

    PubMed

    Sprung, J; Lozada, L J; Zanettin, G; Banoub, M

    1997-12-01

    Acute intra-operative collapse of a lobe without apparent cause is rare. We report a case of transient bilobar atelectasis that developed without any apparent cause after a difficult tracheal intubation in a healthy young patient. Intrabronchial obstruction was ruled out by bronchoscopy. The bilobar atelectasis developed acutely and resolved quickly with mechanical ventilation. The characteristics of the lung collapse were atypical, suggesting either its reflex nature or acute reduction of lung volume owing to intubation-induced coughing. We present a review of the mechanisms of atelectasis.

  15. A comparison of the C-MAC video laryngoscope to the Macintosh direct laryngoscope for intubation in the emergency department.

    PubMed

    Sakles, John C; Mosier, Jarrod; Chiu, Stephen; Cosentino, Mari; Kalin, Leah

    2012-12-01

    We determine the proportion of successful intubations with the C-MAC video laryngoscope (C-MAC) compared with the direct laryngoscope in emergency department (ED) intubations. This was a retrospective analysis of prospectively collected data entered into a continuous quality improvement database during a 28-month period in an academic ED. After each intubation, the operator completed a standardized data form evaluating multiple aspects of the intubation, including patient demographics, indication for intubation, device(s) used, reason for device selection, difficult airway characteristics, number of attempts, and outcome of each attempt. Intubation was considered ultimately successful if the endotracheal tube was correctly inserted into the trachea with the initial device. An attempt was defined as insertion of the device into the mouth regardless of whether there was an attempt to pass the tube. The primary outcome measure was ultimate success. Secondary outcome measures were first-attempt success, Cormack-Lehane view, and esophageal intubation. Multivariate logistic regression analyses, with the inclusion of a propensity score, were performed for the outcome variables ultimate success and first-attempt success. During the 28-month study period, 750 intubations were performed with either the C-MAC with a size 3 or 4 blade or a direct laryngoscope with a Macintosh size 3 or 4 blade. Of these, 255 were performed with the C-MAC as the initial device and 495 with a Macintosh direct laryngoscope as the initial device. The C-MAC resulted in successful intubation in 248 of 255 cases (97.3%; 95% confidence interval [CI] 94.4% to 98.9%). A direct laryngoscope resulted in successful intubation in 418 of 495 cases (84.4%; 95% CI 81.0% to 87.5%). In the multivariate regression model, with a propensity score included, the C-MAC was positively predictive of ultimate success (odds ratio 12.7; 95% CI 4.1 to 38.8) and first-attempt success (odds ratio 2.2; 95% CI 1.2 to 3.8). When

  16. A Comparison of the C-MAC Video Laryngoscope to the Macintosh Direct Laryngoscope for Intubation in the Emergency Department

    PubMed Central

    Sakles, John C.; Mosier, Jarrod; Chiu, Stephen; Cosentino, Mari; Kalin, Leah

    2015-01-01

    Study objective We determine the proportion of successful intubations with the C-MAC video laryngoscope (C-MAC) compared with the direct laryngoscope in emergency department (ED) intubations. Methods This was a retrospective analysis of prospectively collected data entered into a continuous quality improvement database during a 28-month period in an academic ED. After each intubation, the operator completed a standardized data form evaluating multiple aspects of the intubation, including patient demographics, indication for intubation, device(s) used, reason for device selection, difficult airway characteristics, number of attempts, and outcome of each attempt. Intubation was considered ultimately successful if the endotracheal tube was correctly inserted into the trachea with the initial device. An attempt was defined as insertion of the device into the mouth regardless of whether there was an attempt to pass the tube. The primary outcome measure was ultimate success. Secondary outcome measures were first-attempt success, Cormack-Lehane view, and esophageal intubation. Multivariate logistic regression analyses, with the inclusion of a propensity score, were performed for the outcome variables ultimate success and first-attempt success. Results During the 28-month study period, 750 intubations were performed with either the C-MAC with a size 3 or 4 blade or a direct laryngoscope with a Macintosh size 3 or 4 blade. Of these, 255 were performed with the C-MAC as the initial device and 495 with a Macintosh direct laryngoscope as the initial device. The C-MAC resulted in successful intubation in 248 of 255 cases (97.3%; 95% confidence interval [CI] 94.4% to 98.9%). A direct laryngoscope resulted in successful intubation in 418 of 495 cases (84.4%; 95% CI 81.0% to 87.5%). In the multivariate regression model, with a propensity score included, the C-MAC was positively predictive of ultimate success (odds ratio 12.7; 95% CI 4.1 to 38.8) and first-attempt success (odds

  17. Toomey syringe aspiration may be inaccurate in detecting esophageal intubation after gastric insufflation.

    PubMed

    Chew, Gordon S; Vilke, Gary M; Davis, Daniel P; Chan, Theodore C

    2002-11-01

    We sought to determine whether gastric distention from air insufflation affects the accuracy of the Toomey syringe in detecting esophageal intubation. We conducted a randomized, single-blinded, crossover trial using human cadavers in which cuffed endotracheal (ET) tubes were placed into the esophagus and trachea. Operators used the Toomey syringe to determine the location of the ET tube before and after gastric insufflation via Ambu-bag ventilation. Greater amounts of air were aspirated (35.4 cc vs. 13.7 cc, respectively, p < 0.001) and less resistance was noted on a five-point scale (3.2 vs. 4.8, respectively, p < 0.001) from esophageally placed ET tubes after gastric insufflation. Sensitivity in detecting esophageally placed ET tubes decreased from 100% in noninsufflated cadavers to only 58% after gastric insufflation (p < 0.001). In the thawed fresh frozen cadaveric model, the Toomey syringe was unreliable in detecting an esophageal intubation after gastric distention insufflation.

  18. Delayed sequence intubation: is it ready for prime time?

    PubMed

    Taylor, John A; Hohl, Corinne Michele

    2017-01-01

    Clinical question Does delayed sequence intubation (DSI) improve preoxygenation and safety when intubating otherwise uncooperative patients? Article chosen Weingart SD, Trueger S, Wong N, et al. Delayed sequence intubation: a prospective observational study. Ann Emerg Med 2015;65(4):349-55. doi:10.1016/j.annemergmed.2014.09.025 OBJECTIVE: To investigate whether the administration of ketamine 3 minutes prior to the administration of a muscle relaxant allows for optimal preoxygenation in uncooperative patients undergoing intubation.

  19. The i-gel Supraglottic Airway as a Conduit for Fibreoptic Tracheal Intubation - A Randomized Comparison with the Single-use Intubating Laryngeal Mask Airway and CTrach Laryngeal Mask in Patients with Predicted Difficult Laryngoscopy.

    PubMed

    Michálek, Pavel; Donaldson, Will; McAleavey, Francis; Abraham, Alexander; Mathers, Rachel J; Telford, Claire

    2016-01-01

    Fibreoptic intubation through a supraglottic airway is an alternative plan for airway management in difficult or failed laryngoscopy. The aim of this study was to compare three supraglottic airways as conduits in patients with at least one predictor for difficult laryngoscopy. The i-gel was compared with the single-use intubating laryngeal mask airway (sILMA) and CTrach laryngeal mask in 120 adult patients scheduled for elective surgeries under general anaesthesia using a prospective, randomized and single-blinded design. Primary outcome was success rate of tracheal intubation through the device, while secondary outcomes were times required for device insertion and tracheal tube placement, fibreoptic scores and the incidence of perioperative complications and postoperative complaints. The success rates showed no statistical difference between devices (i-gel 100%, CTrach 97.5%, ILMA 95%). Insertion time was shortest for the i-gel (12.4 s) compared with ILMA (19.3 s) and CTrach (24.4 s). Intubation time was shorter in the i-gel group (29.4 s) in comparison with the CTrach (39.8 s, p<0.05) and sILMA (51.9 s, p<0.001) groups. Best fibreoptic scores were observed also in the i-gel group. In total, 24 patients (20%) presented with difficult laryngoscopy. The i-gel showed significantly shorter times for insertion and fibreoptic intubation than the other two devices in this group. No difference was observed in the incidence of postoperative complaints. The i-gel is a suitable alternative to the sILMA and CTrach for fibrescope-guided tracheal intubation. Shorter insertion and intubation times with the i-gel may provide advantage in case of difficult oxygenation.

  20. Hands-Off Time for Endotracheal Intubation during CPR Is Not Altered by the Use of the C-MAC Video-Laryngoscope Compared to Conventional Direct Laryngoscopy. A Randomized Crossover Manikin Study.

    PubMed

    Schuerner, Philipp; Grande, Bastian; Piegeler, Tobias; Schlaepfer, Martin; Saager, Leif; Hutcherson, Matthew T; Spahn, Donat R; Ruetzler, Kurt

    2016-01-01

    Sufficient ventilation and oxygenation through proper airway management is essential in patients undergoing cardio-pulmonary resuscitation (CPR). Although widely discussed, securing the airway using an endotracheal tube is considered the standard of care. Endotracheal intubation may be challenging and causes prolonged interruption of chest compressions. Videolaryngoscopes have been introduced to better visualize the vocal cords and accelerate intubation, which makes endotracheal intubation much safer and may contribute to intubation success. Therefore, we aimed to compare hands-off time and intubation success of direct laryngoscopy with videolaryngoscopy (C-MAC, Karl Storz, Tuttlingen, Germany) in a randomized, cross-over manikin study. Twenty-six anesthesia residents and twelve anesthesia consultants of the University Hospital Zurich were recruited through a voluntary enrolment. All participants performed endotracheal intubation using direct laryngoscopy and C-MAC in a random order during ongoing chest compressions. Participants were strictly advised to stop chest compression only if necessary. The median hands-off time was 1.9 seconds in direct laryngoscopy, compared to 3 seconds in the C-MAC group. In direct laryngoscopy 39 intubation attempts were recorded, resulting in an overall first intubation attempt success rate of 97%, compared to 38 intubation attempts and 100% overall first intubation attempt success rate in the C-MAC group. As a conclusion, the results of our manikin-study demonstrate that video laryngoscopes might not be beneficial compared to conventional, direct laryngoscopy in easily accessible airways under CPR conditions and in experienced hands. The benefits of video laryngoscopes are of course more distinct in overcoming difficult airways, as it converts a potential "blind intubation" into an intubation under visual control.

  1. Comparison of glottic views and intubation times in the supine and 25 degree back-up positions.

    PubMed

    Reddy, Raj M; Adke, Manish; Patil, Pranava; Kosheleva, Irina; Ridley, Saxon

    2016-11-16

    We explored whether positioning patients in a 25° back-up sniffing position improved glottic views and ease of intubation. In the first part of the study, patients were intubated in the standard supine sniffing position. In the second part, the back of the operating table was raised 25° from the horizontal by flexion of the torso at the hips while maintaining the sniffing position. The best view obtained during laryngoscopy was assessed using the Cormack and Lehane classification and Percentage of Glottic Opening (POGO) score. The number of attempts at both laryngoscopy and tracheal intubation, together with the use of ancillary equipment and manoeuvres were recorded. The ease of intubation was indirectly assessed by recording the time interval between beginning of laryngoscopy and insertion of the tracheal tube. Seven hundred eighty one unselected surgical patients scheduled for non-emergency surgery were included. In the back-up position, ancillary laryngeal manoeuvres, which included cricoid pressure, backwards upwards rightward pressure and external laryngeal manipulation, were required less frequently (19.6 % versus 24.6 %, p = 0.004). The time from beginning of laryngoscopy to insertion of the tracheal tube was 14 % shorter (median time 24 versus 28 s, p = 0.031) in the back-up position. There was no significant difference in glottic views. The 25° back-up position improved the ease of intubation as judged by the need for fewer ancillary manoeuvres and shorter time for intubation. ClinicalTrials.gov Identifier: NCT02934347 registered retrospectively on 14th Oct 2016.

  2. [Cuff damage during naso-tracheal intubation for general anesthesia in oral surgery].

    PubMed

    Nakamura, S; Watanabe, T; Hiroi, E; Sasaki, T; Matsumoto, N; Hori, T

    1997-11-01

    In our hospital, twenty-one cases of endotracheal tube cuff rupture during naso-tracheal intubation were noted in cases using 725 polyvinyl chloride (PVC) tracheal tubes. We analysed the causes of cuff troubles in these 21 samples of tubes. When the cuffs were inflated, they were not capable of containing the air in most cases. Some cuffs had small holes (described as pinholes), and the others had longer slits on scrape marks and burst. These scrape marks may have been caused by the object with sharp edges such as spina or crista of the nasal septum, or otherwise by the tip of intubation forceps. The cuff material appeared to be slightly hardened in some samples which may be due to the lubrication. We usually lubricated the tube with lidocaine spray or gel formulation and then sometimes placed it in hot water to soften it for avoiding naso-mucosal injury. It is not generally recommended to place tubes in hot water, as this procedure may soften the cuff and make it more suspectible to damage. The clarification is also needed on the use of lidocaine. Although the gel formulation is acceptable, but the spray formulation is known to react with cuff material and make it more susceptible to inducing blistering, pinholes and sudden rupture of PVC cuffs. We conclude that these cuff damages might have occurred from various causes. A main cause must be passing the tube through the narrow nasal turbinate with spina or crista. Other causes could not only be the use of Magill forceps but also lubrication of the tube with lidocaine spray and placing it in hot water.

  3. Evaporative heat transfer and enhancement performance of serpentine tubes with strip-type inserts using refrigerant-134a

    SciTech Connect

    Hsieh, S.S.; Jang, K.J.; Huang, M.T.

    1999-08-01

    Recent technological implications have given rise to increased interest in enhancement of the in-tube evaporation used in many air conditioning and refrigeration systems. Although many past studies have examined in-tube evaporative heat transfer enhancement and the associated pressure drop with internally finned tubes, in-tube evaporations with strip-type inserts, using R-134a as a refrigerant, have not been conducted. In addition, the fundamental phenomenon of nucleate boiling from a heated wall subject to a strip-type insert is as yet not well understood, especially for the flow in serpentine tubes. In this study, flow boiling tests were conducted in serpentine coil with inserts. To accomplish these tasks, experiments were performed in a seven-pass serpentine test tube with longitudinal strip and cross-strip types inserts, 10.6-mm inside diameter with R-134a as the boiling fluid immersed in a hot water bath.

  4. Use of the GlideScope Ranger Video Laryngoscope for Emergency Intubation in the Prehospital Setting: A Randomized Control Trial.

    PubMed

    Trimmel, Helmut; Kreutziger, Janett; Fitzka, Robert; Szüts, Stephan; Derdak, Christoph; Koch, Elisabeth; Erwied, Boris; Voelckel, Wolfgang G

    2016-07-01

    We sought to assess whether the GlideScope Ranger video laryngoscope may be a reliable alternative to direct laryngoscopy in the prehospital setting. Multicenter, prospective, randomized, control trial with patient recruitment over 18 months. Four study centers operating physician-staffed rescue helicopters or ground units in Austria and Norway. Adult emergency patients requiring endotracheal intubation. Airway management strictly following a prehospital algorithm. First and second intubation attempt employing GlideScope or direct laryngoscopy as randomized; third attempt crossover. After three failed intubation attempts, immediate use of an extraglottic airway device. A total of 326 patients were enrolled. Success rate with the GlideScope (n = 168) versus direct laryngoscopy (n = 158) group was 61.9% (104/168) versus 96.2% (152/158), respectively (p < 0.001). The main reasons for failed GlideScope intubation were failure to advance the tube into the larynx or trachea (26/168 vs 0/158; p < 0.001) and/or impaired sight due to blood or fluids (21/168 vs 3/158; p < 0.001). When GlideScope intubation failed, direct laryngoscopy was successful in 61 of 64 patients (95.3%), whereas GlideScope enabled intubation in four of six cases (66.7%) where direct laryngoscopy failed (p = 0.055). In addition, GlideScope was prone to impaired visualization of the monitor because of ambient light (29/168; 17.3%). There was no correlation between success rates and body mass index, age, indication for airway management, or experience of the physicians, respectively. Video laryngoscopy is an established tool in difficult airway management, but our results shed light on the specific problems in the emergency medical service setting. Prehospital use of the GlideScope was associated with some major problems, thus resulting in a lower intubation success rate when compared with direct laryngoscopy.

  5. The AirView Study: Comparison of Intubation Conditions and Ease between the Airtraq-AirView and the King Vision.

    PubMed

    Schoettker, Patrick; Corniche, Jocelyn

    2015-01-01

    We conducted a study assessing the quality and speed of intubation between the Airtraq with its new iPhone AirView app and the King Vision in a manikin. The primary endpoint was reduction of time needed for intubation. Secondary endpoints included times necessary for intubation. 30 anaesthetists randomly performed 3 intubations with each device on a difficult airway manikin. Participants had a professional experience of 12 years: 60.0% possessed the Airtraq in their hospital, 46.7% the King Vision, and 20.0% both. Median time difference [IQR] to identify glottis (1.1 [-1.3; 3.9] P = 0.019), for tube insertion (2.1 [-2.6; 9.4] P = 0.002) and lung ventilation (2.8 [-2.4; 11.5] P = 0.001), was shorter with the Airtraq-AirView. Median time for glottis visualization was significantly shorter with the Airtraq-AirView (5.3 [4.0; 8.4] versus 6.4 [4.6; 9.1]). Cormack Lehane before intubation was better with the King Vision (P = 0.03); no difference was noted during intubation, for subjective device insertion or quality of epiglottis visualisation. Assessment of tracheal tube insertion was better with the Airtraq-AirView. The Airtraq-AirView allows faster identification of the landmarks and intubation in a difficult airway manikin, while clinical relevance remains to be studied. Anaesthetists assessed the intubation better with the Airtraq-AirView.