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R B Smith - One of the best experts on this subject based on the ideXlab platform.
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canine tracheal blood flow after Endotracheal Tube Cuff inflation during normotension and hypotension
Anesthesia & Analgesia, 1993Co-Authors: Leonid Bunegin, M S Albin, R B SmithAbstract:Tracheal tissue damage associated with Endotracheal intubation may be a direct result of high mucosal contact pressure (MCP) generated by the Endotracheal Tube Cuff. Tracheal blood flow (TBF) was measured at MCPs in the normotensive and hypotensive (mean arterial blood pressure, 50 mm Hg) canine mod
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Canine tracheal blood flow after Endotracheal Tube Cuff inflation during normotension and hypotension
Anesthesia and analgesia, 1993Co-Authors: Leonid Bunegin, M S Albin, R B SmithAbstract:Tracheal tissue damage associated with Endotracheal intubation may be a direct result of high mucosal contact pressure (MCP) generated by the Endotracheal Tube Cuff. Tracheal blood flow (TBF) was measured at MCPs in the normotensive and hypotensive (mean arterial blood pressure, 50 mm Hg) canine model. Control TBFs through the individual rings in contact with the Endotracheal Tube Cuff ranged between 26.6 +/- 2.7 and 44.5 +/- 5.0 with a mean of 35.0 +/- 2.5 mL.min-1 x 100 g-1 during normotension, and 15.0 +/- 4.9 and 22.5 +/- 5.0 with a mean of 18.9 +/- 0.9 mL.min-1 x 100 g-1 during hypotension. TBF was reduced significantly at all elevated MCPs in both groups. TBF also was measured during normotension and hypotension after Cuff inflation to 15 mm Hg MCP at 1-h intervals for 3 h. TBF was reduced significantly from control to 14.9 +/- 1.5 mL.min-1 x 100 g-1 after 1 h during normotension, and continued to decline to 6.1 +/- 0.9 mL.min-1 x 100 g-1 after 3 h. During hypotension, TBF decreased significantly from control to 6.1 +/- 0.6 mL.min-1 x 100 g-1 at 1 h and remained unchanged at 3 h. These findings suggest that even at 20 mm Hg MCP, significant reductions in TBF may occur. For prolonged Endotracheal intubation, especially during hypotension, significant reductions in TBF may occur at even lower MCP.
G. Akkan - One of the best experts on this subject based on the ideXlab platform.
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lidocaine 10 in the Endotracheal Tube Cuff blood concentrations haemodynamic and clinical effects
European Journal of Anaesthesiology, 2000Co-Authors: Fatis Altintas, Pervin Bozkurt, Güner Kaya, G. AkkanAbstract:Summary The purpose of this study was to evaluate the effects (common haemodynamic variables, peak Cuff pressures, the incidence of reaction (‘bucking’) during extubation and the incidence of sore throat after operation) of lidocaine 10% instilled into the Endotracheal Tube Cuff in intubated patients. Plasma concentrations of lidocaine were assayed. Seventy ASA class I–II patients scheduled for plastic surgery were studied. Patients were randomly divided in two groups: the Cuff of the Endotracheal Tube was inflated with either lidocaine 10% (group L) or with saline (group S) immediately after Endotracheal intubation. In group L patients, the haemodynamic changes were less (P < 0.05), and the peak Cuff pressure was lower (P < 0.01) than for group S. At extubation, more patients reacted (‘bucked’) in group S (70.5% vs. 19.4%, P < 0.01). The incidence and severity of sore throat were significantly lower in group L 1 and 24-h after extubation. Plasma lidocaine concentrations did not reach toxic values. Lidocaine 10%, compared with saline, in the Endotracheal Tube Cuff was associated with less disturbance of haemodynamic responses and less incidence of bucking during tracheal extubation. Lidocaine was also effective in reducing of incidence and severity of sore throat after operation.
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Lidocaine 10% in the Endotracheal Tube Cuff: blood concentrations, haemodynamic and clinical effects.
European journal of anaesthesiology, 2000Co-Authors: Fatis Altintas, Pervin Bozkurt, Güner Kaya, G. AkkanAbstract:The purpose of this study was to evaluate the effects (common haemodynamic variables, peak Cuff pressures, the incidence of reaction ('bucking') during extubation and the incidence of sore throat after operation) of lidocaine 10% instilled into the Endotracheal Tube Cuff in intubated patients. Plasma concentrations of lidocaine were assayed. Seventy ASA class I-II patients scheduled for plastic surgery were studied. Patients were randomly divided in two groups: the Cuff of the Endotracheal Tube was inflated with either lidocaine 10% (group L) or with saline (group S) immediately after Endotracheal intubation. In group L patients, the haemodynamic changes were less (P < 0.05), and the peak Cuff pressure was lower (P < 0.01) than for group S. At extubation, more patients reacted ('bucked') in group S (70.5% vs. 19.4%, P < 0.01). The incidence and severity of sore throat were significantly lower in group L 1 and 24-h after extubation. Plasma lidocaine concentrations did not reach toxic values. Lidocaine 10%, compared with saline, in the Endotracheal Tube Cuff was associated with less disturbance of haemodynamic responses and less incidence of bucking during tracheal extubation. Lidocaine was also effective in reducing of incidence and severity of sore throat after operation.
Leonid Bunegin - One of the best experts on this subject based on the ideXlab platform.
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canine tracheal blood flow after Endotracheal Tube Cuff inflation during normotension and hypotension
Anesthesia & Analgesia, 1993Co-Authors: Leonid Bunegin, M S Albin, R B SmithAbstract:Tracheal tissue damage associated with Endotracheal intubation may be a direct result of high mucosal contact pressure (MCP) generated by the Endotracheal Tube Cuff. Tracheal blood flow (TBF) was measured at MCPs in the normotensive and hypotensive (mean arterial blood pressure, 50 mm Hg) canine mod
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Canine tracheal blood flow after Endotracheal Tube Cuff inflation during normotension and hypotension
Anesthesia and analgesia, 1993Co-Authors: Leonid Bunegin, M S Albin, R B SmithAbstract:Tracheal tissue damage associated with Endotracheal intubation may be a direct result of high mucosal contact pressure (MCP) generated by the Endotracheal Tube Cuff. Tracheal blood flow (TBF) was measured at MCPs in the normotensive and hypotensive (mean arterial blood pressure, 50 mm Hg) canine model. Control TBFs through the individual rings in contact with the Endotracheal Tube Cuff ranged between 26.6 +/- 2.7 and 44.5 +/- 5.0 with a mean of 35.0 +/- 2.5 mL.min-1 x 100 g-1 during normotension, and 15.0 +/- 4.9 and 22.5 +/- 5.0 with a mean of 18.9 +/- 0.9 mL.min-1 x 100 g-1 during hypotension. TBF was reduced significantly at all elevated MCPs in both groups. TBF also was measured during normotension and hypotension after Cuff inflation to 15 mm Hg MCP at 1-h intervals for 3 h. TBF was reduced significantly from control to 14.9 +/- 1.5 mL.min-1 x 100 g-1 after 1 h during normotension, and continued to decline to 6.1 +/- 0.9 mL.min-1 x 100 g-1 after 3 h. During hypotension, TBF decreased significantly from control to 6.1 +/- 0.6 mL.min-1 x 100 g-1 at 1 h and remained unchanged at 3 h. These findings suggest that even at 20 mm Hg MCP, significant reductions in TBF may occur. For prolonged Endotracheal intubation, especially during hypotension, significant reductions in TBF may occur at even lower MCP.
Robert J Hoffman - One of the best experts on this subject based on the ideXlab platform.
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Linear correlation of Endotracheal Tube Cuff pressure and volume.
The western journal of emergency medicine, 2009Co-Authors: Robert J Hoffman, Jefrey R. Dahlen, Daniela Lipovic, Kai M. StürmannAbstract:Endotracheal Tube Cuff (ETTc) inflation by standard methods may result in excessive ETTc pressure. Previous studies have indicated that methods of Cuff inflation most frequently used to inflate ETTcs include palpation of the tension in the pilot balloon or injection of a predetermined volume of air to inflate the pilot balloon. If a logarithmic relationship exists between ETTc volume and ETTc pressure, small volumes of additional air will result in dramatic pressure increases after a volume threshold is reached. Our goal was to determine whether the relationship between ETTc volume and ETTc pressure is linear or non-linear. In this Institutional Animal Care and Use Committee-approved study, we recorded ETTc volume and pressure in four anesthetized and mechanically-ventilated canines ranging between 30-40 pounds (mean 34.7lb, SD 3.8lb) that were Endotracheally intubated with a 7.0 mm ETT. The varying Cuff pressures associated with a distribution of 28 progressively increasing volumes of air in the ETTc were recorded. Spearman correlation was performed to determine if a linear or non-linear relationship existed between these variables. The Spearman rho coefficient of correlation between ETTc volume and ETTc pressure was 0.969, or approximately 97%, suggesting near-perfect linear relationship between ETTc volume and ETTc pressure over the range of volumes and pressures tested. Over the range of volumes and pressures tested a linear relationship between volume and pressure results in no precipitous increase in slope of the pressure:volume curve as volume increases.
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linear correlation of Endotracheal Tube Cuff pressure and volume
Western Journal of Emergency Medicine, 2009Co-Authors: Robert J Hoffman, Jefrey R. Dahlen, Daniela Lipovic, Kai M. StürmannAbstract:Author(s): Hoffman, Robert J; Dahlen, Jefrey R.; Lipovic, Daniela; Sturmann, Kai M. | Abstract: Objectives: Endotracheal Tube Cuff (ETTc) inflation by standard methods may result in excessive ETTc pressure. Previous studies have indicated that methods of Cuff inflation most frequently used to inflate ETTcs include palpation of the tension in the pilot balloon or injection of a predetermined volume of air to inflate the pilot balloon. If a logarithmic relationship exists between ETTc volume and ETTc pressure, small volumes of additional air will result in dramatic pressure increases after a volume threshold is reached. Our goal was to determine whether the relationship between ETTc volume and ETTc pressure is linear or non-linear.Methods: In this Institutional Animal Care and Use Committee-approved study, we recorded ETTc volume and pressure in four anesthetized and mechanically-ventilated canines ranging between 30-40 pounds (mean 34.7lb, SD 3.8lb) that were Endotracheally intubated with a 7.0 mm ETT. The varying Cuff pressures associated with a distribution of 28 progressively increasing volumes of air in the ETTc were recorded. Spearman correlation was performed to determine if a linear or non-linear relationship existed between these variables.Results: The Spearman rho coefficient of correlation between ETTc volume and ETTc pressure was 0.969, or approximately 97%, suggesting near-perfect linear relationship between ETTc volume and ETTc pressure over the range of volumes and pressures tested.Conclusions: Over the range of volumes and pressures tested a linear relationship between volume and pressure results in no precipitous increase in slope of the pressure:volume curve as volume increases.[WestJEM. 2009;10:137-139.]
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practicing paramedics cannot generate or estimate safe Endotracheal Tube Cuff pressure using standard techniques
Prehospital Emergency Care, 2007Co-Authors: Vivek Parwani, Robert J Hoffman, Allison Russell, Chetan Bharel, Christine Preblick, Inhei HahnAbstract:Objectives. We sought to determine the ability of paramedics to inflate Endotracheal Tube Cuffs within safe pressure limits as well as to estimate the pressure of previously inflated Endotracheal Tube Cuffs by palpation of the pilot balloon. Methods. Using a tracheal simulation model, we conducted a prospective, observational, cross-sectional simulation study of licensed, practicing paramedics. This included evaluation of their ability to inflate the Cuff of an Endotracheal Tube to a safe pressure, defined as ≤ 25 cm H2O, as well as to identify excessive intraCuff pressure in previously inflated ETT Cuffs by palpation of the pilot balloon. Results. Fifty-three paramedics were sampled. The average pressure generated by inflating the Endotracheal Tube Cuff was > 108 cm H2O. Participants were only 13% sensitive detecting over inflated Endotracheal Tube Cuffs (95% CI 7.3–17.8). Conclusions. Participants were unable to inflate Endotracheal Tube Cuff to safe pressures andwere unable to identify Endotracheal tub...
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Practicing paramedics cannot generate or estimate safe Endotracheal Tube Cuff pressure using standard techniques.
Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors, 2007Co-Authors: Vivek Parwani, Robert J Hoffman, Allison Russell, Chetan Bharel, Christine Preblick, Inhei HahnAbstract:We sought to determine the ability of paramedics to inflate Endotracheal Tube Cuffs within safe pressure limits as well as to estimate the pressure of previously inflated Endotracheal Tube Cuffs by palpation of the pilot balloon. Using a tracheal simulation model, we conducted a prospective, observational, cross-sectional simulation study of licensed, practicing paramedics. This included evaluation of their ability to inflate the Cuff of an Endotracheal Tube to a safe pressure, defined as < or = 25 cm H(2)O, as well as to identify excessive intraCuff pressure in previously inflated ETT Cuffs by palpation of the pilot balloon. Fifty-three paramedics were sampled. The average pressure generated by inflating the Endotracheal Tube Cuff was > 108 cm H(2)O. Participants were only 13% sensitive detecting over inflated Endotracheal Tube Cuffs (95% CI 7.3-17.8). Participants were unable to inflate Endotracheal Tube Cuff to safe pressures and were unable to identify Endotracheal Tube Cuffs with excessive intraCuff pressure by palpation. Clinicians should consider using devices such as manometers to facilitate safe inflation and accurate measurement of Endotracheal Tube Cuff pressure.
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Experienced paramedics cannot inflate or estimate Endotracheal Tube Cuff pressure using standard techniques
Annals of Emergency Medicine, 2004Co-Authors: Vivek Parwani, Inhei Hahn, Robert J HoffmanAbstract:Study objectives: Tracheal necrosis and stenosis may result from an overinflated Endotracheal Tube Cuff. Safe, appropriate pressure in Endotracheal Tube Cuffs is considered to be between 15 and 25 cm H 2 O, which are pressures below normal capillary perfusion pressure. We sought to determine the ability of practicing paramedics to inflate an Endotracheal Tube Cuff to appropriate pressure using standard syringe technique and to assess appropriateness of pressure of previously inflated Endotracheal Tube Cuffs by palpating the pilot balloon. Methods: This institutional review board–approved descriptive survey of 54 paramedics from various base stations licensed and practicing in New York City used a previously tested, tracheal simulation model with a 7.5 Endotracheal Tube with a high-volume low-pressure Cuff (Mallinkrodt, St. Louis, MO). Using their choice of a 5-mL or 10-mL plastic syringe with standard luer lock (Beckton-Dickson, Franklin Lakes, NJ), participants inflated the Endotracheal Tube Cuff by standard method of injecting air as they deemed appropriate in conjunction with palpating the pilot balloon to estimate Cuff pressure. Subsequently, the Endotracheal Tube Cuff pressure was measured using a highly sensitive and accurate analog manometer (Boehringer Laboratories, Norristown, PA). Later, participants palpated the pilot balloon of 9 Endotracheal Tubes with Cuffs previously inflated to know pressures ranging from 0 to 120 cm H 2 O and reported whether the pressure was low, appropriate, or high. Results: No participants inflated the Endotracheal Tube Cuff to a safe pressure. The average Cuff pressure generated was greater than 105 cm H 2 O. The true mean could not be determined because 65% (n=35) of participants inflated to pressures greater than the upper limit of manometer sensitivity (>120 cm H 2 O). Using palpation, participants had an overall sensitivity judging appropriateness of Endotracheal Tube Cuff pressure of 30%, and they were only 13% sensitive in detecting overinflated Endotracheal Tube Cuffs. Experience as a licensed paramedic ranged from 1 to 18 years, with average of 10 years. Conclusion: This group of experienced paramedics had no ability to inflate an Endotracheal Tube Cuff to safe pressure, little ability to accurately estimate pressure of a previously inflated Cuff using standard technique, and minimal ability to detect overinflated Endotracheal Tube Cuffs. Nearly all inflated the Cuff to dangerously high pressures. Clinicians should consider using devices that permit safe and accurate inflation and measurement of Endotracheal Tube Cuff pressure rather than relying on standard palpation technique, which is potentially unsafe and highly inaccurate.
Fatis Altintas - One of the best experts on this subject based on the ideXlab platform.
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lidocaine 10 in the Endotracheal Tube Cuff blood concentrations haemodynamic and clinical effects
European Journal of Anaesthesiology, 2000Co-Authors: Fatis Altintas, Pervin Bozkurt, Güner Kaya, G. AkkanAbstract:Summary The purpose of this study was to evaluate the effects (common haemodynamic variables, peak Cuff pressures, the incidence of reaction (‘bucking’) during extubation and the incidence of sore throat after operation) of lidocaine 10% instilled into the Endotracheal Tube Cuff in intubated patients. Plasma concentrations of lidocaine were assayed. Seventy ASA class I–II patients scheduled for plastic surgery were studied. Patients were randomly divided in two groups: the Cuff of the Endotracheal Tube was inflated with either lidocaine 10% (group L) or with saline (group S) immediately after Endotracheal intubation. In group L patients, the haemodynamic changes were less (P < 0.05), and the peak Cuff pressure was lower (P < 0.01) than for group S. At extubation, more patients reacted (‘bucked’) in group S (70.5% vs. 19.4%, P < 0.01). The incidence and severity of sore throat were significantly lower in group L 1 and 24-h after extubation. Plasma lidocaine concentrations did not reach toxic values. Lidocaine 10%, compared with saline, in the Endotracheal Tube Cuff was associated with less disturbance of haemodynamic responses and less incidence of bucking during tracheal extubation. Lidocaine was also effective in reducing of incidence and severity of sore throat after operation.
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Lidocaine 10% in the Endotracheal Tube Cuff: blood concentrations, haemodynamic and clinical effects.
European journal of anaesthesiology, 2000Co-Authors: Fatis Altintas, Pervin Bozkurt, Güner Kaya, G. AkkanAbstract:The purpose of this study was to evaluate the effects (common haemodynamic variables, peak Cuff pressures, the incidence of reaction ('bucking') during extubation and the incidence of sore throat after operation) of lidocaine 10% instilled into the Endotracheal Tube Cuff in intubated patients. Plasma concentrations of lidocaine were assayed. Seventy ASA class I-II patients scheduled for plastic surgery were studied. Patients were randomly divided in two groups: the Cuff of the Endotracheal Tube was inflated with either lidocaine 10% (group L) or with saline (group S) immediately after Endotracheal intubation. In group L patients, the haemodynamic changes were less (P < 0.05), and the peak Cuff pressure was lower (P < 0.01) than for group S. At extubation, more patients reacted ('bucked') in group S (70.5% vs. 19.4%, P < 0.01). The incidence and severity of sore throat were significantly lower in group L 1 and 24-h after extubation. Plasma lidocaine concentrations did not reach toxic values. Lidocaine 10%, compared with saline, in the Endotracheal Tube Cuff was associated with less disturbance of haemodynamic responses and less incidence of bucking during tracheal extubation. Lidocaine was also effective in reducing of incidence and severity of sore throat after operation.