a bilevel positive pressure ventilation device. Ideally with the help of this literature review, it will be easier to determine when these modalities are most appropriate and useful as well as provide concrete evidence that will be useful when suggesting these ideas to a doctor.
Clinical Application Studies
There are a number of different reasons why a neonate would need some additional ventilatory support immediately after birth. One of the most common reasons would be in the incidence of respiratory distress syndrome (RDS). Respiratory distress syndrome is a disease that typically affects premature newborns caused from an insufficient amount of surfactant in the lungs. For infants with severe RDS, may require endotracheal intubation and administration of surfactant via endotracheal tube. For infants who are still having trouble ventilating, they may stay intubated, however most are extubated immediately and placed on additional noninvasive ventilatory support. Traditionally, the infant may be placed on NCPAP or NIPPV, however more recently there has been studies conducted on HFNC having similar effects to reduce the work of breathing. The study, reported in Pediatric Pulmonology, confirms that the flow from the HFNC creates a positive end expiratory pressure (PEEP) effect which has proven to be very beneficial providing support. Unfortunately, the amount of PEEP being delivered can not be measured, so some healthcare facilities are weary of this tool. Prior…
Anesthesiologists (ASA) advise
that ‘multiple airway features should be assessed’3.
EL-Ganzori simplified risk index (EGRI) combines
and stratifies seven variables derived from parameters
and observations individually associated with difficult
intubation, a score more than 4 has been used as
the definition of difficult intubation in different
In spite of the development of numerous airway
devices in the past two decades, a recent British survey
concluded that difficulty with…
Direct laryngoscope and intubation would be difficult as the patient had limited mouth opening. The Supraglottic device such as laryngeal mask airway was considered as the most suitable option and patient was prepared for that.
A routine proper preoperative assessment was done and the condition explained to the patient and an informed written consent was taken. The patient was kept fasting for six hours and premedicated.
The preoperative investigations were done and…
Incidence of difficult intubation
Difficult tracheal intubation contributes greatly to anaesthesia related morbidity and mortality. The principal adverse outcomes associated with the difficult airway include brain injury, cardiopulmonary arrest, unnecessary tracheostomy, airway trauma, damage to teeth and death8,9
The incidence of failed tracheal intubation ranges from 1 in 1000–2000 cases in the elective setting10,3.
Failed and difficult tracheal intubations are associated with…
RSI: Benefits vs. Risks
Often patients presents in an emergency department (ED) or those treated in the field with a compromised airway and requires urgent airway control and protection to prevent hypoxaemia and secondary brain damage. Unlike in anaesthesia these patients are often none staved, unstable and critically ill. Although they present with a low Glasgow Coma Scale scores their airway protective reflexes might still be intact which increases the risk of aspiration on an intubation…
remain bradycardic after PPV are intubated and mechanically ventilated.
Ideally, treatment should look to decrease insistences of pneumothorax and bronchopulmonary dysplasia as well as the need for intubation and mechanical ventilation.
In this review, the effectiveness of various methods of respiratory support are compared. For preterm infants requiring respiratory support, early continuous positive airway pressure treatment is more effective than intubation and prophylactic surfactant…
Biomedical Ethics requires respect for an individual. How we address respect is through a number of principles; one of which is the principle of autonomy. The principle of autonomy is “we owe others respect for their autonomy and that showing such respect may be as important or even more important than producing benefits for others.” (Fry, S. T., Veatch, R. M., & Taylor, C., 2011, p. 150). A perfect example is demonstrated in Case 16-2 in which an attending physician is teaching intubation…
To identify a strategy for improving oral care so as to prevent VAP and to enhance quality of life of ICU patients.
VAP is hospital-acquired pneumonia that develops in an intubated patient after 48 hours or more of mechanical ventilation, and that was not present before intubaton (Fields, 2008). The development of VAP is a concern and its prevention is essential because it is the most common nosocomial infection in mechanically ventilated patients and is a preventable…
necessary. For this implementation institution being a hospital, it lays a good foundation with the right environment crucial for evolving evidence based practice (EBP), and application for change
Description of current deficit and Issue Requiring Change
During the observation for the last few years, it has been concluded that the deficit or lack of knowledge on the transmission of ventilator associated pneumonia (VAP) on critical ill patients in mechanical intubation is the major cause of…
provide a high quality safe cost effective patient care (Zaccagnini and White 2014). In policy development each discipline work collaboratively to create evidence base policy that will guide the safe care to the patient in the clinical area, each member contributing their expertise.
The first example in my facility where collaboration contributed to policy change in the composition of Response Team. Recently our dedicated rapid team added a paramedic to the team. The disciplines represented on…