Background: The severe acute respiratory syndrome coronavirus-2-2019 pandemic has posed significant challenges and barrier devices such as aerosol/intubation box, intubation tent, and intubation screen have been widely used during endotracheal intubation by the clinicians without any definite proven benefit. The initial experience at our institute with the intubation box posed some difficulties leading to failed intubations. Hence, as an alternative, we switched to a transparent plastic intubation screen that is likely to provide better vision and space during intubation. We evaluated the impact of intubation box and plastic screen on intubations in this simulation-based crossover study. Materials and Methods: Ten anesthesiologists performed 90 intubations in an operating room on a Laerdal® adult airway management trainer. Each participant performed 9 intubations, 3 without any barrier and 3 each with intubation box and plastic screen. The primary outcome was intubation time; secondary outcomes included first-pass success and breaches to personal protective equipment. Results: Intubation time with no barrier was significantly shorter than with the intubation box (median interquartile range [IQR]: 25 [22–28] vs. 40 [30–51] s, P < 0.001) and with the screen (median [IQR] 29 [25–35] s, P = 0.015). The intubation time was significantly lesser with the screen compared to the box (P = 0.023). The first-pass success was 86.66%, 96.66%, and 100% in the box, screen, and no barrier groups, respectively. Conclusion: In comparison to an intubation box, the transparent plastic screen decreases intubation times and has greater operator comfort. These devices require further evaluation for patient safety.
Purpose: To study the prevalence of back pain in patients of Budd–Chiari syndrome (BCS) with inferior vena cava (IVC) obstruction, and to evaluate the role of IVC recanalization in resolution of back pain. Methods: All patients with BCS and IVC obstruction who underwent IVC recanalization between January 2018 and October 2022 were included. Patients with degenerative spine disease or other identifiable causes for back pain were excluded; remaining patients were assessed for the presence of back pain. In patients with back pain, pain relief was assessed at 24 h following IVC recanalization. Results: Fifty-eight patients with BCS and IVC occlusion were identified, of which six with degenerative spine diseases were excluded. Of the remaining 52 patients, 34 (65.4%) had back pain, with pain score between 3 and 9. Engorged epidural venous plexus on preprocedural imaging (p = 0.002), and degree of luminal narrowing (p = 0.021) had a significant association with back pain. Twenty-nine of thirty-four patients (85.3%) with back pain had pain relief immediately following IVC recanalization, more so in patients with engorged epidural venous plexus on preprocedural imaging (p < 0.001). Conclusion: Back pain is one of the under-reported symptoms of IVC obstruction in BCS. IVC recanalization by IVC angioplasty with or without stenting relieves back pain due to the decompression of engorged epidural veins.
Conventionally, oxygen is given at 4 to 6 L/min through nasal cannula for supplementation of oxygen. The FiO2 achieved through this can be up to 0.4. Flows more than this can cause dryness to the nasal mucosa without much increase in the FiO2. High-flow nasal cannula (HFNC) uses flow up to 60 L/min. Positive end-expiratory pressure is created in the nasopharynx and it is also conducted to the lower airways. Studies have shown HFNC improves washout of CO2 and decreases respiratory rate. Patient compliance also improves due to the comfort of the cannula compared to the non-invasive ventilation through a mask.
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