Toleranz des endotrachealen Tubus bei beatmeten Intensivpatienten

Nydahl, Peter; Hermes, Carsten; Dubb, Rolf; Kaltwasser, Arnold; Schuchhardt, Danny

doi:10.1007/s00063-014-0449-x

Cited by 5 publications

(1 citation statement)

References 40 publications

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“…Critically ill patients requiring long-term ventilation often receive a tracheostomy to facilitate weaning from the ventilator, reduce dead space, and avoid laryngeal injury [ 1 – 3 ]. Percutaneous dilatational tracheostomy (PDT) has gained widespread acceptance and has replaced surgical tracheostomy as the technique of choice in many intensive care units for its convenience and speed [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Bronchoscopy versus an endotracheal tube mounted camera for the peri-interventional visualization of percutaneous dilatational tracheostomy - a prospective, randomized trial (VivaPDT)

et al. 2017

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BackgroundPercutaneous dilatational tracheostomy (PDT) in critically ill patients often involves bronchoscopic optical guidance. However, this procedure is not without disadvantages. Therefore, we aimed to study a recently introduced endotracheal tube-mounted camera (VivaSightTM-SL tube [VST]; ETView, Misgav, Israel) for guiding PDT.MethodsThis was a randomized controlled trial involving 46 critically ill patients who received PDT using optical guidance with a VST or with bronchoscopy. The primary outcome measure was visualization of the tracheal structures (i.e., identification and monitoring of the thyroid, cricoid, and tracheal cartilage and the posterior wall) rated on 4-point Likert scales. Secondary measures were the quality of ventilation (before puncture and during the tracheostomy procedure rated on 4-point Likert scales) and blood gases sampled at standardized time points.ResultsThe mean ratings for visualization (lower values better; values given for per-protocol analysis) were 5.4 (95% CI 4.5–6.3) for the VST group and 4.0 (95% CI 4.0–4.0) for the bronchoscopy group (p < 0.001). Mean ventilation ratings were 2.5 (95% CI 2.1–2.9) for VST and 5.0 (95% CI 4.4–5.7) for bronchoscopy (p < 0.001). Arterial carbon dioxide increased to 5.9 (95% CI 5.4–6.5) kPa in the VST group vs. 8.3 (95% CI 7.2–9.5) kPa in the bronchoscopy group (p < 0.001), and pH decreased to 7.40 (95% CI 7.36–7.43) in the VST group vs. 7.26 (95% CI 7.22–7.30) in the bronchoscopy group (p < 0.001), at the end of the intervention.ConclusionsVisualization of PDT with the VST is not noninferior to guidance by bronchoscopy. Ventilation is superior with less hypercarbia with the VST. Because visualization is not a prerequisite for PDT, patients requiring stable ventilation with normocarbia may benefit from PDT with the VST.Trial registrationClinicalTrials.gov, NCT02861001. Registered on 13 June 2016.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-017-1901-0) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Bronchoscopy versus an endotracheal tube mounted camera for the peri-interventional visualization of percutaneous dilatational tracheostomy - a prospective, randomized trial (VivaPDT)

et al. 2017

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Lagerungstherapie und Frühmobilisation auf der Intensivstation

Hermes

Nydahl

Henzler

et al. 2016

Med Klin Intensivmed Notfmed

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The 2007 guidelines "Positioning for prophylaxis and therapy of pulmonary disorders" were completely revised in 2015 on behalf of the German Society of Anaesthesiology and Intensive Care Medicine. With regard to practical and scientific relevance, early mobilization of patients in critical care has been included in the guidelines for the first time. Furthermore, the recommendations for prone positioning have been updated, based on current evidence in medicine and nursing. In addition, recommendations regarding unsuitable positions that may actually harm patients were made. As such, the flat supine position should only be used in cases of urgent medical or nursing needs. This underlines the importance of a moderately elevated head of bed position (20(o)-45(o)) in mechanically ventilated patients.

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Medizinische Grundlagen

2023

Frührehabilitation in Der Intensivmedizin

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Toleranz des endotrachealen Tubus bei beatmeten Intensivpatienten

Abstract: Tolerance of the ETT is a complex phenomenon. A reflected and critical evaluation of the behavior of the patient with an ETT is recommended. Interventions that increase the tolerance of the ETT should be adapted to the situation of the patient and should be evaluated daily.

Cited by 5 publications

References 40 publications

Bronchoscopy versus an endotracheal tube mounted camera for the peri-interventional visualization of percutaneous dilatational tracheostomy - a prospective, randomized trial (VivaPDT)

Bronchoscopy versus an endotracheal tube mounted camera for the peri-interventional visualization of percutaneous dilatational tracheostomy - a prospective, randomized trial (VivaPDT)

Lagerungstherapie und Frühmobilisation auf der Intensivstation

Medizinische Grundlagen

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