Name: endotracheal intubation using a flexible intubation endoscope as a standardized model for safe airway management in swine
Uploaded: 2022-08-25T13:30:00
Description: Watch this Scientific Journal Video about Endotracheal Intubation Using a Flexible Intubation Endoscope as a Standardized Model for Safe Airway Management in Swine at JoVE.com

Forfatterne vil gerne takke Dagmar Dirvonskis for hendes fremragende tekniske support.

Forsøgene i denne protokol blev godkendt af Statens og Institutionens Dyreplejekomité (Landesuntersuchungsamt Rheinland-Pfalz, Koblenz, Tyskland; godkendelsesnr. G20-1-135). Forsøgene blev udført efter ARRIVE-retningslinjerne. Samlet set blev 10 bedøvede hangrise (Sus scrofa domestica) med en gennemsnitsvægt på 30 kg ± 2 kg og 12-16 uger i alderen anvendt til denne undersøgelse.
1. Tilberedning af dyr
<ol><li>Oprethold et normalt miljø for dyrene for at mi...

I tidligere undersøgelser har vores forskergruppe allerede beskrevet specifikke detaljer om de translationelle fordele ved svinemodellen 2,27,32,33. Generelt bør reduktion af dyrets stressniveau og unødig smerte være en integreret del af enhver undersøgelsesprotokol og er afgørende for at generere pålideligt reproducerbare data. Derfor er vågen endoskopisk styret intubation af grisen me...

An erratum was issued for:&#160;<a href="https://www.jove.com/t/63955">Endotracheal Intubation Using a Flexible Intubation Endoscope As a Standardized Model for Safe Airway Management in Swine</a>. The Protocol, Representative Results, and Discussion sections were updated.
In the Protocol, step 1.5 was updated from:
Disinfect the skin with a disinfectant (alcoholic) before inserting a peripheral vein cannula (22 G) into an ear vein. Spray the area, wipe once, then spray again, and allow the disinfectant to dry.
to:
Disinfect the skin with a disinfectant (alcoholic) before inserting a peripheral vein cannula (22 G) into an ear vein. Spray the area, wipe once, then spray again, and allow the disinfectant to dry. Secure the ear cannula with a band-aid (See Table of Materials).
In the Protocol, step 3.7 was updated from:
While maintaining the position of the endoscope, advance the endotracheal tube until it becomes visible in the camera image. 
NOTE: If the endotracheal tube cannot be advanced through the glottic plane, there is a possibility that it has become caught on the arytenoid cartilage. In this case, the endotracheal tube must be withdrawn 1 cm and rotated by 90&#176; before gently advancing again. If necessary, this maneuver can be repeated. Similar calibers of flexible intubation endoscope and endotracheal tube can minimize the risk of this issue occurring. If the endotracheal tube cannot be advanced despite this maneuver, it is likely that the subglottic narrowness-the narrowest part of the porcine larynx-cannot be passed. In this case, a smaller endotracheal tube size needs to be selected. Regular commercially available endotracheal tubes in sizes 6.5 cm or 7.0 cm ID should be able to pass the glottis as long as no anatomic abnormalities are present.
to:
While maintaining the position of the endoscope, advance the endotracheal tube until it becomes visible in the camera image. 
NOTE: If the endotracheal tube cannot be advanced through the glottic plane, there is a possibility that it has become caught on the arytenoid cartilage. In this case, the endotracheal tube must be withdrawn 1 cm and rotated by 90&#176; before gently advancing again. If necessary, this maneuver can be repeated. Similar calibers of flexible intubation endoscope and endotracheal tube can minimize the risk of this issue occurring. If the endotracheal tube cannot be advanced despite this maneuver, it is likely that the subglottic narrowness-the narrowest part of the porcine larynx-cannot be passed. In this case, a smaller endotracheal tube size needs to be selected. Regular commercially available endotracheal tubes in sizes 6.5 cm or 7.0 cm ID should be able to pass the glottis as long as no anatomic abnormalities are present. Endotracheal tube size requirements vary depending on the piglet size and breed.
In the Representative Results, the sixth paragraph was updated from:
Statistical analyses were performed using commercially available software (see Table of Materials). Normal distribution was examined using the Kolmogorov-Smirnoff test28. If a normal distribution was determined, group differences were analyzed using t-tests of independent samples29 or the Mann-Whitney U test30 for the non-parametric version. Data are presented as mean (&#177; standard deviation). Correlations of ordinal-scale data were examined using Spearman&#39;s correlation coefficient31. A significance level of p &#60; 0.05 was assumed.
to:
Statistical analyses were performed using commercially available software (see Table of Materials). Normal distribution was examined using the Kolmogorov-Smirnoff test28. If a normal distribution was determined, group differences were analyzed using t-tests of independent samples29 or the Mann-Whitney U test30 for the non-parametric version. Data are presented as mean (&#177; standard deviation). Correlations of ordinal-scale data were examined using Spearman&#39;s correlation coefficient31. A significance level of p &#60; 0.05 was assumed. All tests were performed with exploratory intention; therefore p-values are descriptive. Nevertheless, p &#60; 0.05 was accepted as indicative of statistical significance.
In the Representative Results, the legend for figure 1 was updated from:
Figure 1: Number of intubation attempts in group comparison. For the group that was intubated using a flexible intubation endoscope, every intubation attempt was successful; in the group that was conventionally intubated, it took an average of 1.4 attempts before the endotracheal tube could be placed correctly. Error bars show the standard deviation. <a href="https://www.jove.com/files/ftp_upload/63955/63955fig01large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
to:
Figure 1: Number of intubation attempts in group comparison. For the group that was intubated using a flexible intubation endoscope, every intubation attempt was successful; in the group that was conventionally intubated, it took an average of 1.4 attempts before the endotracheal tube could be placed correctly. Error bars show the standard deviation. n = 5 (for each group).&#160;<a href="https://www.jove.com/files/ftp_upload/63955/63955fig01large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
In the Representative Results, figure 2 was updated from:
<img alt="Figure 2" class="xfigimg" src="/files/ftp_upload/63955/63955fig02.jpg" /> 
Figure 2: Time until CO2 detection in group comparison. For the group that was intubated using a flexible intubation endoscope, it took significantly longer until end-tidal CO2 could be detected, depicted as mean and standard deviation. <a href="https://www.jove.com/files/ftp_upload/63955/63955fig02large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
to:
<img alt="Figure 2" class="xfigimg" src="/files/ftp_upload/63955/63955fig2v2.jpg" /> 
Figure 2: Time until CO2 detection in group comparison. For the group that was intubated using a flexible intubation endoscope, it took significantly longer until end-tidal CO2 could be detected, depicted as mean and standard deviation. n = 5 (for each group).&#160;<a href="https://www.jove.com/files/ftp_upload/63955/63955fig2v2large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
In the Discussion, the fifth paragraph was updated from:
The increased duration had no clinical significance in this cohort. At no time was the termination criterion-a saturation of less than 93%-reached. This is shown in the results because a procedure change was unnecessary at any time. Prior adequate mask ventilation is a critical step to allow sufficient time for fiberoptic endotracheal tube placement to avoid rapid desaturation34. These results are consistent with previous studies comparing conventional intubation and endoscopically assisted intubations with inexperienced providers35.
to:
The increased duration had no clinical significance in this cohort. At no time was the termination criterion-a saturation of less than 93%-reached. This is shown in the results because a procedure change was unnecessary at any time. Prior adequate mask ventilation is a critical step to allow sufficient time for fiberoptic endotracheal tube placement to avoid rapid desaturation34. These results are consistent with previous studies comparing conventional intubation and endoscopically assisted intubations with inexperienced providers35. We attribute the prolonged duration of fiberoptic intubation to the fact that one must first reorient again after insertion, whereas with conventional intubation, one retains a view of the glottis. It is also important to avoid contact with the mucosa with the flexible intubation endoscope during advancement. This requires occasional corrective maneuvers. Last but not least, after successful placement, retraction of the relatively long endoscope is required, which increases the time to CO2 detection slightly.

An erratum was issued for:&#160;<a href="https://www.jove.com/t/63955">Endotracheal Intubation Using a Flexible Intubation Endoscope As a Standardized Model for Safe Airway Management in Swine</a>. The Protocol, Representative Results, and Discussion sections were updated.

Erratum: Endotracheal Intubation Using a Flexible Intubation Endoscope As a Standardized Model for Safe Airway Management in Swine

Endotracheal intubation er ofte et grundlæggende krav til translationel forskning i svinemodeller til forskellige indgreb, der kræver en sikret luftvej eller højt ventilationstryk (såsom ventilation under kardiopulmonal genoplivning1 eller akut respiratorisk distress syndrom2) eller kræver, at cerebral blodgennemstrømning ikke kompromitteres gennem intern kompression af supraglottiske luftvejsanordninger3 , som lejlighedsvis formeres som alternativer i forbindelse med en forventet vanskelig luftvej hos svin 4,5.
Mens lungefysiologien hos svin viser lignende træk som hos mennesker6, er det undertiden betydeligt vanskeligere at sikre luftvejene7 på grund af specifikke forskelle i porcins orotracheale anatomi. Svinets snut har en smal åbning med en meget stor tunge, strubehovedet er ekstremt mobilt, og epiglottis er relativt stor, med en fri ende, der strækker sig til den bløde gane. Caudalt danner strubehovedet en stump vinkel med luftrøret. Arytenoidbrusk er store8. Den smalleste del af luftvejene er på det subglottiske niveau9, der kan sammenlignes med luftvejsanatomien hos børn10. Da strubehovedet hos svin er meget mobilt, er der risiko for, at enden af endotrakealrøret passerer gennem stemmebåndene, men strubehovedet forskydes kun kausalt med op til flere centimeter, hvilket kan forveksles med en korrekt intubation 8,11. Derudover er esophageal intubation en almindelig risiko, når man beskæftiger sig med porcint luftvejsstyring12.
Hyppigheden af vanskelige eller umulige endotrakeale intubationer med en tilsvarende negativ indvirkning på eksperimentet eller tidlig dødelighed er ikke systematisk registreret, men flere caserapporter er blevet offentliggjort13,14. Hos mennesker er der mulighed for at anvende et fleksibelt intubationsendoskop i forbindelse med en uventet vanskelig konventionel intubation15. Forskellige falske intubationer går ofte forud for denne foranstaltning. Disse gentagne intubationsforsøg er forbundet med bivirkninger hos mennesker16,17, især luftvejskomplikationer 18. Sådanne hændelser er skadelige hos forsøgsdyr, da de i det enkleste tilfælde repræsenterer en confoundervariabel i forsøget; I værste fald kan de føre til unødvendigt tab af dyret.
Denne undersøgelse har udviklet en model baseret på retningslinjerne for forventet vanskelig luftvejsstyring hos mennesker 15,19,20,21,22,23,24. Tidligere er en lignende teknik blevet beskrevet til læring af fiberoptisk intubation i humane undersøgelser25,26. Protokollen, der præsenteres i denne rapport, har til formål at tilvejebringe en standardiseret og let at tilpasse intubationsmodel, der også gør det muligt for ikke-luftvejsspecialister at udføre vellykket og sikker endotracheal intubation hos svin.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Ambu aScope Regular</td>
			<td>Ambu GmbH, Medizinprodukte, Bad Nauheim, Germany</td>
			<td></td>
			<td>Disposable fiber optic outer diameter 5 mm</td>
		</tr>
		<tr>
			<td>Ambu aView Monitor</td>
			<td>Ambu GmbH, Medizinprodukte, Bad Nauheim, Germany</td>
			<td></td>
			<td>monitor</td>
		</tr>
		<tr>
			<td>Atracurium Hikma 50 mg/5mL</td>
			<td>Hikma Pharma GmbH, Martinsried</td>
			<td></td>
			<td>atracurium</td>
		</tr>
		<tr>
			<td>Azaperone (Stresnil) 40mg/mL</td>
			<td>Lilly Deutschland GmbH, Bad Homburg, Germany</td>
			<td></td>
			<td>azaperone</td>
		</tr>
		<tr>
			<td>BD Discardit II Spritze 2, 5, 10, 20 mL</td>
			<td>Becton Dickinson S.A. Carretera, Mequinenza Fraga, Spain</td>
			<td></td>
			<td>syringe</td>
		</tr>
		<tr>
			<td>BD Luer Connecta</td>
			<td>Becton Dickinson Infusion Therapy, AB Helsingborg, Schweden</td>
			<td></td>
			<td>3-way-stopcock</td>
		</tr>
		<tr>
			<td>BD Microlance 3 20 G</td>
			<td>Becton Dickinson S.A. Carretera, Mequinenza Fraga, Spain</td>
			<td></td>
			<td>cannula</td>
		</tr>
		<tr>
			<td>Curafix i.v. classics</td>
			<td>Lohmann &#38; Rauscher International GmbH &#38; Co. KG, Rengsdorf, Germany</td>
			<td></td>
			<td>Cannula retention dressing</td>
		</tr>
		<tr>
			<td>Engstr&#246;m Carestation</td>
			<td>GE Heathcare, Madison USA</td>
			<td></td>
			<td>ventilator</td>
		</tr>
		<tr>
			<td>Fentanyl-Janssen 0.05 mg/mL</td>
			<td>Janssen-Cilag GmbH, Neuss</td>
			<td></td>
			<td>fentanyl</td>
		</tr>
		<tr>
			<td>F&#252;hrungsstab, Durchmesser 4.3</td>
			<td>R&#252;sch</td>
			<td></td>
			<td>endotracheal tube introducer</td>
		</tr>
		<tr>
			<td>IBM SPSS Statistics for Windows, Version 20</td>
			<td>IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp.)</td>
			<td></td>
			<td>Statistical software</td>
		</tr>
		<tr>
			<td>Incetomat-line 150 cm</td>
			<td>Fresenius, Kabi Deutschland, GmbH</td>
			<td></td>
			<td>perfusor line</td>
		</tr>
		<tr>
			<td>Intrafix Primeline</td>
			<td>B. Braun Melsungen AG, Melsungen, Germany</td>
			<td></td>
			<td>Infusion line</td>
		</tr>
		<tr>
			<td>JOZA Einmal Nitril Untersuchungshandschuhe</td>
			<td>JOZA, M&#252;nchen, Germany</td>
			<td></td>
			<td>disposable gloves</td>
		</tr>
		<tr>
			<td>Laryngoscope, 45.48.50, KL 2000</td>
			<td>Medicon</td>
			<td></td>
			<td>Laryngoscope handle</td>
		</tr>
		<tr>
			<td>Littmann Classic III Stethoscope</td>
			<td>3M Deutschland GmbH, Neuss, Germany</td>
			<td></td>
			<td>stethoscope</td>
		</tr>
		<tr>
			<td>Luer Lock</td>
			<td>B.Braun Melsungen AG, Germany</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Maimed Vlieskompresse</td>
			<td>Maimed GmbH, Neuenkirchen, Germany</td>
			<td></td>
			<td>Fleece compress to fix the tongue</td>
		</tr>
		<tr>
			<td>Masimo LNCS Adtx SpO2 sensor</td>
			<td>Masimo Corporation Irvine, Ca 92618 USA</td>
			<td></td>
			<td>saturation clip for the tail</td>
		</tr>
		<tr>
			<td>Masimo LNCS TC-I SpO2 ear clip sensor</td>
			<td>Masimo Corporation Irvine, Ca 92618 USA</td>
			<td></td>
			<td>Saturation clip for the ear</td>
		</tr>
		<tr>
			<td>Masimo Radical 7</td>
			<td>Masimo Corporation Irvine, Ca 92618 USA</td>
			<td></td>
			<td>periphereal oxygen saturation</td>
		</tr>
		<tr>
			<td>Midazolam 15 mg/3 mL</td>
			<td>Hameln Pharma GmbH, Hameln, Germany</td>
			<td></td>
			<td>midazolam</td>
		</tr>
		<tr>
			<td>Midmark Canine Mask Small Plastic with Diaphragm FRSCM-0005</td>
			<td>Midmark Corp., Dayton, Ohio, USA</td>
			<td></td>
			<td>dog ventilation mask</td>
		</tr>
		<tr>
			<td>Octeniderm farblos</td>
			<td>Sch&#252;lke &#38; Mayr GmbH, Nordenstedt, Germany</td>
			<td></td>
			<td>Alcoholic disinfectant</td>
		</tr>
		<tr>
			<td>Original Perfusor syringe 50 mL</td>
			<td>B.Braun Melsungen AG, Germany</td>
			<td></td>
			<td>perfusor syringe</td>
		</tr>
		<tr>
			<td>Perfusor FM Braun</td>
			<td>B.Braun Melsungen AG, Germany</td>
			<td></td>
			<td>syringe pump</td>
		</tr>
		<tr>
			<td>Propofol 2% 20 mg/mL (50 mL flasks)</td>
			<td>Fresenius, Kabi Deutschland, GmbH</td>
			<td></td>
			<td>propofol</td>
		</tr>
		<tr>
			<td>R&#220;SCH F&#252;hrungsstab f&#252;r Endotrachealtubus (ID 5.6 mm)</td>
			<td>Teleflex Medical Sdn. Bhd, Malaysia</td>
			<td></td>
			<td>PVC coated tube guiding wire</td>
		</tr>
		<tr>
			<td>R&#252;schelit Super Safety Clear &#62;ID 6/6.5 /7.0 mm</td>
			<td>Teleflex Medical Sdn. Bhd, Malaysia</td>
			<td></td>
			<td>endotracheal tube</td>
		</tr>
		<tr>
			<td>Stainless Macintosh Gr&#246;&#223;e 4</td>
			<td>Welch Allyn69604</td>
			<td></td>
			<td>blade for laryngoscope</td>
		</tr>
		<tr>
			<td>Sterofundin</td>
			<td>B.Braun Melsungen AG, Melsungen, Germany</td>
			<td></td>
			<td>Balanced electrolyte solution</td>
		</tr>
		<tr>
			<td>Ultrastop Antibeschlagmittel bottle with dropper 25 mL</td>
			<td>Sigmapharm Arzneimittel GmbH, Wien, Austria</td>
			<td></td>
			<td>Antifog agent</td>
		</tr>
		<tr>
			<td>Vasofix Safety 22 G-16 G</td>
			<td>B.Braun Melsungen AG, Germany</td>
			<td></td>
			<td>venous catheter</td>
		</tr>
		<tr>
			<td>VBM Cuff Manometer</td>
			<td>VBM Medizintechnik GmbH, Sulz a.N., Germany</td>
			<td></td>
			<td>cuff pressure gauge</td>
		</tr>
		<tr>
			<td>Zelette</td>
			<td>Lohmann &#38; Rauscher International GmbH &#38; Co. KG, Rengsdorf, Germany</td>
			<td></td>
			<td>Tissue swab</td>
		</tr>
	</tbody>
</table>

endotracheal intubation using a flexible intubation endoscope as a standardized model for safe airway management in swine

Endotracheal intubation er ofte et grundlæggende krav til translationel forskning i svinemodeller til forskellige indgreb, der kræver en sikret luftvej eller højt ventilationstryk. Endotracheal intubation er en udfordrende færdighed, der kræver et minimum antal vellykkede endotrakeale intubationer for at opnå en høj succesrate under optimale forhold, hvilket ofte er uopnåeligt for ikke-anæstesiologiske forskere. På grund af den specifikke svineluftvejsanatomi kan der normalt antages en vanskelig luftvej. Umuligheden af at etablere en sikker luftvej kan resultere i personskade, bivirkninger eller laboratoriedyrets død. Ved hjælp af en prospektiv, randomiseret, kontrolleret evalueringsmetode har det vist sig, at fiberoptisk assisteret endotracheal intubation tager længere tid, men har en højere first-pass succesrate end konventionel intubation uden at forårsage klinisk relevante fald i iltmætning. Denne model præsenterer et standardiseret regime for endoskopisk guidet endotracheal intubation, hvilket giver en sikret luftvej, især for forskere, der er uerfarne i teknikken til endotracheal intubation via direkte laryngoskopi. Denne procedure forventes at minimere dyrs lidelser og unødvendige tab af dyr.

Endotracheal intubation blev udført på 10 hangrise (alder 12-16 uger, vægt 30 kg ± 3 kg) i en prospektiv, randomiseret, kontrolleret studieindstilling. Grisene blev randomiseret i to grupper: den ene var konventionelt laryngoskopisk intuberet (CI-gruppe), og den anden gruppe blev intuberet assisteret via et fleksibelt intubationsendoskop som beskrevet i protokollen (FIE-gruppen). Gruppeopgaven blev udført ved at trække forseglede konvolutter. Efterforskeren blev tildelt tilfældigt dagligt.
<p class="j...

Watch this Scientific Journal Video about Endotracheal Intubation Using a Flexible Intubation Endoscope as a Standardized Model for Safe Airway Management in Swine at JoVE.com

Endotracheal Intubation Using a Flexible Intubation Endoscope as a Standardized Model for Safe Airway Management in Swine

Brugen af svin i forskning er steget i de senere år. Ikke desto mindre er grise præget af vanskelig luftvejsanatomi. Ved at demonstrere, hvordan man udfører endoskopisk guidet endotracheal intubation, sigter denne protokol mod yderligere at øge forsøgsdyrs sikkerhed for at undgå dyrs lidelse og unødig død.

Endotracheal intubation ved hjælp af et fleksibelt intubationsendoskop som en standardiseret model for sikker luftvejsstyring hos svin

Endotracheal intubation is often a basic requirement for translational research in porcine models for various interventions that require a secured airway ...

Denne protokol giver en standardiseret tilgang til endoskopisk guidet endotracheal intubation hos svin. Dette gør det lettere og sikrere at sikre luftvejene end konventionel endotracheal intubation. Sammenlignet med den standard, konventionelle endotracheale intubation er denne teknik lettere at lære med en stejlere indlæringskurve og tillader direkte tilsyn af en erfaren eksaminator.Vi anbefaler stærkt, at inducerende anæstesi kun udføres af specialuddannet personale eller under deres direkte overvågning. Ved hjælp af en videomonitor er direkte korrektion af en vejleder mulig. For at begynde endotracheal intubation skal du have en assistent stående på venstre side af hovedet på et bedøvet svin.Få assistentens venstre hånd til at åbne munden, klem tungen udad og lad den kompressere. Bed assistenten om at trykke ned på højre overlæbe med højre pegefinger for bedre mundåbning. For at udføre direkte laryngoskopi skal du indsætte laryngoskopet i højre side af munden og skubbe det fremad, mens du skubber tungen til venstre.Fremskynd spidsen af laryngoskopet, indtil det hviler i den epiglotiske vallecula. Skub forsigtigt epiglottis til side med en rørstyretråd med en blid øsebevægelse fra højre piriform fordybning til venstre langs den bløde gane. Før håndtaget på laryngoskopet til assistenten for at fastgøre det i den aktuelle position.Tag derefter det fleksible intubationsendoskop, hvorpå et endotrakealt rør allerede er monteret og er forbundet til en videomonitor. Indsæt endoskopet oralt og før det over bunden af tungen, indtil glottis er visualiseret. Fremskynd endoskopet mellem vokalbåndene ind i luftrøret.Bekræft luftrørets anatomi ved visuelt at identificere bruskringene og pars membranacea. Fortsæt med at fremme endoskopet, indtil det hviler over carinaen. Rør ikke ved den følsomme slimhinde for at undgå hævelse og blødning.Mens endoskopets position opretholdes, skal du fremme endotrachealrøret, indtil det bliver synligt i kamerabilledet. Efter positionering fjernes det fleksible intubationsendoskop, mens endotrachealrøret opretholdes. Brug derefter en 10 ml sprøjte til at blæse manchetten op med 10 ml luft.Kontroller manchettrykket med en manchetleder. Bekræft den korrekte placering af endotrachealrøret og tilstrækkelig ventilation ved periodisk og regelmæssig udånding af kuldioxid via kapnografi og dobbeltsidet ventilation via auskultation. Når du har tilsluttet røret med ventilatoren, skal du starte mekanisk ventilation.Antallet af intubationsforsøg og den tid, der kræves til kuldioxiddetektion i fleksibelt intubationsendoskop eller FIE, og konventionelt intuberede eller CI-grupper, er vist her. I FIE-gruppen var hvert intubationsforsøg vellykket, mens det i CI-gruppen tog et gennemsnit på 1,4 forsøg. I FIE-gruppen var det nødvendigt med en længere varighed for kuldioxid at blive detekteret i ventilatoren sammenlignet med CI-gruppen.I det usandsynlige tilfælde, at glottis ikke visualiseres godt med endoskopet, er det vigtigt, at maskeventilationen genoptages, så snart der er et relevant fald i iltsituationen.

Research

JoVE Journal

Medicine

A Novel Rescue Technique for Difficult Intubation and Difficult Ventilation

We describe a novel non surgical technique to maintain oxygenation and ventilation in a case of difficult intubation and difficult ventilation, which ...

Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care

The Institute of Medicine has targeted patient-centeredness as an important area of quality improvement. A major dimension of patient-centeredness is ...

Guidelines for Elective Pediatric Fiberoptic Intubation

Fiberoptic intubation in pediatric patients is often required especially in difficult airways of syndromic patients i.e. Pierre Robin Syndrome. Small ...

Endotracheal Intubation in Mice via Direct Laryngoscopy Using an Otoscope

Endotracheal Intubation in Mice via Direct Laryngoscopy Using an Otoscope

Endotracheal i mus<em&gt; Via</em&gt; Direkte laryngoskopi Brug af en otoskop

Mice, both wildtype and transgenic, are the principal mammalian model in biomedical research currently. Intubation and mechanical ventilation are ...

A Simple Method of Mouse Lung Intubation

En simpel metode til Mouse Lung Intubation

A  simple procedure to intubate mice for pulmonary function measurements would  have several advantages in longitudinal studies with limited numbers or  ...

Intubation-mediated Intratracheal (IMIT) Instillation: A Noninvasive, Lung-specific Delivery System

Intubation-mediated Intratracheal IMIT Instillation: A Noninvasive, Lung-specific Delivery System

Intubation-medieret Intratracheal (IMIT) Instillation: en noninvasiv, Lunge-specifik Delivery System

Respiratory disease studies typically involve the use of murine models as surrogate systems. However, there are significant physiologic differences ...

An Improved Method for Rapid Intubation of the Trachea in Mice

En forbedret fremgangsmåde til hurtig intubation af trachea i mus

Despite some anatomical and physiological differences, mouse models continue to be an essential tool for studying human lung disease. Bleomycin toxicity ...

Topical Airway Anesthesia for Awake-endoscopic Intubation Using the Spray-as-you-go Technique with High Oxygen Flow

Aktuel Airway Anæstesi til Awake-endoskopisk Intubation Brug af Spray-as-you-go teknik med høj Oxygen Flow

A patient&#39;s willingness to cooperate is an absolute precondition for successful awake intubation of the trachea. Whilst drug-sedation of patients can ...

Tachycardia-Induced Cardiomyopathy As a Chronic Heart Failure Model in Swine

Takykardi-induceret kardiomyopati som kronisk hjertesvigt Model hos svin

A stable and reliable model of chronic heart failure is required for many experiments to understand hemodynamics or to test effects of new treatment ...

The Dyspepsia Educational Tool As a Novel Aid in Dyspepsia Management

Dyspepsia pædagogisk værktøj som en roman støtte i dyspepsi Management

Digital educational tools have a well-established role in current healthcare. In particular, disorders that are managed non-pharmacologically benefit from ...