Name: laryngeal mask airway (lma) placement in a neonatal patient simulator using a non-inflatable supraglottic airway (sga)
Uploaded: 2023-07-14T14:10:00
Description: Watch this Scientific Journal Video about Laryngeal Mask Airway LMA Placement in a Neonatal Patient Simulator Using a Non-Inflatable Supraglottic Airway SGA at JoVE.com

内容完全由作者负责，并不一定代表美国国立卫生研究院的官方观点。BAS 得到了俄克拉荷马州共享临床和转化资源 （U54GM104938） 的支持，并获得了美国国家普通医学科学研究所颁发的机构发展奖 （IDeA）。

此处描述的所有方法均已获得俄克拉荷马大学健康科学中心机构审查委员会的批准。
1.放置喉罩
<ol><li>选择适当大小的 SGA（新生儿大小 1 [2-5 kg]）。</li>
	<li>打开 SGA。取下装有设备的包装。</li>
	<li>打开包装。将 SGA 转移到包装的盖子上。</li>
	<li>握住整体咬合块，在 SGA 的背面、侧面和正面涂上一层薄薄的润滑剂。<ol><li>检查是否有润滑剂，必要时将其取出。</li...

<ol>
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新生儿复苏培训可将导致足月产时相关死亡减少 30%18。俄克拉荷马大学 （OU） Health 的俄克拉荷马儿童医院位于俄克拉荷马州俄克拉荷马城的俄克拉荷马大学健康科学中心校园内，要求所有协助管理新生儿的医疗保健提供者保持最新的 NRP 培训。根据目前的 NRP 指南，新生儿复苏最重要的方面是有效提供正压通气 （PPV）13,17。
<p class=...

出生窒息每年导致 ~100 万人死亡，是新生儿早期死亡的主要原因1.在高收入国家，围产期窒息的发生率为~1/1000活产;在中低收入国家，这一数字可能高出10倍1。大约 15%-20% 的窒息婴儿在出生后第一个月死亡，多达四分之一的幸存者维持永久性神经功能缺损 2,3。据美国疾病控制与预防中心报告，宫内缺氧和出生窒息占婴儿死亡率的 10%4。在美国，10% 的新生儿在产房内需要帮助呼吸，不到 1% 需要更先进的复苏措施，例如心脏按压和药物治疗5。在出生后第一分钟内进行干预对结局具有重要的长期影响6.
对于那些不经常进行新生儿复苏的人来说，使用面罩进行有效通气通常具有挑战性。由此导致的缺氧、心动过缓和紧急气管插管会增加意外的新生儿重症监护病房 （NICU） 入院率。与面罩技术不佳相关的最常见问题包括面罩泄漏、空气堵塞和胸部偏移不足 7,8,9。NRP 包括通气矫正步骤，但如果不经常执行，就很难掌握这些技能。
美国心脏协会和美国儿科学会制定了新生儿复苏计划（NRP），以教授基于证据的新生儿护理方法。NRP 算法要求在面罩通气无效或长时间时进行气管插管5.然而，儿科实习生也表现出插管困难，几乎没有机会练习10、11、12。当面罩通风不足且气管插管不成功或不可行时，SGA 是体重 >1500 g 的新生儿的合适替代气道13,14,15,16。尽管许多研究支持SGA在中低收入国家进行初始呼吸管理的可行性和实用性，但缺乏数据支持在高收入国家使用SGA进行初始PPV9,10,11。
我们推测，掌握 SGA 的使用有可能减少 PPV 中断，从而改善复苏结果。我们的总体目标是评估重点SGA培训对新生儿复苏结果的有效性，包括PPV持续时间、通气失败和并发症。

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>CO2 detector</td>
			<td>Medtronic USA</td>
			<td>42271500</td>
			<td>Nellcor pediatric colorimetric CO2 detector (pedicap)</td>
		</tr>
		<tr>
			<td>I-gel supraglottic airway</td>
			<td>Intersurgical</td>
			<td>8201000</td>
			<td>Neonatal size # 1</td>
		</tr>
		<tr>
			<td>Lubricant</td>
			<td>Laerdal Medical AS</td>
			<td>252090</td>
			<td>Airway Lubricant Spray Can (180 mL)</td>
		</tr>
		<tr>
			<td>Neonatal Patient Simulator&#160;</td>
			<td>Laerdal Medical AS</td>
			<td>296-00050</td>
			<td>SimNewB Light tetherless</td>
		</tr>
		<tr>
			<td>Positive pressure ventilation device</td>
			<td>Fisher &#38; Paykel Healthcare</td>
			<td>RD900</td>
			<td>Neopuff Infant T-Piece Resuscitator</td>
		</tr>
	</tbody>
</table>

laryngeal mask airway (lma) placement in a neonatal patient simulator using a non-inflatable supraglottic airway (sga)

在新生儿复苏过程中，正压通气 （PPV） 的有效输送可能具有挑战性。在新生儿复苏过程中，通过适当的接口实现气道通畅对于避免气道阻塞和渗漏以及优化 PPV 的可及性至关重要。由于面罩通风的复杂性，提供者已经探索了纠正措施。然而，这些方法难以掌握，因此在复苏的关键时刻和并发症的发生可能存在通气延迟和/或中断的风险。此外，新生儿气管插管是一种侵入性手术，需要大量的实践和培训。声门上气道 （SGA） 是一种有用的喉罩气道 （LMA） 接口，可减少实现安全气道所需的时间，并减少气管插管的需要。尽管有关于其有效性的现有证据，但培训不足和意识不足限制了 SGA 在现实世界中的使用，一线提供者报告对 SGA 安置的信心较低。在这里，我们提供了SGA安置的详细说明，其指导只需要最少的培训，并且可以在很短的时间内熟练掌握。简而言之，在对新生儿人体模型进行初始通气矫正步骤后，医务人员将不可充气的 SGA 插入喉部。这种方法允许单个人以非侵入性方式提供有效的 PPV，而无需昂贵的设备，例如视频喉镜检查。教师可以在任何临床和研究环境中轻松轻松地教授这种技术，而且成本很低。对于不同的收入环境也是如此，包括高收入、中等收入和低收入国家。

成功放置SGA后，可以通过听听双侧肺部空气进入情况并通过通气观察胸壁运动来确认有效的PPV（图1）。有时，不正确的位置会导致肺通气无效，导致无法提高心率、血氧饱和度改善以及 CO2 色度计的颜色变为黄色。
我们机构设施最近的病例系列17 详细介绍了产房中声门上气道放置和新生儿复苏在现实生活中的使用。初次置入成...

Watch this Scientific Journal Video about Laryngeal Mask Airway LMA Placement in a Neonatal Patient Simulator Using a Non-Inflatable Supraglottic Airway SGA at JoVE.com

Laryngeal Mask Airway LMA Placement in a Neonatal Patient Simulator Using a Non-Inflatable Supraglottic Airway SGA

该方案旨在描述一种在新生儿复苏期间放置和建立声门上（替代）气道的方法。它可用于一线医务人员无法对需要复苏的新生儿进行通气或气管插管的情况。

使用非充气声门上气道 （SGA） 将喉罩气道 （LMA） 放置在新生儿患者模拟器中

The effective delivery of positive pressure ventilation (PPV) can be challenging during neonatal resuscitation. Achieving a patent airway through an ...

这种方法可以帮助回答新生儿复苏领域的关键问题，这是从胎儿到新生儿生命的过渡的桥梁。该技术的主要优点是可用于一线医务人员无法为需要复苏的新生儿通气或气管插管的挑战性情况。该技术的意义延伸到呼吸窘迫综合征的治疗。这种方法可以深入了解出生窒息或缺氧缺血性脑病。首先，选择合适大小的声门上气道或SGA。打开 SGA 并取出装有设备的包装。然后打开包装，将 SGA 转移到包装的盖子上。接下来，握住整体咬合块，在 SGA 的背面、侧面和正面涂上一层薄薄的润滑剂，避免接触设备的袖带。仔细检查设备是否有异物或润滑剂团阻塞远端开口，并将 SGA 放回笼式包装中。接下来，用口胃管给胃减压。从容器中取出 SGA 并牢牢握住润滑的 SGA。现在站在婴儿的头上，将设备放置在袖带出口朝向婴儿下巴的位置。在确保宝宝处于嗅探姿势后，头部伸展，颈部弯曲，轻轻张开嘴巴并压下下巴，然后再继续。然后将前导的软尖端压入嘴里，靠在舌头顶部的婴儿硬腭上，保持对上颚的压力。沿着口腔和上颚的轮廓轻轻向内滑动设备，直到感觉到阻力。将气道尖端置于食管上段，将袖带对准喉骨架。接下来，要确认喉罩的正确放置，请将二氧化碳检测器连接到 PPV 设备。正确放置后，确保通气期间双侧胸部运动，并聆听均匀的呼吸音。使用胶带将 SGA 从上颌骨固定到上颌骨。要取下喉罩，请使用球形抽吸或抽吸导管清除口腔和喉咙中的分泌物。然后取下 SGA 设备并监测心率、呼吸和血氧饱和度。在接受 SGA 干预的新生儿队列中，初始置入成功，并在所有病例中立即稳定下来，38% 的病例在出生时使用时避免入院 NICU。与具有指定角色的训练有素的团队合作非常重要，以确保一致地完成所有任务。定期练习喉罩的放置。一旦掌握，喉罩的放置可以在 10 秒内完成。在达到声门上气道后，可以及时有效地进行正压通气、持续气道正压通气、辅助供氧和/或表面活性剂给药，以促进肺通气。该技术改善了熟练的一线医务人员在出生关键时刻对抑郁新生儿的通气训练和性能。对这项技术的研究将优化新生儿复苏护理的提供。

Research

JoVE Journal

Medicine

Laryngeal Mask Airway (LMA) Placement in a Neonatal Patient Simulator Using a Non-Inflatable Supraglottic Airway (SGA)

Automated Measurement of Pulmonary Emphysema and Small Airway Remodeling in Cigarette Smoke-exposed Mice

肺气肿，小气道重塑的香烟烟雾暴露小鼠自动测量

COPD is projected to be the third most common cause of mortality world-wide by 2020(1).  Animal models of COPD are used to identify molecules that ...

科研

医学

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

气道局部麻醉清醒用于内镜插管使用喷雾为你去技术在高氧流量

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

Learning Modern Laryngeal Surgery in a Dissection Laboratory

在解剖实验室学习现代喉外科

Surgery for laryngeal malignancies requires millimetric accuracy from the different endoscopic and open techniques available. Practice of this surgery is ...

The Rigid Tube as an Alternative in Controlling the Problematic Airway

刚性管作为控制问题气道的替代方案

The unexpected problematic airway represents a large proportion of anesthesia-related morbidity and mortality. The retromolar or paraglossal approach is ...

Real-Time Dynamic Navigation System for the Precise Quad-Zygomatic Implant Placement in a Patient with a Severely Atrophic Maxilla

实时动态导航系统，用于在严重萎缩性上颌骨患者中精确放置四颧植入物

Zygomatic implants (ZIs) are an ideal way to address cases of a severely atrophic edentulous maxilla and maxilla defects because they replace extensive ...

Design and Development of a Model to Study the Effect of Supplemental Oxygen on the Cystic Fibrosis Airway Microbiome

研究辅助供氧对囊性纤维化气道微生物组影响的模型的设计与开发

Airway microbial communities are thought to play an important role in the progression of cystic fibrosis (CF) and other chronic pulmonary diseases. ...

A Neonatal BALB/c Mouse Model of Necrotizing Enterocolitis

Necrotizing enterocolitis (NEC) is the most severe gastrointestinal (GI) disease that often occurs in premature infants, especially very low birth weight ...

A Retrograde Implantation Approach for Peritoneal Dialysis Catheter Placement in Mice

一种小鼠腹膜透析导管放置的逆行植入方法

Murine models are employed to probe various aspects of peritoneal dialysis (PD), such as peritoneal inflammation and fibrosis. These events drive ...

Rapid Viscoelastic Characterization of Airway Mucus Using a Benchtop Rheometer

使用台式流变仪快速表征气道粘液的粘弹性

In muco-obstructive lung diseases (e.g., asthma, chronic obstructive pulmonary disease, cystic fibrosis) and other respiratory conditions (e.g., ...

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

使用柔性插管内窥镜作为猪安全气道管理的标准化模型的气管插管

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

使用非充气声门上气道 （SGA） 将喉罩气道 （LMA） 放置在新生儿患者模拟器中

使用非充气声门上气道（SGA）将喉罩气道（LMA）放置在新生儿患者模拟器中