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Related Concept Videos

Endotracheal Intubation I: Procedure01:15

Endotracheal Intubation I: Procedure

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Endotracheal or ET intubation is a critical medical procedure used to secure a patient's airway, often in acute respiratory distress, apnea, upper airway obstruction, ineffective clearance of secretions, high risk for aspiration, or during general anesthesia.
The ET tube comprises various components, including a standard adaptor to attach a bag-valve-mask (BVM) or ventilator, a cuff, a pilot balloon, and radiopaque markings along its length to measure the insertion distance. The tube sizes...
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Tracheostomy: Procedure and Tubes01:28

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A tracheostomy is a surgical procedure that creates an artificial opening into the trachea, typically at the second or third cartilaginous ring level. This opening allows the insertion of a tracheostomy tube, which can replace an endotracheal tube, provide mechanical ventilation, bypass an upper airway obstruction, or remove accumulated tracheobronchial secretions.
Tracheostomy tubes can be made of semiflexible plastic (polyurethane or silicone), rigid plastic, or metal, and they come in...
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Endotracheal Intubation II: Nursing Management01:17

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Endotracheal intubation is a critical procedure that can be lifesaving for many patients with respiratory distress or failure. The role of nursing in managing endotracheal tubes is pivotal, as it involves pre-intubation preparation, assisting during the procedure, and post-extubation care.
1. Nursing Care of Patients Before Intubation
Before the endotracheal intubation procedure, nurses play an essential role in ensuring the process goes smoothly. The nurses must be familiar with intubation...
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Endotracheal Tube Extubation01:24

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Endotracheal tube extubation is a critical procedure in weaning patients from mechanical ventilation. It involves physically removing the oral or nasal endotracheal (ET) tube, marking the final step in liberating a patient from ventilatory support.
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Oxygen Delivering System III: Tracheostomy and T-piece01:23

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Oxygen delivery is critical in clinical care, especially for patients with respiratory disorders or those undergoing surgical procedures. Various systems, such as tracheostomy and the T-piece, deliver oxygen to the lungs, ensuring adequate arterial oxygenation.
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Endoscopic Studies II: Thoracocentesis01:26

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Thoracentesis(Thoracocentesis), commonly known as pleural tap, is a medical procedure where a 22 gauge needle is inserted into the pleural space, the area between the lung and chest wall. This procedure is commonly performed to diagnose or treat various respiratory disorders.
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A Novel Rescue Technique for Difficult Intubation and Difficult Ventilation
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Cuffed versus uncuffed endotracheal tubes for neonates.

Vedanta Dariya1, Luca Moresco2, Matteo Bruschettini3,4

  • 1Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA.

The Cochrane Database of Systematic Reviews
|January 24, 2022
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Limited evidence suggests cuffed endotracheal tubes (ETT) may reduce reintubation in neonates, but more research is needed. Current data on harms like stridor and mortality is very uncertain due to a single small study.

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Area of Science:

  • Neonatal Medicine
  • Pediatric Anesthesiology
  • Respiratory Care

Background:

  • Endotracheal intubation is common in neonates, with cuffed endotracheal tubes (ETT) increasingly used.
  • Cuffed ETTs aim to reduce air leak, aspiration, and accidental extubation.
  • Evidence on their safety and efficacy in neonates is limited.

Purpose of the Study:

  • To assess the benefits and harms of cuffed versus uncuffed ETTs for neonatal respiratory support.
  • To compare inflated cuffed ETTs, non-inflated cuffed ETTs, and uncuffed ETTs.

Main Methods:

  • Systematic search of CENTRAL, PubMed, and CINAHL.
  • Included randomized controlled trials (RCTs), quasi-RCTs, and cluster-randomized trials.
  • Independent data extraction and risk of bias assessment using Cochrane Neonatal methods.

Main Results:

  • One eligible RCT (69 neonates) compared cuffed versus uncuffed ETTs.
  • Very low-certainty evidence for outcomes including postextubation stridor, reintubation, and mortality.
  • Cuffed ETTs may reduce reintubation for any reason (RR 0.06, 95% CI 0.01 to 0.45).

Conclusions:

  • Evidence is limited by a single RCT with possible bias and very low certainty.
  • Further RCTs are needed to evaluate cuffed ETTs in neonates for both short-term and chronic use.
  • More research is required to definitively assess benefits and harms, including subglottic stenosis risk.