Acute and Critical Care

Original Articles

Trauma
Bedside ultrasonographic evaluation of optic nerve sheath diameter for monitoring of intracranial pressure in traumatic brain injury patients: a cross sectional study in level II trauma care center in India: Sujit J. Kshirsagar, Anandkumar H. Pande, Sanyogita V. Naik, Alok Yadav, Ruchira M. Sakhala, Sangharsh M. Salve, Aysath Nuhaimah, Priyanka Desai; Acute Crit Care. 2024;39(1):155-161. Published online February 23, 2024; DOI: https://doi.org/10.4266/acc.2023.01172

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Background
Optic nerve sheath diameter (ONSD) is an emerging non-invasive, easily accessible, and possibly useful measurement for evaluating changes in intracranial pressure (ICP). The utilization of bedside ultrasonography (USG) to measure ONSD has garnered increased attention due to its portability, real-time capability, and lack of ionizing radiation. The primary aim of the study was to assess whether bedside USG-guided ONSD measurement can reliably predict increased ICP in traumatic brain injury (TBI) patients. Methods: A total of 95 patients admitted to the trauma intensive care unit was included in this cross sectional study. Patient brain computed tomography (CT) scans and Glasgow Coma Scale (GCS) scores were assessed at the time of admission. Bedside USG-guided binocular ONSD was measured and the mean ONSD was noted. Microsoft Excel was used for statistical analysis. Results: Patients with low GCS had higher mean ONSD values (6.4±1.0 mm). A highly significant association was found among the GCS, CT results, and ONSD measurements (P<0.001). Compared to CT scans, the bedside USG ONSD had 86.42% sensitivity and 64.29% specificity for detecting elevated ICP. The positive predictive value of ONSD to identify elevated ICP was 93.33%, and its negative predictive value was 45.00%. ONSD measurement accuracy was 83.16%. Conclusions: Increased ICP can be accurately predicted by bedside USG measurement of ONSD and can be a valuable adjunctive tool in the management of TBI patients.

Citations

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Measurement of Optic Nerve Sheath Diameter by Bedside Ultrasound in Patients With Traumatic Brain Injury Presenting to Emergency Department: A Review
Preethy Koshy, Charuta Gadkari
Cureus.2024;[Epub] CrossRef

Trauma
The correlation between carotid artery Doppler and stroke volume during central blood volume loss and resuscitation: Isabel Kerrebijn, Sarah Atwi, Mai Elfarnawany, Andrew M. Eibl, Joseph K. Eibl, Jenna L. Taylor, Chul Ho Kim, Bruce D. Johnson, Jon-Émile S. Kenny; Acute Crit Care. 2024;39(1):162-168. Published online February 23, 2024; DOI: https://doi.org/10.4266/acc.2023.01095

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Abstract PDF: Background
Using peripheral arteries to infer central hemodynamics is common among hemodynamic monitors. Doppler ultrasound of the common carotid artery has been used in this manner with conflicting results. We investigated the relationship between changing common carotid artery Doppler measures and stroke volume (SV), hypothesizing that more consecutively-averaged cardiac cycles would improve SV-carotid Doppler correlation. Methods: Twenty-seven healthy volunteers were recruited and studied in a physiology laboratory. Carotid artery Doppler pulse was measured with a wearable, wireless ultrasound during central hypovolemia and resuscitation induced by a stepped lower body negative pressure protocol. The change in maximum velocity time integral (VTI) and corrected flow time of the carotid artery (ccFT) were compared with changing SV using repeated measures correlation. Results: In total, 73,431 cardiac cycles were compared across 27 subjects. There was a strong linear correlation between changing SV and carotid Doppler measures during simulated hemorrhage (repeated-measures linear correlation [Rrm ]=0.91 for VTI; 0.88 for ccFT). This relationship improved with larger numbers of consecutively-averaged cardiac cycles. For ccFT, beyond four consecutively-averaged cardiac cycles the correlation coefficient remained strong (i.e., Rrm of at least 0.80). For VTI, the correlation coefficient with SV was strong for any number of averaged cardiac cycles. For both ccFT and VTI, Rrm remained stable around 25 consecutively-averaged cardiac cycles. Conclusions: There was a strong linear correlation between changing SV and carotid Doppler measures during central blood volume loss. The strength of this relationship was dependent upon the number of consecutively-averaged cardiac cycles.

Basic science and research
A machine learning model for predicting favorable outcome in severe traumatic brain injury patients after 6 months: Mehdi Nourelahi, Fardad Dadboud, Hosseinali Khalili, Amin Niakan, Hossein Parsaei; Acute Crit Care. 2022;37(1):45-52. Published online January 21, 2022; DOI: https://doi.org/10.4266/acc.2021.00486

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Abstract PDF

Background
Traumatic brain injury (TBI), which occurs commonly worldwide, is among the more costly of health and socioeconomic problems. Accurate prediction of favorable outcomes in severe TBI patients could assist with optimizing treatment procedures, predicting clinical outcomes, and result in substantial economic savings. Methods: In this study, we examined the capability of a machine learning-based model in predicting “favorable” or “unfavorable” outcomes after 6 months in severe TBI patients using only parameters measured on admission. Three models were developed using logistic regression, random forest, and support vector machines trained on parameters recorded from 2,381 severe TBI patients admitted to the neuro-intensive care unit of Rajaee (Emtiaz) Hospital (Shiraz, Iran) between 2015 and 2017. Model performance was evaluated using three indices: sensitivity, specificity, and accuracy. A ten-fold cross-validation method was used to estimate these indices. Results: Overall, the developed models showed excellent performance with the area under the curve around 0.81, sensitivity and specificity of around 0.78. The top-three factors important in predicting 6-month post-trauma survival status in TBI patients are “Glasgow coma scale motor response,” “pupillary reactivity,” and “age.” Conclusions: Machine learning techniques might be used to predict the 6-month outcome in TBI patients using only the parameters measured on admission when the machine learning is trained using a large data set.

Citations

Citations to this article as recorded by

Enhancing hospital course and outcome prediction in patients with traumatic brain injury: A machine learning study
Guangming Zhu, Burak B Ozkara, Hui Chen, Bo Zhou, Bin Jiang, Victoria Y Ding, Max Wintermark
The Neuroradiology Journal.2024; 37(1): 74. CrossRef
Machine Learning in Neuroimaging of Traumatic Brain Injury: Current Landscape, Research Gaps, and Future Directions
Kevin Pierre, Jordan Turetsky, Abheek Raviprasad, Seyedeh Mehrsa Sadat Razavi, Michael Mathelier, Anjali Patel, Brandon Lucke-Wold
Trauma Care.2024; 4(1): 31. CrossRef
Science fiction or clinical reality: a review of the applications of artificial intelligence along the continuum of trauma care
Olivia F. Hunter, Frances Perry, Mina Salehi, Hubert Bandurski, Alan Hubbard, Chad G. Ball, S. Morad Hameed
World Journal of Emergency Surgery.2023;[Epub] CrossRef
Gastrointestinal failure, big data and intensive care
Pierre Singer, Eyal Robinson, Orit Raphaeli
Current Opinion in Clinical Nutrition & Metabolic Care.2023; 26(5): 476. CrossRef
Prediction performance of the machine learning model in predicting mortality risk in patients with traumatic brain injuries: a systematic review and meta-analysis
Jue Wang, Ming Jing Yin, Han Chun Wen
BMC Medical Informatics and Decision Making.2023;[Epub] CrossRef
Predicting return to work after traumatic brain injury using machine learning and administrative data
Helena Van Deynse, Wilfried Cools, Viktor-Jan De Deken, Bart Depreitere, Ives Hubloue, Eva Kimpe, Maarten Moens, Karen Pien, Ellen Tisseghem, Griet Van Belleghem, Koen Putman
International Journal of Medical Informatics.2023; 178: 105201. CrossRef
Fluid-Based Protein Biomarkers in Traumatic Brain Injury: The View from the Bedside
Denes V. Agoston, Adel Helmy
International Journal of Molecular Sciences.2023; 24(22): 16267. CrossRef
Predicting Outcome in Patients with Brain Injury: Differences between Machine Learning versus Conventional Statistics
Antonio Cerasa, Gennaro Tartarisco, Roberta Bruschetta, Irene Ciancarelli, Giovanni Morone, Rocco Salvatore Calabrò, Giovanni Pioggia, Paolo Tonin, Marco Iosa
Biomedicines.2022; 10(9): 2267. CrossRef

Rapid response system
A Pilot Study of the Effectiveness of Medical Emergency System Implementation at a Single Center in Korea: Su Hwan Lee, Ah Young Leem, Youngok Nho, Young Ah Kim, Kyung Duck Kim, Young Sam Kim, Se Kyu Kim, Kyung Soo Chung; Korean J Crit Care Med. 2017;32(2):133-141. Published online May 16, 2017; DOI: https://doi.org/10.4266/kjccm.2016.01011

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Abstract PDF

Background
An automatic alarm system was developed was developed for unexpected vital sign instability in admitted patients to reduce staffing needs and costs related to rapid response teams. This was a pilot study of the automatic alarm system, the medical emergency system (MES), and the aim of this study was to determine the effectiveness of the MES before expanding this system to all departments.
Methods
This retrospective, observational study compared the performance of patients admitted to the pulmonary department at a single center using patient data from three 3-month periods (before implementation of the MES: December 2013-February 2014; after implementation of the MES: December 2014-February 2015 and December 2015-February 2016).
Results
A total of 571 patients were admitted to the pulmonary department during the three observation periods. During this pilot study, the MES automatically issued 568 alarms for 415 admitted patients. There was no significant difference in the rate of cardiopulmonary resuscitation (CPR) before and after application of the MES. The mortality rate also did not change. However, it appeared that CPR was prevented in four patients admitted from the general ward to the intensive care unit (ICU) during MES implementation. The median length of hospital stay and median length of ICU stay were not significantly different before and after MES implementation.
Conclusions
Although we did not find a significant improvement in outcomes upon MES implementation, the CPR rate and mortality rate did not increase despite increased comorbidities. This was a small pilot study, and, based on these results, we believe that the MES may have significant effects in longer-term and larger-scale studies.

Citations

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Society of Critical Care Medicine Guidelines on Recognizing and Responding to Clinical Deterioration Outside the ICU: 2023
Kimia Honarmand, Randy S. Wax, Daleen Penoyer, Geoffery Lighthall, Valerie Danesh, Bram Rochwerg, Michael L. Cheatham, Daniel P. Davis, Michael DeVita, James Downar, Dana Edelson, Alison Fox-Robichaud, Shigeki Fujitani, Raeann M. Fuller, Helen Haskell, Ma
Critical Care Medicine.2024; 52(2): 314. CrossRef
Rapid response systems in Korea
Bo Young Lee, Sang-Bum Hong
Acute and Critical Care.2019; 34(2): 108. CrossRef

Review

Cardiology/Infection
How Do I Integrate Hemodynamic Variables When Managing Septic Shock?: Olfa Hamzaoui, Jean-Louis Teboul; Korean J Crit Care Med. 2016;31(4):265-275. Published online November 30, 2016; DOI: https://doi.org/10.4266/kjccm.2016.00927

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Abstract PDF

Hemodynamic management of sepsis-induced circulatory failure is complex since this pathological state includes multiple cardiovascular derangements that can vary from patient to patient according to the degree of hypovolemia, of vascular tone depression, of myocardial depression and of microvascular dysfunction. The treatment of the sepsis-induced circulatory failure is thus not univocal and should be adapted on an individual basis. As physical examination is insufficient to obtain a comprehensive picture of the hemodynamic status, numerous hemodynamic variables more or less invasively collected, have been proposed to well assess the severity of each component of the circulatory failure and to monitor the response to therapy. In this article, we first describe the hemodynamic variables, which are the most relevant to be used, emphasizing on their physiological meaning, their validation and their limitations in patients with septic shock. We then proposed a general approach for managing patients with septic shock by describing the logical steps that need to be followed in order to select and deliver the most appropriate therapies. This therapeutic approach is essentially based on knowledge of physiology, of pathophysiology of sepsis, and of published data from clinical studies that addressed the issue of hemodynamic management of septic shock.

Citations

Citations to this article as recorded by

Enhancement in Performance of Septic Shock Prediction Using National Early Warning Score, Initial Triage Information, and Machine Learning Analysis
Hyoungju Yun, Jeong Ho Park, Dong Hyun Choi, Sang Do Shin, Myoung-jin Jang, Hyoun-Joong Kong, Suk Wha Kim
The Journal of Emergency Medicine.2021; 61(1): 1. CrossRef

Original Article

Comparison of Hemodynamic Changes by the Thoracic Electrical Bioimpedance Device during Endotracheal Intubation or Insertion of Laryngeal Mask Airway in General Anesthesia: Han Mok You, Jin Mo Kim, Jae Kyu Cheun; Korean J Crit Care Med. 1998;13(1):67-72.

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Abstract PDF: Introduction: we measured the hemodynamic changes by the thoracic electrical bioimpedance (TEB) device during induction of anesthesia, endotracheal intubation or insertion of layngeal mask airway (LMA). This TEB device is safe, reliable and estimate continuously and invasively hemodynamic variables.
METHODS
We measured the cardiovascular response of endotracheal intubation or that of LMA insertion in thirty ASA class I patients. General anesthesia was induced with injection of fentany 1 microgram/kg, thiopetal sodium 5 mg/kg and vecuronium 1 mg/kg intravenously. Controlled ventilation was for 3 minutes with inhalation of 50% nitrous oxide and 1.5 vol% of enflurane before tracheal intubation or LMA insertion in all patients. The patient was randomly assinged to either tracheal intubation group (ET group) or laryngeal mask airway group (LMA group). Heart rate (HR), mean arterial pressure (MAP), systemic vascular resistance (SVR), stroke index (SI) and cardic index (CI) were measured to pre-induction, pre-intubation, 1 minute after intubation, 2 minute, 3 minute, 5 minute, 7 minute.
RESULTS
MAP and SVR were decreased effectively LMA group than ET group during 1 minute after intubation, 2 minute, 3 minute, 5 minute, 7 minute (p<0.05). HR was decreased effectively LMA group than ET group between pre-induction and 1 minute after intubation, between 1 minute after intubation and 2 minute after intubation (p<0.05). But, SI and CI were no difference between ET group and LMA group during induction of anesthesia and intubation (p<0.05).
CONCLUSION
The insertion of LMA is beneficial for certain patients than endotracheal tube to avoid harmful cardiovascular response in the management of airway during anesthesia.

Review

Hemodynamic Monitoring and Treatment Strategy of Acute Heart Failure: Chul Soo Park; Korean J Crit Care Med. 2011;26(1):1-5.; DOI: https://doi.org/10.4266/kjccm.2011.26.1.1

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Abstract PDF

Acute heart failure (AHF) has emerged as a major public health problem over the past 2 decades and AHF represents a period of high risk for patients, during which time the patients are more susceptible to have fatal outcomes or be re-hospitalized, compared to periods of chronic stable heart failure. The goals of AHF treatment are symptomatic relief and hemodynamic stabilization, which need accurate assessment of volume status and cardiac function of patients. Until now, there is a paucity of controlled clinical data to define optimal treatment for patients with AHF and most guidelines published by the American Heart Association or European Society of Cardiology have been generated by the consensus opinions of experts. In these guidelines, routine invasive hemodynamic monitoring of AHF patients is not recommended because there have not been any reports showing survival benefit in patients monitored with pulmonary artery catheters. At present, treatment strategies based on clinical characteristics such as pulmonary congestion and tissue hypoperfusion rather than invasive hemodynamic monitoring is widely accepted. In this article, we discuss an optimal management plan including appropriate assessment of the hemodynamic status of patients and treatment of AHF.

Citations

Citations to this article as recorded by

Thoracic aortic aneurysms exerting high extrinsic pressure on the airway
Hanna Jung, Young Woo Do, Sang Yub Lee, Youngok Lee, Tak Hyuk Oh, Gun Jik Kim
Journal of Cardiothoracic Surgery.2019;[Epub] CrossRef
Relationship of Temperature and Humidity with the Number of Daily Emergency Department Visits for Acute Heart Failure: Results from a Single Institute from 2008-2010
Sang Hyun Ha, Bong Gun Song, Na Kyoung Lee, Chang Shin Choi, Chong Kun Hong, Jun Ho Lee, Seong Youn Hwang
Korean Journal of Critical Care Medicine.2012; 27(3): 165. CrossRef

Original Article

Retrospective Analysis of the Postoperative Patients Admitted to General Surgical-Medical Intensive Care Unit: Jun Rho Yoon, Choon Hak Lim, Mi Jung Kim; Korean J Crit Care Med. 2008;23(1):18-24.; DOI: https://doi.org/10.4266/kjccm.2008.23.1.18

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Abstract PDF

BACKGROUND
The present study was designed to examine the purpose of intensive care unit (ICU) admission and the prevalence of disease in postoperative patients admitted to general surgical-medical ICU.
METHODS
Between 1 January 2007 and 31 December 2007, 646 cases of 612 patients admitted to a general postoperative patients admitted to general surgical-medical ICU were examined. The patients were classified into two groups, ICU treatment and ICU monitoring groups according to Knaus' suggestion which defines the kinds of treatment done exclusively in ICU. Patients' demographics, preoperative American Society of Anesthesiologists physical status classification (ASA) grade, prevalence of disease and emergent operation rate were analyzed.
RESULTS
255 patients (39.5%) were included in the ICU treatment group and 391 cases (60.5%) in the ICU monitoring group. The prevalence of respiratory, gastrointestinal, and central nervous diseases was higher significantly in the ICU treatment group. In addition, the average of ASA grade and the duration of operation were higher significantly in the ICU treatment group.
CONCLUSION
Admission rate only for monitoring was higher than one for intensive treatment. An alternative strategy should be considered to care for postoperative patients who need just close monitoring.

Citations

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Retrospective investigation of anesthetic management and outcome in patients with deep neck infections
Tae Kwane Kim, Hye Jin Yoon, Yuri Ko, Yuna Choi, Ui Jin Park, Jun Rho Yoon
Anesthesia and Pain Medicine.2019; 14(3): 347. CrossRef

Case Report

Clinical Experience of the Lower Extremity Nerve Block for a Neurocritically Ill Patient Who is Not Able to Communicate:A Case Report: Jun Rho Yoon, Tae Kwan Kim, Je Chun Yu, Yee Suk Kim, In Soo Han, Yong Ju Oh; Korean J Crit Care Med. 2007;22(1):48-51.

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Abstract PDF: A 73-year-old man was scheduled for the surgical reduction of fractured femur which occurred ar 3 months ago by the accident. The mental status of the patient was stuporous (Glasgow coma scale: 5) due to the complication of the head trauma. We performed nerve blocks (femoral, sciatic, lateral femoral cutaneous, and illiohypogastric nerve blocks) for the surgical reduction of left femur with 55 ml of 0.25% ropivacaine. The electroencephalography was monitored continuously during the 4 hour operation as well as monitoring the hemodynamic and respiratory parameters. The operation was performed successfully and the patient recovered uneventfully.

Original Article

Hemodynamic Effect of Pulmonary Artery Ligation during Pneumonectomy: Kwang Ho Lee, Hyun Kyo Lim, Eun Sung Jun, Young Bok Lee, Kyung Bong Yoon, Jae Chan Choi, Soon Yul Kim, Ryung Choi; Korean J Crit Care Med. 2000;15(2):88-92.

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Abstract PDF: BACKGROUND
Pulmonary artery ligation during pneumonectomy increase the pulmonary blood flow of dependent lung and may increase the pulmonary arterial pressure and pulmonary vascular resistance. The purpose of this study is to evaluate the hemodynamic effect of pulmonary artery ligation during pneumonectomy.
METHODS
Nine patients who were supposed to receive pneumonectomy were studied. Hemodynamic measurements were performed following two lung ventilation (TLV), one lung ventilation (OLV), after pulmonary artery ligation and after pneumonectomy.
RESULTS
There is no significant differences in heart rate, systemic arterial pressure, pulmonary arterial pressure, pulmonary capillary wedge pressure, cardiac index and pulmonary vascular resistance index. Arterial oxygen tension significantly reduced during OLV and increased after pulmonary artery ligation and after pneumonectomy.
CONCLUSIONS
These results suggest that pulmonary artery ligation during pneumonectomy may not affect the cardiopulmonary hemodynamics.

Case Report

The Use of Thiopental Sodium with BIS Monitoring in Hypoxic Brain Damage: Jae Young Kwon, Sul Ki Song, Kyung Hoon Kim, Sang Wook Shin, Seong Wan Baik; Korean J Crit Care Med. 2000;15(1):52-55.

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Abstract PDF: Hypoxemia is a common and potentially serious postoperative complication. Hypoxic encephalopahty may occur in prolonged hypoxemia. This condition needs brain protection. There are many brain protective methods. The primary cental nervous system protective mechanism of the barbiturates is attributed to their ability to decrease the cerebral metabolic rate, thus improving the ratio of oxygen (O2) supply to O2 demand. The electroencephalogram-derived bispectral index system (BIS) is a promising new method to predict probability of recovery of consciousness. We experienced two cases of hypoxic brain damage in recovery room. The patients were treated with thiopental and monitored with BIS. The use of thiopental as brain protection during complete global ischemia after cardiac arrest was not effective.

Original Articles

The Comparison of Buccal SpO2 and Finger SpO2 Accuracy in Patients with Moderate Defect in Pulmonary Function Test: Mee Young Chung, Jun Seuk Chea, Chang Jae Kim, Byung Ho Lee, Seung Ho Joo; Korean J Crit Care Med. 2000;15(1):31-34.

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Abstract PDF: BACKGROUND
The reliability of pulse oxymetry probes when applied to the finger or toes may be compromised in certain patients. Other sites less subject to mechanical interference or a pathophysiologic decrease in pulse amplitude have been sought. In the patients with moderate defect (N=20) in pulmonary function test, we examined the accuracy of buccal and digital SpO2 (oxygen saturation of pulse oxymetry) monitoring.
METHODS
SpO2 probe was placed firmly in the corner of the patient's mouth. Buccal and finger SpO2 and radial SaO2 (arterial oxygen saturation) were measured before the induction of anesthesia. The agreement between SaO2 and each SpO2 were calculated with the method outlined by Bland and Altman.
RESULTS
Buccal SpO2 was higher than finger SpO2, but finger SpO2 agreed more closely with SaO2 (buccal; 97.9+/-1.89, finger; 94.5+/-2.48, radial; 93.73+/-2.73%).
CONCLUSIONS
We conclude that buccal SpO2 monitoring may offer alternative when other sites aren't available. But, we suggest that buccal SpO2 should be further evaluated for the accuracy.

Effectiveness of Left Infrascapular Skin Temperature Monitoring in the ICU: Young Joo Lee, Hyun Jue Gill, Kuem Hee Chung, Jeong Yeon Hong, Bong Ki Moon, Myoung Eun Kim, Min Hyup Choi, Young Seok Lee; Korean J Crit Care Med. 1998;13(2):229-233.

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Abstract PDF: BACKGOUND: Many sites are used to measure the body temperature and each site has different physiologic and practical importance. Several types of skin temperature monitoring have been used as simple, inexpensive and viable alternatives in many settings. In the operating area, it is difficult to insert a temperature probe during operation. The object of this study was to compare the difference and the correlation between the temperature of the left infrascapular skin region and temperatures of axilla, nasopharynx and rectum, METHODS: Forty-two adult patients who were admitted at surgical ICU were studied. After covering the bed with insulator and sheets, patients were placed in supine position. Temperature monitoring was done at the same time using four temperature probes from two bedside patient monitors in the same patient. The temperatures were measured twice at 30 minutes after application of the temperature probe at 10 minute intervals and the average temperature was recorded.
RESULTS
The differences between skin temperature and rectal, nasopharyngeal, and axillary temperatures were -0.64+/-0.21degrees C (p<0.05), -0.40+/-0.21degrees C, and 0.24+/-0.21degrees C respectively. The lineal correlation between skin temperature and rectal, nasopharyngeal, and axillary temperatures were 0.839, 0.854, and 0.819, respectively (p<0.001).
CONCLUSION
This study suggests that the monitoring of the skin temperature at the left infrascapular skin region is well correlated with the nasopharyngeal, rectal and axillary temperatures. And it will be an easy, simple and safe method which can be used for the patients who are alert but need continuous temperature monitoring in the intensive care unit and as well as for the patients who are in the middle of operation.

Effects of Intravenous Lidocaine on Intra-abdominal Pressure during Endotracheal Suctioning: Wha Ja Kang, Seok Hee Ham, Young Kyu Choi, Moo Il Kwon; Korean J Crit Care Med. 1998;13(2):224-228.

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Abstract PDF: BACKGOUND: We evaluated the effect of intravenous lidocaine (1 mg/kg and 2 mg/kg) on intra-abdominal pressure (IAP) during endotracheal suctioning.
METHODS
We studied 40 patients undergoing endotracheal intubation during mechanical ventilation. Group I (1 mg/kg) and group II (2 mg/kg)were given lidocaine double fashion. The endotracheal suctioning (ETS) was done 1, 3, 5 and 7 min after the injection of lidocaine. IAP, systolic blood pressure (SBP), diastolic blood preassure (DBP), and heart rate (HR) during ETS were recorded, IAP was measured using a transurethral bladder catheters. The cough response to ETS was classified as " cough score".
RESULTS
Before administration of lidocaine, ETS produced significant increase in SBP, DBP, IAP and HR compared with baseline values in the two groups (p<0.05). Both groups showed no significant changes in SBP, DBP, and HR during the study. In group I, ETS produced a significant increase in IAP 5 and 7min after lidocaine treatment (p<0.05). There were significant differences between the two groups 5 and 7 min after lidocaine treatment (p<0.05). The score of cough decreased significantly in both groups 3 min after lidocaine treatment but there was a significant difference between the two groups at 7 min.
CONCLUSIONS
We concluded that lidocaine pretreatment significantly blunted the increase in IAP, SBP DBP and HR caused by ETS and this effect lasts for 3 min in group I and 7 min in group II.

Endobronchial Insufflation of Air Supports Ventilation in Apneic Dogs: Ji Han Rhyu, Sun Gyoo Park; Korean J Crit Care Med. 1998;13(2):198-204.

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Abstract PDF: BACKGOUND: Mass casualties from organophosphorus inhalation die from respiratory depression. Gas supplies and equipment are limited for mechanical ventilation of multiple subjects in emergency situation. Endobronchial insufflation of air (EIA) can be simply performed with air compressor and catheter. The author tried to examine the usefulness of EIA in five apneic dogs induced by tetrodotoxin (TTX) infusion.
METHOD
Five anesthetized dogs were intubated with endotracheal tube and endobronchial insufflation catheter and instrumented with arterial catheter and ventilated with controlled mechanical ventilation (CMV) while 12 microgram/kg TTX was infused intravenous over 90 minutes to produce apnea. EIA of 1 microliter/kg/min was delivered through a 35 cm long, 0.8 cm ID catheter with a forked end placed astride the carina. During conventional ventilation, arterial blood gases and pH were measured (base line, BL). The data were measured after confirmation of apnea for 1 minute (time=0, control value), and then measured serially for 4 hours of EIA.
RESULT
All animals survived and were alert and neurologically normal within 24 hours. The changes of arterial oxygen tension (PaO2) were no significant difference between control value and 10, 20, 30 minute (p<0.05), and arterial carbon dioxide tension (PaCO2) were significant increase in control value compared to base line (p<0.05), and pH were no significant difference in all values (p<0.05). Spontaneous respiratory efforts slowly returned after 45 minute of EIA and resulted in the improvement of gas exchange.
CONCLUSION
EIA recognized as a sort of ventilatory technique is useful only when other equipments could not be available. The EIA catheter can be placed by cricothyroidotomy. EIA is very helpful in supporting ventilation, and it also helps the apneic dogs stay in normal condition.

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