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Cuff Inflation-supplemented Videoscope-guided Nasal Intubation

12. november 2017 opdateret af: Jun joohyun, Hallym University Kangnam Sacred Heart Hospital

Cuff Inflation-supplemented Videoscope-guided Nasal Intubation: The Effect of Tube Thermo-softening on the Nasotracheal Navigability

Epistaxis or post-pharyngeal bleeding is the most common complication after nasotracheal intubation (NTI). Prior thermal softening of the endotracheal tube (ET) has been recommended as one of the methods to prevent nasal trauma from nasotracheal intubation. However, thermal softening of tubes tends to adversely affect the nasotracheal navigation of the ET.

During NTI under conventional direct laryngoscopy, the tip of the Macintosh laryngoscope is advanced into the vallecula, indirectly elevating the epiglottis by applying pressure on the hyoepiglottic ligament. Although this maneuver allows optimal visualization of the glottis, it lifts the larynx away from the tip of the advancing nasotracheal tube (NTT), which generally lies along the posterior pharyngeal wall. Most clinicians use Magill forceps to direct the tip of the NTT anteriorly to enter the glottis. Magill forceps may cause damage to the cuff of an ET or may injure oropharyngeal mucosa.

The use of a video laryngoscope and a cuff inflation technique has been proposed as a method for reducing the malalignment of tubes. Indirect laryngoscopy using a Video laryngoscopy can reduce malalignment by minimizing lifting the glottis during laryngoscopy. The cuff inflation technique (wherein the cuff of ET tube is inflated with 15 mL of air) has been used while performing "blind" NTI to guide such malaligned polyvinyl chloride (PVC) ET tubes into the laryngeal inlet. Recently, one study reported that the cuff inflation technique consistently improved the oropharyngeal insertion of the different ET tubes of varying stiffness during direct laryngoscope-guided NTI.

There has never been study about effect of cuff inflation technique on navigability when performing NTI under video laryngoscopy guidance with ET tubes of varying stiffness.Investigators assessed and compared the incidence of nasal injury and nasotracheal navigability with two technique during cuff inflation-supplemented NTI guided by video- laryngoscopy

Studieoversigt

Status

Ukendt

Betingelser

Intervention / Behandling

Undersøgelsestype

Interventionel

Tilmelding (Forventet)

140

Fase

  • Ikke anvendelig

Kontakter og lokationer

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Studiesteder

  • Korea, Republikken
      • Seoul, Korea, Republikken
        • Rekruttering
        • Kangnam Sacred Heart Hospital, Hallym University College of Medicine
        • Kontakt:

Deltagelseskriterier

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Berettigelseskriterier

Aldre berettiget til at studere

18 år og ældre (Voksen, Ældre voksen)

Tager imod sunde frivillige

Ingen

Køn, der er berettiget til at studere

Alle

Beskrivelse

Inclusion Criteria:

  • ASA status I-III, older than 18 yr, who under went elective surgery and requiring ET intubation as part of anesthetic management were enrolled in the study.

Exclusion Criteria:

  • Patients with bleeding diathesis, history of recurrent nasal obstruction or any nasal/pharyngeal surgery, and those with anticipated difficult tracheal intubation were excluded.

Studieplan

Dette afsnit indeholder detaljer om studieplanen, herunder hvordan undersøgelsen er designet, og hvad undersøgelsen måler.

Hvordan er undersøgelsen tilrettelagt?

Design detaljer

  • Primært formål: Forebyggelse
  • Tildeling: Randomiseret
  • Interventionel model: Parallel tildeling
  • Maskning: Firedobbelt

Våben og indgreb

Deltagergruppe / Arm
Intervention / Behandling
Placebo komparator: Room temperature
The nasotracheal tube, sized 6.0 -7.0 mm inner diameter (ID), were put into a bottle of sterilized normal saline (1 L, 25 °C) at room temperature.
Andet: Room temperature
nasotracheal tube, sized 6.0 -7.0 mm inner diameter (ID), were put into a bottle of sterilized normal saline (1 L, 25 °C) at room temperature.
Eksperimentel: Thermo-softening
The naso tracheal tube, sized 6.0 -7.0 mm inner diameter (ID), were put into a bottle of sterilized normal saline (1 L) at warm cabinet set to 45°C (approximately 117°F).
Andet: Thermo-softening
The thermosoftening treatment of the tubes was performed by using a warm cabinet set to 45°C (approximately 117°F). One bottle of normal saline (1 L) containing a thermometer and three tubes (6.0 -7.0 mm ID) was put into a chamber of the cabinet 30 min before intubation.

Hvad måler undersøgelsen?

Primære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
severity of epistaxis
Tidsramme: during navigation from nose to oropharynx
The severity of epistaxis was evaluated under VL using a 4-point scale:no epistaxis; mild epistaxis (blood on the tracheal tube only); moderate epistaxis (blood pooling in the pharynx); or severe epistaxis (blood in the pharynx sufficient to impede intubation)
during navigation from nose to oropharynx

Sekundære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
the navigation of ET tube from nose to oropharynx
Tidsramme: during navigation from nose to oropharynx
The navigability (ease of insertion) was scored as grade 1 if the tube advanced smoothly from the nose into oropharynx, grade 2 if there was resistance in the passage that could be managed by side-to-side rotation of the tube, and grade 3 if the tube impinged unduly and the other nostril had to be used.
during navigation from nose to oropharynx
time
Tidsramme: The passage of each ET tube from nasal cavity to trachea was divided into 3 phases (phase 1: from the nose into oropharynx, phase 2: from oropharynx into the laryngeal inlet , phase 3: from the laryngeal inlet into the trachea)
time required for passage of tube in each phase
The passage of each ET tube from nasal cavity to trachea was divided into 3 phases (phase 1: from the nose into oropharynx, phase 2: from oropharynx into the laryngeal inlet , phase 3: from the laryngeal inlet into the trachea)
air volume
Tidsramme: during navigation from oropharynx to laryngeal inlet
the volume of air needed for cuff inflation during navigation from oropharynx to laryngeal inlet
during navigation from oropharynx to laryngeal inlet
the navigation of ET tube from oropharynx to laryngeal inlet
Tidsramme: during navigation from oropharynx to the laryngeal inlet
The tube was then advanced further from oropharynx into the laryngeal inlet under video laryngoscopic vision, and a smooth passage was scored as grade 1. In case the tube failed to align with the laryngeal inlet, the tube tip was withdrawn into the laryngopharynx and the cuff of the tube was sequentially inflated with air in 4 mL aliquots up to a maximal volume of 40 mL by an assistant on request until it aligned with the laryngeal inlet (cuff inflation technique) and got engaged in it thereafter (grade 2). If this technique was unsuccessful, the cuff was deflated and Magill forceps were used to engage the tube tip into the laryngeal inlet (grade 3).
during navigation from oropharynx to the laryngeal inlet
the navigation of ET tube from laryngeal inlet to trachea
Tidsramme: during navigation from laryngeal inlet to trachea
A smooth passage was considered grade 1. If the ET tube tip got stuck in the laryngeal vestibule, optimal external laryngeal manipulation (OELM) applied (grade2); If the ET tube tip got stuck in the laryngeal vestibule, it was rotated clockwise while maintaining a gentle forward pressure on it until it got disengaged from its impingement and then slipped into the trachea (grade 3). In case this maneuver was unsuccessful, Magill forceps were used to complete the intubation process (grade 4).
during navigation from laryngeal inlet to trachea

Samarbejdspartnere og efterforskere

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Sponsor

Hallym University Kangnam Sacred Heart Hospital

Datoer for undersøgelser

Disse datoer sporer fremskridtene for indsendelser af undersøgelsesrekord og resumeresultater til ClinicalTrials.gov. Studieregistreringer og rapporterede resultater gennemgås af National Library of Medicine (NLM) for at sikre, at de opfylder specifikke kvalitetskontrolstandarder, før de offentliggøres på den offentlige hjemmeside.

Studer store datoer

Studiestart (Faktiske)

10. juni 2017

Primær færdiggørelse (Forventet)

1. december 2017

Studieafslutning (Forventet)

1. december 2017

Datoer for studieregistrering

Først indsendt

19. april 2017

Først indsendt, der opfyldte QC-kriterier

27. april 2017

Først opslået (Faktiske)

2. maj 2017

Opdateringer af undersøgelsesjournaler

Sidste opdatering sendt (Faktiske)

14. november 2017

Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier

12. november 2017

Sidst verificeret

1. november 2017

Mere information

Begreber relateret til denne undersøgelse

Andre undersøgelses-id-numre

  • 2017-03-020

Plan for individuelle deltagerdata (IPD)

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Kliniske forsøg med Nasotracheal intubation

Kliniske forsøg med Room temperature

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