Temperature loss by ventilation in a calorimetric bench model.

In intensive care medicine heat moisture exchangers are standard tools to warm and humidify ventilation gases in order to prevent temperature loss of patients or airway epithelia damage. Despite being at risk of hypothermia especially after trauma, intubated emergency medicine patients are often ventilated with dry and in winter probably cold ventilation gases. We tried to assess the amount of temperature-loss due to ventilation with cold, dry medical oxygen in comparison to ventilation with warm and humidified oxygen.

Safer employment of nitrous oxide in anesthesia machines-a technical simulation.

Several incidents of anesthesia-attributed mortality in the past were caused by misconnection of gas pipelines resulting in ventilation with pure nitrous oxide. A simple safety feature may be to "mark" nitrous oxide with a lower pressure than oxygen and room air within the hospital's gas pipeline system. Then, any misconnection of gas pipelines could be detected by pressure differences with a manometer in the anesthesia machine.

A dual-use laryngoscope to facilitate apneic oxygenation.

Background: In preoxygenated patients, time until oxygen saturation drops can be extended by insufflating oxygen into their airways, thus oxygenating them apneically.

Objectives: To compare different methods of apneic oxygenation.

Methods: A noncommercial dual-use laryngoscope with an internal lumen in its blade was used to provide oxygen insufflation into a simulated laryngeal space during intubation.

Head position angles to open the upper airway differ less with the head positioned on a support.

Introduction: The aim of the study was to assess the effects of positioning the head on a support on "head position angles" to optimally open the upper airway during bag-valve mask ventilation.

Methods: We ventilated the lungs of anesthetized adults with a bag-valve mask and the head positioned with (n = 30) or without a support (n = 30). In both groups, head position angles and ventilation parameters were measured with the head positioned in (1) neutral position, (2) in a position deemed optimal for ventilation by the investigator, and (3) in maximal extension.

BMP-2 immobilized on nanocrystalline diamond-coated titanium screws; demonstration of osteoinductive properties in irradiated bone.

Background: Irradiation results in impaired bone healing. Thus, osteosynthesis procedures are afflicted with increased failure rates. To improve osseointegration bone morphogenetic protein-2 (BMP-2) immobilized on nanocrystalline diamond (NCD)-coated implant surfaces might be 1 solution.

Mobile phone-assisted basic life support augmented with a metronome.

Background: Basic life support (BLS) performed by lay rescuers is poor. We developed software for mobile phones augmented with a metronome to improve BLS.

Study Objectives: To assess BLS in lay rescuers with or without software assistance.

Suctioning via the tube during endotracheal intubation in a model of severe upper airway haemorrhage: is there an advantage vs. suctioning with a separate catheter?

Introduction: In a model of severe simulated upper airway haemorrhage, we compared two techniques of performing endotracheal intubation: (1) suctioning via the endotracheal tube during laryngoscopy with subsequently advancing the endotracheal tube, and (2) the standard intubation strategy with performing laryngoscopy, and performing suction with subsequently advancing the endotracheal tube.

Methods: Forty-one emergency medical technicians intubated the trachea of a manikin with severe simulated airway haemorrhage using each technique in random order.

Results: There was no significant difference in the number of oesophageal intubations between suctioning via the tube and the standard intubation strategy [8/41 (20%) vs.

Head-position angles in children for opening the upper airway.

Aims: Inexperienced health-care-providers may encounter severe problems to ventilate an unconscious child. Designing a ventilating device that could indicate how to open an upper airway correctly may be beneficial. Neutral position in young children and slight head extension in older children is recommended, although the optimal head angle is not clear.

Anaesthesia in prehospital emergencies and in the emergency room.

Aims: To review anaesthesia in prehospital emergencies and in the emergency room, and to discuss guidelines for anaesthesia indication; pre-oxygenation; anaesthesia induction and drugs; airway management; anaesthesia maintenance and monitoring; side effects and training.

Methods: A literature search in the PubMed database was performed and 87 articles were included in this non-systematic review.

Conclusions: For pre-oxygenation, high-flow oxygen should be delivered with a tight-fitting face-mask provided with a reservoir.

The mouth-to-bag resuscitator during standard anaesthesia induction in apnoeic patients.

Aim: Ventilation of a non-intubated emergency patient by inexperienced rescuers with a standard bag-valve device may result in high inspiratory flow rates and subsequently high airway pressures with stomach inflation. Therefore, a self-inflating bag has been developed that requires lay rescuers to blow up a single-use balloon inside an adult bag-valve device, which, in turn, displaces air within the bag towards the patient. This concept has been compared to standard adult bag-valve devices earlier in bench models but not in patients.

Ventilation strategies in the obstructed airway in a bench model simulating a nonintubated respiratory arrest patient.

Background: The Smart Bag MO(R) is an adult flow-limited bag-valve device designed to reduce the risk of stomach inflation in an unprotected airway. Its properties in severe airway obstruction are as yet unknown.

Methods: In a bench model, we evaluated respiratory mechanics and delivered tidal volumes although ventilating at airway resistances of 4, 10, and 20 cm H(2)O .

A suction laryngoscope facilitates intubation for physicians with occasional emergency medical service experience--a manikin study with severe simulated airway haemorrhage.

Introduction: We developed a suction laryngoscope, which enables simultaneous suction and laryngoscopy in cases of airway haemorrhage and evaluated its potential benefits in physicians with varying emergency medical service experience.

Methods: Eighteen physicians with regular and 24 physicians with occasional emergency medical service experience intubated the trachea of a manikin with severe simulated airway haemorrhage using the suction laryngoscope and the Macintosh laryngoscope in random order.

Results: In physicians with regular emergency medical service experience, there was neither a difference in time needed for intubation [median (IQR, CI 95%)]: 34 (18, 30-46) vs.

Effects of stomach inflation on haemodynamic and pulmonary function during spontaneous circulation in pigs.

Aim: Stomach inflation during mask ventilation is frequent, but the effects on haemodynamic and pulmonary function are unclear. We evaluated the effects of stomach inflation on haemodynamic and pulmonary function during spontaneous circulation in a porcine model.

Methods: Randomised prospective animal study.

Automated emergency ventilation devices in a simulated unprotected airway.

Background: Automated ventilation devices are becoming more popular for emergency ventilation, but there is still not much experience concerning the optimal ventilation mode.

Methods: In a bench model representing a non-intubated patient in respiratory and cardiac arrest, we compared a pressure-cycled with a time- and volume-cycled automated ventilation device in their completely automated modes. The main study endpoints were inspiratory time, respiratory rate, stomach inflation, and lung tidal volumes.

Effects of a suction laryngoscope in a model with simulated severe airway hemorrhage.

In severe airway hemorrhage, simultaneous suction and laryngoscopy may render intubation difficult. We built a suction laryngoscope that consists of an adjustable stainless steel-guide tube fixed at the lingual surface of a standard Macintosh laryngoscope blade. Via this steel-guide tube, a large suction catheter can be inserted and positioned exactly to suction pharyngeal blood or vomitus, rendering simultaneous suctioning and laryngoscopy possible.

Minimizing stomach inflation versus optimizing chest compressions.

In a bench model, we evaluated a bag-valve device (Smart Bag MO) with limited maximum inspiratory gas flow developed to reduce the risk of stomach inflation in an unprotected airway. During simulated cardiopulmonary resuscitation with uninterrupted chest compressions, ventilation with the "disabled" Smart Bag MO or an adult self-inflating bag-valve device provided only adequate tidal volumes if inspiratory time was 0.5 s.