METHODS: Non-inferiority randomized, clinical trial involving patients presenting with acute respiratory failure conducted in the ED of a local hospital. Participants were randomly allocated to receive either hCPAP or fCPAP as per the trial protocol. The primary endpoint was respiratory rate reduction. Secondary endpoints included discomfort, improvement in Dyspnea and Likert scales, heart rate reduction, arterial blood oxygenation, partial pressure of carbon dioxide (PaCO2), dryness of mucosa and intubation rate.
RESULTS: 224 patients were included and randomized (113 patients to hCPAP, 111 to fCPAP). Both techniques reduced respiratory rate (hCPAP: from 33.56 ± 3.07 to 25.43 ± 3.11 bpm and fCPAP: from 33.46 ± 3.35 to 27.01 ± 3.19 bpm), heart rate (hCPAP: from 114.76 ± 15.5 to 96.17 ± 16.50 bpm and fCPAP: from 115.07 ± 14.13 to 101.19 ± 16.92 bpm), and improved dyspnea measured by both the Visual Analogue Scale (hCPAP: from 16.36 ± 12.13 to 83.72 ± 12.91 and fCPAP: from 16.01 ± 11.76 to 76.62 ± 13.91) and the Likert scale. Both CPAP techniques improved arterial oxygenation (PaO2 from 67.72 ± 8.06 mmHg to 166.38 ± 30.17 mmHg in hCPAP and 68.99 ± 7.68 mmHg to 184.49 ± 36.38 mmHg in fCPAP) and the PaO2:FiO2 (Partial pressure of arterial oxygen: Fraction of inspired oxygen) ratio from 113.6 ± 13.4 to 273.4 ± 49.5 in hCPAP and 115.0 ± 12.9 to 307.7 ± 60.9 in fCPAP. The intubation rate was lower with hCPAP (4.4% for hCPAP versus 18% for fCPAP, absolute difference -13.6%, p = 0.003). Discomfort and dryness of mucosa were also lower with hCPAP.
CONCLUSION: In patients presenting to the ED with acute cardiogenic pulmonary edema or decompensated COPD, hCPAP was non-inferior to fCPAP and resulted in greater comfort levels and lower intubation rate.
CASE: We report a case of postoperative unilateral hypoglossal nerve palsy after uncomplicated use of the LMA Protector. To the best of our knowledge, this could be the second reported case.
CONCLUSIONS: This case demonstrates that anesthetists need to routinely measure cuff pressure and that the Cuff PilotTM technology is not a panacea for potential cranial nerve injury after airway manipulation.
Methods: A quasi-experimental trial study was conducted to compare the effectiveness of nasal rinsing between two groups. The intervention group was instructed to perform nasal rinsing during ablution, while the control group was not asked to do nasal rinsing. Both groups were provided progress diaries to record the symptoms of respiratory tract infection, including cough, rhinorrhoea, nasal blockage, fever, and sore throat, as well as thick phlegm, shortness of breath, epistaxis, and changes in sense of smell. The groups were also instructed to record any visits to clinics for their symptoms throughout their stay in Makkah for the Hajj ritual.
Results: The study showed that nasal rinsing significantly reduced the symptoms of cough, rhinorrhoea, and nasal blockage. The intervention group had an increased number of visits to healthcare facilities for treatment, when compared to those of the control group. There were no significant differences in the groups regarding the symptoms of fever and sore throat.
Conclusion: Nasal rinsing can be included as part of intervention methods that include vaccination and the use of a face mask. Nasal rinsing can be easily practiced by the pilgrims, since it is a Sunnah act in ablution, which is an integral element of Muslims' daily life.
METHODS: We evaluated the performance characteristics of the LMA Protector™ in 30 unparalysed, moderately obese patients. First attempt insertion rate, time for insertion, oropharyngeal leak pressure (OLP), and incidence of complications were recorded.
RESULTS: We found high first and second attempt insertion rates of 28(93%) and 1(33%) respectively, with one failed attempt where no capnography trace could be detected, presumably from a downfolded device tip. The LMA Protector™ was inserted rapidly in 21.0(4.0) seconds and demonstrated high OLP of 31.8(5.4) cmH2O. Fibreoptic assessment showed a clear view of vocal cords in 93%. The incidence of blood staining on removal of device was 48%, postoperative sore throat 27%, dysphagia 10% and dysphonia 20% (all self-limiting, resolving a few hours postoperatively).
CONCLUSIONS: We conclude that the LMA Protector™ was associated with easy, expedient first attempt insertion success, demonstrating high oropharyngeal pressures and good anatomical position in the moderately obese population, with relatively low postoperative airway morbidity.
TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry, ACTRN12617001152314 . Registered 7 August 2017.
METHODS: This randomized trial was conducted from December 2019-June 2020. 234 nulliparas, 34-36 weeks' gestation with self-reported night sleep