ENDOTRACHEAL TUBE

Lubricious Coatings for Biomaterials. Coatings of poly(ethylene oxide) when dry are tactile. If brought into contact with water, the poly(ethylene oxide) hydates rapidly and forms a lubricious coating. This type of technology is of great interest for biomedical devices introduced into the human body, such as catheters and endotracheal tubes, and for sutures (114—117). 

For the treatment of lung surfactant deficiency in premature human infants suffering from respiratory distress syndrome, limited clinical trials were performed showing that liposomes in the lung-instilled intratracheally either as an aerosolized mist (Ivey et al., 1977) or as a suspension via an endotracheal tube (Fujiwara et al., 1980)—rapidly improved lung function. No adverse effects were observed as a result of the supplementation with surfactant-like material. It appears, therefore, that liposomes are a suitable system for the delivery of major phospholipid components of endogenous lung surfactant. 

Atropine, epinephrine, and lidocaine can be administered through the tracheal tube before venous access is achieved at 2-2.5 times the recommended intravenous dose diluted with 10 mL of normal saline or sterile water. Stop CPR, administer beyond the tip of the endotracheal tube, follow with five quick insufflations to aerosolize the drug, and then resume CPR. 

Removal of nasogastric and endotracheal tubes when appropriate... 

Intubation and mechanical ventilation increase the risk of HAP/VAP 6- to 21 -fold.2,22 VAP also may be related to colonization of the ventilator circuit23 Risk of aspiration is increased in these patients owing to the supine positioning of the patient, the presence of the endotracheal tube preventing closure of the... 

The therapy for IRDS includes mechanical ventilation with continuous positive airway pressure. This maintains adequate ventilation and prevents airway collapse between breaths with the formation of atelectasis. Therapy also includes administration of exogenous pulmonary surfactant. Two types of surfactants are used to prevent and treat IRDS in the U.S. These include surfactants prepared from animal sources as well as synthetic surfactants. Exogenous pulmonary surfactants are administered as a suspension (in saline) through the endotracheal tube used for mechanical ventilation. 

Weeks et al. (1963) reported that 80% of the 1,1-dimethylhydrazine administered via endotracheal tube to anesthetized mongrel dogs was retained in the respiratory tract. It was unclear if the retention was monitored only for the 51-64 min duration of exposure. 

Tubing, catheters, cannulas, endotracheal tubing, feeding and pressure monitoring tubing... 

Alternatively, if the patient has been intubated, epinephrine can be injected via the endotracheal tube directly into the bronchial tree at the same dosage for IV injection. It is rapidly absorbed through the lung capillary bed. 

Aerosol - Some subjects requiring assisted ventilation have experienced serious difficulties because of inadequate ventilation and gas exchange. Drug precipitation within the ventilatory apparatus, including the endotracheal tube, has resulted in increased positive and expiratory pressure and increased positive inspiratory pressure. Accumulation of fluid in tubing ( rain out ) also has been noted. 

Dilute epinephrine 1 10,000 may be administered through an endotracheal tube, if no other parenteral access is available, directly into the bronchial tree. It is rapidly absorbed there from the capillary bed of the lung. 

Supportive care is important, especially in unconscious patients. If the airway is protected (gag reflex or cuffed endotracheal tube present), then activated charcoal can be given. Repeated doses of oral activated charcoal increase the rate of elimination of several tricyclic antidepressants, but may not influence outcome. 

It is inappropriate to employ gastric lavage unless the lungs can be protected, either by virtue of patient having an adequate cough reflex or by means of a cuffed endotracheal tube. 

Intubation after the first trimester with a small cuffed endotracheal tube and use of a small laryngoscope and a laryngoscope blade to reduce the risk of bleeding from attempted intubation... 

Suppression of the cough reflex is a well-recognized action of opioids. Codeine in particular has been used to advantage in persons suffering from pathologic cough and in patients in whom it is necessary to maintain ventilation via an endotracheal tube. However, cough suppression by opioids may allow accumulation of secretions and thus lead to airway obstruction and atelectasis. 

First, the airway should be cleared of vomitus or any other obstruction and an oral airway or endotracheal tube inserted if needed. For many patients, simple positioning in the lateral decubitus position is sufficient to move the flaccid tongue out of the airway. Breathing should be assessed by observation and oximetry and, if in doubt, by measuring arterial blood gases. Patients with respiratory insufficiency should be intubated and mechanically ventilated. The circulation should be assessed by continuous monitoring of pulse rate, blood pressure, urinary output, and evaluation of peripheral perfusion. 

If the patient is awake or if the airway is protected by an endotracheal tube, gastric lavage may be performed using an orogastric or nasogastric tube—as large a tube as possible. Lavage solutions (usually 0.9% saline) should be at body temperature to prevent hypothermia. 

Following fires in which endotracheal tubes became ignited by surgical lasers or electrocautery in atmospheres enriched by oxygen and/or nitrous oxide, the flammability of PVC, silicone rubber and red rubber tubes in enriched atmospheres was studied [1], Ozonised oxygen was reacted with hydrogen at low pressure to generate hydroxyl radicals. Pressure in the apparatus was maintained by a vacuum pump protected from ozone by a tube of heated silver foil. On two occasions there was an explosion in the plastic vent pipe from the vacuum pump. The vent gas should have been outside explosive limits and the exact cause is not clear the editor suspects peroxide formation. 

Latini G, Avery GB. 1999. Materials degradation in endotracheal tubes a potential contributor to bronchopulmonary dysplasia. Acta Paediatr 88 1174-1175. 

Keywords Biomaterials surface functionalization, XPS, Tof-SIMS, photo-immobilization, glycoengineering, bacterial adhesion, endotracheal tubes, PS biosensors fluorescence immunoassays, AgN03, PVC, Pseudomonas aeruginosa... 

Pseudomonas aeruginosa bacterial adhesion on PVC endotracheal tubes can be reduced either by rf plasma modification or wet chemical treatment using AgNO . 

D. J. Balazs, Surface Modification and Characterization of Endotracheal Tube Surfaces to Reduce Pseudomonas Aeruginosa Adhesion Plasma treatment, Plasma Polymerization and Chemical Methods (PhD Thesis EPFL no. 2748, 2003). 

D. J. Balazs, K. Triandafillu, Y. Chevolot, B.-O Aronsson, H. Harms, P. Descouts, and H. J. Mathieu, Surface Modification of PVC Endotracheal Tubes by Oxygen Glow Discharge to Reduce Bacterial Adhesion, Surf. Interface Anal. 35, 301-309 (2003). 

M. Ramstedt and H. J. Mathieu, Ways to decrease the adhesion of Pseudomonas Aeruginosa bacteria to the surfaces of endotracheal tubes, ECASIA 05 Book of Abstracts, Vienna, 2005, p. 76. 

The surgical placement of vascular catheters and the instillation of bacteria, either intratracheally or intraperitoneally, require general anesthesia. Anesthesia is induced with a combination of ketamine and xylazine and maintained with additional doses of ketamine as needed. During the surgical procedure the rabbit breathes spontaneously through an endotracheal tube (3.0 mm ID, 4.2 mm OD, Kendall/Sheridan, Argyle, NY). 

The bacterial suspension (0.5-1 mL) is administered blindly to the right lung with a 5 french catheter (AccuMark, Keene, NH) advanced through an endotracheal tube. 

To facilitate the placement of the endotracheal tube a small amount of lidocaine (0.1-0.2 mL) can be used to anesthetize the back of the oropharynx. This is accomplished by advancing the endotracheal tube to the back of the oropharynx and administering the lidocaine through the endotracheal tube. 

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