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1
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Lyell’s syndrome as a factor which escalates the risk of laryngotracheal stenosis and atresia after intubation

100%
Nowak N., Kotowski M., Sroczyński J., Szydłowski J.
Polski Przegląd Otorynolaryngologiczny
|
2019
|
vol. 8(3)
50-54
EN
Toxic epidermal necrolysis (TEN) also known as Lyell’s Syndrome is a rare, acute hypersensitivity reaction characterized by cutaneous and mucosal necrosis covering more than 30% of surface [1]. Lyell’s syndrome is self limited, but potentially recurrent disease. The mortality for toxic epidermal necrolysis is approaching to 20–66% [2]. Lyell Syndrome is extremely rare diseases with an estimated overall incidence of 1–2 per 1 million inhabitants per year [3]. TEN is more common in women, it can occur at any age, whereas mostly occurs in older patients in their fifth to seventh decades. Death is caused either by sepsis or by respiratory distress which is either due to pneumoniae or damage to the linings of the airway [4]. Subglottic stenosis is the most common anomaly of larynx and trachea requiring tracheostomy in pediatric population [5]. Subglottic part of larynx is the narrowest section of laryngotracheal area of airways in childhood [5]. It is estimated that most of subglottic stenosis cases is acquired and developed as a result of injury caused by long-term use of endotracheal tube,only 5% of subglottic stenosis is congenital [6]. Latest improvements about construction of endotracheal tube and rules of procedures reduced frequency of subglottic stenosis to less than 1%. There are no statistics or medical reports about tracheal atresia caused by intubation or Lyell’s syndrome. This situation forced us to recognise Lyell’s syndrome and endotracheal intubation overlapping on each other as a cause of medical state of our 2 years old patient.
2
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A novel video laryngoscope for the use in hypoxemic COVID-19 patients: a case report

88%
Mustahsin M., Khan Z. A., Singh G., Choubey S.
Critical Care Innovations
|
2021
|
vol. 4
|
issue 2
38-43
EN
Critically ill COVID-19 patients require endotracheal intubations due to hypoxemic respiratory failure. These patients tend to desaturate fast especially during the intubation. Video laryngoscopes are recommended for airway management in COVID-19 patients due to better glottic view, higher first attempt success rates, less risk of contamination from airway secretions due to increased distance of patient’s and intubator’s face. Commercially available video laryngoscopes are expensive, difficult to acquire especially during pandemic and require training to use them. In order to overcome these issues, the authors designed a video laryngoscope by modifying the commonly used Macintosh laryngoscope blade which makes it easy to use, is low cost (approximately 90% cheaper than average cost of commercially available video laryngoscopes) and does not require any additional training. Moreover an oxygen channel was integrated along with the camera for deep laryngeal oxygen insufflation which has the additional advantage of delaying the desaturation during laryngoscopy. With these added advantages this modified video laryngoscope would prove to be a valuable tool for airway management team during current COVID-19 crisis.
3
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Improving the safety of healthcare workers during endotracheal intubation in patients in critical care during the COVID-19 pandemic.

75%
Mitura K.
Critical Care Innovations
|
2020
|
vol. 3
|
issue 3
31-36
EN
The safety of healthcare workers is a priority for public health protection. This is the basic principle we teach apprentices in paramedics, nursing and medicine. Only a safe specialist can help those in need. The COVID-19 pandemic suddenly appeared and resulted in more attention being paid to the possibility of droplet transmission. Until now, medical staff only paid attention to blood-borne and contact infections, and the air-borne route was underestimated. Current painful experiences raised by SARS-CoV-2 require us to verify the current procedures performance and introduce the principles of safe for the staff to perform endotracheal intubation with appropriate protection measures. Healthcare workers should use barrier surgical caps, goggles or face shield, FFP3 mask, protective gowns, double gloves and utilize proper hand washing technique. Additionally, some protective barriers might be used to minimize aerosol dispersion during endotracheal intubation.
PL
Bezpieczeństwo pracowników służby zdrowia jest priorytetem publicznego systemu ochrony zdrowia. To jest podstawowa zasada, której uczymy praktykantów w zakresie ratownictwa medycznego, pielęgniarstwa i medycyny. Tylko odpowiednio zabezpieczony specjalista może pomóc potrzebującym. Pandemia COVID-19 pojawiła się nagle, w wyniku czego zwrócono większą uwagę na możliwość przenoszenia zakażeń drogą kropelkową. Aż do chwili obecnej personel medyczny zwracał uwagę tylko na infekcje krwiopochodne i kontaktowe, a droga powietrzna była niedoceniana. Obecne bolesne doświadczenia związane z SARS-CoV-2 wymagają od nas weryfikacji aktualnych procedur i wprowadzenia zasad bezpiecznego dla personelu wykonywania intubacji dotchawiczej przy zachowaniu odpowiednich środków ochronnych. Pracownicy służby zdrowia powinni używać ochronnych czepków chirurgicznych, okularów ochronnych lub osłony twarzy, maski FFP3, fartuchów ochronnych, podwójnych rękawic i stosować odpowiednią technikę mycia rąk. Dodatkowo w celu zminimalizowania ryzyka można zastosować dodatkowe bariery ochronne zapobiegające dyspersji aerozolu podczas intubacji dotchawiczej.
4
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Pre-hospital methods of oxygen therapy and airway management in patients with suspected or confirmed COVID-19.

63%
Kmieciak A., Kubiak K., Kotliński K.
Critical Care Innovations
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2020
|
vol. 3
|
issue 2
16-28
EN
There are many treatment suggestions for patients infected with SARS-CoV-2 virus during the coronavirus epidemic. The most common patterns of practice, which are publicly available on social media and medical portals, mainly concern mechanical ventilation methods, but these are examples used in intensive care units. After a retrospective analysis of most recommendations, good practices, guidelines, and primarily based on our experience, the authors of this article prepared a short compendium on safe oxygen therapy in patients suspected or confirmed with the SARS-CoV-2 virus and safe methods of instrumental airway management, minimizing production aerosol. The methods of conducting passive oxygen therapy, controlling breathing, clear upper airway with use of supraglottic devices and modified endotracheal intubation will allow medical personnel to increase their safety in supplying airway management in patients with suspected or confirmed COVID-19. This is extremely important in times of epidemic, where medical personnel in prehospital care is at high risk of being infected with SARS-CoV-2 virus.
PL
Istnieje wiele sugestii dotyczących leczenia pacjentów zakażonych wirusem SARS-CoV-2 podczas epidemii. Najczęstsze praktyczne wzorce, które są publicznie dostępne w mediach społecznościowych i portalach medycznych, dotyczą głównie metod wentylacji mechanicznej, ale są to przykłady stosowane na oddziałach intensywnej terapii. Po retrospektywnej analizie rekomendacji, dobrych praktyk, wytycznych i przede wszystkim w oparciu o własne doświadczenie, autorzy przygotowali krótkie kompendium na temat bezpiecznej terapii tlenowej u pacjentów podejrzanych lub z potwierdzonym zakażeniem wirusem SARS-CoV-2 oraz bezpiecznych metod przyrządowego udrożniania dróg oddechowych, minimalizujących produkcję aerozolu. Metody prowadzenia pasywnej terapii tlenowej, kontrolowanie oddychania, oczyszczanie górnych dróg oddechowych za pomocą przyrządu nadgłośniowego i zmodyfikowana intubacja dotchawiczna pozwolą personelowi medycznemu zwiększyć bezpieczeństwo podczas zabezpieczenia dróg oddechowych u pacjentów z podejrzeniem lub potwierdzonym COVID-19. Jest to niezwykle ważne w czasach epidemii, w której personel medyczny w opiece przedszpitalnej jest narażony na duże ryzyko zarażenia wirusem SARS-CoV-2.
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