Pediatric Elective Intubation With and Without Muscle Relaxation Utilizing the Shikani Optical Stylet
Terminated
Rady Children's Hospital, San Diego
N/A
2007-01-01
The investigators' primary specific aims are to demonstrate that:
1. Pediatric patients with normal airways, undergoing elective surgical procedures, can be
successfully intubated when deeply sedated, without the use of muscle relaxants using
the Shikani Optical Stylet.
2. Shikani intubation of pediatric patients is equally effective in children that are
deeply sedated or paralyzed as evidenced by a non-significant difference in:
- Time to intubation (defined as no more than a 30 second time difference between the
two groups);
- Incidence of adverse events.
Effects of Neuromuscular Blocking Agents (NMBA) on the Alteration of Transpulmonary Pressures at the Early Phase of Acute Respiratory Distress Syndrome (ARDS)
Unknown status
Assistance Publique Hopitaux De Marseille
Phase 4
2012-04-01
Mortality in Acute Respiratory Distress Syndrome is high (40 to 60 %). Protective mechanical
ventilation, until 2010, was the cornerstone of the ARDS therapeutic strategies. Recently, a
prospective multicenter study demonstrates that a 48h continuous infusion of neuromuscular
blocking agents (NMBA) have a positive impact on mortality of ARDS patients. (Papazian et al.
ACURASYS Study. NEJM 2010; 363:1107-16). The mechanisms through which NMBAs could improve
survival remain speculative. They are as follows:
- reduction of the consumption of oxygen linked to ventilatory workload;
- increase of chest wall compliance improving mechanical ventilation during ARDS and
better adaptation to the protective ventilation strategy;
- anti-inflammatory effect contributing to a reduction in pulmonary inflammation and
improvement in oxygenation,
- reduction of the variations of transpulmonary pressure (TPP) by the way of better
synchronisation between patient and the ventilator.
The use of NMBA could also reduce the ventilator induced lung injury by a better control of
TPP.
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