چاپ صفحه |  صفحه نخست سامانه |  چکیده مقاله |  نویسندگان |  دانلود مقاله | دانشگاه علوم پزشکی تبریز |
| Lighthall et al. state that after the LMA is connected to a positive-pressure ventilation system, verification of proper LMA placement is achieved through auscultation of breath sounds.1 Unlike the assessment of an endotracheal tube, LMA function is better evaluated by auscultation over the neck rather than the chest.2 However, LMA function is more often assessed by observing the following measures: airway pressure and chest movement with manual ventilation in the prone position, reservoir-bag refill during expiration, auscultation over the neck, cuff-leak pressure, capnography, and expired tidal volume and flow-volume loop.1 Gas exchange and the possibility of obstruction are assessed more appropriately by the latter two techniques. Capnography has recently become the standard for identifying the correct device position. Although clinically significant cardiorespiratory failure during emergencies might limit the efficacy of capnography due to considerably decreased pulmonary perfusion, end-tidal carbon dioxide measures and patterns allow monitoring of not only proper LMA placement but also hemodynamics and the success of resuscitation. Hence, the use of capnography even in emergency conditions should not be overlooked.2 Samad E.J. Golzari, M.D. Ata Mahmoodpoor, F.I.C.M. Tabriz University of Medical Sciences Tabriz, Iran amahmoodpoor@yahoo.com No potential conflict of interest relevant to this letter was reported. 1. Joshi S, Sciacca RR, Solanki DR, Young WL, Mathru MM. A prospective evaluation of clinical tests for placement of laryngeal mask airways. Anesthesiology 1998;89:1141-6. 2. Morley PT. Monitoring the quality of cardiopulmonary resuscitation. Curr Opin Crit Care 2007;13:261-7. DOI: 10.1056/NEJMc1315505 The authors reply: The nature and role of ventilation during cardiopulmonary resuscitation (CPR) have been revised in recent guidelines and are likely to evolve further. The data cited by Wang et al. are from large prehospital resuscitation registries that suggest better outcomes associated with bag-and-mask ventilation than with LMA. However, retrospective risk adjustments leave open the possibility of confounding by factors such as provider training, order of interventions, and time trade-offs between airway instrumentation and chest compressions administered by a small crew. A variety of studies suggest that mask ventilation is not a default skill one can assume for most responders to an arrest.1,2 Bagand- mask ventilation often requires two providers to be successful, as compared with a single provider who uses LMA.3 In addition, the incidence of gastric regurgitation may be lower if LMA is used as a primary airway before endotracheal intubation, as compared with bag-andmask ventilation.4 |
| نویسنده | نفر چندم مقاله |
|---|---|
| صمد اسلام جمال گلزاری | اول |
| عطا محمودپور | دوم |
| نام فایل | تاریخ درج فایل | اندازه فایل | دانلود |
|---|---|---|---|
| L-NEJM-LMA.pdf | 1398/09/12 | 313097 | دانلود |
