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Acta Ophthalmologica Feb 2020To report the incidence and outcomes of suction loss during small incision lenticule extraction (SMILE).
PURPOSE
To report the incidence and outcomes of suction loss during small incision lenticule extraction (SMILE).
METHODS
The incidence of suction loss was measured over 4000 consecutive SMILE procedures and categorized by cause, the interface in which suction was lost and management (restart/continue SMILE, re-SMILE thinner cap, convert to laser in-situ keratomileusis [LASIK]). One-year outcomes were compared to the fellow eye where no suction loss occurred.
RESULTS
There were 20 cases of suction loss (0.50%): during the lenticule interface in seven eyes, lenticule side cut in one eye, cap interface in nine eyes and small incision for three eyes. Small incision lenticule extraction (SMILE) was continued in seven eyes, thinner cap SMILE in four eyes, LASIK in eight eyes, and the small incision was manually completed in one eye. Suction loss was caused by a Bell's reflex in 10 eyes, fixation light tracking in six eyes, patient anxiety in two eyes, a nociceptive reflex in one eye and false suction in one eye. There was no difference in results for suction loss and fellow eyes, respectively: uncorrected distance visual acuity was 20/20 or better in 100% in both groups, spherical equivalent was within ±0.50 D in 85% and 79%, one line loss of corrected distance visual acuity in 5% and 0%, and no eyes lost two lines.
CONCLUSION
Suction loss can be managed depending on the interface during which suction is lost. Treatment was completed on the same day in all instances. Visual and refractive outcomes were unaffected compared to the fellow eye in this series.
Topics: Adult; Corneal Stroma; Female; Follow-Up Studies; Humans; Incidence; Keratomileusis, Laser In Situ; Lasers, Excimer; Male; Middle Aged; Myopia; Postoperative Complications; Refraction, Ocular; Retrospective Studies; Suction; Surgical Flaps; United Kingdom; Visual Acuity; Young Adult
PubMed: 31448878
DOI: 10.1111/aos.14215 -
The Cochrane Database of Systematic... Dec 2016Peritonsillar abscess is a common infection presenting as a collection of pus in the peritonsillar area. The condition is characterised by a severe sore throat,... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Peritonsillar abscess is a common infection presenting as a collection of pus in the peritonsillar area. The condition is characterised by a severe sore throat, difficulty in swallowing and pain on swallowing, fever and malaise, and trismus. Needle aspiration and incision and drainage are the two main treatment modalities currently used in the treatment of this condition. The effectiveness of one versus the other has not been clearly demonstrated and remains an area of debate.
OBJECTIVES
To assess the effectiveness and risks of needle aspiration versus incision and drainage for the treatment of peritonsillar abscess in older children (eight years of age or older), adolescents and adults.
SEARCH METHODS
The Cochrane ENT Information Specialist searched the ENT Trials Register; Central Register of Controlled Trials (CENTRAL 2016, Issue 7); Ovid MEDLINE; Ovid Embase; CINAHL; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 25 August 2016.
SELECTION CRITERIA
Randomised controlled trials comparing needle aspiration with incision and drainage.
DATA COLLECTION AND ANALYSIS
We used the standard methodological procedures expected by Cochrane. Our primary outcomes were recurrence rate (proportion of patients needing repeat intervention) and adverse effects associated with the intervention. Secondary outcomes were time to resumption of normal diet, complications of the disease process and symptom scores. We used GRADE to assess the quality of evidence for each outcome; this is indicated in italics.
MAIN RESULTS
We included 11 studies (674 participants). The risk of bias was high or unclear in all of the included studies. All studies compared needle aspiration to incision and drainage.All but one of the 11 studies reported on the primary outcome of recurrence. When we pooled data from the 10 studies the recurrence rate was higher in the needle aspiration group compared with incision and drainage: risk ratio (RR) 3.74 (95% confidence interval (CI) 1.63 to 8.59; 612 participants). We detected moderate heterogeneity in this analysis (I = 48%). In interpreting the pooled result it is important to note that the evidence for this outcome was of very low quality.None of the other outcomes (adverse effects of the intervention, time to resumption of normal diet, complications of the disease process and symptom scores) were consistently measured across all studies.Only three studies reported on adverse effects/events associated with the intervention and only one such event in a single patient was reported (post-procedure bleeding following incision and drainage: 1/28, 3.6%) (very low-quality evidence). Time to resumption of normal diet was compared in two studies; neither found an obvious difference between needle aspiration and incision and drainage (very low-quality evidence).Only three studies stated that they would report complications of the disease process. In these three studies, the only complication reported was admission to hospital for dehydration in two patients who underwent incision and drainage (2/13, 6.7%). Symptom scores were measured in four studies; three evaluated pain using different scales and one other symptoms. The data could not be pooled in a meta-analysis. Two studies evaluating procedural pain reported this to be lower in the needle aspiration groups. One study found comparable rates of pain resolution at five days post-intervention between groups. The quality of the evidence for symptom scores was very low.
AUTHORS' CONCLUSIONS
Although a number of studies have sought to evaluate whether or not needle aspiration or incision and drainage is more effective in patients with peritonsillar abscess, there is no high-quality evidence to allow a firm conclusion to be drawn and the answer remains uncertain. Very low-quality evidence suggests that incision and drainage may be associated with a lower chance of recurrence than needle aspiration. There is some very low-quality evidence to suggest that needle aspiration is less painful.
Topics: Adolescent; Adult; Child; Drainage; Eating; Humans; Needles; Peritonsillar Abscess; Recurrence; Retreatment; Suction; Symptom Assessment; Time Factors
PubMed: 28009937
DOI: 10.1002/14651858.CD006287.pub4 -
Journal of Clinical Monitoring and... Dec 2021The purpose of this study was to assess Analgesia/Nociception Index (ANI) and bispectral index (BIS) variations in supine and prone position during closed-tracheal...
The purpose of this study was to assess Analgesia/Nociception Index (ANI) and bispectral index (BIS) variations in supine and prone position during closed-tracheal suction in intensive care unit (ICU) patients with severe COVID-19 pneumonia requiring myorelaxation and prone positioning. We retrospectively reviewed the data of 15 patients hospitalized in ICU for severe COVID-19 pneumonia requiring sedation, myorelaxation and prone positioning. The BIS, instant ANI (ANIi), mean ANI (ANIm), heart rate (HR), systolic blood pressure (SBP) and SpO were retrieved in supine and prone position 1 min before tracheal suction then every minute from the beginning of tracheal suction during 4 min and compared using ANOVA for repeated measures (p < 0.05 considered as statistically significant). Both ANIm and ANIi decreased significantly during tracheal suction with no difference between positions, whereas BIS showed no significant variation within time and between groups. The median [Q1-Q3] ANIm value decreased from 87 [68-98] to 79 [63-09] in supine position and from 79 [63-95] to 78 [66-98] in prone position 2 min after the beginning of tracheal suction. The median [Q1-Q3] ANIi value decreased earlier 1 min after the beginning of tracheal suction from 84 [69-98] to 73 [60-90] in supine position and from 84 [60-99] to 71 [51-88] in prone position. Both HR, SBP and SpO varied modestly but significantly during tracheal suction with no difference between positions. Monitoring ANI, but not BIS, may be of interest to detect noxious stimuli such as tracheal suction in ICU myorelaxed patients with severe COVID-19 pneumonia requiring prone positioning.
Topics: Analgesia; COVID-19; Humans; Intensive Care Units; Nociception; Prone Position; Prospective Studies; Retrospective Studies; SARS-CoV-2; Suction; Supine Position
PubMed: 33159268
DOI: 10.1007/s10877-020-00612-w -
Australian Critical Care : Official... Nov 2022Endotracheal suction is an invasive airway clearance technique used in mechanically ventilated children. This article outlines the methods used to develop appropriate... (Review)
Review
OBJECTIVES
Endotracheal suction is an invasive airway clearance technique used in mechanically ventilated children. This article outlines the methods used to develop appropriate use criteria for endotracheal suction interventions in mechanically ventilated paediatric patients.
METHODS
The RAND Corporation and University of California, Los Angeles Appropriateness Method was used to develop paediatric appropriate use criteria. This included the following sequential phases of defining scope and key terms, a literature review and synthesis, expert multidisciplinary panel selection, case scenario development, and appropriateness ratings by an interdisciplinary expert panel over two rounds. The panel comprised experts in the fields of paediatric and neonatal intensive care, respiratory medicine, infectious diseases, critical care nursing, implementation science, retrieval medicine, and education. Case scenarios were developed iteratively by interdisciplinary experts and derived from common applications or anticipated intervention uses, as well as from current clinical practice guidelines and results of studies examining interventions efficacy and safety. Scenarios were rated on a scale of 1 (harm outweighs benefit) to 9 (benefit outweighs harm), to define appropriate use (median: 7 to 9), uncertain use (median: 4 to 6), and inappropriate use (median: 1 to 3) of endotracheal suction interventions. Scenarios were than classified as a level of appropriateness.
CONCLUSIONS
The RAND Corporation/University of California, Los Angeles Appropriateness Method provides a thorough and transparent method to inform development of the first appropriate use criteria for endotracheal suction interventions in paediatric patients.
Topics: Infant, Newborn; Child; Humans; Suction; Respiration, Artificial; Critical Care Nursing
PubMed: 34924248
DOI: 10.1016/j.aucc.2021.10.006 -
PloS One 2021Species-specific monitoring activities represent fundamental tools for natural resource management and conservation but require techniques that target species-specific...
Species-specific monitoring activities represent fundamental tools for natural resource management and conservation but require techniques that target species-specific traits or markers. Sea lamprey, a destructive invasive species in the Laurentian Great Lakes and conservation target in North America and Europe, is among very few fishes that possess and use oral suction, yet suction has not been exploited for sea lamprey control or conservation. Knowledge of specific characteristics of sea lamprey suction (e.g., amplitude, duration, and pattern of suction events; hereafter 'suction dynamics') may be useful to develop devices that detect, record, and respond to the presence of sea lamprey at a given place and time. Previous observations were limited to adult sea lampreys in static water. In this study, pressure sensing panels were constructed and used to measure oral suction pressures and describe suction dynamics of juvenile and adult sea lampreys at multiple locations within the mouth and in static and flowing water. Suction dynamics were largely consistent with previous descriptions, but more variation was observed. For adult sea lampreys, suction pressures ranged from -0.6 kPa to -26 kPa with 20 s to 200 s between pumps at rest, and increased to -8 kPa to -70 kPa when lampreys were manually disengaged. An array of sensors indicated that suction pressure distribution was largely uniform across the mouths of both juvenile and adult lampreys; but some apparent variation was attributed to obstruction of sensing portal holes by teeth. Suction pressure did not differ between static and flowing water when water velocity was lower than 0.45 m/s. Such information may inform design of new systems to monitor behavior, distribution and abundance of lampreys.
Topics: Animals; Fishes; Introduced Species; Lampreys; Petromyzon; Pressure; Suction
PubMed: 33905407
DOI: 10.1371/journal.pone.0247884 -
Acta Neurochirurgica Jul 2021Aerosol is a health risk to theatre staff. This laboratory study quantifies the reduction in particulate matter aerosol concentrations produced by electrocautery and...
BACKGROUND
Aerosol is a health risk to theatre staff. This laboratory study quantifies the reduction in particulate matter aerosol concentrations produced by electrocautery and drilling when using mitigation strategies such as irrigation, respirator filtration and suction in a lab environment to prepare for future work under live OR conditions.
METHODS
We combined one aerosol-generating procedure (monopolar cutting or coagulating diathermy or high-speed diamond- or steel-tipped drilling of cadaveric porcine tissue) with one or multiple mitigation strategies (instrument irrigation, plume suction and filtration using an FFP3 respirator filter) and using an optical particle counter to measure particulate matter aerosol size and concentrations.
RESULTS
Significant aerosol concentrations were observed during all aerosol-generating procedures with concentrations exceeding 3 × 10 particles per 100 ml. Considerable reductions in concentrations were observed with mitigation. In drilling, suction, FFP3 filtration and wash alone respectively reduced aerosol by 19.3-31.6%, 65.1-70.8% and 97.2 to > 99.9%. The greatest reduction (97.38 to > 99.9%) was observed when combining irrigation and filtration. Coagulating diathermy reduced concentrations by 88.0-96.6% relative to cutting, but produced larger particles. Suction alone, and suction with filtration reduced aerosol concentration by 41.0-49.6% and 88.9-97.4% respectively. No tested mitigation strategies returned aerosol concentrations to baseline.
CONCLUSION
Aerosol concentrations are significantly reduced through the combined use of filtration, suction and irrigation. Further research is required to characterise aerosol concentrations in the live OR and to find acceptable exposure limits, and in their absence, to find methods to further reduce exposure to theatre staff.
Topics: Aerosols; Animals; Particulate Matter; Suction; Swine; Ventilators, Mechanical
PubMed: 34031774
DOI: 10.1007/s00701-021-04874-4 -
The Journal of Thoracic and... Mar 2020
Topics: Heart Failure; Heart-Assist Devices; Humans; Incidence; Mitral Valve Insufficiency; Suction; Ventricular Function, Right
PubMed: 31128905
DOI: 10.1016/j.jtcvs.2019.04.047 -
American Journal of Critical Care : An... Sep 2020Patients experience endotracheal intubation in various settings with wide-ranging risks for postintubation complications such as aspiration and ventilator-associated... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Patients experience endotracheal intubation in various settings with wide-ranging risks for postintubation complications such as aspiration and ventilator-associated conditions.
OBJECTIVES
To evaluate associations between intubation setting, presence of aspiration biomarkers, and clinical outcomes.
METHODS
This study is a subanalysis of data from the NO-ASPIRATE single-blinded randomized clinical trial. Data were prospectively collected for 513 adult patients intubated within 24 hours of enrollment. Patients with documented aspiration events at intubation were excluded. In the NO-ASPIRATE trial, intervention patients received enhanced oropharyngeal suctioning every 4 hours and control patients received sham suctioning. Tracheal specimens for α-amylase and pepsin tests were collected upon enrollment. Primary outcomes were ventilator hours, lengths of stay, and rates of ventilator-associated conditions.
RESULTS
Of the baseline tracheal specimens, 76.4% were positive for α-amylase and 33.1% were positive for pepsin. Proportions of positive tracheal α-amylase and pepsin tests did not differ significantly between intubation locations (study hospital, transfer from other hospital, or field intubation). No differences were found for ventilator hours or lengths of stay. Patients intubated at another hospital and transferred had significantly higher ventilator-associated condition rates than did those intubated at the study hospital (P = .02). Ventilator-associated condition rates did not differ significantly between patients intubated in the field and patients in other groups.
CONCLUSIONS
Higher ventilator-associated condition rates associated with interhospital transfer may be related to movement from bed, vehicle loading and unloading, and transport vehicle vibrations. Airway assessment and care may also be suboptimal in the transport environment.
Topics: Adult; Aged; Aged, 80 and over; Biomarkers; Female; Humans; Intubation, Intratracheal; Length of Stay; Male; Middle Aged; Pepsin A; Prospective Studies; Respiratory Aspiration; Risk Factors; Single-Blind Method; Socioeconomic Factors; Suction; Trachea; alpha-Amylases
PubMed: 32869069
DOI: 10.4037/ajcc2020129 -
Translational Cancer Research Feb 2020Many studies have been performed to evaluate the effect of subcutaneous suction drainage to prevent incisional surgical site infections (SSIs) after radical colorectal...
BACKGROUND
Many studies have been performed to evaluate the effect of subcutaneous suction drainage to prevent incisional surgical site infections (SSIs) after radical colorectal surgery. However, the result has been controversial. The main reason may be that subcutaneous suction drainage is more prone to develop blockages, and the drainage tubes themselves serve as a conduit for bacteria into the wound. Therefore, we modified this method and evaluated this new method (subcutaneous suction drainage and intermittent irrigation) in patients who underwent radical colorectal surgery.
METHODS
A total of 119 patients who underwent open radical colorectal surgery were included in our study from April 2015 to November 2017. A total of 61 patients were included in the irrigation group (subcutaneous suction drainage or intermittent irrigation), and 58 patients were included in the control group (no subcutaneous suction drainage and intermittent irrigation). The key endpoints were the incidence rate of incisional SSIs, the inpatient stay, and hospitalization expenses. All of the patients in our study had the following characteristics: (I) their subcutaneous fat thickness was more than 1.5 cm by means of CT or MRI measure before operation; (II) the patients had at least one of the following cases before operation: diabetes mellitus, hypoalbuminemia (ALB ≤35 g/L), anemia (Hb ≤90 g/L) or tumorous obstruction.
RESULTS
The incidence of incisional SSIs rate was 27/119 (22.7%) in the overall patients, 22/61 (36.1%) in the control group, and 5/58 (8.6%) in the group. The rate of SSIs in the irrigation group was significantly lower than the control group (P<0.001). The inpatient stay (9.64±4.15) in the irrigation group was shorter than the control group (12.26±5.55) (P=0.004). The hospitalization expenses (57,356±9,518) in the irrigation group were lower than the control group (62,119±11,101) (P=0.014). One of the patients in the control group died of pulmonary infection due to intraoperative aspiration. There was no death in the irrigation group.
CONCLUSIONS
The subcutaneous suction drainage and intermittent irrigation is safe and effective to prevent incisional SSIs in radical colorectal surgery.
PubMed: 35117436
DOI: 10.21037/tcr.2019.12.32 -
The Cochrane Database of Systematic... Jun 2017This is an updated version of an original Cochrane review published in Issue 6, 2014. Pelvic lymphadenectomy is associated with significant complications including... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
This is an updated version of an original Cochrane review published in Issue 6, 2014. Pelvic lymphadenectomy is associated with significant complications including lymphocyst formation and related morbidities. Retroperitoneal drainage using suction drains has been recommended as a method to prevent such complications. However, findings from recent studies have challenged this policy.
OBJECTIVES
To assess the effects of retroperitoneal drainage versus no drainage after pelvic lymphadenectomy on lymphocyst formation and related morbidities in women with gynaecological cancer.
SEARCH METHODS
We searched the Cochrane Central Register of Controlled Trials (CENTRAL, Issue 3, 2017) in the Cochrane Library, electronic databases MEDLINE (1946 to March Week 2, 2017), Embase (1980 to 2017 week 12), and the citation lists of relevant publications. We also searched the trial registries for ongoing trials on 20 May 2017.
SELECTION CRITERIA
Randomised controlled trials (RCTs) that compared the effect of retroperitoneal drainage versus no drainage after pelvic lymphadenectomy in women with gynaecological cancer. Retroperitoneal drainage was defined as placement of passive or active suction drains in pelvic retroperitoneal spaces. No drainage was defined as no placement of passive or active suction drains in pelvic retroperitoneal spaces.
DATA COLLECTION AND ANALYSIS
We assessed studies using methodological quality criteria. For dichotomous data, we calculated risk ratios (RRs) and 95% confidence intervals (CIs). We examined continuous data using mean difference (MD) and 95% CI.
MAIN RESULTS
Since the last version of this review, we have identified no new studies for inclusion. The review included four studies with 571 women. Regarding short-term outcomes (within four weeks after surgery), retroperitoneal drainage was associated with a comparable rate of overall lymphocyst formation when all methods of pelvic peritoneum management were considered together (2 studies; 204 women; RR 0.76, 95% CI 0.04 to 13.35; moderate-quality evidence). When the pelvic peritoneum was left open, the rates of overall lymphocyst formation (1 study; 110 women; RR 2.29, 95% CI 1.38 to 3.79) and symptomatic lymphocyst formation (2 studies; 237 women; RR 3.25, 95% CI 1.26 to 8.37) were higher in the drained group. At 12 months after surgery, the rates of overall lymphocyst formation were comparable between the groups (1 study; 232 women; RR 1.48, 95% CI 0.89 to 2.45; high-quality evidence). However, there was a trend toward increased risk of symptomatic lymphocyst formation in the group with drains (1 study; 232 women; RR 7.12, 95% CI 0.89 to 56.97; low-quality evidence).
AUTHORS' CONCLUSIONS
Placement of retroperitoneal tube drains has no benefit in the prevention of lymphocyst formation after pelvic lymphadenectomy in women with gynaecological malignancies. When the pelvic peritoneum is left open, the tube drain placement is associated with a higher risk of short- and long-term symptomatic lymphocyst formation. We found the quality of evidence using the GRADE approach to be moderate to high for most outcomes, except for symptomatic lymphocyst formation at 12 months after surgery, and unclear or low risk of bias.
Topics: Drainage; Female; Genital Neoplasms, Female; Humans; Lymph Node Excision; Lymphocele; Pelvis; Randomized Controlled Trials as Topic; Retroperitoneal Space; Suction
PubMed: 28660687
DOI: 10.1002/14651858.CD007387.pub4