BACKGROUND: Tracheal intubation failure in patients with difficult airway is still not uncommon. While videolaryngoscopes such as the Glidescope offer better glottic vision due to an acute-angled blade, this advantage does not always lead to an increased success rate because successful insertion of the tube through the vocal cords may be the limiting factor. We hypothesize that combined use of Glidescope and fiberscope used only as a dynamic guide facilitates tracheal intubation compared to a conventional Glidescope technique with a preshaped nondynamic stylet. METHODS: One hundred sixty adult patients with predicted difficult airway were randomly assigned to a conventional Glidescope (standard Glidescope group) or a combined Glidescope + fiberscope group intubation. In the Glidescope + fiberscope group under direct vision from the Glidescope, tracheal intubation was performed using the fiberscope as a guide without using fiberoptic vision, while in the standard Glidescope group, a conventional stylet-guided intubation technique was performed. We evaluated the rate of tracheal intubation success at first attempt as the primary end point (Fisher exact test). The difference between groups in airway injury, time to successful intubation, and the need for an alternative technique was also evaluated. RESULTS: First-attempt intubation success was higher in the Glidescope + fiberscope group than in the standard Glidescope group (91% vs 67%; P = .0012; fragility index, 8; absolute risk reduction, 24% [95% CI, 12%–36%]). Median time to successful tracheal intubation was shorter in the Glidescope + fiberscope group (50 vs 64 seconds; P = .035). Airway injury rate was lower in the Glidescope + fiberscope group than in the standard Glidescope group (1% vs 11%; P = .035; fragility index, 1; absolute risk reduction, 10% [95% CI, 3%–18%]). Alternative rescue technique requirements to achieve tracheal intubation were higher in the standard Glidescope group (24% vs 4%; P < .001; fragility index, 7). CONCLUSIONS: The use of a dynamic, flexible guide during a Glidescope laryngoscopy in patients with a predicted difficult airway compared to a standard intubation technique improves first-attempt intubation success, decreases the incidence of airway injury and time to successful intubation, as well as the need of an alternative technique to succeed.
Chemical products such as PEO/PPO block copolymers or alkoxylated resins tend to work well in chemical demulsification of light hydrocarbons (°API > 20) but fail to do so in the presence of heavy and extra heavy crude emulsions. Moreover, a large knowledge gap between the relationship of instability mechanisms at the liquid−liquid interface and the tendency of demulsifier systems to promote phase separation has limited the ability of practitioners in field operations to properly select a system for a particular application. To address this issue, here, an enhanced quantitative protocol is put forward to assess the chemical demulsification of heavy crude oil (HCO) emulsions by coupling transmission/backscattering measurements to traditional bottle tests. The applicability of the method was evaluated by adding a wide variety of commercially available demulsifiers to HCO emulsions from a Colombian oilfield. The collected data on interfacial tension and average droplet size showed that for the complex case of HCO emulsions, interfacial activity and fast kinetics are not sufficient criteria for phase separation. The best performing chemicals (separated water ∼85%) exhibited a low reduction of the interfacial tension at equilibrium (IFT ∼ 20 mN/m). This evidence strongly suggests that separation might be likely triggered after the intermingling of the demulsifier with the oil phase such that the density difference between phases is considerably increased (∼5% change on average). Furthermore, HPLC-MS results showed that spatial and chemical configuration, as well as steric effects, drive the performance of demulsifiers and must be carefully considered for new developments.
En el siglo actual uno de los objetivos de la educación es inculcar habilidades cognitivas que les permitan buscar, encontrar y comprender información mediante una lectura crítica. Dichas habilidades son deseables en cualquier carrera ingenieril, pero se vuelven imprescindibles en disciplinas como la ‘Inteligencia Artificial’ donde aparecen innovaciones casi todos los días. En tal sentido, las Redes Bayesianas son un tipo de Sistema Inteligente que permite identificar el estilo de aprendizaje de los alumnos. Sin embargo, no representan satisfactoriamente la manera en que esos conocimientos evolucionan. Por consiguiente, el presente trabajo propone aplicar un Modelo Dinámico para diagnosticar el proceso de aprendizaje de los alumnos y así comprender mejor su comportamiento.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
customersupport@researchsolutions.com
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.