36th ISICEM: 7 takeaways

At Cook, we were among the first to recognize the clinical impact of EBUS procedures. That’s why we focused our expertise as market leaders in ultrasound needles to create a full range of EchoTip® EBUS needles to meet your sampling needs. Now, you can potentially achieve cytology and histology in your EBUS procedures, even in the challenging pulmonary hilar region. Our goal is simple: to give you the cytological and histological information to help you deliver the best patient care.

EchoTip ProCore® Endobronchial HD Ultrasound Biopsy Needle

The EchoTip ProCore needle is used with the Olympus® ultrasound endoscope for fine needle biopsy of submucosal and extramural lesions within or adjacent to the tracheobronchial tree or gastrointestinal tract.

The EchoTip ProCore needle is used with the Pentax® ultrasound endoscope for fine needle biopsy of submucosal and extramural lesions within or adjacent to the tracheobronchial tree.

Features and benefits
•  The needle features a core trap designed for receiving tissue in the delicate pulmonary area.
•  The needle has a high definition dimpling pattern for needle visibility.
•  The 5 cm long needle extension presents a large diagnostic reach.
•  The naturally contoured handle offers needle control and stability.
•  The device has an adjustable sheath length.
•  On scopes with metal Luer hubs, the removable sheath adjuster allows direct connection to the scope.
•  On scopes with metal non-Luer hubs, the sturdy scope adapter design allows secure connection, procedural stability, and suction and injection capability due to the airtight valve.

View more details about the EchoTip ProCore Endobronchial HD Ultrasound Biopsy Needle.

EchoTip® Ultra Endobronchial HD Ultrasound Needle

The EchoTip Ultra needle is used with the Olympus ultrasound endoscope for fine needle aspiration of submucosal and extramural lesions within or adjacent to the tracheobronchial tree or gastrointestinal tract.

The EchoTip Ultra needle is used with the Pentax ultrasound endoscope for fine needle aspiration of submucosal and extramural lesions within or adjacent to the tracheobronchial tree.

Features and benefits
•  The needle has a high-definition dimpling pattern for needle visibility.
•  The naturally contoured handle offers needle control and stability.
•  On scopes with metal Luer hubs, the removable sheath adjuster allows direct connection to the scope.
•  On scopes with metal non-Luer hubs, the sturdy scope adapter design allows secure connection, procedural stability, and suction and injection capability due to the airtight valve.
•  The integrated sheath adjuster offers compatibility with a full range of ultrasound endoscopes.

View more details about the EchoTip Ultra Endobronchial HD Ultrasound Needle.

Olympus is a registered trademark of Olympus Corporation.

Pentax is a registered trademark of Hoya Corporation.

Our endobronchial blocker allows one-lung ventilation through a conventional single-lumen endotracheal tube that is easier to place and poses a lower risk of trauma to internal structures than a double-lumen tube.¹  View the Arndt Endobronchial Blocker’s indications for use, specifications, components, and other resources by clicking the links below.

Arndt Endobronchial Blocker

Intended to differentially intubate a patient’s bronchus in order to isolate the left or right lung for procedures that require one-lung ventilation. The product is intended for use by physicians trained and experienced in the use of fiberoptic bronchoscopes and airway anatomy. Standard techniques for use of fiberoptic bronchoscopes and endobronchial blockers should be employed.

Features and benefits

•  The low-pressure, high-volume balloon creates excellent surface area contact with the inner bronchial wall while minimizing potential trauma to the bronchus.

•  The adjustable guide loop is coupled with an appropriately sized bronchoscope to enable precise placement.

View more details about the Arndt Endobronchial Blocker.

Citations

1. Knoll H, Ziegeler S, Schreiber JU, et al. Airway injuries after one-lung ventilation: a comparison between double-lumen tube and endobronchial blocker: a randomized, prospective, controlled trial. Anesthesiology. 2006;105(3):471-477.

The plenary sessions at the 36th International Symposium on Intensive Care and Emergency Medicine (ISICEM) offered valuable clinical perspective in the areas of airway management and enteral feeding. If you weren’t able to be there, here were some of the notable takeaways.

From the presentation by Dr. Paul Mayo¹ 

1. The learning curve for airway management is steep for U.S. intensivists. Dr. Paul Mayo emphasized that most intensivists in the U.S. come from a pulmonary or respiratory background, whereas, in Europe, most intensivists have a background in anesthesia. The baseline of airway management training is higher for intensivists with an anesthesiology background. This leads to a steep learning curve in airway management for most U.S. intensivists.

2. Most urgent endotracheal intubations (UEIs) are for difficult airways. Dr. Mayo also shared that most UEIs in the ICU are classed as being performed for difficult airways because of factors including limited mouth opening, reduced neck extension, or comorbidities.

3. Mortality for UEI has been reported to be as high as 2%.  Dr. Mayo stressed that this makes UEI the most dangerous critical care procedure.

From the presentation by Professor Jaber² 

4. Difficult intubations are more common in the ICU than in the OR. Professor Jaber emphasized that 10-20% of intubations are difficult in the ICU compared to the 3-5% of intubations that are difficult in the OR. This leads to more complications for ICU patients.

5. During a UEI, always oxygenate first, then call for help. Oxygenation takes priority over everything else.

6. The MACOCHA score is now a part of the French difficult airway guidelines. During his presentation about difficult intubation in the ICU, Professor Jaber asserted, “All patients admitted in the ICU should have an evaluation of their airway.” With the help of a close colleague, Dr. De Jong, Professor Jaber has developed a new ICU-based UEI score called the MACOCHA Score, which has been accepted into the new French difficult airway guidelines.

From the presentation by Dr. Kenneth Christopher³

1. Transpyloric feeding may reduce the incidence of aspiration pneumonia. “The biggest problem with delivering tube feed in our ICU is GRV,” shared Dr. Kenneth Christopher during his enteral feeding presentation. Because of the gastric residual volume (GRV) problem, his ICU’s biggest concern is the increased risk of aspiration pneumonia. He feels transpyloric feeding is the best way to prevent aspiration pneumonia in an ICU patient.

Interested in receiving industry news, product updates, and top takeaways from other meetings? Sign up for our email newsletter.

Drs. Mayo, Jaber, and Christopher are not paid consultants of Cook Medical.

Citations

¹ Mayo P. Team approach to urgent endotracheal intubation. Presented at: 36th International Symposium on Intensive Care and Emergency Medicine (ISICEM); March 15-18, 2016; Brussels, BE.

² Jaber S. Difficult intubation in the ICU. Presented at: 36th International Symposium on Intensive Care and Emergency Medicine (ISICEM); March 15-18, 2016; Brussels, BE.

³ Christopher K. How I optimize enteral feeding. Presented at: 36th International Symposium on Intensive Care and Emergency Medicine (ISICEM); March 15-18, 2016; Brussels, BE.