Objective To compare the efficacy of four different methods to locate tracheal tube in the tracheal:modified transillumination method,21/23 cm rule,marked the intubation at a distance,and fiberoptic bronchoscope.Methods A prospective randomized controlled trial was conducted.120 endotracheally intubated adult patients with American Society of Anesthesiologists (ASA) classification Ⅰ-Ⅱ and admitted to Central Hospital of Fengxian in Shanghai from January to March 2015 were enrolled.The patients were randomly divided into four groups (n =30) and located by 21/23 cm rule,marked the intubation at a distance,fiberoptic bronchoscope and modified transillumination method (using homemade locator guided by a red laser fiber to position the depth of tube) respectively.An endotracheal tube was inserted and measured the distance of the tube tip to the carina (TTC),vocal cords to tracheal tube cuff (VC-TC) in three different neck positions,i.e.neck in flexion,neutral,and extension position.The number of improper position in four groups was recorded.Results There were no significant differences in gender,age,and body mass index among the four groups.Six of the 30 patients using marked tracheal tuba method failed to find vocal cords with laryngoscope,while the other three methods all completed successfully.① From neck flexion to extension,TTC was gradually increased,while VC-TC was gradually decreased.In neck flexion and extension positions,TTC distance in the 21/23 cm rule group was significantly shorter than that in the fiberoptic bronchoscope group (cm:1.44 ± 1.14 vs.2.11 ±0.54,3.01 ±1.18 vs.3.80±0.71,both P ＜ 0.05),and the distance was also shorter than that in modified transillumination method group (cm:1.44 ± 1.14 vs.1.93 ± 0.81,3.01--1.18 vs.3.45 ± 0.91,both P ＞ 0.05).VC-TC distance in the 21/23 cm rule group was significantly longer than that in the modified transillumination,the marked intubation,and the fiberoptic bronchoscope groups in neck neutral and extension positions,respectively (cm:3.07 ± 1.08 vs.2.28±0.76,2.29±0.90,2.49±0.86;2.64±0.94 vs.1.82±0.72,1.81-0.94,2.02±0.91,all P ＜ 0.05).TTC and VC-TC distances in three neck positions in the modified transiflumination group were shorter than those in the fiberoptic bronchoscope group without statistical significance.② If TTC was too short,an accidental bronchus intubation could happen,while if VC-TC was too short,an accidental damage of the vocal cord inducing by the cuff press could happen.In the 21/23 cm rule group,there were 7 cases that the tube wrongly inserted to bronchus in neck flexion,and 1 case in neutral and extension positions respectively.In the marked intubation group,there were 4 cases that the tube wrongly inserted into bronchus in neck flexion,and 1 case in neck neutral position,and there were 4 cases that the vocal cords were pressed by the cuffs in extension position.In the modified transillumintion and the fiberoptic bronchoscope groups,there was only 1 case that the tube wrongly inserted to bronchus in neck flexion respectively.Conclusions When neck position changed during trachea intubation,it was easier that the tube wrongly inserted to bronchus for 21/23 cm rule method to locate the position.Bronchus intubations and cuff press vocal cords could happen using the marked tube method,which was less be found using modified transillumination or fiberoptic bronchoscope methods.Finally,the modified transillumination methods can be used to locate with satisfactory effect.

ObjectiveTo evaluate the effect of auscultation, partial pressure of carbon dioxide in end-expiration (PETCO2), transillumination technique to judge whether the endotracheal tube is misplaced into the esophagus. Methods A blinded randomized controlled trial was conducted. Sixty patients with American Society of Anesthesiology (ASA) gradeⅠ-Ⅱundergoing endotracheal intubation in Fengxian Central Hospital admitted from September 2014 to February 2015 were enrolled. Two endotracheal tubes with the same size were respectively inserted into the trachea and esophagus for the same depth after general anesthesia by the same person. Two blinded anesthetists with different experience checked the tube position using three methods including auscultation, PETCO2, and transillumination technique, respectively. The order of the tubes tested (trachea or esophagus) and the method used were randomized according to randomise numbers table. The experienced anesthetists conducted the test first, followed by an inexperienced anesthetist conducting the same methods. The numbers of right and wrong determinations with different methods by different anesthetists were recorded.Results Sixty patients underwent the procedures for 180 times, with intratracheal intubation for 90 times, and esophageal intubation for 90 times. It was shown that the results were not different in two groups [96.7% (174/180) vs. 92.2% (166/180),χ2 = 3.500,P = 0.057]. By using auscultation, the correct rate of experienced anesthetist was higher than that of inexperienced (95.0% vs. 78.3%,χ2 = 5.786,P = 0.013). Using PETCO2, both anesthetists were correct in all cases, and the accuracy was 100%. Using transillumination, the experienced anesthetist was mistaken in 3 cases (accuracy was 95.0%), while the inexperienced mistook in 1 case (accuracy was 98.3%), and no significant difference was found between two groups (χ2 = 0.500,P = 0.250). The correct rate of using transilluminaion was significantly higher than that of using auscultation (χ2 = 7.563,P = 0.004). The sensitivity and specificity of the auscultation was 70.0% and 80.0%, that of transillumination technique was 96.7% and 93.3%,and PETCO2 was 100%, respectively, for two groups.ConclusionsPETCO2 is the most reliable method for determining tube position, and it is superior to auscultation and transilluminaion. Transillumintaion technique is superior to auscultation, irrespective of anesthetists' experience, while the accuracy of auscultation showed an obvious relationship with the anesthetists' experience.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective: To investigate the effect of hypertensive disorder complicating pregnancy (HDCP) on the mortality and early complications of premature infants. Methods: The general clinical data of preterm infants with gestational age 24-36^{+ 6} weeks were collected from the cooperative units in the task group from January 1, 2013 to December 31, 2014.According to the severity of HDCP, the infants were divided into 4 groups: HDCP group, preeclampsia group, eclampsia group and non HDCP group, the mortality and major complications of preterm infants were compared, and the influencing factors were analyzed. Results: The mortality rate of preterm in the HDCP group was significantly higher than that of non HDCP group, and there was statistical significance (χ²=9.970, P=0.019). Eclampsia had a highest fatality rate (4.8%) in the early stage, compared with non HDCP group (2.2%), and the difference was statistically significant.Comparison of HDCP group (1.8%) and eclampsia group (3.2%) suggested that there was no statistically significant difference.The incidence of respiratory distress syndrome (RDS) in preterm in HDCP group was significantly higher than that of non HDCP group, and there was statistical significance (χ²=13.241, P=0.004). Eclampsia group showed the highest incidence (35.4%), compared with non HDCP group (16.2%), the difference was statistically significant, but compared with HDCP group (19.9%), preeclampsia group (17.1%), there was no significant diffe-rence.The incidence of bronchopulmonary dysplasia (BPD) in preterm in HDCP group was significantly higher than that of non HDCP group (χ²=9.592, P=0.022), the highest incidence showed up in eclampsia group (9.7%), compared with non HDCP group (2.0%) and HDCP group (1.7%), the difference was statistically significant.But there was no statistically significant difference, compared with preeclampsia group.As the degree of HDCP aggravated, the incidence of BPD gradually rose.There was no significant impact on necrotizing enterocolitis (NEC), retinopathy of prematurity (ROP), intraventricular hemorrhage (IVH) and sepsis of HDCP (χ²=7.054, 7.214, 0.358, 3.852; P=0.070, 0.065, 0.949, 0.278). Considering the overall outcome of the child, that was, whether the child died or survived, he had at least one complication, and HDCP had an effect on it (χ²=15.697, P=0.001), so the incidence increased while the degree of HDCP rose gradually.After adjusting gestational age, birth weight, sex, way of delivery, placental abruption and front placenta, prenatal hormonal, gestational diabetes, neonatal asphyxia and other factors, the results displayed that HDCP was the factor leading to the death of premature baby (OR=2.159, 95%CI: 1.093-4.266), and comparison between preeclampsia and eclampsia showed no statistical difference (P=0.714, 0.389); HDCP had no significant influence on RDS, BDP, ICH, NEC, ROP and sepsis. Conclusions HDCP leads to increased risk of premature death, but also leads to the increased incidence of RDS and BPD, but it had no obvious effect on NEC, ROP, IVH, sepsis and other complications.