QuickPrototype es una herramienta de software para crear prototipos rápidos. Permite a los diseñadores y desarrolladores crear versiones iniciales de interfaces de usuario y flujos de trabajo de aplicaciones sin necesidad de codificar. Estos prototipos tempranos permiten probar conceptos, recibir comentarios de usuarios y guiar el diseño de productos antes de comenzar el desarrollo completo.
QuickPrototype es una herramienta de software para crear prototipos rápidos. Permite a los diseñadores y desarrolladores crear versiones iniciales de interfaces de usuario y flujos de trabajo de aplicaciones sin necesidad de codificar. Estos prototipos tempranos permiten probar conceptos, recibir comentarios de usuarios y guiar el diseño de productos antes de comenzar el desarrollo completo.
2024 State of Marketing Report – by HubspotMarius Sescu
https://www.hubspot.com/state-of-marketing
· Scaling relationships and proving ROI
· Social media is the place for search, sales, and service
· Authentic influencer partnerships fuel brand growth
· The strongest connections happen via call, click, chat, and camera.
· Time saved with AI leads to more creative work
· Seeking: A single source of truth
· TLDR; Get on social, try AI, and align your systems.
· More human marketing, powered by robots
ChatGPT is a revolutionary addition to the world since its introduction in 2022. A big shift in the sector of information gathering and processing happened because of this chatbot. What is the story of ChatGPT? How is the bot responding to prompts and generating contents? Swipe through these slides prepared by Expeed Software, a web development company regarding the development and technical intricacies of ChatGPT!
Product Design Trends in 2024 | Teenage EngineeringsPixeldarts
The realm of product design is a constantly changing environment where technology and style intersect. Every year introduces fresh challenges and exciting trends that mold the future of this captivating art form. In this piece, we delve into the significant trends set to influence the look and functionality of product design in the year 2024.
How Race, Age and Gender Shape Attitudes Towards Mental HealthThinkNow
Mental health has been in the news quite a bit lately. Dozens of U.S. states are currently suing Meta for contributing to the youth mental health crisis by inserting addictive features into their products, while the U.S. Surgeon General is touring the nation to bring awareness to the growing epidemic of loneliness and isolation. The country has endured periods of low national morale, such as in the 1970s when high inflation and the energy crisis worsened public sentiment following the Vietnam War. The current mood, however, feels different. Gallup recently reported that national mental health is at an all-time low, with few bright spots to lift spirits.
To better understand how Americans are feeling and their attitudes towards mental health in general, ThinkNow conducted a nationally representative quantitative survey of 1,500 respondents and found some interesting differences among ethnic, age and gender groups.
Technology
For example, 52% agree that technology and social media have a negative impact on mental health, but when broken out by race, 61% of Whites felt technology had a negative effect, and only 48% of Hispanics thought it did.
While technology has helped us keep in touch with friends and family in faraway places, it appears to have degraded our ability to connect in person. Staying connected online is a double-edged sword since the same news feed that brings us pictures of the grandkids and fluffy kittens also feeds us news about the wars in Israel and Ukraine, the dysfunction in Washington, the latest mass shooting and the climate crisis.
Hispanics may have a built-in defense against the isolation technology breeds, owing to their large, multigenerational households, strong social support systems, and tendency to use social media to stay connected with relatives abroad.
Age and Gender
When asked how individuals rate their mental health, men rate it higher than women by 11 percentage points, and Baby Boomers rank it highest at 83%, saying it’s good or excellent vs. 57% of Gen Z saying the same.
Gen Z spends the most amount of time on social media, so the notion that social media negatively affects mental health appears to be correlated. Unfortunately, Gen Z is also the generation that’s least comfortable discussing mental health concerns with healthcare professionals. Only 40% of them state they’re comfortable discussing their issues with a professional compared to 60% of Millennials and 65% of Boomers.
Race Affects Attitudes
As seen in previous research conducted by ThinkNow, Asian Americans lag other groups when it comes to awareness of mental health issues. Twenty-four percent of Asian Americans believe that having a mental health issue is a sign of weakness compared to the 16% average for all groups. Asians are also considerably less likely to be aware of mental health services in their communities (42% vs. 55%) and most likely to seek out information on social media (51% vs. 35%).
AI Trends in Creative Operations 2024 by Artwork Flow.pdfmarketingartwork
Creative operations teams expect increased AI use in 2024. Currently, over half of tasks are not AI-enabled, but this is expected to decrease in the coming year. ChatGPT is the most popular AI tool currently. Business leaders are more actively exploring AI benefits than individual contributors. Most respondents do not believe AI will impact workforce size in 2024. However, some inhibitions still exist around AI accuracy and lack of understanding. Creatives primarily want to use AI to save time on mundane tasks and boost productivity.
Organizational culture includes values, norms, systems, symbols, language, assumptions, beliefs, and habits that influence employee behaviors and how people interpret those behaviors. It is important because culture can help or hinder a company's success. Some key aspects of Netflix's culture that help it achieve results include hiring smartly so every position has stars, focusing on attitude over just aptitude, and having a strict policy against peacocks, whiners, and jerks.
PEPSICO Presentation to CAGNY Conference Feb 2024Neil Kimberley
PepsiCo provided a safe harbor statement noting that any forward-looking statements are based on currently available information and are subject to risks and uncertainties. It also provided information on non-GAAP measures and directing readers to its website for disclosure and reconciliation. The document then discussed PepsiCo's business overview, including that it is a global beverage and convenient food company with iconic brands, $91 billion in net revenue in 2023, and nearly $14 billion in core operating profit. It operates through a divisional structure with a focus on local consumers.
Content Methodology: A Best Practices Report (Webinar)contently
This document provides an overview of content methodology best practices. It defines content methodology as establishing objectives, KPIs, and a culture of continuous learning and iteration. An effective methodology focuses on connecting with audiences, creating optimal content, and optimizing processes. It also discusses why a methodology is needed due to the competitive landscape, proliferation of channels, and opportunities for improvement. Components of an effective methodology include defining objectives and KPIs, audience analysis, identifying opportunities, and evaluating resources. The document concludes with recommendations around creating a content plan, testing and optimizing content over 90 days.
How to Prepare For a Successful Job Search for 2024Albert Qian
The document provides guidance on preparing a job search for 2024. It discusses the state of the job market, focusing on growth in AI and healthcare but also continued layoffs. It recommends figuring out what you want to do by researching interests and skills, then conducting informational interviews. The job search should involve building a personal brand on LinkedIn, actively applying to jobs, tailoring resumes and interviews, maintaining job hunting as a habit, and continuing self-improvement. Once hired, the document advises setting new goals and keeping skills and networking active in case of future opportunities.
A report by thenetworkone and Kurio.
The contributing experts and agencies are (in an alphabetical order): Sylwia Rytel, Social Media Supervisor, 180heartbeats + JUNG v MATT (PL), Sharlene Jenner, Vice President - Director of Engagement Strategy, Abelson Taylor (USA), Alex Casanovas, Digital Director, Atrevia (ES), Dora Beilin, Senior Social Strategist, Barrett Hoffher (USA), Min Seo, Campaign Director, Brand New Agency (KR), Deshé M. Gully, Associate Strategist, Day One Agency (USA), Francesca Trevisan, Strategist, Different (IT), Trevor Crossman, CX and Digital Transformation Director; Olivia Hussey, Strategic Planner; Simi Srinarula, Social Media Manager, The Hallway (AUS), James Hebbert, Managing Director, Hylink (CN / UK), Mundy Álvarez, Planning Director; Pedro Rojas, Social Media Manager; Pancho González, CCO, Inbrax (CH), Oana Oprea, Head of Digital Planning, Jam Session Agency (RO), Amy Bottrill, Social Account Director, Launch (UK), Gaby Arriaga, Founder, Leonardo1452 (MX), Shantesh S Row, Creative Director, Liwa (UAE), Rajesh Mehta, Chief Strategy Officer; Dhruv Gaur, Digital Planning Lead; Leonie Mergulhao, Account Supervisor - Social Media & PR, Medulla (IN), Aurelija Plioplytė, Head of Digital & Social, Not Perfect (LI), Daiana Khaidargaliyeva, Account Manager, Osaka Labs (UK / USA), Stefanie Söhnchen, Vice President Digital, PIABO Communications (DE), Elisabeth Winiartati, Managing Consultant, Head of Global Integrated Communications; Lydia Aprina, Account Manager, Integrated Marketing and Communications; Nita Prabowo, Account Manager, Integrated Marketing and Communications; Okhi, Web Developer, PNTR Group (ID), Kei Obusan, Insights Director; Daffi Ranandi, Insights Manager, Radarr (SG), Gautam Reghunath, Co-founder & CEO, Talented (IN), Donagh Humphreys, Head of Social and Digital Innovation, THINKHOUSE (IRE), Sarah Yim, Strategy Director, Zulu Alpha Kilo (CA).
Trends In Paid Search: Navigating The Digital Landscape In 2024Search Engine Journal
The search marketing landscape is evolving rapidly with new technologies, and professionals, like you, rely on innovative paid search strategies to meet changing demands.
It’s important that you’re ready to implement new strategies in 2024.
Check this out and learn the top trends in paid search advertising that are expected to gain traction, so you can drive higher ROI more efficiently in 2024.
You’ll learn:
- The latest trends in AI and automation, and what this means for an evolving paid search ecosystem.
- New developments in privacy and data regulation.
- Emerging ad formats that are expected to make an impact next year.
Watch Sreekant Lanka from iQuanti and Irina Klein from OneMain Financial as they dive into the future of paid search and explore the trends, strategies, and technologies that will shape the search marketing landscape.
If you’re looking to assess your paid search strategy and design an industry-aligned plan for 2024, then this webinar is for you.
5 Public speaking tips from TED - Visualized summarySpeakerHub
From their humble beginnings in 1984, TED has grown into the world’s most powerful amplifier for speakers and thought-leaders to share their ideas. They have over 2,400 filmed talks (not including the 30,000+ TEDx videos) freely available online, and have hosted over 17,500 events around the world.
With over one billion views in a year, it’s no wonder that so many speakers are looking to TED for ideas on how to share their message more effectively.
The article “5 Public-Speaking Tips TED Gives Its Speakers”, by Carmine Gallo for Forbes, gives speakers five practical ways to connect with their audience, and effectively share their ideas on stage.
Whether you are gearing up to get on a TED stage yourself, or just want to master the skills that so many of their speakers possess, these tips and quotes from Chris Anderson, the TED Talks Curator, will encourage you to make the most impactful impression on your audience.
See the full article and more summaries like this on SpeakerHub here: https://speakerhub.com/blog/5-presentation-tips-ted-gives-its-speakers
See the original article on Forbes here:
http://www.forbes.com/forbes/welcome/?toURL=http://www.forbes.com/sites/carminegallo/2016/05/06/5-public-speaking-tips-ted-gives-its-speakers/&refURL=&referrer=#5c07a8221d9b
ChatGPT and the Future of Work - Clark Boyd Clark Boyd
Everyone is in agreement that ChatGPT (and other generative AI tools) will shape the future of work. Yet there is little consensus on exactly how, when, and to what extent this technology will change our world.
Businesses that extract maximum value from ChatGPT will use it as a collaborative tool for everything from brainstorming to technical maintenance.
For individuals, now is the time to pinpoint the skills the future professional will need to thrive in the AI age.
Check out this presentation to understand what ChatGPT is, how it will shape the future of work, and how you can prepare to take advantage.
The document provides career advice for getting into the tech field, including:
- Doing projects and internships in college to build a portfolio.
- Learning about different roles and technologies through industry research.
- Contributing to open source projects to build experience and network.
- Developing a personal brand through a website and social media presence.
- Networking through events, communities, and finding a mentor.
- Practicing interviews through mock interviews and whiteboarding coding questions.
Google's Just Not That Into You: Understanding Core Updates & Search IntentLily Ray
1. Core updates from Google periodically change how its algorithms assess and rank websites and pages. This can impact rankings through shifts in user intent, site quality issues being caught up to, world events influencing queries, and overhauls to search like the E-A-T framework.
2. There are many possible user intents beyond just transactional, navigational and informational. Identifying intent shifts is important during core updates. Sites may need to optimize for new intents through different content types and sections.
3. Responding effectively to core updates requires analyzing "before and after" data to understand changes, identifying new intents or page types, and ensuring content matches appropriate intents across video, images, knowledge graphs and more.
A brief introduction to DataScience with explaining of the concepts, algorithms, machine learning, supervised and unsupervised learning, clustering, statistics, data preprocessing, real-world applications etc.
It's part of a Data Science Corner Campaign where I will be discussing the fundamentals of DataScience, AIML, Statistics etc.
Time Management & Productivity - Best PracticesVit Horky
Here's my presentation on by proven best practices how to manage your work time effectively and how to improve your productivity. It includes practical tips and how to use tools such as Slack, Google Apps, Hubspot, Google Calendar, Gmail and others.
The six step guide to practical project managementMindGenius
The six step guide to practical project management
If you think managing projects is too difficult, think again.
We’ve stripped back project management processes to the
basics – to make it quicker and easier, without sacrificing
the vital ingredients for success.
“If you’re looking for some real-world guidance, then The Six Step Guide to Practical Project Management will help.”
Dr Andrew Makar, Tactical Project Management
2024 State of Marketing Report – by HubspotMarius Sescu
https://www.hubspot.com/state-of-marketing
· Scaling relationships and proving ROI
· Social media is the place for search, sales, and service
· Authentic influencer partnerships fuel brand growth
· The strongest connections happen via call, click, chat, and camera.
· Time saved with AI leads to more creative work
· Seeking: A single source of truth
· TLDR; Get on social, try AI, and align your systems.
· More human marketing, powered by robots
ChatGPT is a revolutionary addition to the world since its introduction in 2022. A big shift in the sector of information gathering and processing happened because of this chatbot. What is the story of ChatGPT? How is the bot responding to prompts and generating contents? Swipe through these slides prepared by Expeed Software, a web development company regarding the development and technical intricacies of ChatGPT!
Product Design Trends in 2024 | Teenage EngineeringsPixeldarts
The realm of product design is a constantly changing environment where technology and style intersect. Every year introduces fresh challenges and exciting trends that mold the future of this captivating art form. In this piece, we delve into the significant trends set to influence the look and functionality of product design in the year 2024.
How Race, Age and Gender Shape Attitudes Towards Mental HealthThinkNow
Mental health has been in the news quite a bit lately. Dozens of U.S. states are currently suing Meta for contributing to the youth mental health crisis by inserting addictive features into their products, while the U.S. Surgeon General is touring the nation to bring awareness to the growing epidemic of loneliness and isolation. The country has endured periods of low national morale, such as in the 1970s when high inflation and the energy crisis worsened public sentiment following the Vietnam War. The current mood, however, feels different. Gallup recently reported that national mental health is at an all-time low, with few bright spots to lift spirits.
To better understand how Americans are feeling and their attitudes towards mental health in general, ThinkNow conducted a nationally representative quantitative survey of 1,500 respondents and found some interesting differences among ethnic, age and gender groups.
Technology
For example, 52% agree that technology and social media have a negative impact on mental health, but when broken out by race, 61% of Whites felt technology had a negative effect, and only 48% of Hispanics thought it did.
While technology has helped us keep in touch with friends and family in faraway places, it appears to have degraded our ability to connect in person. Staying connected online is a double-edged sword since the same news feed that brings us pictures of the grandkids and fluffy kittens also feeds us news about the wars in Israel and Ukraine, the dysfunction in Washington, the latest mass shooting and the climate crisis.
Hispanics may have a built-in defense against the isolation technology breeds, owing to their large, multigenerational households, strong social support systems, and tendency to use social media to stay connected with relatives abroad.
Age and Gender
When asked how individuals rate their mental health, men rate it higher than women by 11 percentage points, and Baby Boomers rank it highest at 83%, saying it’s good or excellent vs. 57% of Gen Z saying the same.
Gen Z spends the most amount of time on social media, so the notion that social media negatively affects mental health appears to be correlated. Unfortunately, Gen Z is also the generation that’s least comfortable discussing mental health concerns with healthcare professionals. Only 40% of them state they’re comfortable discussing their issues with a professional compared to 60% of Millennials and 65% of Boomers.
Race Affects Attitudes
As seen in previous research conducted by ThinkNow, Asian Americans lag other groups when it comes to awareness of mental health issues. Twenty-four percent of Asian Americans believe that having a mental health issue is a sign of weakness compared to the 16% average for all groups. Asians are also considerably less likely to be aware of mental health services in their communities (42% vs. 55%) and most likely to seek out information on social media (51% vs. 35%).
AI Trends in Creative Operations 2024 by Artwork Flow.pdfmarketingartwork
Creative operations teams expect increased AI use in 2024. Currently, over half of tasks are not AI-enabled, but this is expected to decrease in the coming year. ChatGPT is the most popular AI tool currently. Business leaders are more actively exploring AI benefits than individual contributors. Most respondents do not believe AI will impact workforce size in 2024. However, some inhibitions still exist around AI accuracy and lack of understanding. Creatives primarily want to use AI to save time on mundane tasks and boost productivity.
Organizational culture includes values, norms, systems, symbols, language, assumptions, beliefs, and habits that influence employee behaviors and how people interpret those behaviors. It is important because culture can help or hinder a company's success. Some key aspects of Netflix's culture that help it achieve results include hiring smartly so every position has stars, focusing on attitude over just aptitude, and having a strict policy against peacocks, whiners, and jerks.
PEPSICO Presentation to CAGNY Conference Feb 2024Neil Kimberley
PepsiCo provided a safe harbor statement noting that any forward-looking statements are based on currently available information and are subject to risks and uncertainties. It also provided information on non-GAAP measures and directing readers to its website for disclosure and reconciliation. The document then discussed PepsiCo's business overview, including that it is a global beverage and convenient food company with iconic brands, $91 billion in net revenue in 2023, and nearly $14 billion in core operating profit. It operates through a divisional structure with a focus on local consumers.
Content Methodology: A Best Practices Report (Webinar)contently
This document provides an overview of content methodology best practices. It defines content methodology as establishing objectives, KPIs, and a culture of continuous learning and iteration. An effective methodology focuses on connecting with audiences, creating optimal content, and optimizing processes. It also discusses why a methodology is needed due to the competitive landscape, proliferation of channels, and opportunities for improvement. Components of an effective methodology include defining objectives and KPIs, audience analysis, identifying opportunities, and evaluating resources. The document concludes with recommendations around creating a content plan, testing and optimizing content over 90 days.
How to Prepare For a Successful Job Search for 2024Albert Qian
The document provides guidance on preparing a job search for 2024. It discusses the state of the job market, focusing on growth in AI and healthcare but also continued layoffs. It recommends figuring out what you want to do by researching interests and skills, then conducting informational interviews. The job search should involve building a personal brand on LinkedIn, actively applying to jobs, tailoring resumes and interviews, maintaining job hunting as a habit, and continuing self-improvement. Once hired, the document advises setting new goals and keeping skills and networking active in case of future opportunities.
A report by thenetworkone and Kurio.
The contributing experts and agencies are (in an alphabetical order): Sylwia Rytel, Social Media Supervisor, 180heartbeats + JUNG v MATT (PL), Sharlene Jenner, Vice President - Director of Engagement Strategy, Abelson Taylor (USA), Alex Casanovas, Digital Director, Atrevia (ES), Dora Beilin, Senior Social Strategist, Barrett Hoffher (USA), Min Seo, Campaign Director, Brand New Agency (KR), Deshé M. Gully, Associate Strategist, Day One Agency (USA), Francesca Trevisan, Strategist, Different (IT), Trevor Crossman, CX and Digital Transformation Director; Olivia Hussey, Strategic Planner; Simi Srinarula, Social Media Manager, The Hallway (AUS), James Hebbert, Managing Director, Hylink (CN / UK), Mundy Álvarez, Planning Director; Pedro Rojas, Social Media Manager; Pancho González, CCO, Inbrax (CH), Oana Oprea, Head of Digital Planning, Jam Session Agency (RO), Amy Bottrill, Social Account Director, Launch (UK), Gaby Arriaga, Founder, Leonardo1452 (MX), Shantesh S Row, Creative Director, Liwa (UAE), Rajesh Mehta, Chief Strategy Officer; Dhruv Gaur, Digital Planning Lead; Leonie Mergulhao, Account Supervisor - Social Media & PR, Medulla (IN), Aurelija Plioplytė, Head of Digital & Social, Not Perfect (LI), Daiana Khaidargaliyeva, Account Manager, Osaka Labs (UK / USA), Stefanie Söhnchen, Vice President Digital, PIABO Communications (DE), Elisabeth Winiartati, Managing Consultant, Head of Global Integrated Communications; Lydia Aprina, Account Manager, Integrated Marketing and Communications; Nita Prabowo, Account Manager, Integrated Marketing and Communications; Okhi, Web Developer, PNTR Group (ID), Kei Obusan, Insights Director; Daffi Ranandi, Insights Manager, Radarr (SG), Gautam Reghunath, Co-founder & CEO, Talented (IN), Donagh Humphreys, Head of Social and Digital Innovation, THINKHOUSE (IRE), Sarah Yim, Strategy Director, Zulu Alpha Kilo (CA).
Trends In Paid Search: Navigating The Digital Landscape In 2024Search Engine Journal
The search marketing landscape is evolving rapidly with new technologies, and professionals, like you, rely on innovative paid search strategies to meet changing demands.
It’s important that you’re ready to implement new strategies in 2024.
Check this out and learn the top trends in paid search advertising that are expected to gain traction, so you can drive higher ROI more efficiently in 2024.
You’ll learn:
- The latest trends in AI and automation, and what this means for an evolving paid search ecosystem.
- New developments in privacy and data regulation.
- Emerging ad formats that are expected to make an impact next year.
Watch Sreekant Lanka from iQuanti and Irina Klein from OneMain Financial as they dive into the future of paid search and explore the trends, strategies, and technologies that will shape the search marketing landscape.
If you’re looking to assess your paid search strategy and design an industry-aligned plan for 2024, then this webinar is for you.
5 Public speaking tips from TED - Visualized summarySpeakerHub
From their humble beginnings in 1984, TED has grown into the world’s most powerful amplifier for speakers and thought-leaders to share their ideas. They have over 2,400 filmed talks (not including the 30,000+ TEDx videos) freely available online, and have hosted over 17,500 events around the world.
With over one billion views in a year, it’s no wonder that so many speakers are looking to TED for ideas on how to share their message more effectively.
The article “5 Public-Speaking Tips TED Gives Its Speakers”, by Carmine Gallo for Forbes, gives speakers five practical ways to connect with their audience, and effectively share their ideas on stage.
Whether you are gearing up to get on a TED stage yourself, or just want to master the skills that so many of their speakers possess, these tips and quotes from Chris Anderson, the TED Talks Curator, will encourage you to make the most impactful impression on your audience.
See the full article and more summaries like this on SpeakerHub here: https://speakerhub.com/blog/5-presentation-tips-ted-gives-its-speakers
See the original article on Forbes here:
http://www.forbes.com/forbes/welcome/?toURL=http://www.forbes.com/sites/carminegallo/2016/05/06/5-public-speaking-tips-ted-gives-its-speakers/&refURL=&referrer=#5c07a8221d9b
ChatGPT and the Future of Work - Clark Boyd Clark Boyd
Everyone is in agreement that ChatGPT (and other generative AI tools) will shape the future of work. Yet there is little consensus on exactly how, when, and to what extent this technology will change our world.
Businesses that extract maximum value from ChatGPT will use it as a collaborative tool for everything from brainstorming to technical maintenance.
For individuals, now is the time to pinpoint the skills the future professional will need to thrive in the AI age.
Check out this presentation to understand what ChatGPT is, how it will shape the future of work, and how you can prepare to take advantage.
The document provides career advice for getting into the tech field, including:
- Doing projects and internships in college to build a portfolio.
- Learning about different roles and technologies through industry research.
- Contributing to open source projects to build experience and network.
- Developing a personal brand through a website and social media presence.
- Networking through events, communities, and finding a mentor.
- Practicing interviews through mock interviews and whiteboarding coding questions.
Google's Just Not That Into You: Understanding Core Updates & Search IntentLily Ray
1. Core updates from Google periodically change how its algorithms assess and rank websites and pages. This can impact rankings through shifts in user intent, site quality issues being caught up to, world events influencing queries, and overhauls to search like the E-A-T framework.
2. There are many possible user intents beyond just transactional, navigational and informational. Identifying intent shifts is important during core updates. Sites may need to optimize for new intents through different content types and sections.
3. Responding effectively to core updates requires analyzing "before and after" data to understand changes, identifying new intents or page types, and ensuring content matches appropriate intents across video, images, knowledge graphs and more.
A brief introduction to DataScience with explaining of the concepts, algorithms, machine learning, supervised and unsupervised learning, clustering, statistics, data preprocessing, real-world applications etc.
It's part of a Data Science Corner Campaign where I will be discussing the fundamentals of DataScience, AIML, Statistics etc.
Time Management & Productivity - Best PracticesVit Horky
Here's my presentation on by proven best practices how to manage your work time effectively and how to improve your productivity. It includes practical tips and how to use tools such as Slack, Google Apps, Hubspot, Google Calendar, Gmail and others.
The six step guide to practical project managementMindGenius
The six step guide to practical project management
If you think managing projects is too difficult, think again.
We’ve stripped back project management processes to the
basics – to make it quicker and easier, without sacrificing
the vital ingredients for success.
“If you’re looking for some real-world guidance, then The Six Step Guide to Practical Project Management will help.”
Dr Andrew Makar, Tactical Project Management
Beginners Guide to TikTok for Search - Rachel Pearson - We are Tilt __ Bright...
French cuffed tube study
1. Annales Franc ´ ´
¸aises d’Anesthesie et de Reanimation 29 (2010) 687–692
Article original
´ ´ ´ `
Comparaison de serum sale, d’air et d’un melange oxygene–protoxyde
d’azote pour le remplissage des ballonnets de sondes d’intubation chez l’enfant ?
´
Etude prospective randomisee ´
Comparison of saline, air, and a mixture oxygen–nitrous oxide for endotracheal cuff tracheal
tube inflation in children? A Prospective randomized trial
C. Dadure *, M. Granier, S. Bringuier, L. Dehour, O. Raux, A. Rochette, R. Troncin, X. Capdevila
´sie-re
Service d’anesthe ´animation A, CHU Lapeyronie, avenue du Doyen-Gaston-Giraud, 34000 Montpellier, France
I N F O A R T I C L E ´ ´
R E S U M E
Historique de l’article : ´
Objectif. – Comparer chez l’enfant le nombre de degonflage ou de regonflage necessaire afin de´
Recu le 1 avril 2009
¸ maintenir la pression entre 15 et 35 cmH2O selon le produit de gonflage du ballonnet de la sonde
´
Accepte le 9 juin 2010 d’intubation.
ˆ
Disponible sur Internet le 21 aout 2010 ´
Type d’e ´tude. – Etude prospective, randomisee. ´
Patients et me ´thode. – Quatre-vingt-dix enfants ages d’un mois a 15 ans ont ete inclus en trois groupes
ˆ ´ ` ´ ´
´s
Mots cle : ´ ´ ´ ` ´
(G). Les patients etaient ventiles avec un melange a 50 %O2–50 %N2O. Les ballonnets etaient gonfles ´
Ballonnet ` ´
jusqu’a 20 cmH2O de pression avec de l’air (G1), un melange O2–N2O (G2), du SSI (G3). Les pressions
Sonde d’intubation ´ ´ ´
etaient relevees toutes les dix minutes puis ajustees pour rester comprises entre 15 et 35 cmH2O. La
Pression
´ ´ ´
survenue de manifestations oropharyngees etait notee en SSPI.
Protoxyde d’azote
Re´sultats. – Les trois groupes etaient comparables pour l’age, le poids, le sexe. La duree de chirurgie etait
´ ˆ ´ ´
Enfants
ˆ ˆ ´ ´ ´
significativement plus longue dans le G3. Le ballonnet a du etre degonfle plus frequemment dans le G1 :
ˆ
60 % des cas (p < 0,0001) versus 10 % pour G2 et 3,3 % pour G3. Le ballonnet a du etre regonfle plus ´
´
frequemment dans le G2 : 76,6 % des cas (p < 0,0001) versus 3,3 % pour G1 et G3. La survenue d’effets
´ ´
indesirables etait comparable dans les trois groupes.
´
Conclusion. – L’utilisation d’air ou d’un melange O2–N2O pour gonfler les ballonnets n’est pas une
´ ´
methode fiable. Le SSI maintient une pression plus stable mais le monitorage n’est pas aise et de plus les
fabricants de sondes ne recommandent pas son utilisation. Gonfler les ballonnets avec de l’air en
´
monitorant systematiquement la pression est la technique la plus simple d’utilisation.
´
ß 2010 Elsevier Masson SAS. Tous droits reserves. ´
A B S T R A C T
Keywords: Objective. – The purpose of the present study was to compare how many inflate and deflate are
Cuff necessary to maintain the endotracheal tube cuff pressure between 15 and 35 cm H2O by using air, O2–
Endotracheal tube
N2O mix or saline solution.
Pressure
Study design. – Randomized and prospective study.
Nitrous oxide
Children Patients and methods. – Ninety children from 1 month to 15 years of age were included in the study. All
patients were ventilated with O250%–N2O50%. Subsequently, the patients were divided in three
groups: (1) Group 1: patients with air inflated cuffs; (2) Group 2: patients with O2–N2O mix inflated
cuffs; (3) Group 3: patients with saline solution inflated cuffs. In all groups cuffs were inflated to reach
an intracuff pressure of 20 cmH2O. The cuff pressure was then monitored every 10 minutes and
adjusted to be between 15 and 35 cmH2O. Laryngeal and tracheal symptoms were noted in the recovery
room.
Results. – The three groups of patients were similar for age, weight, and sex. The length of surgery was
significantly longer in Group 3. The deflate rate was higher in Group 1 (60%) than in Group 2 (10%) or 3
* Auteur correspondant.
Adresse e-mail : c-dadure@chu-montpellier.fr (C. Dadure).
´ ´
0750-7658/$ – see front matter ß 2010 Elsevier Masson SAS. Tous droits reserves.
doi:10.1016/j.annfar.2010.06.022
2. 688 ´sie et de Re
C. Dadure et al. / Annales Francaises d’Anesthe
¸ ´animation 29 (2010) 687–692
(3.3%) (p < 0.0001). The inflate rate was higher in Group 2 (76.6%) than in Group 1 or 3 (both 3.3%)
(p < 0.0001). Side effects were comparable in the three groups of patients.
Conclusion. – Using air or O2–N2O mix to inflate cuffs is not reliable. SSI helps to maintain a more stable
cuff pressure but monitoring is difficult and sometimes contraindicated by tracheal tubes producers.
Inflating cuffs with air and regularly monitoring pressure is the most reliable and easiest technique.
ß 2010 Elsevier Masson SAS. All rights reserved.
1. Introduction groupe air : remplissage avec de l’air ;
´ ´
groupe melange : remplissage avec un melange oxygene– `
´
L’intubation tracheale est une pratique courante en anesthesie ´ `
protoxyde d’azote a 50 % ;
´ ´ ´
pediatrique. Longtemps consideree comme inutile voire dange- ´ ´ ´
groupe serum sale isotonique (SSI) : remplissage avec du serum
reuse, l’utilisation de sonde d’intubation avec ballonnet chez ´
sale isotonique.
´ ´ ´ ´
l’enfant de moins de huit ans a ete rehabilitee par l’etude de Khine ´
et al. [1]. Cependant, la mise en place d’une sonde d’intubation avec ´
Cette randomisation aleatoire a ete realisee, la veille de ´ ´ ´ ´
´ ´
ballonnet en anesthesie pediatrique resta longtemps controversee, ´ ´
l’intervention, par le departement d’information medicale de ´
´
et seuls 25 % des anesthesistes pediatriques, membres de ´ ´
notre etablissement.
l’Association des ´
anesthesistes-reanimateurs ´ ´
pediatriques ` ´
Les criteres d’exclusion etaient l’age inferieur a un mois ou ˆ ´ `
d’expression franc ´
¸aise (Adarpef), declaraient, en 2001, utiliser ´ `
superieur a 15 ans, un enfant classe ASA 4, une contre-indication a ´ `
couramment ce type de sonde [2]. Les sondes a ballonnet ont ` l’utilisation du protoxyde d’azote, une chirurgie en decubitus ´
l’avantage de limiter le nombre de laryngoscopie et le nombre de ´
ventral ou lateral, une mobilisation de la tete pendant l’interven- ˆ
´
reintubation, en assurant une bonne etancheite des voies ´ ´ ´ ´
tion, une duree d’intervention inferieure a 25 minutes. ´ `
´
aeriennes, et permettent l’utilisation de circuit ferme et de reduire ´ ´ ´ ´ ´
Les enfants etaient premediques 30 minutes avant l’interven- ´
´
la contamination par les gaz anesthesiques des salles d’interven- tion par de l’hydroxyzine (1 mg/kg) per os ou du midazolam
´
tion [1]. Elles limitent egalement le risque d’inhalation [3,4] et (0,35 mg/kg) intrarectal selon l’age et la mise en place d’un ˆ
permettent d’utiliser des pressions inspiratoires plus elevees lors ´ ´ monitorage standard en salle d’intervention etait effectue. Le type ´ ´
´
de la ventilation peroperatoire sur des poumons a compliance ` ´ ´
d’induction etait laisse au choix de l’anesthesiste. L’induction par ´
diminuee [5].´ ´ ´ ´
inhalation etait realisee par sevoflurane a 6 % et pouvait etre ´ ` ˆ
´ ´
Il est clairement demontre chez l’adulte que le protoxyde ´ ´
completee par des agents intraveineux apres la pose de la voie `
`
d’azote diffuse a travers le polyvinyle des ballonnets des sondes veineuse. L’induction par voie intraveineuse etait realisee par 3 a ´ ´ ´ `
d’intubation et peut augmenter les pressions exercees sur la ´ 5 mg/kg de propofol et 1 a 3 mg/kg de fentanyl chez des enfants
`
´
trachee [6]. Chez l’enfant, la pression des ballonnets gonfles avec ´ ´ ` ´
deja perfuses ou acceptant la pose de voie veineuse. Aucun curare
´
de l’air lors d’une ventilation mecanique utilisant un melange a ´ ` ´ ´ ´
n’a ete utilise pour faciliter l’intubation et aucune anesthesie locale ´
`
50 % de protoxyde d’azote et d’oxygene est imprevisible [7]. Des ´ ´ ´ ´
de glotte n’etait realisee avant l’intubation. Durant l’induction, les
´ ´ ´ ´ ´
lesions de la muqueuse tracheale ont ete decrites chez l’adulte et ´ ´
patients etaient ventiles avec un melange a 50 % oxygene–50 % ´ ` `
l’animal, en cas d’augmentation de la pression dans le ballonnet protoxyde d’azote. La trachee etait intubee avec une sonde a´ ´ ´ `
[8–11]. Chez l’enfant, la muqueuse tracheale au niveau du ´ ballonnet (HUDSON Respiratory Care1, SHERIDAN Upplandsvasby,
ˆ
cartilage cricoıde est extremement fragile et tout traumatisme
¨ ` ´
Sweden) dont le diametre etait choisi selon la formule de Khine
ˆ `
entraıne un œdeme de la muqueuse et une reduction conside- ´ ´ ` ˆ
(diametre interne en mm = age en annees/4 + 3) [1]. Le ballonnet ´
´
rable de la section de la region sous-glottique [12]. De nombreux ´
de la sonde d’intubation etait alors gonfle avec un des produits de ´
´ ´ ´ ´
moyens ont ete evalues chez l’adulte pour limiter la diffusion ´
remplissage definit lors de la randomisation. Pendant l’interven-
`
du protoxyde d’azote a travers le ballonnet et pour diminuer ´
tion, les patients etaient sous ventilation mecanique en volume ´
´
la pression exercee sur la muqueuse tracheale : utilisation de ´ ˆ ´
controle : volume courant de 10 mL/kg, fraction inspiree d’oxygene ´ `
sondes basse pression [13], remplissage du ballonnet avec `
et de protoxyde d’azote a 50 %, frequence respiratoire adaptee a ´ ´ `
´
differents produits [9,14], monitorage de la pression du ˆ
l’age du patient pour obtenir une fraction expiree en CO2 entre ´
` ´
ballonnet [15]. A ce jour, aucune etude n’a evalue les techniques ´ ´ 28 et 32 mmHg.
´
permettant la stabilite de la pression interne des ballonnets ´
Dans les groupes air et melange O2–N2O, le monitorage de la
´
lors d’une anesthesie utilisant du protoxyde d’azote en chirurgie pression du ballonnet de la sonde d’intubation etait realise par un ´ ´ ´
´ ´
pediatrique. Le but de cette etude prospective randomisee ´ ` `
manometre a pression (Mallinckrot Medical Athlone, Ireland). Pour ´
est de comparer la variation de pression des ballonnets ´
le groupe air, le ballonnet etait gonfle avec une seringue contenant ´
des sondes d’intubation chez l’enfant, lors d’une anesthesie ´ ´ ´
de l’air preleve dans la salle et a une pression de 20 cmH2O. Le `
´ ´ ´ `
generale utilisant un melange a 50 % de protoxyde d’azote, en ` ´ ´
manometre etait connecte au ballonnet de la sonde durant toute
fonction de trois produits de remplissage du ballonnet : air, ´
l’intervention pour eviter toute erreur de manipulation. Le
´ `
melange oxygene–protoxyde d’azote a 50 % ou serum sale ` ´ ´ ´ ´ ´
ballonnet etait gonfle ou degonfle par la poire du manometre. ´ `
isotonique. ´
Pour le groupe melange O2–N2O, le ballonnet etait gonfle a une ´ ´ `
pression de 20 cmH2O par une seringue contenant un melange a ´ `
´
2. Patients et methode `
50 % oxygene–50 % protoxyde d’azote preleve au niveau du filtre ´ ´
´ ´ ´
antibacterien. Le melange etait preleve lorsque l’analyseur de gaz ´ ´
` ´ ´ ´
Apres avis du comite d’ethique et consentement eclaire des ´ ´
indiquait une fraction inspiree de protoxyde et d’oxygene a 50 %. Le ` `
ˆ ´ `
parents, 90 enfants, ages de un mois a 15 ans et de classes American ` ´ ´
manometre etait connecte directement au ballonnet de la sonde
Society of Anesthesiologists (ASA) comprises entre 1 et 3, devant ˆ `
grace a un robinet trois voies et celui-ci etait laisse en place durant ´ ´
´ ´ ´
beneficier d’une chirurgie orthopedique, digestive ou plastique, ´
toute l’intervention pour eviter toute erreur de manipulation. Le
´ ´ ´
ont ete inclus dans cette etude. L’inclusion des patients a ete ´ ´ ` ´
manometre et le robinet etaient purges avec le melange. Le ´ ´
´ ´ `
realisee apres randomisation en trois groupes en fonction du ´ ´ ´
ballonnet etait gonfle ou degonfle par une seringue connectee au ´ ´
produit de remplissage : niveau du robinet et contenant le melange gazeux. Pour ces ´
3. ´sie et de Re
C. Dadure et al. / Annales Francaises d’Anesthe
¸ ´animation 29 (2010) 687–692 689
´
groupes, lorsque la pression etait superieure ou egale a 35 cmH2O, ´ ´ ` appliquant une correction de Bonferroni au seuil de significa-
´ ´ ´
le ballonnet etait degonfle par la seringue pour etre ramene a une ˆ ´ ` ´
tivite.
pression de 20 cmH2O. Lorsque la pression etait inferieure ou egale ´ ´ ´
` ´
a 15 cmH2O, le ballonnet etait regonfle avec le meme melange pour ´ ˆ ´ ´
3. Resultats
ramener la pression a 20 cmH2O. `
Pour le groupe SSI, la pression du ballonnet de la sonde ´ ´
Quatre-vingt-dix patients ont ete inclus. Aucun patient n’a ete ´ ´
´ ´
d’intubation etait mesuree par une cellule de pression electronique ´ ´ ˆ
exclu de l’etude pour arret du protoxyde d’azote durant l’inter-
(capteur de pressions, Edwards Life Sciences Unterschleissheim, ´ ´
vention. Les donnees demographiques, ainsi que les parametres `
Germany). La cellule de pression etait connectee au ballonnet et ´ ´ ´ ´
chirurgicaux et anesthesiques etaient comparables entre les trois
´ `
reliee a un module de pression. L’ensemble du systeme etait purge ` ´ ´ ` ´
groupes a l’exception de la duree d’anesthesie. Le groupe SSI a eu ´
´
avec SSI. La pression etait exprimee en mmHg. Afin d’obtenir ´ ´ ´ ´
une duree mediane d’anesthesie significativement plus longue que
´
l’equivalence des pressions en cmH2O, nous avons utilise la ´ ´
les deux autres groupes. Les donnees demographiques, chirurgi- ´
formule : pression (cmH2O) = pression (mmHg)/0,75. Le ballonnet ´ ´
cales et anesthesiques sont notees dans le Tableau 1. Le nombre de
´ `
etait rempli avec du SSI a l’aide d’une seringue afin d’obtenir une tentatives de laryngoscopie et le nombre de patients presentant ´
´
pression de 15 mmHg (equivalent a 20 cmH2O). Lorsque la ` ´ ´
une infection des voies aeriennes superieures (VAS) preexistante ´
´ ´
pression etait superieure ou egale a 26 mmHg (equivalent a ´ ` ´ ` sont comparables dans les trois groupes.
´
35 cmH2O), du SSI etait retire pour ramener la pression a ´ ` ´ ´
Le nombre total de degonflages etait significativement plus
´
15 mmHg. Lorsque la pression etait inferieure ou egale a 11 mmHg ´ ´ ` ´
important dans le groupe air compare aux groupes melange et SSI ´
´ `
(equivalent a 15 cmH2O), du SSI etait reinjecte dans le ballonnet ´ ´ ´ ˆˆ ´
(p 0,0001). Le ballonnet a du etre degonfle au moins une fois dans ´
`
pour ramener la pression a 15 mmHg. L’heure du premier gonflage 60 % des cas (18 patients sur 30) dans le groupe air versus 10 %
`
et de l’ajustement correspondait a T0 et au debut du monitorage de ´ (trois patients sur 30) et 3,3 % (un patient sur 30) respectivement
la pression dans le ballonnet. ´
dans les groupes melange et SSI. Le nombre de regonflages etait ´
´ ´
Les donnees demographiques (age, poids, sexe, score ASA, ˆ significativement plus important dans le groupe melange compare ´ ´
´
infection des voies aeriennes preexistante) ainsi que les para- ´ ´ ´ ´
aux groupes air et SSI (p 0,0001). Il a ete necessaire de regonfler
` ´
metres anesthesiques (type d’induction, duree de l’anesthesie, ´ ´ au moins une fois dans 76,66 % des cas (23 patients sur 30) dans le
`
diametre de la sonde, nombre de laryngoscopie) et les parametres ` ´
groupe melange versus 3,3 % (un patient sur 30) dans les groupes
´
chirurgicaux (type et duree de l’intervention et position perope- ´ ´ ´
air et SSI. Les resultats sont presentes sur la Fig. 1. ´
´ ´
ratoire) etaient notes. La pression du ballonnet de la sonde ´
Le nombre de degonflages par patient etait significativement ´
´ ´
d’intubation etait relevee toutes les dix minutes. Le nombre de plus important dans le groupe air compare aux groupes melange et ´ ´
gonflages ou de regonflages necessaire afin de maintenir une ´ SSI (p 0,0001). Le nombre de regonflages par patient etait ´
` ´
pression a l’interieur du ballonnet entre 20 et 35 cmH2O etait ´ significativement plus important dans le groupe melange compare ´ ´
´ ´ ´
egalement note ainsi que le delai de gonflage ou de degonflage par ´ aux groupes air et SSI (p 0,0001). La mediane etait de deux ´ ´
`
rapport a T0. L’utilisation peroperatoire de corticoıdes etait ´ ¨ ´ ´
regonflages dans le groupe melanges versus zero dans les deux ´
´ ´
egalement relevee. En cas de necessite si le protoxyde d’azote ´ ´ autres groupes. Un patient du groupe melange a necessite ´ ´ ´
´
etait interrompu durant l’intervention, le patient etait alors sorti de ´ 11 regonflages de son ballonnet. La verification postoperatoire ´ ´
´
l’etude. du ballonnet a permis de confirmer que celui-ci n’avait pas ete ´ ´
`
A la fin de l’acte chirurgical, les patients etaient reveilles et ´ ´ ´ ´
endommage lors de la laryngoscopie.
´
extubes en salle d’intervention et ensuite transportes en salle de ´ ´ ´
Le delai de premier degonflage en raison d’une pression dans le
surveillance post-interventionnelle (SSPI). Durant la periode de ´ ´ `
ballonnet superieure a 35 cmH2O (ou equivalant) n’etait pas ´ ´
surveillance dans cette salle, l’existence de symptomatologie ´
statistiquement different entre les trois groupes : respectivement
´ ` ´
laryngee a type de toux, de dyspnee ou de voie rauque etait relevee ´ ´ 30, 50 et 45 minutes pour les groupes air, melange et SSI. De meme, ´ ˆ
ainsi que toute symptomatologie pharyngee (mal de gorge). Ces ´ ´
il n’y a pas eu de difference significative en ce qui concerne le delai ´
´ ´ ´
donnees etaient relevees par une infirmiere n’ayant pas connais- ` du premier regonflage en raison d’une pression dans le ballonnet
´
sance du produit utilise pour le remplissage du ballonnet, en salle ´ ` ´
inferieure a 15 cmH2O (ou equivalant) entre les trois groupes.
de soins post-interventionnelle. La presence d’une sonde nasogas- ´ ´
Nous n’avons pas mis en evidence de difference significative ´
´ ´
trique etait egalement notee. ´ entre les trois groupes pour la survenue d’une symptomatologie
´ ´
L’analyse statistique a ete effectuee en collaboration avec le ´ ´ ´
pharyngee ou laryngee (Fig. 2). Le pourcentage global de
´
service d’information medicale du CHU de Montpellier a l’aide ` ´
symptomatologie pharyngee pour les trois groupes etait de ´
du logiciel SAS, version 8.02 (SAS Institute INC, Cary, Etats-Unis). ´ ´
8,9 %. La symptomatologie laryngee se divisait en voie rauque
´
Le nombre de sujet necessaire a ete evalue grace a une analyse ´ ´ ´ ´ ˆ ` pour 12,2 % des enfants, une toux et une voie rauque dans 4,4 % des
´
preliminaire descriptive. Le pourcentage de degonflage retrouve ´ ´ cas et une toux seule dans 1,1 % des cas, soit 17,7 % de
´
etait de 50 % dans le groupe air et de 10 % dans le groupe ´
symptomatologie laryngee pour l’ensemble des trois groupes.
´ ´
melange equimolaire O2–N2O. Pour un risque a = 0,05 et une L’incidence globale des symptomatologies pharyngee et laryngee ´ ´
puissance b = 0,8, le nombre de sujet a ete estime a 20 par ´ ´ ´ ` ´
etait de 13,3 %.
groupe. Du fait de la correction de Bonferroni necessaire pour la ´
comparaison de trois groupes, nous avons majore le nombre de ´ 4. Discussion
`
sujet a 30 par groupe. Le nombre total de sujets necessaires est ´
´ `
fixe a 90 patients. La normalite des donnees a ete analysee. ´ ´ ´ ´ ´ L’utilisation de SSI pour gonfler les ballonnets des sondes
L’analyse des variables qualitatives a ete realisee par le test du ´ ´ ´ ´ ´ ´ ´
endotracheales en anesthesie pediatrique permet un nombre de
Chi2 ou le test exact de Fisher lorsque les effectifs etaient trop ´ ´
regonflage ou de degonflage significativement plus faible que lors
faibles pour remplir les conditions de validite du Chi2. La ´ ´ `
de l’utilisation d’air ou d’un melange oxygene–protoxyde d’azote.
comparaison des variables quantitatives entre les trois groupes a ´ ´
Cela temoigne d’une plus grande stabilite de la pression dans le
´ ´ ´ ´ `
ete realisee a l’aide d’une Anova ou du test Kruskal-Wallis du fait ballonnet de la sonde d’intubation. L’utilisation d’air pour remplir
de faibles effectifs et/ou de la distribution non gaussienne des ´
le ballonnet de la sonde d’intubation chez l’enfant necessite un
´ ´
variables considerees. Quand une significativite (p 0,05) ´ ´
nombre significativement plus important de degonflages afin de
´ ´
apparaissait, les donnees etaient comparees deux a deux en ´ ` maintenir une pression entre 20 et 35 cmH2O par rapport a un `
4. 690 ´sie et de Re
C. Dadure et al. / Annales Francaises d’Anesthe
¸ ´animation 29 (2010) 687–692
Tableau 1
´ ´ ` ´
Donnees demographiques et parametres anesthesiques et chirurgicaux des patients en fonction des groupes.
Groupe air ´
Groupe melange Groupe SSI
Nombre de patients 30 30 30
ˆ
Age (an) 8,5 (0,5–15) 7,5 (0,8–15) 5 (0,2–14)
Poids (kg) 25,5 (6–58) 25,5 (8,9–80) 17,5 (7–72)
Sexe (M/F) 13/17 18/12 16/14
Score ASA (1/2/3) 23/7/0 21/7/2 22/7/1
Type de chirurgie (visc/ortho/plastique) 12/10/8 7/13/10 7/20/3
´
Duree d’intervention (min) 75 (25–135) 75 (25–240) 120 (25–340)
´ ´
Duree d’anesthesie (min) 110 (30–210) 105 (40–250) 160 (60–590)*
`
Diametre interne SB (mm)
4 3 4 7
4,5 7 5 6
5 2 3 2
5,5 4 3 4
6 4 3 6
6,5 8 7 2
7 2 5 1
7,5 0 0 2
Nombre de laryngoscopie 1 (1–2) 1 (1–3) 1 (1–3)
´
Infection VAS preexistante (nombre de patients) 3 2 1
´ ´ ´ ´
SSI : serum sale isotonique ; ASA : score de l’American Society of Anesthesiologists ; visc : chirurgie viscerale ; ortho : chirurgie orthopedique ; plastie : chirurgie plastique ;
´ ´ `
VAS : voies aeriennes superieures ; SB : sonde a ballonet.
*
´ ´ ˆ
Valeurs exprimees en nombre et en mediane (extremes), p 0,05.
[(Fig._1)TD$IG]
`
protoxyde d’azote 67 % (identique a celui de ventilation) versus SSI.
´
Leurs resultats montraient que la pression du ballonnet augmen-
´ ´
tait quand de l’air etait utilise pour gonfler le ballonnet. La pression
moyenne du ballonnet en fin d’intervention etait de 56,6 mmHg, ´
´
elle ne changeait pas avec le serum physiologique et elle diminuait
´
avec l’utilisation du melange (pression en fin d’intervention a `
` ´
13,3 mmHg). Contrairement a notre etude, les auteurs avaient
´ ´
decide de ne pas limiter ou corriger la pression dans le ballonnet. Ils
´
ont ainsi observe une variation de pression du ballonnet allant de
`
2 a 119 mmHg [16]. Dans notre population, l’utilisation d’air ou du
´
melange gazeux comme produit de gonflage entraınait, parfois de ˆ
` ´ ´ ´
manieres repetees, des augmentations ou des baisses de pression
´ ´
necessitant des degonflages ou regonflages. Dans la litterature ´
´ ´
Fig. 1. Pourcentages de patients necessitant un degonflage ou un regonflage du
´ ´ ´
adulte, l’ensemble des etudes realisees dans les memes conditions ˆ
ballonnet au moins une fois de la sonde d’intubation en fonction des groupes.
´ ´ ´
a trouve des resultats similaires excepte lors de l’utilisation de
´ ´ `
sondes equipees de systeme de rediffusion du protoxyde [17–19].
´ `
melange oxygene–protoxyde d’azote ou au SSI. L’utilisation d’un ´
Dumans et al. [20], ont montre chez l’enfant lors d’anesthesie ´
´ ` `
melange oxygene–protoxyde d’azote a 50 % necessite un nombre ´ ´ ´ ´ `
generale utilisant un melange oxygene–protoxyde d’azote a 50 % `
significativement plus important de regonflages par rapport aux que le ballonnet de la sonde d’intubation gonfle avec de l’air devait ´
deux autres groupes pour maintenir la pression du ballonnet dans ˆ ´ ´
etre degonfle au moins une fois durant l’intervention dans 70 % des
ˆ ´
le meme intervalle. Il n’y a pas de differences significatives dans ´ `
cas pour maintenir la pression inferieure a 35 cmH2O. Felten et al.
´ ´
l’incidence de lesions laryngees entre les trois groupes. Le groupe ´ ´
[7] ont egalement note que le ballonnet de sonde d’intubation
´
SSI presente toutefois une moindre incidence de troubles larynges ´ ´ ˆ
rempli d’air ambiant necessitait d’etre degonfler chez 85 % des ´
post-extubation. `
patients pour le maintenir a une pression inferieure a 25 cmH2O. ´ `
´
Mitchell et al. [16] ont compare chez l’adulte la variation de ´
L’utilisation d’un melange O2–N2O entraıne frequemment un ˆ ´
pression dans les ballonnets de sondes d’intubation en fonction de ´
degonflage du ballonnet. Karasawa et al. [21] ont evalue la ´ ´
[(Fig._2)TD$IG]
trois produits de gonflage : air versus melange oxygene 33 %– ´ ` ´
variation de pression en fonction de differentes concentrations de
protoxyde d’azote dans le ballonnet, lors de ventilation en
`
protoxyde d’azote 67 %–oxygene 33 %. L’utilisation d’un melange ´
`
dans le ballonnet identique a celui de ventilation entraınait une ˆ
diminution de la pression dans le ballonnet et des fuites etaient ´
´
presentes et audibles autour de certains ballonnets. Ces resultats ´
´
sont en accord avec ceux retrouves dans notre etude. Pour ´
Karasawa et al. [21], la pression restait stable lors de l’utilisation
´ ` `
d’un melange a 40 et a 50 %. En revanche, un melange a 30 % ´ `
ˆ
entraınait une augmentation de pression, significativement plus
´
faible qu’avec de l’air, explique par une rediffusion du protoxyde
d’azote du ballonnet. Le protoxyde d’azote s’equilibre donc pour ´
une concentration plus basse dans le ballonnet que le melange ´
´ ´ ´
Fig. 2. Pourcentages de symptomatologie pharyngee et laryngee retrouvee en salle ˆ ˆ
gazeux. De meme, lors de l’arret du protoxyde d’azote, celui-ci
`
de surveillance post-interventionnelle (SSPI) (deux heures apres extubation) en rediffuse en fonction du gradient de concentration, entraınant un ˆ
fonction des trois groupes. ´ ´
degonflage du ballonnet [22]. Le melange oxygene–protoxyde `
5. ´sie et de Re
C. Dadure et al. / Annales Francaises d’Anesthe
¸ ´animation 29 (2010) 687–692 691
ˆ
d’azote ne semble pas etre une technique fiable pour gonfler le `
L’utilisation de sonde a ballonnet a fait la preuve de son
´
ballonnet car les resultats obtenus selon les concentrations ´ ˆ ´ ´ ´
innocuite et leur utilisation peut etre generalisee quelle que soit
`
semblent tres variables et differents selon les etudes ´ ´ ˆ ´
l’age du patient [30]. Le monitorage systematique de la pression
´
[14,16,21,22]. Dans notre etude, la pression diminue de fac ¸on ´ `
des ballonnets gonfles a l’air chez l’enfant est indispensable lors de
´
importante durant toute la duree de l’anesthesie avec des pressions ´ l’utilisation du protoxyde d’azote durant l’anesthesie afin de ´
` ´
tres basses qui necessitaient un pourcentage important de ´ ´ `
limiter la survenue de lesions tracheales dues a une augmentation
regonflages. La baisse excessive des pressions pourrait permettre de pression dans le ballonnet. Ce monitorage se revele trop ´ `
´
ou majorer des fuites et, par consequent, entraıner une desadapta- ˆ ´ ´ ´ ´ ´
imprevisible s’il est realise uniquement par l’evaluation de la
` ˆ ´
tion a la ventilation controlee, une impossibilite d’utiliser de faibles ´ ´
palpation manuelle du ballonnet [7] et necessite l’utilisation d’un
´
debits de gaz frais et un risque d’inhalation en cas de regurgitation ´ ´ ´ ´ `
materiel adapte. L’utilisation d’un melange oxygene–protoxyde
[1,3,4]. ˆ ˆ
d’azote ne semble pas etre une technique sure et fiable chez
´
Les etudes utilisant le SSI comme produit de gonflage du l’enfant et ne dispense pas du monitorage de la pression du
´
ballonnet retrouvent des resultats comparables aux notres ˆ ballonnet. En ce qui concerne le SSI, son utilisation en pratique
[9,10,16,23]. Combes et al. [9] ont compare la variation de pression ´ ˆ ´
clinique quotidienne ne peut pas etre recommandee du fait de son
lors de l’utilisation de SSI ou d’air et etudie les lesions tracheales ´ ´ ´ ´ ´
monitorage peu aise et de la non-conformite des sondes ´
`
par fibroscopie a l’extubation chez l’adulte. La pression etait ´ `
d’intubation a l’utilisation du SSI pour le gonflage du ballonnet.
significativement plus stable dans le groupe SSI et les lesions ´ Cependant, le SSI est le seul produit de gonflage qui permet de
´
tracheales et les symptomatologies pharyngolaryngees etaient ´ ´ maintenir une pression stable et de limiter l’incidence de troubles
´
egalement plus faibles dans ce groupe. Le SSI est le seul produit de ´ ´
larynges. L’utilisation d’air avec un monitorage systematique de la
gonflage qui permet d’obtenir une pression stable. Cependant, les ´
pression represente la technique la plus simple d’utilisation chez
´
materiaux des ballonnets ne sont pas conc pour etre utilises avec ¸us ˆ ´ l’enfant.
ˆ ´ ´
du SSI. Meme si les etudes realisees chez l’adulte montrent une ´
´ ´
diminution des lesions tracheales [9], l’utilisation de SSI en
´ ˆ
Conflit d’interet
pratique quotidienne ne peut etre recommandee chez l’enfant.ˆ ´
La seule recommandation par les concepteurs de sonde d’utiliser
Aucun.
´ `
du SSI est limitee a la chirurgie au laser du larynx. Les sondes de
type Laser Flex (Mallinckrodt Athlone, Ireland) sont conc ¸ues avec
ˆ
deux ballonnets qui doivent etre remplis avec du SSI. Dans notre ´ ´
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´
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´
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