Correspondence / American Journal of Emergency Medicine 35 (2017) 171-190

patients with infectious diseases [7,8]. In the present study, the percentage of comorbidities was similar in the geriatric and nongeriatric groups (87% vs 82%, P = .411). This similarity eliminated the effect of comorbidities on outcomes in patients with PD peritonitis. Therefore, age may play a limited role in PD peritonitis if the effect of comorbidities has been omitted.

Studies conducted in Japan and France have suggested that PD is a practical renal replacement therapy and can be safely operated by patients, their family, and health care workers [6,9]. The present results reveal that advanced age exerts minimal effects on the outcomes of PD peritonitis in patients with ESRD with comorbid PD. This finding supports the suggestion that PD is a safe renal replacement therapy for elderly patients.

Ching-Chun Wang, MD Chang-Chih Tsai, MD

Emergency Department, Chi Mei Medical Center, Tainan, Taiwan

177

Chien-Chin Hsu, MD, PhD Emergency Department, Chi Mei Medical Center, Tainan, Taiwan Department of Biotechnology, Southern Tainan University of Technology

Tainan, Taiwan

Kuo-Tai Chen, MD Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan Corresponding author: Emergency Department, Chi Mei

Medical Center, 901 Chung-Hwa Road, Yung Kang, Tainan 710 Taiwan. Tel.: +886 6 2812811×57196; fax: +886 6 2816161

E-mail address: [email protected] http://dx.doi.org/10.1016/j.ajem.2016.10.013

References

1. Kim H, An JN, Kim DK, Kim MH, Kim H, Kim YL, et al. Elderly peritoneal dialysis compared with elderly hemodialysis patients and younger peritoneal dialysis patients: competing risk analysis of a Korean prospective cohort study. PLoS One 2015;10:e0131393.
2. Lim WH, Dogra GK, McDonald SP, Brown FG, Johnson DW. Compared with younger peritoneal dialysis patients, elderly patients have similar peritonitis-free survival and lower risk of technique failure, but higher risk of peritonitis-related mortality. Perit Dial Int 2011;31:663-71.
3. Troidle L, Gorban-Brennan N, Kliger A, Finkelstein FO. Continuous peritoneal dialysis- associated peritonitis: a review and current concepts. Semin Dial 2003;16:428-37.
4. Piraino B, Bailie GR, Bernardini J, Boeschoten E, Gupta A, Holmes C, et al. Peritoneal dialysis-related infections recommendations: 2005 update. Perit Dial Int 2005;25:107-31.
5. Troidle L, Finkelstein F. Treatment and outcome of CPD-associated peritonitis. Ann Clin Microbiol Antimicrob 2006;5:6.
6. Hiramatsu M. How to improve survival in geriatric peritoneal dialysis patients. Perit Dial Int 2007;27:S185-9.
7. Lin PC, Tsai CC, Hsu CC, Chen KT. Aging and comorbidity augment disease severity and requirements for treatment resources in older adults with lower extremity skin and soft tissue infection. J Am Geriatr Soc 2016;64:1515-6.
8. Lin PC, Liao YY, Hsu CC, Vong SC, Chen KT. Comorbidities and complications influence the diagnosis and management of geriatric supraglottitis. Am J Emerg Med 2014;32:1334-8.
9. Crastrale C, Evans D, Verger C, Fabre E, Aguilera D, Ryckelynck JP, et al. Peritoneal dialysis in elderly patients: report from the French Peritoneal Dialysis Registry (RDPLF). Nephrol Dial Transplant 2010;25:255-62.

   A novel bimanual lip extraction and backward, upward, rightward pressure combination for improved laryngoscopy

   

   To the Editor,

   Airway management during emergent situations, such as cardiopul- monary resuscitation, is often performed under suboptimal conditions due to several influencing factors such as patient anatomy, severity of trauma, presence of hemorrhage, obstruction of the airway with a foreign object, position of the patient, and skills of the rescuer, as well as circumstantial factors such as the location of where airway

   Figure. The bimanual intubation assist method combining lip extraction with BURP.

   management is performed [1,2]. When performing laryngoscopy with the Macintosh laryngoscope in emergent situations, physicians mainly focus on moving the tongue with the blade and achieving a good view of the glottis [3]. During this process, the upper and lower lips can become squeezed by the lips and teeth, which can lead to soft tissue injury. We previously proposed that the lip pulling method is useful not only for preventing soft tissue injury but also for laryngoscopy [4]. Here, we propose a further improved bimanual tracheal intubation assist method for improving laryngoscopy which combines the lip extraction method with backward, upward, rightward pressure (BURP) (See Figure). During tracheal management using the lip extraction method, we noticed that we could perform the lip pulling method simultaneously with BURP to facilitate tracheal intubation [5]. Specifically, an assistant medical staff member pulls the upper and lower lips outward using their right hand, with sufficient lower lip extraction being possible using the left thumb and index finger. BURP can be performed with 3e fingers (middle, third, and fourth finger) simultaneously. As sufficient oral and pharyngeal observation is essential for rapid and definite tracheal intubation, we believe that this combination could facilitate emergent tracheal intubation in suboptimal situations. Rescuers can

   also assist with head tilting using their right hand.

   A systematic clinical evaluation of laryngoscopy and tracheal intubation efficiency with this combination method is warranted in the future.

   Declaration of interest

   The authors declare no financial interest in relation to the material described here.

   Nobuyasu Komasawa, MD, PhD? Toshiaki Minami, MD, PhD

   Department of Anesthesiology, Osaka Medical College

   *Corresponding author: Department of Anesthesiology Osaka Medical College, Daigaku-machi 2-7, Takatsuki Osaka 569-8686, Japan. Tel.: +81 72 683 2368;

   fax: +81 72 684 6552

   E-mail address: [email protected] http://dx.doi.org/10.1016/j.ajem.2016.10.014

   References

   Komasawa N, Ueki R, Itani M, Nishi S, Kaminoh Y. Validation of Pentax-AWS Airwayscope utility for Intubation device during cardiopulmonary resuscitation on the ground. J Anesth 2010;24:582-6.