ライフサイエンスコーパス: endotracheal

1 A single endotracheal administration of AAV[2/5]cytomegalovirus (

2 t communication of results for malpositioned endotracheal and enteric tubes (2010, 58.56%; 2011, 57.5

3 ateral exploration of the neck under general endotracheal anesthesia.

4 which is usually accomplished under general endotracheal anesthesia.

5 Sputum (96%) or endotracheal aspirate (4%) specimens were cultured as pe

6 TTR for bronchoalveolar lavage (BAL) and endotracheal aspirate (ETA) specimens from hospitalized

7 tients with one or more Aspergillus-positive endotracheal aspirate cultures (n = 524).

8 58 taxa) was high between nasopharyngeal and endotracheal aspirate samples, supporting the use of nas

9 Respective mean endotracheal aspirate/serum concentration ratios were 0.

10 atic patient with from the chalet a positive endotracheal aspirate; all previous and concurrent nasop

11 ative analyses of S. aureus burden in serial endotracheal-aspirate (ETA) samples and VAT/VAP diagnosi

12 We evaluated MRSA and MSSA endotracheal aspirates (ETA) for genotype and alpha-hemo

13 KB001 was detected in endotracheal aspirates from all patients receiving it, a

14 A PCR assay was used to analyze endotracheal aspirates from preterm infants for Ureaplas

15 btained paired nasopharyngeal swabs and deep endotracheal aspirates from these participants (the so-c

16 y rates of Gram-negative bacilli from stored endotracheal aspirates frozen with and without glycerol.

17 e clinical relevance of Aspergillus-positive endotracheal aspirates in critically ill patients is dif

18 We analyzed bacterial diversity in endotracheal aspirates obtained from intubated patients

19 d on nucleic acids extracted from sequential endotracheal aspirates obtained from preterm neonates bo

20 Daily P. aeruginosa quantification of endotracheal aspirates was performed; clinical signs of

21 s of virus recovered in nasal secretions and endotracheal aspirates were highly correlated.

22 l cultures of rectal/fecal swabs, urine, and endotracheal aspirates were performed on admission to th

23 Daily surveillance cultures of endotracheal aspirates were performed on patients intuba

24 tes of potentially pathogenic organisms from endotracheal aspirates when stored with glycerol, thus b

25 Tests that were explored included endotracheal aspirates, bronchoscopy with protected brus

26 ate, representing a 28% (15/54) increase for endotracheal aspirates/sputa and a 15% increase for supe

27 (> or = 1,000,000 colony-forming units/mL in endotracheal aspirates; > or = 10,000 colony-forming uni

28 f pulmonary fibrosis in such chimera mice by endotracheal bleomycin (BLM) injection caused large numb

29 When treated with an endotracheal bleomycin injection, C/EBPbeta CKO mice sho

30 gned to receive surfactant either via a thin endotracheal catheter during CPAP-assisted spontaneous b

31 Endotracheal delivery of AAV[2/1]CMV-TNFR:Fc resulted in

32 for inhibiting RSV infection by mucosal and endotracheal delivery of double-stapled RSV fusion pepti

33 t model of radiation-induced lung injury via endotracheal (ET) or intravascular (IV) administration.

34 ia was observed when curcumin-functionalized endotracheal (ETT-curc) was used.

35 Endotracheal extubation should be performed without caus

36 te intervention for patients who have failed endotracheal extubation.

37 myofibroblast differentiation in response to endotracheal injection of bleomycin.

38 reated with either estradiol or vehicle plus endotracheal injections of either saline or bleomycin.

39 ry fibrosis, male and female rats were given endotracheal injections of either saline or bleomycin.

40 with lipopolysaccharide (LPS) or vehicle via endotracheal injections.

41 optosis in the lungs of mice within hours of endotracheal instillation followed by inflammation and f

42 ey rats to 100% oxygen for 48 or 60 h before endotracheal instillation of either 1 x 10(9) or 4 x 10(

43 groups were similar with respect to need for endotracheal intubation (14.1% of subjects with intramus

44 ertainty) were associated with lower risk of endotracheal intubation (25 studies [3804 patients]).

45 However, the observed success rates of endotracheal intubation (55.4% vs. 54.9%, p = 0.953) and

46 2, 1.2-4.2), as was the proportion requiring endotracheal intubation (66 of 439 for chlorpyrifos, 15.

47 e survival were significantly lower both for endotracheal intubation (adjusted OR, 0.41; 95% CI, 0.37

48 e survival were significantly lower both for endotracheal intubation (adjusted OR, 0.45; 95% CI, 0.37

49 need regular clinical experience to perform endotracheal intubation (ETI) in a safe and effective ma

50 rial (n = 18) compared with those who needed endotracheal intubation (n = 12) (median [interquartile

51 irway management, including 41,972 (6%) with endotracheal intubation and 239,550 (37%) with use of su

52 understood patients' living wills regarding endotracheal intubation and cardiopulmonary rescuscitati

53 severe acute chest syndrome (ACS) requiring endotracheal intubation and erythrocytopheresis are at i

54 and more effective than administration with endotracheal intubation and mechanical ventilation; howe

55 using NPPV for patients who choose to forego endotracheal intubation and to examine the perspectives

56 Both endotracheal intubation and use of supraglottic airways

57 a videolaryngoscope in the ICU on the first endotracheal intubation attempt and intubation-related c

58 In the critically ill undergoing urgent endotracheal intubation by direct laryngoscopy, multiple

59 rrective actions taken during the process of endotracheal intubation by paramedics.

60 s, clinicians attempt to minimize the use of endotracheal intubation by the early introduction of les

61 Direct laryngoscopy and endotracheal intubation can often safely be accomplished

62 moglobin level, arterial pH, and presence of endotracheal intubation during hyperbaric treatment.

63 g (intervention group) or after conventional endotracheal intubation during mechanical ventilation (c

64 agmatic trial in which 150 adults undergoing endotracheal intubation in a medical intensive care unit

65 asma samples were collected within 24 hrs of endotracheal intubation in all patients.

66 uid and plasma were collected within 1 hr of endotracheal intubation in all patients.

67 Among patients undergoing endotracheal intubation in an out-of-hospital emergency

68 With the exception of endotracheal intubation in children, secondary safety ou

69 about the optimal preoxygenation method for endotracheal intubation in critically ill patients.

70 racheostomy is often performed for prolonged endotracheal intubation in critically ill patients.

71 mask is relatively ineffective at preventing endotracheal intubation in patients with acute respirato

72 otension, cardiopulmonary resuscitation, and endotracheal intubation in the catheterization laborator

73 In search for safer approach to endotracheal intubation in this cohort of patients, we e

74 In those that have evaluated the use of endotracheal intubation in this setting, safety issues,

75 NPPV in patients who have decided to forego endotracheal intubation is controversial.

76 Endotracheal intubation is delayed, excessive ventilatio

77 Recognizing patients in whom endotracheal intubation is likely to be difficult can he

78 pediatric ALI/ARDS can be identified before endotracheal intubation is required.

79 at the main determinants of hypoxemia during endotracheal intubation may be related to critical illne

80 Neither endotracheal intubation nor seizure occurred in any grou

81 ort routine use of apneic oxygenation during endotracheal intubation of critically ill adults.

82 Hypoxemia is common during endotracheal intubation of critically ill patients and m

83 ase lowest arterial oxygen saturation during endotracheal intubation of critically ill patients compa

84 hanical or cardiopulmonary resuscitation, or endotracheal intubation on the day of the IR procedure.

85 ence was noted in the complication rates for endotracheal intubation or central venous catheterizatio

86 the 3 centers, there were no cases requiring endotracheal intubation or resulting in death, neurologi

87 ation of invasive mechanical ventilation via endotracheal intubation or tracheotomy.

88 r whether advanced airway management such as endotracheal intubation or use of supraglottic airway de

89 the first-attempt success rate during urgent endotracheal intubation performed by pulmonary and criti

90 Alternatives to endotracheal intubation show some promise in preventing

91 Endotracheal intubation success rates in the prehospital

92 In group 2 aortic patients, endotracheal intubation time was 13 hours shorter and su

93 nderwent tracheostomy, the average time from endotracheal intubation to tracheostomy was 19.7 days +/

94 A secondary outcome was endotracheal intubation up to 30 days.

95 After induction of anesthesia, endotracheal intubation was followed by mechanical venti

96 Endotracheal intubation was successful on the first atte

97 Minimal pulse oximetry value during endotracheal intubation was the primary endpoint.

98 Patients undergoing urgent endotracheal intubation were randomized to Glidescope vi

99 n of the 371 critically ill adults requiring endotracheal intubation who were included in the MACMAN

100 hypoxemic respiratory failure who underwent endotracheal intubation with a novel technique combining

101 iteria were age >/=18 years, aneurysmal SAH, endotracheal intubation with mechanical ventilation, and

102 69 years; 272 men [71.6%]; 379 [99.7%] with endotracheal intubation) completed the study.

103 versus attempting an advanced airway such as endotracheal intubation) in patients with out-of-hospita

104 am providing advanced care such as drugs and endotracheal intubation) was collected.

105 ag-mask ventilation, supraglottic airway, or endotracheal intubation), the training and retraining re

106 patients and families have decided to forego endotracheal intubation, and 3) NPPV as a palliative mea

107 biotic exposure, presence of a central line, endotracheal intubation, and prior fungal colonization r

108 y develop acute respiratory failure, require endotracheal intubation, and survive to be extubated are

109 roving to be a well-tolerated alternative to endotracheal intubation, in particular in those patients

110 lation, today best applied with sedation and endotracheal intubation, might be considered a prophylac

111 predicting a higher likelihood of difficult endotracheal intubation, no clinical finding reliably ex

112 e first serious asthma-related event (death, endotracheal intubation, or hospitalization), as assesse

113 e first serious asthma-related event (death, endotracheal intubation, or hospitalization).

114 y department diagnosis of organ dysfunction, endotracheal intubation, or systolic blood pressure less

115 single-dose etomidate (H0) for facilitating endotracheal intubation, patients without septic shock w

116 Secondary outcomes included endotracheal intubation, recurrent seizures, and timing

117 reatening hypotension or cardiac arrhythmia, endotracheal intubation, seizure recurrence, and death.

118 developed severe episodes of ACS, leading to endotracheal intubation, ventilatory support for respira

119 In critically ill adults undergoing endotracheal intubation, video laryngoscopy improves glo

120 prehospital airway management, specifically endotracheal intubation, will be discussed.

121 ry is a recognized complication of prolonged endotracheal intubation, yet little attention has been p

122 formed on pigs under general anesthesia with endotracheal intubation.

123 Regional anesthesia is preferred to endotracheal intubation.

124 were severe metabolic acidosis and need for endotracheal intubation.

125 y administration of epinephrine, and delayed endotracheal intubation.

126 r patients and families who choose to forego endotracheal intubation.

127 se of NPPV for patients who choose to forego endotracheal intubation.

128 rd against hypoxemia during laryngoscopy and endotracheal intubation.

129 ion devices and pulse oximetry values during endotracheal intubation.

130 e together with mechanical ventilation after endotracheal intubation.

131 the most common serious adverse event during endotracheal intubation.

132 nce in patients with marked hypoxemia before endotracheal intubation.

133 Laryngoscopy following endotracheal intubation.

134 edures and requiring general anesthesia with endotracheal intubation.

135 deterioration and death during or soon after endotracheal intubation.

136 function undergoing general anesthesia with endotracheal intubation.

137 s with acute lung injury before the need for endotracheal intubation.

138 was the proportion of patients who required endotracheal intubation.

139 induction and 2 minutes after completion of endotracheal intubation.

140 direct laryngoscopy for the first attempt at endotracheal intubation.

141 uperior to direct laryngoscopy during urgent endotracheal intubation.

142 xposure to postnatal steroids, and prolonged endotracheal intubation.

143 -compromising sequelae in neonates following endotracheal intubation.

144 ry endpoint was the cumulative prevalence of endotracheal intubation.

145 5 minutes [7.0-20.0], P=0.001), led to fewer endotracheal intubations (52% versus 85%, P<0.001), and

146 Consecutive endotracheal intubations in critically ill patients.

147 omplications were available in all patients: endotracheal intubations, permanent neurologic injuries,

148 Endotracheal intubations, permanent neurologic injuries,

149 We enrolled 202 consecutive endotracheal intubations.

150 lar leak and pulmonary edema formation after endotracheal LPS, and increased vascular leak and mortal

151 ice were tested for lung vascular leak after endotracheal LPS, and systemic vascular leak and mortali

152 xperimental ARDS induced by a single dose of endotracheal LPS.

153 need for positive pressure ventilation by an endotracheal or tracheal tube, a PaO2:FiO2 less than 200

154 Aortic, right atrial, endotracheal pressure, intracranial pressure, and end-ti

155 cted the gas exchange alterations induced by endotracheal suction, high levels of PEEP can help to av

156 leaks, performing lung recruiting maneuvers, endotracheal suctioning, and monitoring ventilator param

157 ements of functional residual capacity after endotracheal suctioning, patients profiting from a conse

158 ALI/ARDS based on pediatric studies include endotracheal surfactant, high-frequency oscillatory vent

159 egatively associated with the presence of an endotracheal tube (adjusted odds ratio, 0.13; 95% CI, 0.

160 ssure changes in a saline filled cuff of the endotracheal tube (Delta15 +/- 2 mm Hg).

161 gery, specifically the use of a double-lumen endotracheal tube (DLT); a few centers use carbon dioxid

162 The endotracheal tube (ETT) is a medical device placed in th

163 tients with confirmed acute occlusion of the endotracheal tube (ETT), acute elevation in peak airway

164 p were kept prone, intubated with a standard endotracheal tube (ETT), and mechanically ventilated for

165 Touching the endotracheal tube (OR, 1.75; 95% CI, 1.38, 2.19), beddin

166 Mechanical ventilation via an endotracheal tube and delirium are important predictors

167 Presence of an endotracheal tube and delirium were negatively associate

168 The horizontal orientation of the endotracheal tube and neck, through lateral body rotatio

169 athing (work to spontaneously inhale through endotracheal tube and ventilator circuit), work by venti

170 y surgery fires due to laser ignition of the endotracheal tube and/or its contents.

171 100B high-frequency ventilator and an 8.0-mm endotracheal tube attached to a 48.9-L plethysmograph.

172 Systemic treatment with linezolid limits endotracheal tube biofilm development and methicillin-re

173 At approximately 7 mins following endotracheal tube clamping, ventricular fibrillation was

174 s a safe, feasible, and efficient device for endotracheal tube cleaning in the clinical setting.

175 The Mucus Shaver is helpful in preventing endotracheal tube colonization by potentially harmful mi

176 Pathologic evaluation of the removed endotracheal tube contents from one of our patients demo

177 sure amplitude, frequency, and the use of an endotracheal tube cuff leak, and to maintain oxygenation

178 Endotracheal tube cuff leaks promote egress of tracheal

179 tidal volume, distal pressure transmission, endotracheal tube cuff leaks, and simulated clinical con

180 procedures relevant to HFOV include setting endotracheal tube cuff leaks, performing lung recruiting

181 Impact of endotracheal tube cuff material and shape on tracheal se

182 otracheal tube or was lodged at the inflated endotracheal tube cuff.

183 n and constantly accumulated at the inflated endotracheal tube cuff.

184 4), or spherical (n = 22) polyvinyl chloride endotracheal tube cuffs.

185 ude transmission is directly correlated with endotracheal tube diameter and peripheral airway resista

186 initiating mechanical ventilation through an endotracheal tube during a 12-wk interval formed the stu

187 anically ventilated for 4 hrs, with head and endotracheal tube elevated 30 degrees from horizontal.

188 (n = 6) received nebulized saline through an endotracheal tube every 4 hrs for 48 hrs.

189 Unplanned endotracheal tube extubation occurred at a rate of 0.82

190 equiring invasive mechanical ventilation via endotracheal tube for acute respiratory failure.

191 an ICU, and mechanically ventilated with an endotracheal tube for longer than 48 hours were enrolled

192 At extubation, only one endotracheal tube from the Mucus Shaver group was coloni

193 An endotracheal tube greater than size 7.0, diabetes, and l

194 Patients receiving a silver-coated endotracheal tube had a statistically significant reduct

195 A silver-coated endotracheal tube has been designed to reduce VAP incide

196 nically ventilated for 72 hrs, with neck and endotracheal tube horizontal.

197 evaluated a new device designed to clean the endotracheal tube in mechanically ventilated patients, t

198 In patients with an endotracheal tube in place, there were a total of 593 ac

199 However, endotracheal tube insertion may be problematic, and vari

200 lung compliance (10, 30, and 50 mL/cm H2O), endotracheal tube internal diameter (6, 7, and 8 mm), bi

201 Decreasing endotracheal tube internal diameter from 8 mm to 7 mm an

202 Test lung findings suggest that endotracheal tube internal diameter is also an important

203 Endotracheal tube intraluminal volume loss is common amo

204 he "Rusch" intubation stylet is used to make endotracheal tube intubation easy.

205 Obstructed endotracheal tube is indicated if R(1) increased > or =3

206 piratory flow demands and degrees of partial endotracheal tube occlusion (25%, 50%, and 75%) were stu

207 During endotracheal tube occlusion with a conventionally contro

208 Y-piece [PY] used as control signal) during endotracheal tube occlusion.

209 ing spontaneous inspiratory flow demands and endotracheal tube occlusion.

210 ressure ventilation; the need to replace the endotracheal tube on admission to the PICU; and the use

211 n be achieved with the use of a double-lumen endotracheal tube or an independent bronchial blocker.

212 absolute lung separation with a double-lumen endotracheal tube or the use of a bronchial blocker in a

213 95% CI, 2.07-33.63] and interacting with the endotracheal tube or tracheotomy site [odds ratio, 5.15;

214 the endotracheal tube, it either entered the endotracheal tube or was lodged at the inflated endotrac

215 blish an airway is by placing a single-lumen endotracheal tube orally or nasotracheally while the pat

216 t from below the vocal cords, usually during endotracheal tube placement.

217 llation, <=2 minutes; device confirmation of endotracheal tube placement; and a monitored/witnessed a

218 At present, the relationship of twitch endotracheal tube pressure to transdiaphragmatic pressur

219 etween twitch esophageal pressure and twitch endotracheal tube pressure was 0.02 cm H2O.

220 Unintentional endotracheal tube removal occurred in 10 of 214 (4.7%) v

221 We prospectively analyzed 70 endotracheal tube samples.

222 The percentage difference in the endotracheal tube segment volumes increased significantl

223 The endotracheal tube segment volumes were statistically sma

224 The average percentage difference in endotracheal tube segment volumes, between the unused en

225 The minimum diameter of the endotracheal tube segments was also statistically smalle

226 to measure the intraluminal volume of 13-cm endotracheal tube segments.

227 The area adjacent to the endotracheal tube showed the same degree of damage in bo

228 with administration of perflubron through an endotracheal tube sideport or conventional mechanical ve

229 In a multivariable analysis, endotracheal tube size (<= 7.5 vs >= 8.0) was significan

230 ently associated diabetes, body habitus, and endotracheal tube size greater than 7.0 with the develop

231 Larger endotracheal tube size was associated with increased ris

232 Endotracheal tube size was independently selected by the

233 thin 2 hrs of intubation to receive standard endotracheal tube suctioning treatment or standard sucti

234 were reintubated with a Univent single lumen endotracheal tube that incorporates an internal catheter

235 The Mucus Shaver is advanced to the distal endotracheal tube tip, inflated, and subsequently withdr

236 The silver-coated endotracheal tube was associated with delayed occurrence

237 At extubation, each endotracheal tube was removed, cultured, and analyzed by

238 at an amplitude of 80 cm H2O) when a 3.5-mm endotracheal tube was used; however, gas flow was attenu

239 Distal and medial hemisections of the endotracheal tube were assessed to quantify methicillin-

240 ted patients and only 8% of patients with an endotracheal tube were mobilized out of bed as part of r

241 ternative technique is to use a double-lumen endotracheal tube while using an airway catheter exchang

242 to the lungs of anesthetized rats through an endotracheal tube, and a series of square-wave pulses we

243 ormedics 3100B high-frequency ventilator, an endotracheal tube, and a test lung, tidal volume was mea

244 illin-resistant S. aureus strain AW7 via the endotracheal tube, extubated, and then monitored for 96

245 When mucus reached the endotracheal tube, it either entered the endotracheal tu

246 During an obstructed endotracheal tube, model parameters change such that the

247 rom the trachea contiguous to the tip of the endotracheal tube, the distal trachea, the carina, and t

248 hen the model is used to diagnose obstructed endotracheal tube, the method has a sensitivity of 90% a

249 Among patients with an endotracheal tube, tracheostomy, and noninvasive ventila

250 d and C(1) decreased with partial obstructed endotracheal tube, whereas R(1) increased and L and C(2)

251 by the use of a catheter passed through the endotracheal tube.

252 secretions from the interior surface of the endotracheal tube.

253 using a bronchial blocker or a double-lumen endotracheal tube.

254 stylet end positioned within the tip of the endotracheal tube.

255 as been used to confirm the placement of the endotracheal tube.

256 ed in ten dogs by partially constricting the endotracheal tube.

257 The model was applied to diagnose obstructed endotracheal tube.

258 a face mask that prevented rebreathing or by endotracheal tube.

259 ry to generate an audible airleak around the endotracheal tube.

260 re made directly into the trachea through an endotracheal tube.

261 days mostly (n = 432; 56%) ventilated via an endotracheal tube.

262 ontaminated pharyngeal secretions around the endotracheal tube.

263 modality can be utilized for confirmation of endotracheal tube.Recent interest in axillary vein cannu

264 ificant iatrogenic withdrawal, and unplanned endotracheal tube/invasive line removal were not signifi

265 ymorphism analysis of virus isolated from an endotracheal-tube aspirate and from bronchoalveolar lava

266 d (1.98+/-1.68) in comparison with untreated endotracheal tubes (3.72+/-2.20, p=.045) or those treate

267 tubes used in patients compared with unused endotracheal tubes (5.4 +/- 0.7 vs. 6.0 +/- 0.6 mL, p <.

268 es used in patients compared with the unused endotracheal tubes (7.5 +/- 0.4 vs. 6.7 +/- 1.2 mm, p <.

269 In patients intubated with endotracheal tubes (ETTs), suctioning is routinely perfo

270 ic UAO, stratified by cuffed versus uncuffed endotracheal tubes (ETTs).

271 Double-lumen endotracheal tubes and bronchial blockers have been foun

272 Double-lumen endotracheal tubes and bronchial blockers should be part

273 s a clinical comparison between double-lumen endotracheal tubes and bronchial blockers to determine w

274 lung isolation devices, namely double-lumen endotracheal tubes and bronchial blockers.

275 eal tube segment volumes, between the unused endotracheal tubes and the endotracheal tubes used in pa

276 se of prophylactic probiotics and subglottic endotracheal tubes are cost-effective for preventing VAP

277 k bacterial deposits were present on all the endotracheal tubes from the control group (p < .001 by F

278 n microscopy showed little secretions on the endotracheal tubes from the study group, whereas thick b

279 Animal studies using small (<4 mm) endotracheal tubes have shown reduced histopathologic ev

280 Using smaller endotracheal tubes may reduce the risk of postextubation

281 No preferred strategies included silver endotracheal tubes or selective gut decontamination.

282 ly decreases the time to recognize misplaced endotracheal tubes placed during resuscitation, their us

283 and the lowest bacterial burden was found in endotracheal tubes treated with linezolid (1.98+/-1.68)

284 egments was also statistically smaller among endotracheal tubes used in patients compared with the un

285 ent volumes were statistically smaller among endotracheal tubes used in patients compared with unused

286 etween the unused endotracheal tubes and the endotracheal tubes used in patients, was 9.8% (range, 0-

287 colonized, whereas in the control group ten endotracheal tubes were colonized (8% vs. 83%; p < .001)

288 The endotracheal tubes were obtained from a previous randomi

289 Endotracheal tubes were obtained from pigs either untrea

290 ted at amplitudes of >40 cm H2O when smaller endotracheal tubes were used.

291 most common infections in patients requiring endotracheal tubes with mechanical ventilation.

292 Current guidelines recommend endotracheal tubes with subglottic secretion drainage to

293 tion, lung secretion drainage, silver-coated endotracheal tubes) or oropharyngeal prophylactic method

294 tiple etiologies, including local effects of endotracheal tubes, neuromuscular weakness, and an alter

295 vation, use of subglottic secretion drainage endotracheal tubes, oral care, chlorhexidine mouth care,

296 ital perspective included subglottic suction endotracheal tubes, probiotics, and the Institute for He

297 bation with 1 of 2 high-volume, low-pressure endotracheal tubes, similar except for a silver coating

298 are coisolated from infections of catheters, endotracheal tubes, skin, eyes, and the respiratory trac

299 mall for commercially available double-lumen endotracheal tubes.

300 lling plastic devices, such as catheters and endotracheal tubing.