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Burton L, Bhargava V. A Scoping Review of Ultrasonographic Techniques in the Evaluation of the Pediatric Airway. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:2463-2479. [PMID: 37334895 DOI: 10.1002/jum.16283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 04/11/2023] [Accepted: 05/18/2023] [Indexed: 06/21/2023]
Abstract
Point-of-care ultrasound is making rapid advancements in pediatrics, and ultrasonographic assessment of the airway is being employed in many specialties such as the pediatric, cardiac, and neonatal intensive care units, emergency department, pulmonary clinic, and the perioperative setting. This scoping review provides a technical description of image acquisition and interpretation, accompanying ultrasound images of the hallmark airway applications in pediatrics, and supporting evidence when available. We describe and illustrate ultrasound-determined endotracheal tube (ETT) sizing, ETT placement and depth confirmation, vocal fold assessment, prediction of post-extubation stridor, difficult laryngoscopy prediction, and cricothyrotomy guidance. This review aims to provide the descriptions and images necessary to learn and apply these skills at the point of care in the pediatric patient.
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Affiliation(s)
- Luke Burton
- Department of Pediatrics, Division of Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Vidit Bhargava
- Department of Pediatrics, Division of Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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2
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Khidr AM, Masoudi J, AlAboud S, Alshahrani M, Bokhari A, Sorbello M, Zdravkovic I, Khalil MA, Al Shadowy S, Al Ghamdi T, Al'ghamdi A, Fallatah S, El Tahan MR. Endobronchial Intubation With the King Vision ® and McGrath ® Laryngoscopes in Simulated Easy and Difficult Airways by Novices (eKingMath). Semin Cardiothorac Vasc Anesth 2023; 27:181-198. [PMID: 36946142 DOI: 10.1177/10892532231163963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Objective. The competency of using video laryngoscopes (VL) for double-lumen tube (DLT) endobronchial intubations can be improved with constant training as assessed by measuring the learning curves. We hypothesized that the time to DLT intubation would be reduced over the intubation attempts. Design. A crossover manikin study. Settings. University-affiliated hospital. Participants. Forty-two novice medical students unfamiliar with DLT intubation. Interventions. Participants were randomly allocated to two sequences, including DLT intubation, using King Vision and McGrath VLs. Each participant completed 100 DLT intubation attempts on both simulated easy and difficult airways on two different mannikins using the study devices (25 attempts for each). Measurements and Main Results. The primary outcome was the time to DLT intubation. The secondary outcomes included the best glottic view, optimizing maneuvers, and intubation first-pass success. The use of King Vision VL was associated with a significantly shorter time to DLT intubation (P < 0.044 and P < 0.05, respectively) and a higher percentage of glottic opening (POGO) compared to the McGrath VL (P < 0.011 and P < 0.002, respectively) in the simulated "easy" and "difficult" over most of the intubation attempts. In the simulated "easy" airway, the first-pass success ratio was higher when using the King Vision VL (median [Minimum-Maximum] 100% [100%-100%] and 100% [88%-100%], P = 0.012). Conclusion. Novice medical students developed skills over intubation attempts, meaning achievement of a faster DLT intubation, better laryngeal exposure, and higher success rate on simulated "easy" and "difficult" airways. A median of 9 DLT intubations was required to achieve a 92% or greater DLT intubation success rate.
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Affiliation(s)
- Alaa M Khidr
- Anesthesiology Department, King Fahd Hospital of Imam Abdulrahman Bin Faisal University, Al Khobar, Saudi Arabia
| | - Jumana Masoudi
- 6th Year Medical Students, College of Medicine, Imam Abdulrahman Bin Faisal University, Al Khobar, Saudi Arabia
| | - Sarah AlAboud
- 6th Year Medical Students, College of Medicine, Imam Abdulrahman Bin Faisal University, Al Khobar, Saudi Arabia
| | - Mashael Alshahrani
- 6th Year Medical Students, College of Medicine, Imam Abdulrahman Bin Faisal University, Al Khobar, Saudi Arabia
| | - Aziza Bokhari
- 6th Year Medical Students, College of Medicine, Imam Abdulrahman Bin Faisal University, Al Khobar, Saudi Arabia
| | | | - Ivana Zdravkovic
- Anesthesia and Intensive Care, Casa di Cura Gibiino, Catania, Italy
| | - Mohamed A Khalil
- Anesthesiology Department, King Fahd Hospital of Imam Abdulrahman Bin Faisal University, Al Khobar, Saudi Arabia
| | - Saeed Al Shadowy
- Anesthesiology Department, King Fahd Hospital of Imam Abdulrahman Bin Faisal University, Al Khobar, Saudi Arabia
| | - Talal Al Ghamdi
- Anesthesiology Department, King Fahd Hospital of Imam Abdulrahman Bin Faisal University, Al Khobar, Saudi Arabia
| | - Abdulmohsen Al'ghamdi
- Anesthesiology Department, King Fahd Hospital of Imam Abdulrahman Bin Faisal University, Al Khobar, Saudi Arabia
| | - Summayah Fallatah
- Anesthesiology Department, King Fahd Hospital of Imam Abdulrahman Bin Faisal University, Al Khobar, Saudi Arabia
| | - Mohamed R El Tahan
- Anesthesiology Department, King Fahd Hospital of Imam Abdulrahman Bin Faisal University, Al Khobar, Saudi Arabia
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Liu Y, Ma W, Liu J. Applications of Airway Ultrasound for Endotracheal Intubation in Pediatric Patients: A Systematic Review. J Clin Med 2023; 12:jcm12041477. [PMID: 36836012 PMCID: PMC9961112 DOI: 10.3390/jcm12041477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/08/2023] [Accepted: 02/10/2023] [Indexed: 02/16/2023] Open
Abstract
Endotracheal intubation is a challenging procedure for pediatric patients. Airway ultrasound as a new technology is suitable for aiding this process, but its diagnostic value remains unclear. We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and the Chinese biomedical literature database to summarize specific applications of airway ultrasound in each step of endotracheal intubation in pediatric patients. Diagnostic accuracy and 95% confidence interval were used as outcomes. In total, 33 studies (6 randomized controlled trials and 27 diagnostic studies) with 1934 airway ultrasound examinations were included. Population included neonates, infants, and older children. Airway ultrasound could be used to determine the endotracheal tube size and confirm endotracheal intubation and intubation depth; the diagnostic accuracy for all these factors was 23.3-100%, 90.6-100%, and 66.7-100%, respectively. Furthermore, the accuracy of airway ultrasound in predicting endotracheal tube size was consistently higher than traditional methods, such as height formula, age formula, and the width of the little finger. In conclusion, airway ultrasound has unique advantages for confirming successful endotracheal intubation in pediatric patients, and it may become an effective auxiliary tool in this field. There is a need to develop a unified airway ultrasound protocol to conduct clinical trials and practice in the future.
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Affiliation(s)
- Yijun Liu
- Department of Anaesthesiology, West China Hospital, Sichuan University, Chengdu 610041, China
- The Research Units of West China (2018RU012)-Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Wei Ma
- Department of Anaesthesiology, West China Hospital, Sichuan University, Chengdu 610041, China
- The Research Units of West China (2018RU012)-Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jin Liu
- Department of Anaesthesiology, West China Hospital, Sichuan University, Chengdu 610041, China
- The Research Units of West China (2018RU012)-Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu 610041, China
- Correspondence:
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Xie F, Zhang Q, Liu S, Yan L, Zhou Y, Sun J. Learning curve of a robotic-assisted bronchoscopy system in sampling peripheral pulmonary nodules. Chin Med J (Engl) 2022; 135:2753-2755. [PMID: 36574242 PMCID: PMC9943830 DOI: 10.1097/cm9.0000000000002304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Indexed: 12/29/2022] Open
Affiliation(s)
- Fangfang Xie
- Department of Respiratory Endoscopy, Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200030, China
- Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai 200030, China
| | - Qin Zhang
- Department of Respiratory Endoscopy, Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200030, China
- Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai 200030, China
| | - Shuaiyang Liu
- Department of Respiratory Endoscopy, Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200030, China
- Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai 200030, China
| | - Lijun Yan
- Department of Respiratory Endoscopy, Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200030, China
- Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai 200030, China
| | - Yongzheng Zhou
- Department of Respiratory Endoscopy, Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200030, China
- Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai 200030, China
| | - Jiayuan Sun
- Department of Respiratory Endoscopy, Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200030, China
- Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai 200030, China
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Xia M, Xu T, Cao S, Jin C, Pei B, Jiang H. A learning curve of a novel multimodal endotracheal intubation assistant device for novices in a simulated airway: a prospective manikin trial with cumulative sum method. Transl Pediatr 2022; 11:1389-1397. [PMID: 36072535 PMCID: PMC9442200 DOI: 10.21037/tp-22-405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 08/23/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Awake fiberoptic intubation is conventionally performed in anticipated difficult airways. However, obstruction by secretions and sputum makes it challenging for novices. A prototype of a novel multimodal endotracheal intubation assistant device (MEIAD) was developed for an indication of airway according to end-tidal carbon dioxide (ETCO2) and image. At the tip, 4 sampling tubes collected ETCO2 concentration. The airway direction is located according to an advanced algorithm based on 4 directions' concentrations. It assists awake intubation, especially with unclear view field. The objective was to analyze the learning curve of MEIAD for novices on a manikin by cumulative sum method (CUSUM) and evaluate the utility. METHODS A total of 16 novice residents with less than 2-year clinical experience were enrolled. After instruction, each individual exercised 40 insertions with MEIAD on a difficult airway simulation. Insertion success (defined as a visualization of the carina within 120 seconds), insertion time (the time from when the guiding scope entered the nasal cavity to the carina was visible), and self-confidence score (subjective score with a numerical rating scale from 0 to 10) were recorded. The acceptable and unacceptable failure rates of CUSUM were set as 15% and 30%, respectively. The exercises were divided into 2 phases (phase 1: 1-20, phase 2: 21-40) for further evaluation. All continuous data were expressed by median (IQR, interquartile ranges) and analyzed using Mann-Whitney test. All categorical variables were expressed as percentages and compared by the χ2 test. RESULTS Among the 16 residents, 15 were able to cross the lower decision boundary in an average of 21.27±9.51 attempts using the novel device. The insertion time [24.0 (17.0-42.0) vs. 17.5 (14.0-28.0) seconds, P<0.001] and success rate (88.4% vs. 97.5%, P<0.001) were improved with increased experience. The confidence score was significantly improved from 2.5 (1.3-4.0) to 7.0 (7.0-8.0). CONCLUSIONS MEIAD showed a satisfactory learning curve and efficacy on the manikin for novices. However, as a small exploratory manikin trial, the results cannot be replicated in clinical practice. MEIAD is expected to be further improved and potential to be an alternative device for difficult airways.
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Affiliation(s)
- Ming Xia
- Department of Anesthesiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tianyi Xu
- Department of Anesthesiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shuang Cao
- Department of Anesthesiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chenyu Jin
- Department of Anesthesiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bei Pei
- Department of Anesthesiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hong Jiang
- Department of Anesthesiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Zhou M, Xu WY, Xu S, Zang QL, Li Q, Tan L, Hu YC, Ma N, Xia JH, Liu K, Ye M, Pu FY, Chen L, Song LJ, Liu Y, Jiang L, Gu L, Zou Z. Prediction of endotracheal tube size in pediatric patients: Development and validation of machine learning models. Front Pediatr 2022; 10:970646. [PMID: 36340734 PMCID: PMC9631215 DOI: 10.3389/fped.2022.970646] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 09/28/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE We aimed to construct and validate machine learning models for endotracheal tube (ETT) size prediction in pediatric patients. METHODS Data of 990 pediatric patients underwent endotracheal intubation were retrospectively collected between November 2019 and October 2021, and separated into cuffed and uncuffed endotracheal tube subgroups. Six machine learning algorithms, including support vector regression (SVR), logistic regression (LR), random forest (RF), gradient boosting tree (GBR), decision tree (DTR) and extreme gradient boosting tree (XGBR), were selected to construct and validate models using ten-fold cross validation in training set. The optimal models were selected, and the performance were compared with traditional predictive formulas and clinicians. Furthermore, additional data of 71 pediatric patients were collected to perform external validation. RESULTS The optimal 7 uncuffed and 5 cuffed variables were screened out by feature selecting. The RF models had the best performance with minimizing prediction error for both uncuffed ETT size (MAE = 0.275 mm and RMSE = 0.349 mm) and cuffed ETT size (MAE = 0.243 mm and RMSE = 0.310 mm). The RF models were also superior in predicting power than formulas in both uncuffed and cuffed ETT size prediction. In addition, the RF models performed slightly better than senior clinicians, while they significantly outperformed junior clinicians. Based on SVR models, we proposed 3 novel linear formulas for uncuffed and cuffed ETT size respectively. CONCLUSION We have developed machine learning models with excellent performance in predicting optimal ETT size in both cuffed and uncuffed endotracheal intubation in pediatric patients, which provides powerful decision support for clinicians to select proper ETT size. Novel formulas proposed based on machine learning models also have relatively better predictive performance. These models and formulas can serve as important clinical references for clinicians, especially for performers with rare experience or in remote areas.
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Affiliation(s)
- Miao Zhou
- Department of Anesthesiology and Surgical Intensive Care Unit, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,School of Anesthesiology, Naval Medical University, Shanghai, China
| | - Wen Y Xu
- Department of Anesthesiology, Second Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Sheng Xu
- National Key Laboratory of Medical Immunology and Institute of Immunology, Naval Medical University, Shanghai, China
| | - Qing L Zang
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Qi Li
- School of Anesthesiology, Naval Medical University, Shanghai, China.,Hebei North University, Zhangjiakou, China
| | - Li Tan
- School of Anesthesiology, Naval Medical University, Shanghai, China.,Hebei North University, Zhangjiakou, China
| | - Yong C Hu
- Department of Anesthesiology, Second Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Ning Ma
- Department of Clinical Laboratory, 905th Hospital of PLA, Shanghai, China
| | - Jian H Xia
- Department of Anesthesiology, Shanghai Pudong New Area People's Hospital, Shanghai, China
| | - Kun Liu
- Department of Anesthesiology, Children's Hospital of Fudan University, Shanghai, China
| | - Min Ye
- Department of Anesthesiology, First Hospital of Nanping City Affiliated to Fujian Medical University, Nanping, China
| | - Fei Y Pu
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Liang Chen
- Department of Anesthesiology, Second Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Li J Song
- School of Anesthesiology, Naval Medical University, Shanghai, China.,Hebei North University, Zhangjiakou, China
| | - Yang Liu
- Department of Anesthesiology, Second Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Lai Jiang
- Department of Anesthesiology and Surgical Intensive Care Unit, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Lin Gu
- Research Center for Advanced Science and Technology, The University of Tokyo, Tokyo, Japan
| | - Zui Zou
- School of Anesthesiology, Naval Medical University, Shanghai, China.,Department of Anesthesiology, Second Affiliated Hospital of Naval Medical University, Shanghai, China
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Gupta B, Ahluwalia P. Prediction of endotracheal tube size in the pediatric age group by ultrasound: A systematic review and meta-analysis. J Anaesthesiol Clin Pharmacol 2022; 38:371-383. [PMID: 36505227 PMCID: PMC9728417 DOI: 10.4103/joacp.joacp_650_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 03/10/2021] [Accepted: 07/06/2021] [Indexed: 12/15/2022] Open
Abstract
Anatomical differences in the airway in pediatric patients, compared to adults pose many challenges during endotracheal intubation, such as selecting the proper sized endotracheal tube (ETT) during intubation. Our primary objective was to assess how accurate is ultrasound (US) co-relation in comparison to standard age-based formulas in pediatric patients. Meta-analysis was registered in PROSPERO 2020, CRD42020220041. Online literature available in PubMed, Cochrane, and Embase, Goggle scholar was searched from year 2000 till November 30, 2020, using relevant Mesh terms, ('airway US' OR (('airway'/exp OR airway) AND ('US'/exp OR US))) AND ('endotracheal intubation'/exp OR 'endotracheal intubation') AND ('pediatric'/exp OR pediatric)" to Predict endotracheal tube size/placement in pediatric age (neonate till 18 years) by the US. Bibliographic cross-references of selected publications were further manually screened. The full texts of each article were studied, once the abstract was found appropriate independently by two reviewers. A total of 48 papers published between 2010 and 2020 were identified as relevant and read in detail. Average numbers of patients were 86 and total numbers of patients were 1978. Most of the studies included pediatric patients posted for elective surgeries under general anesthesia and excluded emergency procedures, known laryngeal or tracheal pathology, high-risk patients, recent upper respiratory tract infections or allergy to ultrasound gel. A total of 18 independent correlations were analyzed. Final combined r value calculated from all the included articles was 0.824 (95% CI 0.677, 0.908) with a P < 0.00001 {strong co-relation (r > 0.80)}. Q statistic of 756.484, and I2 statistics of 97.53% showed a large degree of heterogeneity in the effect size across the studies. Use of US for upper airway in pediatric patients is an effective modality and can effectively predict endotracheal tube size estimations in comparison to standard age-based or height-based formulae in the pediatric age group. US is a non-invasive, cost-effective, portable, and reproducible technique as compared to CT and MRI. It also takes less time with increasing expertise and experience.
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Affiliation(s)
- Bhavna Gupta
- Assistant Professor, AIIMS, Rishikesh, Uttrakhand, India
| | - Pallavi Ahluwalia
- Department of Anaesthesia, Teerthanker Mahaveer Medical College, Moradabad, Uttar Pradesh, India,Address for correspondence: Dr. Pallavi Ahluwalia, Department of Anaesthesia, Teerthanker Mahaveer Medical College, Moradabad, Uttar Pradesh - 244 001, India. E-mail:
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Narayanasamy S, Ding L, Yang F, Gunter J, Samuels P, Mecoli M. Feasibility study of cumulative sum (CUSUM) analysis as a competency assessment tool for ultrasound-guided venous access procedures. Can J Anaesth 2021; 69:256-264. [PMID: 34755274 DOI: 10.1007/s12630-021-02149-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/28/2021] [Accepted: 09/29/2021] [Indexed: 10/19/2022] Open
Abstract
PURPOSE Typically, physician training programs use a self-reported case-log competency assessment that does not measure procedure success or objectively assess competency. Cumulative sum (CUSUM) analysis could provide objective assessments of competency and progress over the training period. Our study objective was to determine the feasibility of CUSUM analysis to assess competency of ultrasound-guided peripheral intravenous (USG-PIV) line placement in pediatric anesthesiology fellows. METHODS We applied a CUSUM analysis to assess competency in USG-PIV placement in three consecutive pediatric anesthesia fellowship classes. After a didactic and hands-on training session, fellows placed a USG-PIV line and self-reported the outcomes via a web-based application. Fellows were deemed competent if the CUSUM curve crossed two consecutive boundary lines from above. RESULTS Twenty-nine fellows reported 1,388 USG-PIV attempts, with 74% success. Most fellows (26/29; 90%) achieved competency by the end of the fellowship. Two fellows identified in the mid-year CUSUM as not progressing towards competency achieved competency after targeted interventions. Fellows achieving competency (11/29 vs 25/29; odds ratio, 15; 95% confidence interval [CI], 1.98 to 113.56; P = 0.01) and attempts needed to achieve competency (19 vs 11; mean difference, 8.5; 95% CI, 3.3 to 13.7; P = 0.002) were significantly lower in younger patients and significantly higher in older patients. CONCLUSION Our study showed that CUSUM can be used to assess competence in USG-PIV procedures performed by pediatric anesthesia fellows and to identify learners not progressing toward competency in procedural skills. Ultrasound-guided venous access required more attempts to achieve competency in younger patients.
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Affiliation(s)
- Suryakumar Narayanasamy
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue MLC 2001, Cincinnati, OH, 45229, USA.
| | - Lili Ding
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Fang Yang
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Department of Mathematical Sciences, University of Cincinnati, Cincinnati, OH, USA
| | - Joel Gunter
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue MLC 2001, Cincinnati, OH, 45229, USA
| | - Paul Samuels
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue MLC 2001, Cincinnati, OH, 45229, USA
| | - Marc Mecoli
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue MLC 2001, Cincinnati, OH, 45229, USA
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Shi J, He J, He J, Li S. Electromagnetic navigation-guided preoperative localization: the learning curve analysis. J Thorac Dis 2021; 13:4339-4348. [PMID: 34422360 PMCID: PMC8339733 DOI: 10.21037/jtd-21-490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 06/19/2021] [Indexed: 12/11/2022]
Abstract
Background The electromagnetic navigation bronchoscopy (ENB) was increasingly used to mark small pulmonary nodules (PNs) for video-assisted thoracic surgery (VATS) resection due to high effectiveness and low risk. However, no study reports the learning curve of ENB-guided preoperative localization. In the study, we aimed to describe the learning curve of ENB-guided preoperative PNs localization initially. Methods Consecutive PNs cases that underwent ENB localizations between October 2018 and October 2019 by the same surgeon in our center were included in the study. The cumulative sum (CUSUM) method was used to analyze the learning curve of ENB localization. Results A total of 89 ENB localization from 64 patients were included in this study. The learning curve was divided into 3 phases: Phase I (the initial 11 cases), Phase II (the 12th to the 47th cases), and Phase III (the 47th to the 89th cases). The success rate of ENB localization has increased with the accumulation of operational experience in 3 phases (72.73%, 91.67%, and 97.62%, P=0.049). The distance from the ENB guide wire tip to the center of the lesion in Phase I was significantly longer than those in Phase II and Phase III (2.46±1.76 vs. 1.36±0.94 and 1.47±0.97 cm, P=0.014 and 0.027, respectively). Sex, bronchus sign, and learning curve phase were independent risk factors influencing operative time (OT) (OR =8.187, 18.847, and 13.920, respectively). Conclusions The technical competency, which is indicated by higher success rate, localization accuracy, and shorter OT, for ENB-guided preoperative PNs localization was achieved at the 47th operation.
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Affiliation(s)
- Jiang Shi
- Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,State Key Laboratory and National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Jiaxi He
- Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,State Key Laboratory and National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Jianxing He
- Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,State Key Laboratory and National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Shuben Li
- Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,State Key Laboratory and National Clinical Research Center for Respiratory Disease, Guangzhou, China
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Rivera-Tocancipá D. Pediatric airway: What is new in approaches and treatments? COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2020. [DOI: 10.5554/22562087.e945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Perioperative morbidity and mortality are high among patients in the extremes of life undergoing anesthesia. Complications in children occur mainly as a result of airway management-related events such as difficult approach, laryngospasm, bronchospasm and severe hypoxemia, which may result in cardiac arrest, neurological deficit or death. Reports and new considerations that have changed clinical practice in pediatric airway management have emerged in recent years. This narrative literature review seeks to summarize and detail the findings on the primary cause of morbidity and mortality in pediatric anesthesia and to highlight those things that anesthetists need to be aware of, according to the scientific reports that have been changing practice in pediatric anesthesia.
This review focuses on the identification of “new” and specific practices that have emerged over the past 10 years and have helped reduce complications associated with pediatric airway management. At least 9 practices grouped into 4 groups are described: assessment, approach techniques, devices, and algorithms. The same devices used in adults are essentially all available for the management of the pediatric airway, and anesthesia-related morbidity and mortality can be reduced through improved quality of care in pediatrics.
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Daniel SJ, Bertolizio G, McHugh T. Airway ultrasound: Point of care in children-The time is now. Paediatr Anaesth 2020; 30:347-352. [PMID: 31901216 DOI: 10.1111/pan.13823] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 12/31/2019] [Accepted: 01/02/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Point-of-care ultrasonography of the airway is becoming a first-line noninvasive adjunct assessment tool of the pediatric airway. It is defined as a focused and goal-directed portable ultrasonography brought to the patient and performed and interpreted on the spot by the provider. Successful use requires a thorough understanding of airway anatomy and ultrasound experience. AIMS To outline the many benefits, and some limitations, of airway ultrasonography in the clinical and perioperative setting. MATERIALS AND METHODS Expert review of the recent literature. RESULTS Ultrasound assessment of the airway may provide the clinician with valuable information that is specific to the individual airway static and dynamic anatomy of the patient. Ultrasound can help identify vocal cord dysfunction and pathology, assess airway size, predict the appropriate diameter of endotracheal and tracheostomy tubes, differentiate tracheal from esophageal intubation, localize the cricothyroid membrane for emergency airway access and identify tracheal rings for US-guided tracheostomy. Ultrasonography is also a great tool for the intraoperative diagnosis of a pneumothorax, the visualization of the movement of the diaphragms, and quantifying the amount of gastric content. Ultrasonography signs, tips, and pearls that allow these diagnoses are highlighted. The major disadvantage of ultrasonography remains interobserver variability, and operator dependence, as it requires specific training and experience. CONCLUSION Although it is not standard of care yet, there is significant potential for the integration of ultrasound technology into the routine care of the airway.
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Affiliation(s)
- Sam J Daniel
- Department of Pediatric Surgery, Montreal Children's Hospital, McGill University, Montreal, QC, Canada.,Department of Otolaryngology-Head and Neck Surgery, Montreal Children's Hospital, McGill University, Montreal, QC, Canada
| | - Gianluca Bertolizio
- Department of Anesthesiology, Montreal Children's Hospital, McGill University, Montreal, QC, Canada
| | - Tobial McHugh
- Department of Pediatric Surgery, Montreal Children's Hospital, McGill University, Montreal, QC, Canada.,Department of Otolaryngology-Head and Neck Surgery, Montreal Children's Hospital, McGill University, Montreal, QC, Canada
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