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Schauer SG, Long BJ, April MD, Resnick-Ault D, Mendez J, Arana AA, Bastman JJ, Davis WT, Maddry JK, Ginde AA, Bebarta VS. A prospective, pragmatic non-inferiority study of emergency intubation success with the single-use i-view versus standard reusable video laryngoscope. Transfusion 2024; 64 Suppl 2:S201-S209. [PMID: 38545924 DOI: 10.1111/trf.17790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 03/01/2024] [Accepted: 03/04/2024] [Indexed: 05/12/2024]
Abstract
INTRODUCTION Video laryngoscope (VL) technology improves first-pass success. The novel i-view VL device is inexpensive and disposable. We sought to determine the first-pass intubation success with the i-view VL device versus the standard reusable VL systems in routine use at each site. METHODS We performed a prospective, pragmatic study at two major emergency departments (EDs) when VL was used. We rotated i-view versus reusable VL as the preferred device of the month based on an a priori schedule. An investigator-initiated interim analysis was performed. Our primary outcome was a first-pass success with a non-inferiority margin of 10% based on the per-protocol analysis. RESULTS There were 93 intubations using the reusable VL devices and 81 intubations using the i-view. Our study was stopped early due to futility in reaching our predetermined non-inferiority margin. Operator and patient characteristics were similar between the two groups. The first-pass success rate for the i-view group was 69.1% compared to 84.3% for the reusable VL group. A non-inferiority analysis indicated that the difference (-15.1%) and corresponding 90% confidence limits (-25.3% to -5.0%) did not fall within the predetermined 10% non-inferiority margin. CONCLUSIONS The i-view device failed to meet our predetermined non-inferiority margin when compared to the reusable VL systems with the study stopping early due to futility. Significant crossover occurred at the discretion of the intubating operator during the i-view month.
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Affiliation(s)
- Steven G Schauer
- US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas, USA
- Brooke Army Medical Center, JBSA, JBSA Fort Sam Houston, Texas, USA
- Uniformed Service University of the Health Sciences, Bethesda, Maryland, USA
| | - Brit J Long
- Brooke Army Medical Center, JBSA, JBSA Fort Sam Houston, Texas, USA
- Uniformed Service University of the Health Sciences, Bethesda, Maryland, USA
- 59th Medical Wing, JBSA Lackland, Texas, USA
| | - Michael D April
- Uniformed Service University of the Health Sciences, Bethesda, Maryland, USA
- 14th Field Hospital, Fort Stewart, Georgia, USA
| | | | - Jessica Mendez
- US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas, USA
| | | | - Jill J Bastman
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | - William T Davis
- Brooke Army Medical Center, JBSA, JBSA Fort Sam Houston, Texas, USA
- Uniformed Service University of the Health Sciences, Bethesda, Maryland, USA
- 59th Medical Wing, JBSA Lackland, Texas, USA
| | - Joseph K Maddry
- US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas, USA
- Brooke Army Medical Center, JBSA, JBSA Fort Sam Houston, Texas, USA
- Uniformed Service University of the Health Sciences, Bethesda, Maryland, USA
- 59th Medical Wing, JBSA Lackland, Texas, USA
| | - Adit A Ginde
- University of Colorado School of Medicine, Aurora, Colorado, USA
- University of Colorado Center for COMBAT Research, Aurora, Colorado, USA
| | - Vikhyat S Bebarta
- 59th Medical Wing, JBSA Lackland, Texas, USA
- University of Colorado School of Medicine, Aurora, Colorado, USA
- University of Colorado Center for COMBAT Research, Aurora, Colorado, USA
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Hickey AJ, Cummings MJ, Short B, Brodie D, Panzer O, Madahar P, O'Donnell MR. Approach to the Physiologically Challenging Endotracheal Intubation in the Intensive Care Unit. Respir Care 2023; 68:1438-1448. [PMID: 37221087 PMCID: PMC10506638 DOI: 10.4187/respcare.10821] [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: 05/25/2023]
Abstract
Endotracheal intubation for airway management is a common procedure in the ICU. Intubation may be difficult due to anatomic airway abnormalities but also due to physiologic derangements that predispose patients to cardiovascular collapse during the procedure. Results of studies demonstrate a high incidence of morbidity and mortality associated with airway management in the ICU. To reduce the likelihood of complications, medical teams must be well versed in the general principles of intubation and be prepared to manage physiologic derangements while securing the airway. In this review, we present relevant literature on the approach to endotracheal intubation in the ICU and provide pragmatic recommendations relevant to medical teams performing intubations in patients who are physiologically unstable.
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Affiliation(s)
- Andrew J Hickey
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Irving Medical Center, New York, New York
| | - Matthew J Cummings
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Irving Medical Center, New York, New York
| | - Briana Short
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Irving Medical Center, New York, New York
| | - Daniel Brodie
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Irving Medical Center, New York, New York
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Oliver Panzer
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York
| | - Purnema Madahar
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Irving Medical Center, New York, New York
| | - Max R O'Donnell
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Irving Medical Center, New York, New York.
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
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3
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Jang W, Kang H, Shin H, Kim C, Lee H, Choi H. Introduction of Infection Prevention Tracheal Intubation Protocol during the COVID-19 Pandemic Is Not Associated with First-Pass Success Rates of Endotracheal Intubation in the Emergency Department: A Before-and-After Comparative Study. J Pers Med 2023; 13:1017. [PMID: 37374006 DOI: 10.3390/jpm13061017] [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: 05/10/2023] [Revised: 06/12/2023] [Accepted: 06/18/2023] [Indexed: 06/29/2023] Open
Abstract
Aerosols and droplets have put healthcare workers performing airway management at high risk of contracting coronavirus disease 2019 (COVID-19). Experts have developed endotracheal intubation (ETI) guidelines and protocols to protect intubators from infection. We aimed to determine whether changes in the emergency department (ED) intubation protocol to prevent COVID-19 infection were associated with first-pass success (FPS) rates in ETI. We used data from the airway management registries in two academic EDs. The study was divided into pre-pandemic (January 2018 to January 2020) and pandemic (February 2020 to February 2022) periods. We selected 2476 intubation cases, including 1151 and 1325 cases recorded before and during the pandemic, respectively. During the pandemic, the FPS rate was 92.2%, which did not change significantly, and major complications increased slightly but not significantly compared with the pre-pandemic period. The OR for the FPS of applying infection prevention intubation protocols was 0.72 (p = 0.069) in a subgroup analysis, junior emergency physicians (PGY1 residents) had an FPS of less than 80% regardless of pandemic protocol implementation. The FPS rate of senior emergency physicians in physiologically difficult airways decreased significantly during the pandemic (98.0% to 88.5%). In conclusion, the FPS rate and complications for adult ETI performed by emergency physicians using COVID-19 infection prevention intubation protocols were similar to pre-pandemic conditions.
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Affiliation(s)
- Wooseok Jang
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul 04763, Republic of Korea
| | - Hyunggoo Kang
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul 04763, Republic of Korea
| | - Hyungoo Shin
- Department of Emergency Medicine, Hanyang University Guri Hospital, Guri 11923, Republic of Korea
| | - Changsun Kim
- Department of Emergency Medicine, Hanyang University Guri Hospital, Guri 11923, Republic of Korea
| | - Heekyung Lee
- Department of Emergency Medicine, Hanyang University Guri Hospital, Guri 11923, Republic of Korea
| | - Hyukjoong Choi
- Department of Emergency Medicine, Hanyang University Guri Hospital, Guri 11923, Republic of Korea
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4
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Mohr NM, Santos Leon E, Carlson JN, Driver B, Krishnadasan A, Harland KK, Ten Eyck P, Mower WR, Foley TM, Wallace K, McDonald LC, Kutty PK, Santibanez S, Talan DA. Endotracheal Intubation Strategy, Success, and Adverse Events Among Emergency Department Patients During the COVID-19 Pandemic. Ann Emerg Med 2023; 81:145-157. [PMID: 36336542 PMCID: PMC9633323 DOI: 10.1016/j.annemergmed.2022.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/09/2022] [Accepted: 09/19/2022] [Indexed: 11/06/2022]
Abstract
STUDY OBJECTIVE To describe endotracheal intubation practices in emergency departments by staff intubating patients early in the coronavirus disease 2019 (COVID-19) pandemic. METHODS Multicenter prospective cohort study of endotracheal intubations conducted at 20 US academic emergency departments from May to December 2020, stratified by known or suspected COVID-19 status. We used multivariable regression to measure the association between intubation strategy, COVID-19 known or suspected status, first-pass success, and adverse events. RESULTS There were 3,435 unique emergency department endotracheal intubations by 586 participating physicians or advanced practice providers; 565 (18%) patients were known or suspected of having COVID-19 at the time of endotracheal intubation. Compared with patients not known or suspected of COVID-19, endotracheal intubations of patients with known or suspected COVID-19 were more often performed using video laryngoscopy (88% versus 82%, difference 6.3%; 95% confidence interval [CI], 3.0% to 9.6%) and passive nasal oxygenation (44% versus 39%, difference 5.1%; 95% CI, 0.9% to 9.3%). First-pass success was not different between those who were and were not known or suspected of COVID-19 (87% versus 86%, difference 0.6%; 95% CI, -2.4% to 3.6%). Adjusting for patient characteristics and procedure factors in those with low anticipated airway difficulty (n=2,374), adverse events (most commonly hypoxia) occurred more frequently in patients with known or suspected COVID-19 (35% versus 19%, adjusted odds ratio 2.4; 95% CI, 1.7 to 3.3). CONCLUSION Compared with patients not known or suspected of COVID-19, endotracheal intubation of those confirmed or suspected to have COVID-19 was associated with a similar first-pass intubation success rate but higher risk-adjusted adverse events.
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Affiliation(s)
- Nicholas M Mohr
- Department of Emergency Medicine, University of Iowa College of Public Health, Iowa City, IA; Division of Critical Care, Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, IA; Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA.
| | - Eliezer Santos Leon
- Department of Emergency Medicine, University of Iowa College of Public Health, Iowa City, IA
| | - Jestin N Carlson
- Department of Emergency Medicine, Allegheny Health Network, Pittsburgh, PA
| | - Brian Driver
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN
| | - Anusha Krishnadasan
- Olive View-University of California Los Angeles Education and Research Institute, Los Angeles, CA
| | - Karisa K Harland
- Department of Emergency Medicine, University of Iowa College of Public Health, Iowa City, IA; Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA
| | - Patrick Ten Eyck
- Institute for Clinical and Translational Sciences, University of Iowa, Iowa City, IA
| | - William R Mower
- University of California Los Angeles, Ronald Reagan Medical Center, Los Angeles, CA
| | - Tyler M Foley
- Department of Internal Medicine, University of Virginia, Charlottesville, VA
| | - Kelli Wallace
- Department of Emergency Medicine, University of Iowa College of Public Health, Iowa City, IA
| | - L Clifford McDonald
- Division of Healthcare Quality Promotion, Division of Preparedness and Emerging Infections, Atlanta, GA
| | - Preeta K Kutty
- Division of Healthcare Quality Promotion, Division of Preparedness and Emerging Infections, Atlanta, GA
| | - Scott Santibanez
- Division of Preparedness and Emerging Infections, Centers for Disease Control and Prevention, Atlanta, GA
| | - David A Talan
- Department of Emergency Medicine, University of Iowa College of Public Health, Iowa City, IA; Olive View-University of California Los Angeles Education and Research Institute, Los Angeles, CA; University of California Los Angeles, Ronald Reagan Medical Center, Los Angeles, CA
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Trivedi S, Hylton D, Mueller M, Juan I, Mun C, Tzeng E, Guan P, Filipovic M, Mandoorah S, Brezenski A, O'Brien EO, Malhotra A, Schmidt U. A Comparison of Intubation and Airway Complications Between COVID-19 and Non-COVID-19 Critically Ill Subjects. Cureus 2023; 15:e35145. [PMID: 36950006 PMCID: PMC10027016 DOI: 10.7759/cureus.35145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2023] [Indexed: 02/20/2023] Open
Abstract
Introduction The number of subjects infected with the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) throughout the western hemisphere increased exponentially in the later months of 2020. With this increase in infection, the number of subjects requiring advanced ventilatory support increased concomitantly. We decided to compare the survival rates between coronavirus disease 2019 (COVID-19) subjects versus non-COVID-19 subjects undergoing intubation in the intensive care unit (ICU). We hypothesized that COVID-19 subjects would have lower rates of survival post-intubation. Methods We screened all subjects admitted to the adult critical care unit between January 2020 and June 2020 to determine if they met the inclusion criteria. These subjects were required to be spontaneously ventilating upon admission and eventually required intubation. Subjects were selected from our electronic health record (EHR) system EPIC© (Epic Systems, Verona, WI) through a retrospective ICU admission analysis. We identified and included 267 non-COVID-19 subjects and 56 COVID-19 subjects. Our primary outcome of interest was intubation-related mortality. We defined intubation mortality as unexpected death (within 48 hours of intubation). Our secondary outcomes were the length of stay in the ICU, length of time requiring ventilator support, and proportion of subjects requiring tracheostomy placement. Results Compared to non-coronavirus disease (COVID) subjects, COVID subjects were more likely to be intubated for acute respiratory distress. COVID subjects had longer stays in the ICU and longer ventilator duration than non-COVID subjects. COVID-positive subjects had a decreased hazard ratio for mortality (HR = 0.42, 95% CI: 0.20-0.87, P < 0.05) and increased chances of survival compared to non-COVID subjects. Conclusions We showed the rates of intubation survival were no different between the COVID and non-COVID groups. We attribute this finding to intubation preparation, a multidisciplinary team approach, and having the most experienced provider lead the intubation process.
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Affiliation(s)
- Suraj Trivedi
- Anesthesia and Critical Care, University of California San Diego School of Medicine, San Diego, USA
| | - Diana Hylton
- Anesthesia and Critical Care, University of California San Diego, San Diego, USA
| | - Matthew Mueller
- Critical Care Medicine, University of California San Diego, Washington, DC, USA
| | - Ilona Juan
- Anesthesiology, Kaiser San Diego, San Diego, USA
| | - Christie Mun
- Anesthesia and Critical Care, University of California San Diego, San Diego, USA
| | - Eric Tzeng
- Anesthesia and Critical Care, University of California San Diego, San Diego, USA
| | - Patricia Guan
- Anesthesiology, University of California San Diego, San Diego, USA
| | - Maya Filipovic
- Anesthesia and Critical Care, University of California San Diego, San Diego, USA
| | - Sohaib Mandoorah
- Critical Care Medicine, University of California San Diego, San Diego, USA
| | - Alyssa Brezenski
- Anesthesiology, University of California San Diego, San Diego, USA
| | - E Orestes O'Brien
- Anesthesia and Critical Care, University of California San Diego, San Diego, USA
| | - Atul Malhotra
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of California San Diego, San Diego, USA
| | - Ulrich Schmidt
- Anesthesiology, University of California San Diego, San Diego, USA
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Daigle CH, Laverriere EK, Bruins BB, Lockman JL, Fiadjoe JE, McGowan N, Napolitano N, Shults J, Nadkarni VM, Nishisaki A. Mitigation and Outcomes of Difficult Bag-Mask Ventilation in Critically Ill Children. J Pediatr Intensive Care 2023. [DOI: 10.1055/s-0042-1760413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
AbstractDifficult bag-mask ventilation (BMV) occurs in 10% of pediatric intensive care unit (PICU) tracheal intubations (TI). The reasons clinicians identify difficult BMV in the PICU and the interventions used to mitigate that difficulty have not been well-studied. This is a prospective, observational, single-center study. A patient-specific data form was sent to PICU physicians supervising TIs from November 2019 through December 2020 to identify the presence of difficult BMV, attempted interventions used, and perceptions about intervention success. The dataset was linked and merged with the local TI quality database to assess safety outcomes. Among 305 TIs with response (87% response rate), 267 (88%) clinicians performed BMV during TI. Difficult BMV was reported in 28 of 267 patients (10%). Commonly reported reasons for difficult BMV included: facial structure (50%), high inspiratory pressure (36%), and improper mask fit (21%). Common interventions were jaw thrust (96%) and an airway adjunct (oral airway 50%, nasal airway 7%, and supraglottic airway 11%), with ventilation improvement in 44% and 73%, respectively. Most difficult BMV was identified before neuromuscular blockade (NMB) administration (96%) and 67% (18/27) resolved after NMB administration. The overall success in improving ventilation was 27/28 (96%). TI adverse outcomes (hemodynamic events, emesis, and/or hypoxemia <80%) are associated with the presence of difficult BMV (10/28, 36%) versus non-difficult BMV (20/239, 8%, p< 0.001). Difficult BMV is common in critically ill children and is associated with increased TI adverse outcomes. Airway adjunct placement and NMB use are often effective in improving ventilation.
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Affiliation(s)
- C. Hunter Daigle
- Division of Critical Care Medicine, Department of Pediatrics, University of Texas at Austin, Dell Children's Medical Center, Austin, Texas, United States
| | - Elizabeth K. Laverriere
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
| | - Benjamin B. Bruins
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
| | - Justin L. Lockman
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
| | - John E. Fiadjoe
- Department of Anesthesiology, Critical Care, and Pain Medicine. Boston Children's Hospital. Boston, Massachusetts, United States
| | - Nancy McGowan
- Department of Respiratory Therapy, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
| | - Natalie Napolitano
- Department of Respiratory Therapy, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
| | - Justine Shults
- Division of Biostatistics, Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
| | - Vinay M. Nadkarni
- Center for Simulation, Advanced Education and Innovation, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
| | - Akira Nishisaki
- Center for Simulation, Advanced Education and Innovation, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
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Ijaz M, Fhrighil SN, Brett R, Connolly J, Conneely A, O'Connor G, O'Halloran M, Yousefian S. Computational design and experimental analysis of a novel visor for COVID-19 patients receiving high-flow nasal oxygen therapy. EUROPEAN JOURNAL OF MECHANICS. B, FLUIDS 2023; 97:93-110. [PMID: 36268504 PMCID: PMC9562623 DOI: 10.1016/j.euromechflu.2022.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 09/16/2022] [Accepted: 09/24/2022] [Indexed: 06/16/2023]
Abstract
The Covid-19 global pandemic has reshaped the requirements of healthcare sectors worldwide. Following the exposure risks associated with Covid-19, this paper aims to design, optimise, and validate a wearable medical device that reduces the risk of transmission of contagious droplets from infected patients in a hospital setting. This study specifically focuses on those receiving high-flow nasal oxygen therapy. The design process consisted of optimising the geometry of the visor to ensure that the maximum possible percentage of harmful droplets exhaled by the patient can be successfully captured by a vacuum tube attached to the visor. This has been completed by deriving a number of concept designs and assessing their effectiveness, based on numerical analysis, computational fluid dynamics (CFD) simulations and experimental testing. The CFD results are validated using various experimental methods such as Schlieren imaging, particle measurement testing and laser sheet visualisation. Droplet capturing efficiency of the visor was measured through CFD and validated through experimental particle measurement testing. The results presented a 5% deviation between CFD and experimental results. Also, the modifications based on the validated CFD results improved the visor effectiveness by 47% and 38% for breathing and coughing events, respectively.
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Affiliation(s)
- Masooma Ijaz
- Mechanical Engineering, College of Engineering and Informatics, National University of Ireland, Galway, Ireland
| | - Sorcha Ni Fhrighil
- Mechanical Engineering, College of Engineering and Informatics, National University of Ireland, Galway, Ireland
| | - Rory Brett
- Mechanical Engineering, College of Engineering and Informatics, National University of Ireland, Galway, Ireland
| | - Jack Connolly
- BioInnovate Ireland, National University of Ireland, Galway, Ireland
| | - Alan Conneely
- National Centre for Laser Applications, School of Physics, College of Science and Engineering National University of Ireland, Galway, Ireland
| | - Gerard O'Connor
- Translational Medical Device Lab, Lambe Institute for Translational Research & HRB Clinical Research Facility, University Hospital Galway, Galway, Ireland
| | - Martin O'Halloran
- Translational Medical Device Lab, Lambe Institute for Translational Research & HRB Clinical Research Facility, University Hospital Galway, Galway, Ireland
| | - Sajjad Yousefian
- Mechanical Engineering, College of Engineering and Informatics, National University of Ireland, Galway, Ireland
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Current Considerations in Emergency Airway Management. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2022; 10:73-86. [DOI: 10.1007/s40138-022-00255-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2022] [Indexed: 12/04/2022]
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Cortese G, Sorbello M, Di Giacinto I, Cedrone M, Urdaneta F, Brazzi L. Human Factors and Airway Management in COVID-19 Patients: The Perfect Storm? J Clin Med 2022; 11:jcm11154271. [PMID: 35893372 PMCID: PMC9330625 DOI: 10.3390/jcm11154271] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/08/2022] [Accepted: 07/19/2022] [Indexed: 01/27/2023] Open
Abstract
The SARS-CoV-2 pandemic heavily impacted healthcare workers, increasing their physical and psychological workload. Specifically, COVID-19 patients’ airway management is definitely a challenging task regarding both severe and acute respiratory failure and the risk of contagion while performing aerosol-generating procedures. The category of anesthesiologists and intensivists, the main actors of airway management, showed a poor psychological well-being and a high stress and burnout risk. Identifying and better defining the specific main SARS-CoV-2-related stressors can help them deal with and effectively plan a strategy to manage these patients in a more confident and safer way. In this review, we therefore try to analyze the relevance of human factors and non-technical skills when approaching COVID-19 patients. Lessons from the past, such as National Audit Project 4 recommendations, have taught us that safe airway management should be based on preoperative assessment, the planning of an adequate strategy, the optimization of setting and resources and the rigorous evaluation of the scenario. Despite, or thanks to, the critical issues and difficulties, the “take home lesson” that we can translate from SARS-CoV-2 to every airway management is that there can be no more room for improvisation and that creating teamwork must become a priority.
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Affiliation(s)
- Gerardo Cortese
- Department of Anaesthesia, Intensive Care and Emergency, AOU Città della Salute e della Scienza, Corso Dogliotti 14, 10126 Turin, Italy; (G.C.); (L.B.)
| | - Massimiliano Sorbello
- Anesthesia and Intensive Care, AOU Policlinico San Marco, 95121 Catania, Italy
- Correspondence:
| | - Ida Di Giacinto
- Anesthesia and Intensive Care, Mazzoni Hospital, 63100 Ascoli Piceno, Italy;
| | - Martina Cedrone
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy;
| | - Felipe Urdaneta
- Department of Anesthesiology, North Florida/South Georgia Veteran Health Systems, University of Florida, Gainesville, FL 32608, USA;
| | - Luca Brazzi
- Department of Anaesthesia, Intensive Care and Emergency, AOU Città della Salute e della Scienza, Corso Dogliotti 14, 10126 Turin, Italy; (G.C.); (L.B.)
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy;
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Gupta B, Jain G, Pathak S, Mishra P, Kumar H, Rao S. Airway management training program for nurses via online course in COVID-19 preparedness. World J Methodol 2022; 12:113-121. [PMID: 35721240 PMCID: PMC9157635 DOI: 10.5662/wjm.v12.i3.113] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 03/27/2022] [Accepted: 05/07/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Nursing officers are an integral component of any medical team. They participate in taking care of basic airway management and assist in advanced airway management, specifically amidst the current coronavirus disease 2019 (COVID-19) pandemic.
AIM To assess the efficacy of a standardized web-based training module for nurses in preparedness to fight against COVID-19.
METHODS The training was held in three sessions of 1 h each, consisting of live audio-visual lectures, case scenarios, and skill demonstrations. The sequence of airway equipment, drug preparation, airway examination, and plans of airway management was demonstrated through mannequin-based video-clips.
RESULTS Pre- and post-test scores as well as objective structured clinical examination scores were analyzed using Student’s t-test and the Likert scale was used for feedback assessment. It was found that the mean score out of the total score of 20 was 8.47 ± 4.2 in the pre-test, while in the post-test it was 17.4 ± 1.8 (P value < 0.001). The participants also felt self-reliant in executing the roles of airway assistant (63.3%) and drug assistant (74.3%). Fear of self-infection with COVID-19 was also high, as 66% of participants feared working with the patient’s airway.
CONCLUSION Amidst this COVID-19 emergency, when the health care systems are being persistently challenged, training of nursing staff in the safe conduct of airway management can ensure delivery of life-saving treatment.
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Affiliation(s)
- Bhavna Gupta
- Department of Anesthesia, All India Institute of Medical Sciences, Rishikesh 249203, Uttarakhand, India
| | - Gaurav Jain
- Department of Anesthesia, All India Institute of Medical Sciences, Rishikesh 249203, Uttarakhand, India
| | - Sharmishtha Pathak
- Department of Anesthesia, All India Institute of Medical Sciences, Rishikesh 249203, Uttarakhand, India
| | - Priyanka Mishra
- Department of Anesthesia, All India Institute of Medical Sciences, Rishikesh 249203, Uttarakhand, India
| | - Hemanth Kumar
- Department of Advanced Centre of Continuous Professional Development, All India Institute of Medical Sciences, Rishikesh 249203, Uttarakhand, India
| | - Shalinee Rao
- Department of Advanced Centre of Continuous Professional Development, All India Institute of Medical Sciences, Rishikesh 249203, Uttarakhand, India
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Russotto V, Rahmani LS, Parotto M, Bellani G, Laffey JG. Tracheal intubation in the critically ill patient. Eur J Anaesthesiol 2022; 39:463-472. [PMID: 34799497 DOI: 10.1097/eja.0000000000001627] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Tracheal intubation is among the most commonly performed and high-risk procedures in critical care. Indeed, 45% of patients undergoing intubation experience at least one major peri-intubation adverse event, with cardiovascular instability being the most common event reported in 43%, followed by severe hypoxemia in 9% and cardiac arrest in 3% of cases. These peri-intubation adverse events may expose patients to a higher risk of 28-day mortality, and they are more frequently observed with an increasing number of attempts to secure the airway. The higher risk of peri-intubation complications in critically ill patients, compared with the anaesthesia setting, is the consequence of their deranged physiology (e.g. underlying respiratory failure, shock and/or acidosis) and, in this regard, airway management in critical care has been defined as "physiologically difficult". In recent years, several randomised studies have investigated the most effective preoxy-genation strategies, and evidence for the use of positive pressure ventilation in moderate-to-severe hypoxemic patients is established. On the other hand, evidence on interventions to mitigate haemodynamic collapse after intubation has been elusive. Airway management in COVID-19 patients is even more challenging because of the additional risk of infection for healthcare workers, which has influenced clinical choices in this patient group. The aim of this review is to provide an update of the evidence for intubation in critically ill patients with a focus on understanding peri-intubation risks and evaluating interventions to prevent or mitigate adverse events.
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Affiliation(s)
- Vincenzo Russotto
- From the Department of Anesthesia and Intensive Care, University Hospital San Luigi Gonzaga, University of Turin, Italy (VR), Department of Emergency and Intensive Care, University Hospital San Gerardo, Monza (GB), University of Milano-Bicocca, Milan, Italy (GB), Department of Anaesthesiology, Critical Care and Pain Medicine, Children's Health Ireland at Temple Street, Dublin, Ireland (LSR), Department of Anesthesiology and Pain Medicine; Interdepartmental Division of Critical Care Medicine, University of Toronto (MP), Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, Canada (MP), Regenerative Medicine Institute at CURAM Centre for Medical Devices, School of Medicine, National University of Ireland (JGL) and Anaesthesia and Intensive Care Medicine, University Hospital Galway, Galway, Ireland (JGL) Correspondence to Vincenzo Russotto, Department of Anesthesia and Intensive Care, University Hospital San Luigi Gonzaga, Regione Gonzole, 10, 10043 Orbassano, Turin, Italy
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12
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Athanassoglou V, Zhong H, Poeran J, Liu J, Cozowicz C, Illescas A, Memtsoudis SG. Anaesthesia practice in the first wave of the COVID-19 outbreak in the United States: a population-based cohort study. Br J Anaesth 2022; 129:e16-e18. [PMID: 35562227 PMCID: PMC9010244 DOI: 10.1016/j.bja.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/07/2022] [Accepted: 04/09/2022] [Indexed: 11/18/2022] Open
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13
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Farrell CM, Hayward BJ. Ethical Dilemmas, Moral Distress, and the Risk of Moral Injury: Experiences of Residents and Fellows During the COVID-19 Pandemic in the United States. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:S55-S60. [PMID: 34817403 PMCID: PMC8855775 DOI: 10.1097/acm.0000000000004536] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
The ongoing COVID-19 pandemic has brought numerous ethical dilemmas to the forefront of clinical care, including for resident and fellow physician trainees. In this paper, the authors draw on their own experiences providing frontline COVID-19 clinical care in New York City in their respective roles as an internal medicine resident and later a pulmonary and critical care fellow, and as an associate program director for a pulmonary and critical care fellowship, along with published literature on trainees' experiences in the pandemic, to describe common ethical dilemmas confronted by residents and fellows during the pandemic. These dilemmas are related to personal health risk, resource allocation, health care inequities, and media relations. The authors use a framework of microethics to underscore how these dilemmas are highly contextualized within trainees' institutions, their specific roles, and the patient populations to which they provide care. They argue that frequent ethical dilemmas, compounded by the intense physical and emotional stress of medical training and the pandemic itself, increase the potential for trainees to experience moral distress. Recurrent moral distress may, in turn, put trainees at risk for moral injury with consequences for their mental health and overall well-being. It is imperative to gain a clear understanding of this issue, not only for those trainees who have experienced or are at risk for experiencing personal consequences but also because it may help identify ways to better support the well-being of providers and the care of patients going forward.
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Affiliation(s)
- Colleen M. Farrell
- C.M. Farrell is a clinical fellow, Division of Pulmonary and Critical Care Medicine and Division of Medical Ethics, Weill Cornell Medicine, New York, New York
| | - Bradley J. Hayward
- B.J. Hayward is assistant professor of clinical medicine, Division of Pulmonary and Critical Care Medicine and Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York
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14
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Airway management in critically ill patients. From International Studies to Clinical Practice – A summary from an EAMS webinar. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2021. [DOI: 10.1016/j.tacc.2021.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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15
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Fuchs A, Lanzi D, Beilstein CM, Riva T, Urman RD, Luedi MM, Braun M. Clinical recommendations for in-hospital airway management during aerosol-transmitting procedures in the setting of a viral pandemic. Best Pract Res Clin Anaesthesiol 2021; 35:333-349. [PMID: 34511223 PMCID: PMC7723398 DOI: 10.1016/j.bpa.2020.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 12/03/2020] [Indexed: 01/08/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), can lead to severe pneumonia and multiorgan failure. While most of the infected patients develop no or only mild symptoms, some need respiratory support or even invasive ventilation. The exact route of transmission is currently under investigation. While droplet exposure and direct contact seem to be the most significant ways of transmitting the disease, aerosol transmission appears to be possible under circumstances favored by high viral load. Despite the use of personal protective equipment (PPE), this situation potentially puts healthcare workers at risk of infection, especially if they are involved in airway management. Various recommendations and international guidelines aim to protect healthcare workers, although evidence-based research confirming the benefits of these approaches is still scarce. In this article, we summarize the current literature and recommendations for airway management of COVID-19 patients.
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Affiliation(s)
- Alexander Fuchs
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland.
| | - Daniele Lanzi
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland.
| | - Christian M Beilstein
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland.
| | - Thomas Riva
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland.
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
| | - Markus M Luedi
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland.
| | - Matthias Braun
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland.
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16
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Walsh EC, Kwo J, Chang MG, Pino RM, Bittner EA. Rapid Expansion of the Airway Response Team to Meet the Needs of the COVID-19 Pandemic. J Healthc Qual 2021; 43:275-283. [PMID: 34009857 PMCID: PMC8407287 DOI: 10.1097/jhq.0000000000000304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION The COVID-19 pandemic has brought unprecedented numbers of patients with acute respiratory distress to medical centers. Hospital systems require rapid adaptation to respond to the increased demand for airway management while ensuring high quality patient care and provider safety. There is limited literature detailing successful system-level approaches to adapt to the surge of COVID-19 patients requiring airway management. METHODS A deliberate system-level approach was used to expand a preexisting airway response service. Through a needs analysis (taking into account both existing resources and anticipated demands), we established priorities and solutions for the airway management challenges encountered during the pandemic. RESULTS During our COVID-19 surge (March 10, 2020, through May 26, 2020), there were 619 airway consults, and the COVID airway response team (CART) performed 341 intubations. Despite a 4-fold increase in intubations during the surge, there was no increase in cardiac arrests or surgical airways and no documented COVID-19 infections among the CART. CONCLUSIONS Our system-level approach successfully met the sudden escalation in demand in airway management incurred by the COVID-19 surge. The approach that addressed staffing needs prioritized provider protection and enhanced quality and safety monitoring may be adaptable to other institutions.
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17
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Comparison of intubation characteristics using intubation box and plastic sheets: A simulation based pilot study. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2021. [DOI: 10.1016/j.tacc.2021.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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18
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van Zundert AAJ, Gatt SP. Recommendations for standards of monitoring in anaesthesia. Anaesthesia 2021; 76:1427-1428. [PMID: 34309012 DOI: 10.1111/anae.15551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- A A J van Zundert
- Royal Brisbane and Women's Hospital, University of Queensland, Brisbane, QLD, Australia
| | - S P Gatt
- University of New South Wales, Kensington, NSW, Australia
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Wong DJN, El-Boghdadly K, Owen R, Johnstone C, Neuman MD, Andruszkiewicz P, Baker PA, Biccard BM, Bryson GL, Chan MTV, Cheng MH, Chin KJ, Coburn M, Jonsson Fagerlund M, Lobo CA, Martinez-Hurtado E, Myatra SN, Myles PS, Navarro G, O'Sullivan E, Pasin L, Quintero K, Shallik N, Shamim F, van Klei WA, Ahmad I. Emergency Airway Management in Patients with COVID-19: A Prospective International Multicenter Cohort Study. Anesthesiology 2021; 135:292-303. [PMID: 33848324 PMCID: PMC8274456 DOI: 10.1097/aln.0000000000003791] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background: Tracheal intubation for patients with COVID-19 is required for invasive mechanical ventilation. The authors sought to describe practice for emergency intubation, estimate success rates and complications, and determine variation in practice and outcomes between high-income and low- and middle-income countries. The authors hypothesized that successful emergency airway management in patients with COVID-19 is associated with geographical and procedural factors. Methods: The authors performed a prospective observational cohort study between March 23, 2020, and October 24, 2020, which included 4,476 episodes of emergency tracheal intubation performed by 1,722 clinicians from 607 institutions across 32 countries in patients with suspected or confirmed COVID-19 requiring mechanical ventilation. The authors investigated associations between intubation and operator characteristics, and the primary outcome of first-attempt success. Results: Successful first-attempt tracheal intubation was achieved in 4,017/4,476 (89.7%) episodes, while 23 of 4,476 (0.5%) episodes required four or more attempts. Ten emergency surgical airways were reported—an approximate incidence of 1 in 450 (10 of 4,476). Failed intubation (defined as emergency surgical airway, four or more attempts, or a supraglottic airway as the final device) occurred in approximately 1 of 120 episodes (36 of 4,476). Successful first attempt was more likely during rapid sequence induction versus non–rapid sequence induction (adjusted odds ratio, 1.89 [95% CI, 1.49 to 2.39]; P < 0.001), when operators used powered air-purifying respirators versus nonpowered respirators (adjusted odds ratio, 1.60 [95% CI, 1.16 to 2.20]; P=0.006), and when performed by operators with more COVID-19 intubations recorded (adjusted odds ratio, 1.03 for each additional previous intubation [95% CI, 1.01 to 1.06]; P=0.015). Intubations performed in low- or middle-income countries were less likely to be successful at first attempt than in high-income countries (adjusted odds ratio, 0.57 [95% CI, 0.41 to 0.79]; P=0.001). Conclusions: The authors report rates of failed tracheal intubation and emergency surgical airway in patients with COVID-19 requiring emergency airway management, and identified factors associated with increased success. Risks of tracheal intubation failure and success should be considered when managing COVID-19. The authors report a secondary analysis of associations of intubation and operator characteristics related to the primary outcome of first-attempt intubation success in 4,476 intubations among 1,722 clinicians at 607 institutions across 32 countries, also considering differential rates of success between high-income and low- and middle-income countries. Although successful first-attempt intubation was noted in 89.7% of intubations, 0.5% required four or more attempts, an emergency surgical airway was required in 0.2%, and a composite variable of failed intubation occurred in 0.8%. Multivariable analysis demonstrated that successful first attempts were more likely with rapid sequence intubations, when operators used powered air-purifying respirators, and with increasing operator experience. Intubations performed in low- and middle-income countries were nearly half as likely to be successful on first attempt than in high-income countries. These results provide potentially useful information for global and local policy-making related to this and future pandemics. However, the observational nature, along with lack of patient level characteristics, leave room for substantial residual confounding of these associations. Supplemental Digital Content is available in the text.
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20
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Lee SS, Kim SJ, Jung JE, Kim GH, Kwon MY, Yun MJ. Infection control in operating rooms for COVID-19 patients. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2021. [DOI: 10.5124/jkma.2021.64.7.491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: Surgeries performed for patients with coronavirus disease 2019 (COVID-19) place the medical staff at very high risk of infection. We suggest recommendations for appropriate operation preparation, anesthetic management, and infection control for COVID-19 patients in operating rooms.Current Concepts: Surgeries must be performed in an airborne infection isolation room, such as a negative-pressure operating room. It is recommended that scheduled surgeries for COVID-19 patients be postponed to an acceptable extent, with the exception of emergency cases. Moreover, the number of medical staff participating in the surgery should be minimized. Medical staffs should practice proper hand hygiene and wear an appropriate level of personal protective equipment depending on the infection risk. While performing surgery and inducing anesthesia in COVID-19 patients, endotracheal intubation should be performed by trained anesthesiologists with a video laryngoscope, preferably using high-efficiency viral filters, which can prevent contamination in the anesthesia machine. Use of disposable equipment or COVID-19 patient-specific devices is recommended to prevent the spread of infection, but instruments that require sharing among multiple patients must be thoroughly cleaned and disinfected before their use for the next patient.Discussion and Conclusion: Medical staff performing surgeries for COVID-19 patients are at very high risk of infection. Therefore, the use of appropriate personal protective equipment, high-efficiency viral filters in breathing circuits during anesthesia, and disinfection of contaminated equipment after the operation are mandatory.
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21
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Goh YS, Ow Yong QYJ, Chen THM, Ho SHC, Chee YIC, Chee TT. The Impact of COVID-19 on nurses working in a University Health System in Singapore: A qualitative descriptive study. Int J Ment Health Nurs 2021; 30:643-652. [PMID: 33280242 DOI: 10.1111/inm.12826] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/12/2020] [Accepted: 11/16/2020] [Indexed: 12/15/2022]
Abstract
Given Singapore's high population density and extensive geographical interconnections, it is unsurprising that the country reported one of the highest numbers of COVID-19 cases in Asia. Past pandemic studies have suggested that nurses working in such crises might experience a deterioration of mental health, which could persist for years beyond the initial outbreak. This study used a qualitative descriptive design to explore nurses' experiences of working in tertiary hospitals during the COVID-19 pandemic. A total of 17 registered nurses who had worked for at least one year prior to the start of the COVID-19 pandemic were recruited from a University Health System in Singapore from March to June 2020. Data were collected through semi-structured interviews lasting at least an hour conducted over an online platform by the principal investigator. The data were analysed through Braun and Clarke's six-step thematic analysis independently by two researchers. Three main themes emerged: (i) challenging moments of COVID-19, during which the participants reported physical and psychological challenges relating to working conditions of the hospital in the initial months of the pandemic; (ii) the professional role as nurses, in where the participants dispelled their worries and demonstrated commitment to their role as nurses; and (iii) support for nurses, which originated from their family, friends and leaders from their organizations for them to persevere and overcome the unprecedented challenges of COVID-19. The nurses in this study demonstrated resilience and professionalism despite the challenges of COVID-19. The findings highlighted the importance of a robust support system for healthcare professionals.
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Affiliation(s)
- Yong-Shian Goh
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Alice Lee Centre for Nursing Studies, National University Health System, Singapore, Singapore
| | - Qing Yun Jenna Ow Yong
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Alice Lee Centre for Nursing Studies, National University Health System, Singapore, Singapore
| | - Terri Hui-Min Chen
- National University Hospital, National University Health System, Singapore, Singapore
| | - Su Hui Cyrus Ho
- National University Hospital, National University Health System, Singapore, Singapore
| | - Yin Ing Cornelia Chee
- National University Hospital, National University Health System, Singapore, Singapore
| | - Tji Tjian Chee
- National University Hospital, National University Health System, Singapore, Singapore
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22
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Foley LJ, Urdaneta F, Berkow L, Aziz MF, Baker PA, Jagannathan N, Rosenblatt W, Straker TM, Wong DT, Hagberg CA. Difficult Airway Management in Adult COVID-19 Patients: Statement by the Society of Airway Management. Anesth Analg 2021; 133:876-890. [PMID: 33711004 DOI: 10.1213/ane.0000000000005554] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The COVID-19 disease, caused by Coronavirus SARS-CoV-2, often results in severe hypoxemia requiring airway management. Because SARS CoV-2 virus is spread via respiratory droplets, bag-mask ventilation, intubation, and extubation may place health care workers (HCW) at risk. While existing recommendations address airway management in patients with COVID-19, no guidance exists specifically for difficult airway management. Some strategies normally recommended for difficult airway management may not be ideal in the setting of COVID-19 infection. To address this issue the Society for Airway Management (SAM) created a task force to review existing literature and current Practice Guidelines for management of the difficult airway by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. SAM task force created recommendations for management of known or suspected difficult airway in the setting of known or suspected COVID-19 infection. The goal of the task force was to optimize successful airway management while minimizing exposure risk. Each member conducted a literature review on specific clinical practice section utilizing standard search engines (PubMed, Ovid, Google Scholar). Existing recommendations and evidence for difficult airway management in COVID-19 context were developed. Each specific recommendation was discussed among task force members and modified until unanimously approved by all task force members. Elements of AGREE Reporting Checklist for dissemination of clinical practice guidelines were utilized to develop this statement. Airway management in the COVID-19 patient increases HCW exposure risk. and difficult airway management often takes longer, may involve multiple procedures with aerosolization potential, strict adherence to personal protective equipment (PPE) protocols is mandatory to reduce risk to providers. When patient's airway risk assessment suggests awake tracheal intubation is an appropriate choice of technique, procedures that may cause increased aerosolization of secretions should be avoided. Optimal preoxygenation before induction with tight seal facemask may be performed to reduce risk of hypoxemia. Unless the patient is experiencing oxygen desaturation, positive pressure bag-mask ventilation after induction may be avoided to reduce aerosolization. For optimal intubating conditions, patients should be anesthetized with full muscle relaxation. Videolaryngoscopy is recommended as first-line strategy for airway management. If emergent invasive airway access is indicated, we recommend a surgical technique such as scalpel-bougie-tube, rather than an aerosolizing generating procedure, such as transtracheal jet ventilation. This statement represents recommendations by SAM task force for the difficult airway management of adults with COVID-19 with the goal to optimize successful airway management while minimizing the risk of clinician exposure.
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Affiliation(s)
- Lorraine J Foley
- Department of Anesthesiology, Winchester Hospital of Beth Israel Lahey Health, Tufts School of Medicine, Boston, MA, USA
| | - Felipe Urdaneta
- Department of Anesthesiology, University of Florida NFSGVHS, Gainesville FL, USA
| | - Lauren Berkow
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Michael F Aziz
- Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Paul A Baker
- Department of Anaesthesiology, University of Auckland, Auckland, New Zealand
| | - Narasimhan Jagannathan
- Department of Anesthesiology Ann & Robert H. Lurie Children's Hospital of Chicago/Northwestern University Feinberg School of Medicine Chicago, IL
| | - William Rosenblatt
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT, USA
| | - Tracey M Straker
- Department of Anesthesiology, Montefiore Hospital, Albert Einstein College of Medicine New York, NY, USA
| | - David T Wong
- Department of Anesthesia, Toronto Western Hospital, University of Toronto, Toronto, Canada
| | - Carin A Hagberg
- Department of Anesthesiology & Perioperative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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23
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Deng TA, Tsui BCH. An Untested and Uncooperative Pediatric Patient Undergoing a Dental Procedure Using a Negative Airflow Tent During the Coronavirus Disease 2019 Pandemic: A Case Report. A A Pract 2021; 15:e01398. [PMID: 33625120 DOI: 10.1213/xaa.0000000000001398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic prompted the creation of novel techniques to protect patients and health care providers. Simulations showed that disposable oxygen face tents act as a physical barrier and can be repurposed as a negative airflow tent. This case study presents a pediatric patient requiring dental surgery, ineligible for preoperative testing for COVID-19 due to developmental delay and aggression. Precautionary measures were taken by means of full personal protective equipment (PPE) and negative airflow tent. The tent added additional protection and is a promising new technique that is disposable, widely available, and offers full access to proceduralists.
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Affiliation(s)
- Taylor A Deng
- From the Department of Anesthesiology, Perioperative, and Pain Medicine, Lucile Packard Children's Hospital at Stanford, Stanford, California
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24
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White-Dzuro G, Gibson LE, Zazzeron L, White-Dzuro C, Sullivan Z, Diiorio DA, Low SA, Chang MG, Bittner EA. Multisystem effects of COVID-19: a concise review for practitioners. Postgrad Med 2021; 133:20-27. [PMID: 32921198 PMCID: PMC7651182 DOI: 10.1080/00325481.2020.1823094] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 09/07/2020] [Indexed: 01/08/2023]
Abstract
While COVID-19 has primarily been characterized by the respiratory impact of viral pneumonia, it affects every organ system and carries a high consequent risk of death in critically ill patients. Higher sequential organ failure assessment (SOFA) scores have been associated with increased mortality in patients critically ill patients with COVID-19. It is important that clinicians managing critically ill COVID-19 patients be aware of the multisystem impact of the disease so that care can be focused on the prevention of end-organ injuries to potentially improve clinical outcomes. We review the multisystem complications of COVID-19 and associated treatment strategies to improve the care of critically ill COVID-19 patients.
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Affiliation(s)
- Gabrielle White-Dzuro
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Lauren E. Gibson
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Luca Zazzeron
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Colin White-Dzuro
- School of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Zachary Sullivan
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Daren A. Diiorio
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sarah A. Low
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Marvin G. Chang
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Edward A. Bittner
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
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25
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Jain V, Gupta K, Bhatia K, Bansal A, Arora S, Khandelwal AK, Rosenberg JR, Levisay JP, Tommaso CL, Ricciardi MJ, Qamar A. Management of STEMI during the COVID-19 pandemic: Lessons learned in 2020 to prepare for 2021. Trends Cardiovasc Med 2020; 31:135-140. [PMID: 33338636 PMCID: PMC7831899 DOI: 10.1016/j.tcm.2020.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 12/08/2020] [Accepted: 12/09/2020] [Indexed: 01/25/2023]
Abstract
As the prevalence of asymptomatic COVID-19 continues to increase, there is an increasing possibility that patients with COVID-19 may presen with ST-segment elevation myocardial infarction (STEMI). With social distancing and restricted access to preventive healthcare and emergency services, the management of acute cardiac emergencies such as myocardial infarction has suffered collateral damage. Thus far, global trends suggest a decrease in STEMI activations with possible worse outcomes due to delayed presentation and management. In this review, we discuss the challenges to STEMI management in the COVID-19 era and provide potential solutions for adherence to evidence-based therapies as the pandemic progresses into the year 2021.
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Affiliation(s)
- Vardhmaan Jain
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland OH, United States
| | - Kartik Gupta
- Department of Internal Medicine, Henry Ford Hospital, Detroit, MI, United States
| | - Kirtipal Bhatia
- Division of Cardiology, St. Luke's Roosevelt Hospital at Mount Sinai Icahn School of Medicine, New York, NY, United States
| | - Agam Bansal
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland OH, United States
| | - Sameer Arora
- Division of Cardiology, University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Akshay K Khandelwal
- Department of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI, United States
| | - Jonathan R Rosenberg
- Section of Interventional Cardiology, NorthShore University Health System, Evanston, IL, United States
| | - Justin P Levisay
- Section of Interventional Cardiology, NorthShore University Health System, Evanston, IL, United States
| | - Carl L Tommaso
- Section of Interventional Cardiology, NorthShore University Health System, Evanston, IL, United States
| | - Mark J Ricciardi
- Section of Interventional Cardiology, NorthShore University Health System, Evanston, IL, United States
| | - Arman Qamar
- Section of Interventional Cardiology, NorthShore University Health System, Evanston, IL, United States.
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26
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Wei H, Jiang B, Behringer EC, Hofmeyr R, Myatra SN, Wong DT, Sullivan EPO, Hagberg CA, McGuire B, Baker PA, Li J, Pylypenko M, Ma W, Zuo M, Senturk NM, Klein U. Controversies in airway management of COVID-19 patients: updated information and international expert consensus recommendations. Br J Anaesth 2020; 126:361-366. [PMID: 33256990 PMCID: PMC7836532 DOI: 10.1016/j.bja.2020.10.029] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 10/28/2020] [Accepted: 10/30/2020] [Indexed: 12/14/2022] Open
Affiliation(s)
- Huafeng Wei
- Department of Anaesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA, USA.
| | - Bailin Jiang
- Department of Anaesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA, USA; Department of Anaesthesiology, Peking University People's Hospital, Beijing, China
| | - Elizabeth C Behringer
- Division of Cardiovascular Surgery & Critical Care, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | - Ross Hofmeyr
- Department of Anaesthesia & Perioperative Medicine, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
| | - Sheila N Myatra
- Department of Anesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - David T Wong
- Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Ellen P O' Sullivan
- Department of Anaesthesia and Intensive Care Medicine, St James's Hospital, Dublin, Ireland
| | - Carin A Hagberg
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Barry McGuire
- Department of Anaesthesia, Ninewells Hospital, Dundee, UK
| | - Paul A Baker
- Department of Anaesthesia, Starship Children's Health, Auckland, New Zealand
| | - Jane Li
- Department of Anaesthesia and Pain Management, Central Coast Local Health District, NSW, Australia
| | - Maksym Pylypenko
- Department of Anesthesiology and Intensive Care, Shupyk National Medical Academy of Postgraduate Education, Kiev, Ukraine
| | - Wuhua Ma
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Mingzhang Zuo
- Department of Anaesthesiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing, China
| | - Nuzhet M Senturk
- Istanbul Universitesi, Istanbul Tıp Fakültesi, Anesteziyoloji AD, Istanbul, Turkey
| | - Uwe Klein
- Südharz-Klinikum Nordhausen, Nordhausen, Germany
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27
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Kumar GP, Kulkarni AP, Govil D, Dixit SB, Chaudhry D, Samavedam S, Zirpe KG, Gopal PB, Kar A. Airway Management and Related Procedures in Critically Ill COVID-19 Patients: Position Statement of the Indian Society of Critical Care Medicine. Indian J Crit Care Med 2020; 24:630-642. [PMID: 33024367 PMCID: PMC7519615 DOI: 10.5005/jp-journals-10071-23471] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
The coronavirus disease (COVID-19) pandemic has affected nearly all nations globally. The highly contagious nature of the disease puts the healthcare workers at high risk of acquiring infection, especially while handling airway and performing aerosol-generating procedures. The Indian Society of Critical Care Medicine, through this position paper, aims to provide guidance for safe airway management to all healthcare workers dealing with airway in COVID-19 patients.
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Affiliation(s)
- G Praveen Kumar
- Institute of Critical Care and Anesthesia, Medanta-the Medicity, Gurugram, Haryana, India
| | - Atul P Kulkarni
- Division of Critical Care Medicine, Department of Anesthesia, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Deepak Govil
- Institute of Critical Care and Anesthesia, Medanta-the Medicity, Gurugram, Haryana, India
| | - Subhal B Dixit
- Department of Critical Care, Sanjeevan and MJM Hospital, Pune, Maharashtra, India
| | - Dhruva Chaudhry
- Department of Pulmonary and Critical Care Medicine, University of Health Sciences, Rohtak, Haryana, India
| | - Srinivas Samavedam
- Department of Critical Care, Virinchi Hospital, Hyderabad, Telangana, India
| | - Kapil G Zirpe
- Department of Neuro Trauma Unit, Grant Medical Foundation, Pune, Maharashtra, India
| | - Palepu Bn Gopal
- Division of Critical Care, CARE Hospitals, Hyderabad, Telangana, India
| | - Arindam Kar
- Institute of Critical Care, Calcutta Medical Research Institute, Kolkata, West Bengal, India
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