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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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Ramoji A, Pahlow S, Pistiki A, Rueger J, Shaik TA, Shen H, Wichmann C, Krafft C, Popp J. Understanding Viruses and Viral Infections by Biophotonic Methods. TRANSLATIONAL BIOPHOTONICS 2022. [DOI: 10.1002/tbio.202100008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Anuradha Ramoji
- Institute of Physical Chemistry and Abbe Center of Photonics, Friedrich Schiller University, Helmholtzweg 4 Jena Germany
- Leibniz Institute of Photonic Technology Jena (a member of Leibniz Health Technologies) , Albert‐Einstein Str. 9 Jena Germany
- Center for Sepsis Control and Care Jena University Hospital, Am Klinikum 1, 07747 Jena Germany
| | - Susanne Pahlow
- Institute of Physical Chemistry and Abbe Center of Photonics, Friedrich Schiller University, Helmholtzweg 4 Jena Germany
- Leibniz Institute of Photonic Technology Jena (a member of Leibniz Health Technologies) , Albert‐Einstein Str. 9 Jena Germany
- InfectoGnostics Research Campus Jena, Philosophenweg 7, 07743 Jena Germany
| | - Aikaterini Pistiki
- Institute of Physical Chemistry and Abbe Center of Photonics, Friedrich Schiller University, Helmholtzweg 4 Jena Germany
- Leibniz Institute of Photonic Technology Jena (a member of Leibniz Health Technologies) , Albert‐Einstein Str. 9 Jena Germany
| | - Jan Rueger
- Leibniz Institute of Photonic Technology Jena (a member of Leibniz Health Technologies) , Albert‐Einstein Str. 9 Jena Germany
| | - Tanveer Ahmed Shaik
- Leibniz Institute of Photonic Technology Jena (a member of Leibniz Health Technologies) , Albert‐Einstein Str. 9 Jena Germany
| | - Haodong Shen
- Institute of Physical Chemistry and Abbe Center of Photonics, Friedrich Schiller University, Helmholtzweg 4 Jena Germany
- Leibniz Institute of Photonic Technology Jena (a member of Leibniz Health Technologies) , Albert‐Einstein Str. 9 Jena Germany
- InfectoGnostics Research Campus Jena, Philosophenweg 7, 07743 Jena Germany
| | - Christina Wichmann
- Institute of Physical Chemistry and Abbe Center of Photonics, Friedrich Schiller University, Helmholtzweg 4 Jena Germany
- Leibniz Institute of Photonic Technology Jena (a member of Leibniz Health Technologies) , Albert‐Einstein Str. 9 Jena Germany
- InfectoGnostics Research Campus Jena, Philosophenweg 7, 07743 Jena Germany
| | - Christoph Krafft
- Leibniz Institute of Photonic Technology Jena (a member of Leibniz Health Technologies) , Albert‐Einstein Str. 9 Jena Germany
| | - Juergen Popp
- Institute of Physical Chemistry and Abbe Center of Photonics, Friedrich Schiller University, Helmholtzweg 4 Jena Germany
- Leibniz Institute of Photonic Technology Jena (a member of Leibniz Health Technologies) , Albert‐Einstein Str. 9 Jena Germany
- Center for Sepsis Control and Care Jena University Hospital, Am Klinikum 1, 07747 Jena Germany
- InfectoGnostics Research Campus Jena, Philosophenweg 7, 07743 Jena Germany
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Barakat MT, Girotra M, Banerjee S. Initial application of deep learning to borescope detection of endoscope working channel damage and residue. Endosc Int Open 2022; 10:E112-E118. [PMID: 35047341 PMCID: PMC8759945 DOI: 10.1055/a-1591-0258] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 04/01/2021] [Indexed: 11/25/2022] Open
Abstract
Background and study aims Outbreaks of endoscopy-related infections have prompted evaluation for potential contributing factors. We and others have demonstrated the utility of borescope inspection of endoscope working channels to identify occult damage that may impact the adequacy of endoscope reprocessing. The time investment and training necessary for borescope inspection have been cited as barriers preventing implementation. We investigated the utility of artificial intelligence (AI) for streamlining and enhancing the value of borescope inspection of endoscope working channels. Methods We applied a deep learning AI approach to borescope inspection videos of the working channels of 20 endoscopes in use at our academic institution. We evaluated the sensitivity, accuracy, and reliability of this software for detection of endoscope working channel findings. Results Overall sensitivity for AI-based detection of borescope inspection findings identified by gold standard endoscopist inspection was 91.4 %. Labels were accurate for 67 % of these working channel findings and accuracy varied by endoscope segment. Read-to-read variability was noted to be minimal, with test-retest correlation value of 0.986. Endoscope type did not predict accuracy of the AI system ( P = 0.26). Conclusions Harnessing the power of AI for detection of endoscope working channel damage and residue could enable sterile processing department technicians to feasibly assess endoscopes for working channel damage and perform endoscope reprocessing surveillance. Endoscopes that accumulate an unacceptable level of damage may be flagged for further manual evaluation and consideration for manufacturer evaluation/repair.
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Affiliation(s)
- Monique T Barakat
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, United States
| | - Mohit Girotra
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, United States
| | - Subhas Banerjee
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, United States
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Matek J, Kolek F, Klementova O, Michalek P, Vymazal T. Optical Devices in Tracheal Intubation-State of the Art in 2020. Diagnostics (Basel) 2021; 11:diagnostics11030575. [PMID: 33810158 PMCID: PMC8004982 DOI: 10.3390/diagnostics11030575] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/15/2021] [Accepted: 03/18/2021] [Indexed: 12/28/2022] Open
Abstract
The review article is focused on developments in optical devices, other than laryngoscopes, in airway management and tracheal intubation. It brings information on advantages and limitations in their use, compares different devices, and summarizes benefits in various clinical settings. Supraglottic airway devices may be used as a conduit for fiberscope-guided tracheal intubation mainly as a rescue plan in the scenario of difficult or failed laryngoscopy. Some of these devices offer the possibility of direct endotracheal tube placement. Hybrid devices combine the features of two different intubating tools. Rigid and semi-rigid optical stylets represent another option in airway management. They offer benefits in restricted mouth opening and may be used also for retromolar intubation. Awake flexible fiberoptic intubation has been a gold standard in predicted difficult laryngoscopy for decades. Modern flexible bronchoscopes used in anesthesia and intensive care are disposable devices and contain optical lenses instead of fibers. Endotracheal tubes with an incorporated optics are used mainly in thoracic anesthesia for lung separation. They are available in double-lumen and single-lumen versions. They offer a benefit of direct view to the carina and do not require flexible fiberscope for their correct placement.
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Affiliation(s)
- Jan Matek
- 1st Department of Surgery—Department of Abdominal, Thoracic Surgery and Traumatology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, 12800 Prague, Czech Republic;
- Medical Faculty, Masaryk University, 62500 Brno, Czech Republic
| | - Frantisek Kolek
- Department of Anesthesiology and Intensive Medicine, University Hospital Motol, V Úvalu 84, 15000 Praha, Czech Republic;
| | - Olga Klementova
- Department of Anesthesiology and Intensive Medicine, University Hospital Olomouc, I.P. Pavlova 185, Nová Ulice, 77900 Olomouc, Czech Republic;
| | - Pavel Michalek
- Department of Anesthesiology and Intensive Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital, U Nemocnice 499/2, 12808 Praha, Czech Republic;
- Department of Anaesthesia, Antrim Area Hospital, Antrim BT41 2RL, UK
| | - Tomas Vymazal
- Department of Anesthesiology and Intensive Medicine, University Hospital Motol, V Úvalu 84, 15000 Praha, Czech Republic;
- Correspondence: ; Tel.: +420-606-413-489
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Losurdo P, Paiano L, Samardzic N, Germani P, Bernardi L, Borelli M, Pozzetto B, de Manzini N, Bortul M. Impact of lockdown for SARS-CoV-2 (COVID-19) on surgical site infection rates: a monocentric observational cohort study. Updates Surg 2020; 72:1263-1271. [PMID: 32926340 PMCID: PMC7488636 DOI: 10.1007/s13304-020-00884-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 09/03/2020] [Indexed: 12/01/2022]
Abstract
Surgical site infections are the most common in-hospital acquired infections. The aim of this study and the primary endpoint is to evaluate how the measures to reduce the SARS-CoV-2 spreading affected the superficial and deep SSI rate. A total of 541 patients were included. Of those, 198 from March to April 2018, 220 from March till April 2019 and 123 in the COVID-19 era from March to April 2020. The primary endpoint occurred in 39 over 541 patients. In COVID-19 era, we reported a lower rate of global SSIs (3.3% vs. 8.4%; p 0.035), few patients developed a superficial SSIs (0.8% vs. 3.4%; p 0.018) and none experienced deep SSIs (0% vs. 3.4%; p 0.025). Comparing the previous two “COVID-19-free” years, no significative differences were reported. At multivariate analysis, the measures to reduce the SARS-CoV-2 spread (OR 0.368; p 0.05) were independently associated with the reduction for total, superficial and deep SSIs. Moreover, the presence of drains (OR 4.99; p 0.009) and a Type III–IV of SWC (OR 1.8; p 0.001) demonstrated a worse effect regarding the primary endpoint. Furthermore, the presence of the drain was not associated with an increased risk of superficial and deep SSIs. In this study, we provided important insights into the superficial and deep SSIs risk assessment for patients who underwent surgery. Simple and easily viable precautions such as wearing surgical masks and the restriction of visitors emerged as promising tools for the reduction of SSIs risk.
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Affiliation(s)
- Pasquale Losurdo
- Division of General Surgery, Department of Medical and Surgical Sciences, Hospital of Cattinara, University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy.
| | - Lucia Paiano
- Division of General Surgery, Department of Medical and Surgical Sciences, Hospital of Cattinara, University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy
| | - Natasa Samardzic
- Division of General Surgery, Department of Medical and Surgical Sciences, Hospital of Cattinara, University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy
| | - Paola Germani
- Division of General Surgery, Department of Medical and Surgical Sciences, Hospital of Cattinara, University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy
| | - Laura Bernardi
- Division of General Surgery, Department of Medical and Surgical Sciences, Hospital of Cattinara, University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy
| | - Massimo Borelli
- Division of General Surgery, Department of Medical and Surgical Sciences, Hospital of Cattinara, University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy
| | - Barbara Pozzetto
- Division of General Surgery, Department of Medical and Surgical Sciences, Hospital of Cattinara, University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy
| | - Nicolò de Manzini
- Division of General Surgery, Department of Medical and Surgical Sciences, Hospital of Cattinara, University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy
| | - Marina Bortul
- Division of General Surgery, Department of Medical and Surgical Sciences, Hospital of Cattinara, University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy
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