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Hu R, Chen Y, Jiang S, Hu T, Huang J, Zhang L, Pan W, Yi L, Huang Y. Factors associated with damages and repair costs of reusable flexible bronchoscopes in pediatrics in China. BMC Pediatr 2024; 24:228. [PMID: 38561723 PMCID: PMC10983617 DOI: 10.1186/s12887-024-04705-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 03/11/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Frequent repairs of pediatric flexible bronchoscopes can lead to a huge financial burden for the hospital. This study aimed to investigate the common causes of the failures in pediatric flexible bronchoscopes and propose the measures to prevent the failures. METHODS This was a retrospective study. We collected repair information of the pediatric flexible bronchoscopes reprocessed in the Department of Sterile Processing at a hospital between September 1, 2018 and September 1, 2022 in order to investigate the causes and possible factors associated with the failures in pediatric flexible bronchoscopes. RESULTS The Department of Sterile Processing staff reprocessed the pediatric flexible bronchoscopes 4280 times. A total of 29 failures were identified. The failure rate was 0.678%. The average repair cost was USD7246.60. The common failures in the pediatric flexible bronchoscopes included dim video image, black dots, improper video image display or no image during angulation adjustment, and pressure marks in the insertion tube. The failure rates in flexible electronic bronchoscopes and small-diameter flexible bronchoscopes were 65.5% and 93.1%, respectively. The failure rate in the pediatric flexible bronchoscopes reprocessed by the staff members with less work experience was 75.9%. CONCLUSION The failure rate in the pediatric flexible bronchoscopes was not high but the repair costs were extremely high. The types and size of the flexible bronchoscopes and work experience of the staff members responsible for bronchoscope reprocessing were the possible factors associated with the failure rate in the pediatric flexible bronchoscopes. It is advisable to further optimize the central workflow and management mode for reprocessing the pediatric flexible bronchoscopes, thereby extending their useful life and reducing costs.
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Affiliation(s)
- Ruixue Hu
- Department of Sterile Processing Nursing, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Yanhua Chen
- Department of Sterile Processing Nursing, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Sixin Jiang
- Department of Sterile Processing Nursing, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Ting Hu
- Department of Sterile Processing Nursing, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Juanli Huang
- Department of Sterile Processing Nursing, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Lu Zhang
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
- Operation Management Department, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Wei Pan
- Department of Sterile Processing Nursing, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Liangying Yi
- Department of Sterile Processing Nursing, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China.
| | - Yan Huang
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China.
- Department of Nursing, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.
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Andersen CØ, Travis H, Dehlholm-Lambertsen E, Russell R, Jørgensen EP. The Cost of Flexible Bronchoscopes: A Systematic Review and Meta-analysis. PHARMACOECONOMICS - OPEN 2022; 6:787-797. [PMID: 35994238 PMCID: PMC9596653 DOI: 10.1007/s41669-022-00356-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/10/2022] [Indexed: 05/28/2023]
Abstract
BACKGROUND AND OBJECTIVE Until 2009, only reusable bronchoscopes were marketed, but the introduction and widespread adoption of single-use flexible bronchoscopes (SFBs) as an emerging technology has since accelerated. Several studies have described the costs of reusable flexible bronchoscopes (RFBs) and SFBs. This meta-analysis aimed to compile the current published evidence to analyse the cost of different scenarios using RFBs and SFBs. METHODS All published literature describing the cost of RFBs or SFBs was identified by searching PubMed, Embase and Google Scholar, limited to those between 1 January, 2009 and 6 November, 2020. Included studies should report the total cost of RFBs. Continuous data were extracted for relevant outcomes and analysed using RStudio® 4.0.3 as the standardised mean difference and standard error of the mean in a mixed-effects model. Risk of bias was assessed based on the reporting quality. RESULTS In the systematic literature review, 342 studies were initially identified, and 11 were included in the final analysis. The mean RFB procedure cost was $266 (standard error of the mean: 34), including capital investments, repairs and reprocessing costs of $91, $92 and $83, respectively. The mean SFB procedure cost was $289 (standard error of the mean: 10). The incremental cost was $23 (standard error of the mean: 33) and was not significant (p = 0.46). Because of the economy of scale, RFB is more likely to be cost minimising compared with SFB when performing 306 or 39 procedures per site or RFB, respectively. CONCLUSIONS In this study, we found no significant difference in the cost of use between RFBs and SFBs and a high risk of bias.
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Difficult airway management practice changes after introduction of the GlideScope videolaryngoscope: A retrospective cohort study. Eur J Anaesthesiol 2021; 37:443-450. [PMID: 32205576 DOI: 10.1097/eja.0000000000001199] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Introduction of the GlideScope videolaryngoscope caused a change in use of other devices for difficult airway management. OBJECTIVE The influence of the GlideScope videolaryngoscope on changes in the indications for and the frequency of use of flexible fibreoptic-assisted intubation and other difficult airway management techniques. DESIGN Retrospective cohort study. SETTING Tertiary care referral centre. METHODS Two periods of equal length (647 days each) before and after introducing the GlideScope were compared. Information about patients who were intubated using nondirect laryngoscopic techniques were analysed. Data were retrieved from the anaesthesia and hospital information management systems. RESULTS Difficult airway management techniques were used in 235/8306 (2.8%) patients before and in 480/8517 (5.6%) (P < 0.0001) patients after the introduction of the GlideScope. There was an overall 44.4% reduction in use of flexible fibreoptic bronchoscopy after GlideScope introduction [before 149/8306 (1.8%); after 85/8517 (1.0%), P < 0.0001]. The GlideScope replaced flexible fibreoptic bronchoscopy in most cases with expected and unexpected difficult intubation. In patients with limited mouth opening, flexible fibreoptic bronchoscopy was still mostly the first choice after the introduction of the GlideScope. There was a 70% reduction in the use of other difficult intubation techniques after the introduction of the GlideScope [before 84/8306 (1.0%); after 22/8517 (0.3%), P < 0.0001)]. CONCLUSION The GlideScope videolaryngoscope replaced flexible fibreoptic bronchoscopy for most patients with expected and unexpected difficult intubation. In the case of limited mouth opening, flexible fibreoptic bronchoscopy was still the first choice after the introduction of the GlideScope. The reduced use of flexible fibreoptic bronchoscopy raises concerns that residents may not be adequately trained in this essential airway management technique. GlideScope use was disproportionately greater than the reduction in the use of flexible fibreoptic bronchoscopy and other difficult intubation techniques. This may be attributed to resident teaching and use in patients with low-to-moderate suspicion of difficult intubation.
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Walczak R, Arnold M, Grewal J, Yuan X, Suryadevara A, Marzouk H. Reusable vs disposable nasopharyngolaryngoscopes: Cost analysis and resident survey. Laryngoscope Investig Otolaryngol 2021; 6:88-93. [PMID: 33614935 PMCID: PMC7883614 DOI: 10.1002/lio2.500] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 11/05/2020] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE Assess the quality of a new disposable nasopharyngolaryngoscope (NPL) through resident feedback at multiple academic institutions and provide a cost analysis of reusable and disposable NPLs at a single academic center. STUDY DESIGN An online survey was distributed to residents at institutions throughout the United States that have implemented use of a disposable NPL (Ambu aScope 4 Rhinolaryngo). SETTING Cost analysis performed at a single academic center. Resident survey distributed to multiple residency programs throughout the United States. SUBJECTS AND METHODS The survey collected demographic information and asked residents to rate the new disposable NPL and other reusable NPLs using a 5-point Likert scale. A cost analysis was performed of both reusable and disposable NPLs using information obtained at a single academic center. RESULTS The survey was distributed to 109 residents throughout the country and 37 were completed for a response rate of 33.9%. The disposable NPL was comparable to reusable NPLs based on ergonomics and maneuverability, inferior in imaging quality (P < .001), and superior in setup (P < .001), convenience (P < .001), and rated better overall (P < .04). The disposable NPL was found to be cheaper per use than reusable NPLs at $171.82 and $170.36 compared to $238.17 and $197.88 per use for the reusable NPL if the life span is 1 year and 5 years respectively. CONCLUSION Disposable NPLs may offer an alternative option and initial feedback obtained from resident physicians is favorable. Cost analysis favors disposable NPLs as the cost-effective option. LEVEL OF EVIDENCE NA.
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Affiliation(s)
- Ryan Walczak
- SUNY Upstate Medical UniversitySyracuseNew YorkUSA
| | - Mark Arnold
- SUNY Upstate Medical UniversitySyracuseNew YorkUSA
| | | | - Xiao Yuan
- SUNY Upstate Medical UniversitySyracuseNew YorkUSA
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Implementation of an Anaesthesia Quality Improvement Programme to Reduce Fibreoptic Bronchoscope Repair Incidents. BIOMED RESEARCH INTERNATIONAL 2020; 2020:1091239. [PMID: 32337218 PMCID: PMC7115174 DOI: 10.1155/2020/1091239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 03/10/2020] [Indexed: 11/17/2022]
Abstract
Background This study was aimed at investigating the effectiveness of the implementation of a comprehensive quality improvement programme (QIP) for reducing the repair rate of the fibreoptic bronchoscope (FOB). Methods A three-stage improvement strategy was implemented between January 2013 and December 2016. Stage one is the acquisition of information on violations of practice guidelines, repair rate, cost of repair, and incidence of unavailability of FOB during anaesthesia induction of the previous year through auditing. Stage two is the implementation of a quality improvement campaign (QIC) based on the results of stage one. Stage three is the programme perpetuation through monitoring compliance with policy on FOB use by regular internal audits. The effectiveness was retrospectively analyzed on a yearly basis. Results The annual repair rate, repair cost, and incidence of FOB unavailability before the QIP implementation were 1%, 18,757 USD, and 1.4%, respectively. After QIC, the repair rate in 2013 dropped by 81% (from 1% in 2012 to 0.19% in 2013, p < 0.05). The annual repair cost fell by 32% from 18,758 USD (2012) to 12,820 USD (2013). Besides, the incidence of FOB unavailability plummeted by 71% from 1.4% to 0.4% during the same period. The annual repair rates and incidence of FOB unavailability remained lower in subsequent three years than those before QIP implementation. Conclusion Implementation of a quality improvement programme was effective for reducing the rate and cost of FOB repair as well as unavailability rate, highlighting its beneficial impact on cost-effectiveness and patient safety in a tertiary referral center setting.
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Mouritsen JM, Ehlers L, Kovaleva J, Ahmad I, El-Boghdadly K. A systematic review and cost effectiveness analysis of reusable vs. single-use flexible bronchoscopes. Anaesthesia 2019; 75:529-540. [PMID: 31701521 PMCID: PMC7079200 DOI: 10.1111/anae.14891] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2019] [Indexed: 12/15/2022]
Abstract
The cost effectiveness of reusable vs. single‐use flexible bronchoscopy in the peri‐operative setting has yet to be determined. We therefore aimed to determine this and hypothesised that single‐use flexible bronchoscopes are cost effective compared with reusable flexible bronchoscopes. We conducted a systematic review of the literature, seeking all reports of cross‐contamination or infection following reusable bronchoscope use in any clinical setting. We calculated the incidence of these outcomes and then determined the cost per patient of treating clinical consequences of bronchoscope‐induced infection. We also performed a micro‐costing analysis to quantify the economics of reusable flexible bronchoscopes in the peri‐operative setting from a high‐throughput tertiary centre. This produced an accurate estimate of the cost per use of reusable flexible bronchoscopes. We then performed a cost effectiveness analysis, combining the data obtained from the systematic review and micro‐costing analysis. We included 16 studies, with a reported incidence of cross‐contamination or infection of 2.8%. In the micro‐costing analysis, the total cost per use of a reusable flexible bronchoscope was calculated to be £249 sterling. The cost per use of a single‐use flexible bronchoscope was £220 sterling. The cost effectiveness analysis demonstrated that reusable flexible bronchoscopes have a cost per patient use of £511 sterling due to the costs of treatment of infection. The findings from this study suggest benefits from the use of single‐use flexible bronchoscopes in terms of cost effectiveness, cross‐contamination and resource utilisation.
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Affiliation(s)
- J M Mouritsen
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - L Ehlers
- Danish Center of Healthcare Improvements, Institute of Business and Management, Aalborg University, Aalborg, Denmark
| | - J Kovaleva
- Sint-Jozefkliniek Bornem and Willebroek, Bornem, Belgium
| | - I Ahmad
- Guy's and St. Thomas' NHS Foundation Trust, London, UK.,King's College London, UK
| | - K El-Boghdadly
- Guy's and St. Thomas' NHS Foundation Trust, London, UK.,King's College London, UK
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Sohrt A, Ehlers L, Udsen FW, Mærkedahl A, McGrath BA. Cost Comparison of Single-Use Versus Reusable Bronchoscopes Used for Percutaneous Dilatational Tracheostomy. PHARMACOECONOMICS - OPEN 2019; 3:189-195. [PMID: 30167996 PMCID: PMC6533350 DOI: 10.1007/s41669-018-0091-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
BACKGROUND Both single-use and reusable bronchoscopes are suitable for percutaneous dilatational tracheostomy (PDT) to visualise the trachea during the insertion process. To determine the least costly option, the price of single-use bronchoscopes must be weighed against the estimated average cost of a bronchoscopy with reusable equipment. In the latter case, the acquisition cost must be spread over the equipment's useful life and other relevant costs, such as reprocessing and repair, must be included. OBJECTIVE This study aimed to calculate the cost of using single-use or reusable bronchoscopes per PDT procedure. METHODS A systematic literature search was conducted to identify studies comparing the costs of reusable and single-use bronchoscopes for PDT. Inclusion criteria were articles assessing the cost of single-use or reusable bronchoscopes, and where costs were divided into acquisition, reprocessing, and repair costs. A questionnaire regarding repair rates and costs for reusable bronchoscopes was sent to 366 hospitals in the US, UK, and Germany to supplement the identified literature. RESULTS Eleven studies met the inclusion criteria. Ninety-nine completed responses were received, of which 31 hospitals used reusable equipment for PDT. Literature research revealed an average acquisition cost of $US135 (SD 152) and reprocessing cost of $US123 (SD 128). Additionally, a combination of data from the literature and the questionnaires gave a repair cost per use of $US148 (SD 242), resulting in a total average cost of $US406 for reusable bronchoscopes and $US249 (SD 36) for single-use bronchoscopes per PDT procedure. Thus, the incremental cost per use of a reusable bronchoscope compared with a single-use bronchoscope was $US157. CONCLUSIONS We conclude that significant savings can be made by using single-use bronchoscopes to guide PDT in preference to reusable bronchoscopes. Results depend on hospital setting, the reprocessing procedures, annual bronchoscope procedures, individual repair cost, and repair rates.
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Affiliation(s)
- Anne Sohrt
- Ambu A/S, Baltorpbakken 13, 2750, Ballerup, Denmark.
| | - Lars Ehlers
- Department of Business and Management, Fibigerstraede 11, 9220, Aalborg, Denmark
| | - Flemming Witt Udsen
- Department of Health Science and Technology, Frederik Bajers Vej 7, 9220, Aalborg, Denmark
| | | | - Brendan A McGrath
- Wythenshawe Hospital, Manchester University Hospital NHS Foundation Trust, Southmoor Road, Manchester, M23 9LT, UK
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Jiang J, Ma DX, Li B, Wu AS, Xue FS. Videolaryngoscopy versus fiberoptic bronchoscope for awake intubation - a systematic review and meta-analysis of randomized controlled trials. Ther Clin Risk Manag 2018; 14:1955-1963. [PMID: 30410341 PMCID: PMC6197207 DOI: 10.2147/tcrm.s172783] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Background Awake intubation with videolaryngoscopy (VL) is a novel method that is drawing more and more attention as an alternative to awake intubation with fiberoptic bronchoscope (FOB). This meta-analysis is designed to determine the performance of VL compared to the FOB for awake intubation. Methods The Cochrane Central Register of Controlled Trials, PubMed, Embase, and Web of science were searched from database inception until October 30, 2017. Randomized controlled trials comparing VL and FOB for awake intubation were selected. The primary outcome was the overall success rate. Rev-Man 5.3 software was used to perform the pooled analysis and assess the risk of bias for each eligible study. The GRADE system was used to assess the quality of evidence for all outcomes. Results Six studies (446 patients) were included in the review for data extraction. Pooled analysis did not show any difference in the overall success rate by using VL and FOB (relative risk [RR], 1.00; P=0.99; high-quality evidence). There was no heterogeneity among studies (I2=0). Subgroup analyses showed no differences between two groups through nasal (RR, 1.00; P=1.00; high-quality evidence) and oral intubations (RR, 1.00; P=0.98; high-quality evidence). The intubation time was shorter by using VL than by using FOB (mean difference, −40.4 seconds; P<0.01; low-quality evidence). There were no differences between groups for other outcomes (P>0.05). Conclusion For awake intubation, VL with a shorter intubation time is as effective and safe as FOB. VL may be a useful alternative to FOB.
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Affiliation(s)
- Jia Jiang
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Da-Xu Ma
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Bo Li
- Beijing Hospital of Traditional Chinese Medicine, Affiliated to Capital Medical University, Beijing Institute of Traditional Chinese Medicine, Beijing 100010, China
| | - An-Shi Wu
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Fu-Shan Xue
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China,
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Saunders R, Davis JA, Kranke P, Weissbrod R, Whitaker DK, Lightdale JR. Clinical and economic burden of procedural sedation-related adverse events and their outcomes: analysis from five countries. Ther Clin Risk Manag 2018. [PMID: 29535525 PMCID: PMC5836671 DOI: 10.2147/tcrm.s154720] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Background Studies have reported on the incidence of sedation-related adverse events (AEs), but little is known about their impact on health care costs and resource use. Methods Health care providers and payers in five countries were recruited for an online survey by independent administrators to ensure that investigators and respondents were blinded to each other. Surveys were conducted in the local language and began with a “screener” to ensure that respondents had relevant expertise and experience. Responses were analyzed using Excel and R, with the Dixon’s Q statistic used to identify and remove outliers. Global and country-specific average treatment patterns were calculated via bootstrapping; costs were mean values. The sum product of costs and intervention probability gave a cost per AE. Results Responses were received from 101 providers and 26 payers, the majority having >5 years of experience. At a minimum, the respondents performed a total of 3,430 procedural sedations per month. All AEs detailed occurred in clinical practice in the last year and were reported to cause procedural delays and cancellations in some patients. Standard procedural sedation costs ranged from €74 (Germany) to $2,300 (US). Respondents estimated that AEs would increase costs by between 16% (Italy) and 179% (US). Hypotension was reported as the most commonly observed AE with an associated global mean cost (interquartile range) of $43 ($27–$68). Other frequent AEs, including mild hypotension, bradycardia, tachycardia, mild oxygen desaturation, hypertension, and brief apnea, were estimated to increase health care spending on procedural sedation by $2.2 billion annually in the US. Conclusion All sedation-related AEs can increase health care costs and result in substantial delays or cancellations of subsequent procedures. The prevention of even minor AEs during procedural sedation may be crucial to ensuring its value as a health care service.
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Affiliation(s)
| | | | - Peter Kranke
- Department of Anaesthesia and Critical Care, University of Würzburg, Würzburg, Germany
| | | | - David K Whitaker
- Department of Anaesthesia, Manchester Royal Infirmary, Manchester, UK
| | - Jenifer R Lightdale
- Pediatric Gastroenterology, Hepatology and Nutrition, University of Massachusetts, Worcester, MA, USA
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Cost-Effectiveness of Disposable Bronchoscopes: Needs Comparison with Fiberoptic Bronchoscopes too. J Bronchology Interv Pulmonol 2018; 25:e6-e7. [DOI: 10.1097/lbr.0000000000000431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Huang HB, Peng JM, Xu B, Liu GY, Du B. Video Laryngoscopy for Endotracheal Intubation of Critically Ill Adults: A Systemic Review and Meta-Analysis. Chest 2017; 152:510-517. [PMID: 28629915 DOI: 10.1016/j.chest.2017.06.012] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 05/21/2017] [Accepted: 06/01/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Endotracheal intubation (EI) in ICU patients is associated with an increased risk of life-threatening adverse events due to unstable conditions, rapid deterioration, limited preparation time, and variability in the expertise of operators. The goal of this study was to compare the effect of video laryngoscopy (VL) and direct laryngoscopy (DL) in ICU patients requiring EI. METHODS We searched for relevant studies in PubMed, Embase, and the Cochrane database from inception through January 30, 2017. Randomized controlled trials were included if they reported data on any of the predefined outcomes in ICU patients requiring EI and managed with VL or DL. Results were expressed as risk ratios (RRs) or mean differences (MDs) with accompanying 95% CIs. RESULTS Five randomized controlled trials with 1,301 patients were included. Despite better glottic visualization with VL (RR = 1.24; 95% CI, 1.07 to 1.43; P = .003), use of VL did not result in a significant increase in the first-attempt success rate (RR = 1.08; 95% CI, 0.92-1.26; P = .35) compared with DL. In addition, time to intubation (MD = 4.12 s; 95% CI, -15.86-24.09; P = .69), difficult intubation (RR = 0.72; 95% CI, 0.30-1.70; P = .45), mortality (RR = 1.02; 95% CI, 0.84-1.25; P = .83), and most other complications were similar between the VL and DL groups. CONCLUSIONS The VL technique did not increase the first-attempt success rate during EI in ICU patients compared with DL. These findings do not support routine use of VL in ICU patients.
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Affiliation(s)
- Hui-Bin Huang
- Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Peking, People's Republic of China; Department of Critical Care Medicine, the First Affiliated Hospital of Fujian Medical University, Fuzhou, People's Republic of China
| | - Jin-Min Peng
- Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Peking, People's Republic of China
| | - Biao Xu
- Critical Care Medicine Center, the PLA 302 Hospital, Fengtai District, Beijing, People's Republic of China
| | - Guang-Yun Liu
- Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Peking, People's Republic of China
| | - Bin Du
- Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Peking, People's Republic of China.
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Grensemann J, Eichler L, Hopf S, Jarczak D, Simon M, Kluge S. Feasibility of an endotracheal tube-mounted camera for percutaneous dilatational tracheostomy. Acta Anaesthesiol Scand 2017; 61:660-667. [PMID: 28493334 DOI: 10.1111/aas.12904] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 03/08/2017] [Accepted: 04/13/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Percutaneous dilatational tracheostomy (PDT) in critically ill patients is often led by optical guidance with a bronchoscope. This is not without its disadvantages. Therefore, we aimed to study the feasibility of a recently introduced endotracheal tube-mounted camera (VivaSight™-SL, ET View, Misgav, Israel) in the guidance of PDT. METHODS We studied 10 critically ill patients who received PDT with a VivaSight-SL tube that was inserted prior to tracheostomy for optical guidance. Visualization of the tracheal structures (i.e., identification and monitoring of the thyroid, cricoid, and tracheal cartilage and the posterior wall) and the quality of ventilation (before puncture and during the tracheostomy) were rated on four-point Likert scales. Respiratory variables were recorded, and blood gases were sampled before the interventions, before the puncture and before the insertion of the tracheal cannula. RESULTS Visualization of the tracheal landmarks was rated as 'very good' or 'good' in all but one case. Monitoring during the puncture and dilatation was also rated as 'very good' or 'good' in all but one. In the cases that were rated 'difficult', the visualization and monitoring of the posterior wall of the trachea were the main concerns. No changes in the respiratory variables or blood gases occurred between the puncture and the insertion of the tracheal cannula. CONCLUSION Percutaneous dilatational tracheostomy with optical guidance from a tube-mounted camera is feasible. Further studies comparing the camera tube with bronchoscopy as the standard approach should be performed.
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Affiliation(s)
- J. Grensemann
- Department of Intensive Care Medicine; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - L. Eichler
- Department of Intensive Care Medicine; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - S. Hopf
- Department of Intensive Care Medicine; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - D. Jarczak
- Department of Intensive Care Medicine; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - M. Simon
- Department of Respiratory Medicine; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - S. Kluge
- Department of Intensive Care Medicine; University Medical Center Hamburg-Eppendorf; Hamburg Germany
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Terjesen CL, Kovaleva J, Ehlers L. Early Assessment of the Likely Cost Effectiveness of Single-Use Flexible Video Bronchoscopes. PHARMACOECONOMICS - OPEN 2017; 1:133-141. [PMID: 29442335 PMCID: PMC5691847 DOI: 10.1007/s41669-017-0012-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
BACKGROUND Bronchoscopic procedures are common in the clinical setting, with estimates indicating 500,000 are undertaken per year in the USA alone. These procedures are generally regarded as safe. Unfortunately, a risk of cross-contamination between patients, with possible subsequent infection, is associated with the re-usable technology typically used in these procedures. OBJECTIVE Our objective was to conduct an early cost-effectiveness analysis (CEA) of single-use flexible video bronchoscope technology compared with the current reusable technology in a US hospital intensive care setting. METHODS We conducted a CEA to determine an incremental cost-effectiveness ratio (ICER), and constructed a decision analytic model based on the best available evidence from a literature search and a Delphi panel. We also conducted several one- and two-way sensitivity analyses and a probabilistic sensitivity analysis to illuminate the uncertainty associated with the estimates. RESULTS The literature search showed ample evidence of risk, albeit little of it was quantifiable. Estimates from the Delphi method found approximately a 3% risk of cross-contamination and approximately a 21% risk of subsequent infection. Pneumonia was estimated as the most likely manifestation of infection. The CEA showed a saving of $US118 per procedure and elimination of 0.7% of the risk of infection with the single-use technology. Relevant sensitivity analyses generally validated this result. CONCLUSION This study suggests that implementation of the single-use technology in the intensive care unit is cost effective in most scenarios. However, this result should be interpreted with caution because of the lack of certain knowledge on this particular topic.
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Affiliation(s)
| | | | - Lars Ehlers
- Danish Center for Healthcare Improvements, Aalborg University, Fibigerstraede 11, 9220, Aalborg, Denmark.
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Terjesen CL, Kovaleva J, Ehlers L. Early Assessment of the Likely Cost Effectiveness of Single-Use Flexible Video Bronchoscopes. PHARMACOECONOMICS - OPEN 2017; 1:133-141. [PMID: 29442335 DOI: 10.1007/s41669-017-0012-9lk] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND Bronchoscopic procedures are common in the clinical setting, with estimates indicating 500,000 are undertaken per year in the USA alone. These procedures are generally regarded as safe. Unfortunately, a risk of cross-contamination between patients, with possible subsequent infection, is associated with the re-usable technology typically used in these procedures. OBJECTIVE Our objective was to conduct an early cost-effectiveness analysis (CEA) of single-use flexible video bronchoscope technology compared with the current reusable technology in a US hospital intensive care setting. METHODS We conducted a CEA to determine an incremental cost-effectiveness ratio (ICER), and constructed a decision analytic model based on the best available evidence from a literature search and a Delphi panel. We also conducted several one- and two-way sensitivity analyses and a probabilistic sensitivity analysis to illuminate the uncertainty associated with the estimates. RESULTS The literature search showed ample evidence of risk, albeit little of it was quantifiable. Estimates from the Delphi method found approximately a 3% risk of cross-contamination and approximately a 21% risk of subsequent infection. Pneumonia was estimated as the most likely manifestation of infection. The CEA showed a saving of $US118 per procedure and elimination of 0.7% of the risk of infection with the single-use technology. Relevant sensitivity analyses generally validated this result. CONCLUSION This study suggests that implementation of the single-use technology in the intensive care unit is cost effective in most scenarios. However, this result should be interpreted with caution because of the lack of certain knowledge on this particular topic.
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Affiliation(s)
| | | | - Lars Ehlers
- Danish Center for Healthcare Improvements, Aalborg University, Fibigerstraede 11, 9220, Aalborg, Denmark.
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Edenharter GM, Gartner D, Pförringer D. Decision Support for the Capacity Management of Bronchoscopy Devices. Anesth Analg 2017; 124:1963-1967. [DOI: 10.1213/ane.0000000000001729] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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16
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Falzon D, Alston RP, Coley E, Montgomery K. Lung Isolation for Thoracic Surgery: From Inception to Evidence-Based. J Cardiothorac Vasc Anesth 2017; 31:678-693. [DOI: 10.1053/j.jvca.2016.05.032] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Indexed: 12/15/2022]
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17
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Perbet S, Blanquet M, Mourgues C, Delmas J, Bertran S, Longère B, Boïko-Alaux V, Chennell P, Bazin JE, Constantin JM. Cost analysis of single-use (Ambu ® aScope™) and reusable bronchoscopes in the ICU. Ann Intensive Care 2017; 7:3. [PMID: 28050896 PMCID: PMC5209315 DOI: 10.1186/s13613-016-0228-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 12/20/2016] [Indexed: 11/25/2022] Open
Abstract
Background Flexible optical bronchoscopes are essential for management of airways in ICU, but the conventional reusable flexible scopes have three major drawbacks: high cost of repairs, need for decontamination, and possible transmission of infectious agents. The main objective of this study was to measure the cost of bronchoalveolar lavage (BAL) and percutaneous tracheostomy (PT) using reusable bronchoscopes and single-use bronchoscopes in an ICU of an university hospital. The secondary objective was to compare the satisfaction of healthcare professionals with reusable and single-use bronchoscopes. Methods The study was performed between August 2009 and July 2014 in a 16-bed ICU. All BAL and PT procedures were performed by experienced healthcare professionals. Cost analysis was performed considering ICU and hospital organization. Healthcare professional satisfaction with single-use and reusable scopes was determined based on eight factors. Sensitivity analysis was performed by applying discount rates (0, 3, and 5%) and by simulation of six situations based on different assumptions. Results At a discount rate of 3%, the costs per BAL for the two reusable scopes were 188.86€ (scope 1) and 185.94€ (scope 2), and the costs per PT for the reusable scope 1 and scope 2 and single-use scopes were 1613.84€, 410.24€, and 204.49€, respectively. The cost per procedure for the reusable scopes depended on the number of procedures performed, maintenance costs, and decontamination costs. Healthcare professionals were more satisfied with the third-generation single-use Ambu® aScope™. Conclusions The cost per procedure for the single-use scope was not superior to that for reusable scopes. The choice of single-use or reusable bronchoscopes in an ICU should consider the frequency of procedures and the number of bronchoscopes needed. Electronic supplementary material The online version of this article (doi:10.1186/s13613-016-0228-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- S Perbet
- Réanimation Adultes & USC, Pôle de Médecine Péri-Opératoire, CHU Clermont-Ferrand, Clermont-Ferrand, France. .,R2D2, EA 7281, Faculté de Médecine, Université d'Auvergne, Clermont-Ferrand, France. .,Réanimation Médico-Chirugicale, Pôle de Médecine Péri-Opératoire, Hôpital Gabriel-Montpied, CHU Clermont-Ferrand, 58 Rue Montalembert, 63000, Clermont-Ferrand Cedex, France.
| | - M Blanquet
- Service de Santé Publique, CHU Clermont-Ferrand, 7, Place Henri-Dunant, 63058, Clermont-Ferrand Cedex 1, France.,Clermont Université, Université d'Auvergne, EA 4681, PEPRADE (Périnatalité, grossesse, Environnement, PRAtiques médicales et DEveloppement), Clermont-Ferrand, France
| | - C Mourgues
- Service de Santé Publique, CHU Clermont-Ferrand, 7, Place Henri-Dunant, 63058, Clermont-Ferrand Cedex 1, France.,Clermont Université, Université d'Auvergne, EA 4681, PEPRADE (Périnatalité, grossesse, Environnement, PRAtiques médicales et DEveloppement), Clermont-Ferrand, France
| | - J Delmas
- Réanimation Adultes & USC, Pôle de Médecine Péri-Opératoire, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - S Bertran
- Réanimation Adultes & USC, Pôle de Médecine Péri-Opératoire, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - B Longère
- Réanimation Adultes & USC, Pôle de Médecine Péri-Opératoire, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - V Boïko-Alaux
- Pharmacie centrale, Centrale d'Approvisionnement de Matériel Stérile, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - P Chennell
- Pharmacie centrale, Centrale d'Approvisionnement de Matériel Stérile, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - J-E Bazin
- Réanimation Adultes & USC, Pôle de Médecine Péri-Opératoire, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - J-M Constantin
- Réanimation Adultes & USC, Pôle de Médecine Péri-Opératoire, CHU Clermont-Ferrand, Clermont-Ferrand, France.,R2D2, EA 7281, Faculté de Médecine, Université d'Auvergne, Clermont-Ferrand, France
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18
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Reena. Use of Ambu® aScope™ 3 in difficult airway management in giant lipoma neck. EGYPTIAN JOURNAL OF ANAESTHESIA 2017. [DOI: 10.1016/j.egja.2016.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Reena
- Heritage Institute of Medical Sciences, Varanasi, Uttar Pradesh, India
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Mendonca C, Mesbah A, Velayudhan A, Danha R. A randomised clinical trial comparing the flexible fibrescope and the Pentax Airway Scope (AWS)(®) for awake oral tracheal intubation. Anaesthesia 2016; 71:908-14. [PMID: 27228959 DOI: 10.1111/anae.13516] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2016] [Indexed: 11/26/2022]
Abstract
We compared awake fibreoptic intubation with awake intubation using the Pentax Airway Scope(®) in 40 adult patients. Sedation was achieved using a target-controlled remifentanil infusion of 1-5 ng.ml(-1) and midazolam. The airway was anaesthetised with lidocaine spray and gargle. The total procedure time - a composite of sedation time, topical anaesthesia time and intubation time - was recorded. The operator's impression of the ease of the procedure and the patients' reported comfort were recorded on a 0-100 mm visual analogue scale. The median (IQR [range]) for total procedure time was 900 (739-1059 [616-1215]) s with the fibrescope and 651 (601-720 [498-900]) s with the Pentax Airway Scope (p = 0.0001). The median (IQR [range]) intubation time was 420 (283-480 [120-608]) s with the fibrescope and 183 (144-220 [107-420]) s with the Pentax Airway Scope (p = 0.0002). The median (IQR [range]) visual analogue scores for the operator's ease of intubation for the fibrescope and Pentax Airway Scope were 83.6 (72.0-98.0 [49.0-100.0]) and 86.8 (84.0-91.0 [61.0-100.0]), respectively (p = 0.3507). The median (IQR [range]) visual analogue score for patient comfort was 85.5 (81.0-97.0 [69.0-100.0]) and 79.4 (74.0-85.0 [59.0-100.0]) for the fibrescope and Pentax Airway Scope, respectively (p = 0.06). Total procedure time was significantly shorter with the Pentax Airway Scope compared with the fibrescope, with no difference in procedure difficulty or patient discomfort.
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Affiliation(s)
- C Mendonca
- Department of Anaesthesia, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - A Mesbah
- Department of Anaesthesia, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - A Velayudhan
- Department of Anaesthesia, Heart of England Foundation NHS Foundation Trust, Birmingham, UK
| | - R Danha
- Department of Anaesthesia, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
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Kramer A, Müller D, Pförtner R, Mohr C, Groeben H. Fibreoptic vs videolaryngoscopic (C-MAC®D-BLADE) nasal awake intubation under local anaesthesia. Anaesthesia 2015; 70:400-6. [DOI: 10.1111/anae.13016] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2014] [Indexed: 11/29/2022]
Affiliation(s)
- A. Kramer
- Department of Anaesthesia, Critical Care Medicine and Pain Therapy; Kliniken Essen-Mitte; Essen Germany
| | - D. Müller
- Department of Anaesthesia, Critical Care Medicine and Pain Therapy; Kliniken Essen-Mitte; Essen Germany
| | - R. Pförtner
- Department of Oral and Cranio-, Maxillofacial Surgery; Kliniken Essen-Mitte; Essen Germany
| | - C. Mohr
- Department of Oral and Cranio-, Maxillofacial Surgery; Kliniken Essen-Mitte; Essen Germany
| | - H. Groeben
- Department of Anaesthesia, Critical Care Medicine and Pain Therapy; Kliniken Essen-Mitte; Essen Germany
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21
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McCahon RA, Whynes DK. Cost comparison of re-usable and single-use fibrescopes in a large English teaching hospital. Anaesthesia 2015; 70:699-706. [DOI: 10.1111/anae.13011] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2014] [Indexed: 01/01/2023]
Affiliation(s)
- R. A. McCahon
- Department of Anaesthesia; Queen's Medical Centre; Nottingham University Hospitals NHS Trust; Nottingham UK
| | - D. K. Whynes
- School of Economics; University of Nottingham; Nottingham UK
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22
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Mankikian J, Ehrmann S, Guilleminault L, Le Fol T, Barc C, Ferrandière M, Boulain T, Dequin PF, Guillon A. An evaluation of a new single-use flexible bronchoscope with a large suction channel: reliability of bronchoalveolar lavage in ventilated piglets and initial clinical experience. Anaesthesia 2014; 69:701-6. [PMID: 24773281 DOI: 10.1111/anae.12641] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2014] [Indexed: 11/27/2022]
Abstract
A single-use flexible bronchoscope with a large suction channel has become available recently and we have evaluated this innovative device. Firstly, bronchoalveolar lavage was performed and quantified in ventilated piglets. Next, the bronchoscope was evaluated in three intensive care units and a satisfaction questionnaire was carried out. Sixteen bronchoalveolar lavages were performed in piglets with a recovery rate of 83 (79-86 [72-89])% of the instilled volume. Quality and performance of all devices tested was identical. The medical satisfaction questionnaire was as follows: 'acceptable' to 'very good' for quality of aspiration, manoeuvrability and quality of vision; 'very good' to 'perfect' for setting up and insertion. This encouraging preliminary evaluation demonstrates the effectiveness of this new single-use device, which may obviate the need for disinfection procedures and, thereby, eradicate a potential vector of patient cross-contamination.
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Affiliation(s)
- J Mankikian
- CHRU de Tours, Service de Réanimation Polyvalente, Tours, France
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Aïssou M, Coroir M, Debes C, Camus T, Hadri N, Gutton C, Beaussier M. Analyse de coût comparant les fibroscopes à usage unique (Ambu® aScope™) et les fibroscopes réutilisables pour l’intubation difficile. ACTA ACUST UNITED AC 2013; 32:291-5. [DOI: 10.1016/j.annfar.2013.01.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Accepted: 01/14/2013] [Indexed: 11/25/2022]
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Gupta D, Srirajakalidindi A, Wang H. Reduced turnover times make flexible optical reusable scope with EndoSheath(®) Technology significantly cost-effective. J Biomed Res 2013; 26:241-7. [PMID: 23554755 PMCID: PMC3596739 DOI: 10.7555/jbr.26.20120050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Accepted: 06/20/2012] [Indexed: 11/19/2022] Open
Abstract
EndoSheath bronchoscopy (Vision Sciences, Inc.) uses a sterile, disposable microbial barrier that may meet the growing needs for safe, efficient, and cost effective flexible bronchoscopy. The purpose of this open-label comparative study was to compare and calculate the costs-per-airway-procedure of the reusable fiberscope when used with and without EndoSheath® Technology; and to record the turnover time from the completion of the use of each scope until its readiness again for the next use. Seventy-five new patients' airways requiring airway maneuvers and manipulations with Vision Sciences, Inc., reusable fiberscope with EndoSheath® Technology were evaluated for the costs comparisons with reassessed historical costs data for Olympus scope assisted tracheal intubations. As compared to costs of an intubation ($158.50) with Olympus scope at our institute, the intubation costs with Vision Sciences, Inc., reusable fiberscope with EndoSheath technology was $81.50 (P < 0.001). The mean turnover time was 5.44 min with EndoSheath technology as compared to previously reported 30 min with Olympus fiberscope (P < 0.001). Based on our institutional experience, Vision Sciences, Inc., reusable fiberscope with EndoSheath technology is significantly cost effective as compared to the Olympus scope with significantly improved turnover times.
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Affiliation(s)
- Deepak Gupta
- Department of Anesthesiology, Detroit Medical Center, Wayne State University, Detroit, MI 48201, USA
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Krugel V, Bathory I, Frascarolo P, Schoettker P. Comparison of the single-use Ambu®aScope™ 2 vs the conventional fibrescope for tracheal intubation in patients with cervical spine immobilisation by a semirigid collar*. Anaesthesia 2012; 68:21-6. [DOI: 10.1111/anae.12044] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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