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Sjöberg C, Ringdal M, Jildenstål P. Postoperative Recovery in the Youngest: Beyond Technology. CHILDREN (BASEL, SWITZERLAND) 2024; 11:1021. [PMID: 39201955 PMCID: PMC11353086 DOI: 10.3390/children11081021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Revised: 08/09/2024] [Accepted: 08/19/2024] [Indexed: 09/03/2024]
Abstract
BACKGROUND Measuring and interpreting vital signs in pediatric patients recovering from anaesthesia, particularly those up to 36 months old, is challenging. Nurses' decision-making regarding the level of monitoring must balance patient safety with individualized care. This study aimed to explore the perceptions of critical care nurses and registered nurse anesthetists regarding their experiences and actions when making decisions about vital sign monitoring for children in post-anesthesia care units (PACUs). METHODS A qualitative study utilizing the critical incident technique was conducted. Interviews were performed with a purposeful sample of 17 critical care nurses and registered nurse anaesthetists from two hospitals. RESULTS Nurses reported that the rationale for decisions concerning the need for vital sign monitoring in children was both adequate and inadequate. Actions were taken to adjust the monitoring of vital signs, optimizing conditions for assessment and ensuring the child's safe recovery. CONCLUSIONS The complexity of accurately monitoring children makes it challenging for nurses in the PACU to adhere to guidelines. Evidence-based care and safety are compromised when technology has limitations and is not adapted for paediatric use, leading to a greater reliance on experience and clinical assessment. This reliance on experience is crucial for reliable assessment but also entails accepting greater risks.
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Affiliation(s)
- Carina Sjöberg
- Department of Medicine and Health Sciences, Lund University, 223 62 Lund, Sweden;
- Department of Anaesthesiology, Surgery and Intensive Care, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden
| | - Mona Ringdal
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, 413 46 Gothenburg, Sweden;
- Department of Anestesiology and Critical Care, West Hospital, 442 34 Kungälv, Sweden
| | - Pether Jildenstål
- Department of Medicine and Health Sciences, Lund University, 223 62 Lund, Sweden;
- Department of Anaesthesiology, Surgery and Intensive Care, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, 413 46 Gothenburg, Sweden;
- Department of Anaesthesiology and Intensive Care, Örebro University Hospital and School of Medical Sciences, Örebro University, 701 82 Örebro, Sweden
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Humphreys S, von Ungern-Sternberg BS, Taverner F, Davidson A, Skowno J, Hallett B, Sommerfield D, Hauser N, Williams T, Spall S, Pham T, Atkins T, Jones M, King E, Burgoyne L, Stephens P, Vijayasekaran S, Slee N, Burns H, Franklin D, Hough J, Schibler A. High-flow nasal oxygen for children's airway surgery to reduce hypoxaemic events: a randomised controlled trial. THE LANCET. RESPIRATORY MEDICINE 2024; 12:535-543. [PMID: 38788748 DOI: 10.1016/s2213-2600(24)00115-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 03/13/2024] [Accepted: 04/03/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND Tubeless upper airway surgery in children is a complex procedure in which surgeons and anaesthetists share the same operating field. These procedures are often interrupted for rescue oxygen therapy. The efficacy of nasal high-flow oxygen to decrease the frequency of rescue interruptions in children undergoing upper airway surgery is unknown. METHODS In this multicentre randomised trial conducted in five tertiary hospitals in Australia, children aged 0-16 years who required tubeless upper airway surgery were randomised (1:1) by a web-based randomisation tool to either nasal high-flow oxygen delivery or standard oxygen therapy (oxygen flows of up to 6 L/min). Randomisation was stratified by site and age (<1 year, 1-4 years, and 5-16 years). Subsequent tubeless upper airway surgery procedures in the same child could be included if there were more than 2 weeks between the procedures, and repeat surgical procedures meeting this condition were considered to be independent events. The oxygen therapy could not be masked, but the investigators remained blinded until outcome data were locked. The primary outcome was successful anaesthesia without interruption of the surgical procedure for rescue oxygenation. A rescue oxygenation event was defined as an interruption of the surgical procedure to deliver positive pressure ventilation using either bag mask technique, insertion of an endotracheal tube, or laryngeal mask to improve oxygenation. There were ten secondary outcomes, including the proportion of procedures with a hypoxaemic event (SpO2 <90%). Analyses were done on an intention-to-treat (ITT) basis. Safety was assessed in all enrolled participants. This trial is registered in the Australian New Zealand Clinical Trials Registry, ACTRN12618000949280, and is completed. FINDINGS From Sept 4, 2018, to April 12, 2021, 581 procedures in 487 children were randomly assigned to high-flow oxygen (297 procedures) or standard care (284 procedures); after exclusions, 528 procedures (267 assigned to high-flow oxygen and 261 assigned to standard care) in 483 children (293 male and 190 female) were included in the ITT analysis. The primary outcome of successful anaesthesia without interruption for tubeless airway surgery was achieved in 236 (88%) of 267 procedures on high-flow oxygen and in 229 (88%) of 261 procedures on standard care (adjusted risk ratio [RR] 1·02, 95% CI 0·96-1·08, p=0·82). There were 51 (19%) procedures with a hypoxaemic event in the high-flow oxygen group and 57 (22%) in the standard care group (RR 0·86, 95% CI 0·58-1·24). Of the other prespecified secondary outcomes, none showed a significant difference between groups. Adverse events of epistaxis, laryngospasm, bronchospasm, hypoxaemia, bradycardia, cardiac arrest, hypotension, or death were similar in both study groups. INTERPRETATION Nasal high-flow oxygen during tubeless upper airway surgery did not reduce the proportion of interruptions of the procedures for rescue oxygenation compared with standard care. There were no differences in adverse events between the intervention groups. These results suggest that both approaches, nasal high-flow or standard oxygen, are suitable alternatives to maintain oxygenation in children undergoing upper airway surgery. FUNDING Thrasher Research Fund, the Australian and New Zealand College of Anaesthetists, the Society for Paediatric Anaesthesia in New Zealand and Australia.
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Affiliation(s)
- Susan Humphreys
- Department of Anaesthesia, Queensland Children's Hospital, Brisbane, QLD, Australia; The University of Queensland, Brisbane, QLD, Australia
| | - Britta S von Ungern-Sternberg
- Division of Emergency Medicine, Anaesthesia, and Pain Medicine, Perth Children's Hospital, Perth, WA, Australia; University of Western Australia, Perth, WA, Australia
| | - Fiona Taverner
- Department of Children's Anaesthesia, Women's and Children's Hospital, Adelaide, SA, Australia; University of Adelaide, Adelaide, SA, Australia
| | - Andrew Davidson
- Department of Anaesthesia, Royal Children's Hospital, Melbourne, VIC, Australia; Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Justin Skowno
- Department of Anaesthesia, The Children's Hospital at Westmead, Sydney, NSW, Australia; School of Child and Adolescent Health, University of Sydney, Sydney, NSW, Australia
| | - Ben Hallett
- Department of Anaesthesia, Royal Children's Hospital, Melbourne, VIC, Australia; Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - David Sommerfield
- Division of Emergency Medicine, Anaesthesia, and Pain Medicine, Perth Children's Hospital, Perth, WA, Australia; University of Western Australia, Perth, WA, Australia
| | - Neil Hauser
- Division of Emergency Medicine, Anaesthesia, and Pain Medicine, Perth Children's Hospital, Perth, WA, Australia; University of Western Australia, Perth, WA, Australia
| | - Tara Williams
- Department of Anaesthesia, Queensland Children's Hospital, Brisbane, QLD, Australia; The University of Queensland, Brisbane, QLD, Australia
| | - Susan Spall
- Department of Anaesthesia, Queensland Children's Hospital, Brisbane, QLD, Australia
| | - Trang Pham
- Department of Anaesthesia, Queensland Children's Hospital, Brisbane, QLD, Australia
| | - Tiffany Atkins
- Institute for Evidence-Based Healthcare, Bond University, Robina, QLD, Australia
| | - Mark Jones
- Institute for Evidence-Based Healthcare, Bond University, Robina, QLD, Australia
| | - Emma King
- Department of Children's Anaesthesia, Women's and Children's Hospital, Adelaide, SA, Australia
| | - Laura Burgoyne
- Department of Children's Anaesthesia, Women's and Children's Hospital, Adelaide, SA, Australia; University of Adelaide, Adelaide, SA, Australia
| | - Philip Stephens
- Department of Anaesthesia, Queensland Children's Hospital, Brisbane, QLD, Australia
| | - Shyan Vijayasekaran
- Division of Emergency Medicine, Anaesthesia, and Pain Medicine, Perth Children's Hospital, Perth, WA, Australia; University of Western Australia, Perth, WA, Australia
| | - Nicola Slee
- Department of Ear, Nose, and Throat Surgery, Queensland Children's Hospital, Brisbane, QLD, Australia
| | - Hannah Burns
- Department of Ear, Nose, and Throat Surgery, Queensland Children's Hospital, Brisbane, QLD, Australia; The University of Queensland, Brisbane, QLD, Australia
| | - Donna Franklin
- The University of Queensland, Brisbane, QLD, Australia; Children's Critical Care Research Collaborative Group, Griffith University, Gold Coast University Hospital, Southport, QLD, Australia; Wesley Research Institute, Brisbane, QLD, Australia; Menzies Health Institute Queensland, Southport, QLD, Australia
| | - Judith Hough
- Australia Catholic University, Department of Physiotherapy, Brisbane, QLD, Australia
| | - Andreas Schibler
- Critical Care Research Group, St Andrew's War Memorial Hospital, Wesley Research Institute, Brisbane, QLD, Australia; College of Medicine & Dentistry, James Cook University, Townsville, QLD, Australia.
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Young E, Nocera TM, Reilly M, Tobias JD, D’Mello A. An in vitro technique to measure resistance to compression and kinking of endotracheal tubes. Saudi J Anaesth 2024; 18:331-337. [PMID: 39149727 PMCID: PMC11323910 DOI: 10.4103/sja.sja_15_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 01/13/2024] [Indexed: 08/17/2024] Open
Abstract
Background During intraoperative care, ventilatory parameters including peak inflating pressure (PIP) and exhaled tidal volumes are continuously monitored to assess changes in respiratory resistance and compliance. Changes in these parameters, such as an increase in PIP or a decrease in the exhaled tidal volume, may indicate various pathologic processes that may require immediate attention to prevent inadequate ventilation resulting in hypoxemia or hypercarbia. A kinked endotracheal tube (ETT) may mimic other pathologic processes including bronchospasm, mainstem intubation, or ventilator malfunction. As newer ETTs are developed, a key factor in their design should be resistance to kinking or occlusion due to patient positioning. Methods The current project developed and describes the process for using a repeatable in vitro mechanical test to determine resistance to kinking by an ETT. Results The mechanical testing procedure can be used to determine the compression force and distance required to kink an ETT under different conditions including temperature. The force required to induce devastating kink failure was lower during heated testing conditions. The addition of airflow through the ETTs during compression testing confirms the occurrence of airway obstruction at approximately the same time a mechanical kink is observed on the force-versus-distance curves. Conclusions These procedures may be used to characterize and evaluate ETT designs under in vitro conditions mimicking those in the clinical practice.
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Affiliation(s)
- Emily Young
- Wright State University Boonshoft School of Medicine, Dayton, Ohio, United States of America
| | - Tonya M. Nocera
- School of Engineering, The Ohio State University, Columbus, Ohio, United States of America
| | - Matthew Reilly
- School of Engineering, The Ohio State University, Columbus, Ohio, United States of America
| | - Joseph D. Tobias
- Department of Anesthesiology and Pain Medicine, Nationwide Children’s Hospital, Columbus, Ohio, United States of America
- Department of Anesthesiology and Pain Medicine, The Ohio State University, Columbus, Ohio, United States of America
| | - Ajay D’Mello
- Department of Anesthesiology and Pain Medicine, Nationwide Children’s Hospital, Columbus, Ohio, United States of America
- Department of Anesthesiology and Pain Medicine, The Ohio State University, Columbus, Ohio, United States of America
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Zhang Q, Cui Y. Letter to the editor: Transportation of neonates: From OR to NICU. Asian J Surg 2024:S1015-9584(24)01119-9. [PMID: 38834471 DOI: 10.1016/j.asjsur.2024.05.224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 05/24/2024] [Indexed: 06/06/2024] Open
Affiliation(s)
- Qianqian Zhang
- Department of Anesthesiology, The Affiliated Hospital, School of Medicine, UESTC Chengdu Women's & Children's Central Hospital, Chengdu, 610091, China
| | - Yu Cui
- Department of Anesthesiology, The Affiliated Hospital, School of Medicine, UESTC Chengdu Women's & Children's Central Hospital, Chengdu, 610091, China.
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Dundaru-Bandi D, Antel R, Ingelmo P. Advances in pediatric perioperative care using artificial intelligence. Curr Opin Anaesthesiol 2024; 37:251-258. [PMID: 38441085 DOI: 10.1097/aco.0000000000001368] [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: 04/25/2024]
Abstract
PURPOSE OF THIS REVIEW This article explores how artificial intelligence (AI) can be used to evaluate risks in pediatric perioperative care. It will also describe potential future applications of AI, such as models for airway device selection, controlling anesthetic depth and nociception during surgery, and contributing to the training of pediatric anesthesia providers. RECENT FINDINGS The use of AI in healthcare has increased in recent years, largely due to the accessibility of large datasets, such as those gathered from electronic health records. Although there has been less focus on pediatric anesthesia compared to adult anesthesia, research is on- going, especially for applications focused on risk factor identification for adverse perioperative events. Despite these advances, the lack of formal external validation or feasibility testing results in uncertainty surrounding the clinical applicability of these tools. SUMMARY The goal of using AI in pediatric anesthesia is to assist clinicians in providing safe and efficient care. Given that children are a vulnerable population, it is crucial to ensure that both clinicians and families have confidence in the clinical tools used to inform medical decision- making. While not yet a reality, the eventual incorporation of AI-based tools holds great potential to contribute to the safe and efficient care of our patients.
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Affiliation(s)
| | - Ryan Antel
- Department of Anesthesia, McGill University
| | - Pablo Ingelmo
- Department of Anesthesia, McGill University
- Division of Pediatric Anesthesia
- Edwards Family Interdisciplinary Center for Complex Pain. Montreal Children's Hospital
- Research Institute, McGill University Health Center
- Alan Edwards for Research on Pain. McGill University, Montreal, Quebec, Canada
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Snyder CW, Kristiansen KO, Jensen AR, Sribnick EA, Anders JF, Chen CX, Lerner EB, Conti ME. Defining pediatric trauma center resource utilization: Multidisciplinary consensus-based criteria from the Pediatric Trauma Society. J Trauma Acute Care Surg 2024; 96:799-804. [PMID: 37880842 DOI: 10.1097/ta.0000000000004181] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
BACKGROUND Pediatric trauma triage and transfer decisions should incorporate the likelihood that an injured child will require pediatric trauma center (PTC) resources. Resource utilization may be a better basis than mortality risk when evaluating pediatric injury severity. However, there is currently no consensus definition of PTC resource utilization that encompasses the full scope of PTC services. METHODS Consensus criteria were developed in collaboration with the Pediatric Trauma Society (PTS) Research Committee using a modified Delphi approach. An expert panel was recruited representing the following pediatric disciplines: prehospital care, emergency medicine, nursing, general surgery, neurosurgery, orthopedics, anesthesia, radiology, critical care, child abuse, and rehabilitation medicine. Resource utilization criteria were drafted from a comprehensive literature review, seeking to complete the following sentence: "Pediatric patients with traumatic injuries have used PTC resources if they..." Criteria were then refined and underwent three rounds of voting to achieve consensus. Consensus was defined as agreement of 75% or more panelists. Between the second and third voting rounds, broad feedback from attendees of the PTS annual meeting was obtained. RESULTS The Delphi panel consisted of 18 members from 15 institutions. Twenty initial draft criteria were developed based on literature review. These criteria dealt with airway interventions, vascular access, initial stabilization procedures, fluid resuscitation, blood product transfusion, abdominal trauma/solid organ injury management, intensive care monitoring, anesthesia/sedation, advanced imaging, radiologic interpretation, child abuse evaluation, and rehabilitative services. After refinement and panel voting, 14 criteria achieved the >75% consensus threshold. The final consensus criteria were reviewed and endorsed by the PTS Guidelines Committee. CONCLUSION This study defines multidisciplinary consensus-based criteria for PTC resource utilization. These criteria are an important step toward developing a criterion standard, resource-based, pediatric injury severity metric. Such metrics can help optimize system-level pediatric trauma triage based on likelihood of requiring PTC resources. LEVEL OF EVIDENCE Diagnostic Test/Criteria; Level II.
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Affiliation(s)
- Christopher W Snyder
- From the Division of Pediatric Surgery (C.W.S.), Johns Hopkins All Children's Hospital, St. Petersburg, Florida; Department of Anesthesia (K.O.K., M.E.C.), Dartmouth-Hitchcock Medical Center, Geisel School of Medicine, Lebanon, New Hampshire; Division of Pediatric Surgery (A.R.J.), Benioff Children's Hospital, University of California-San Francisco, San Francisco, California; Department of Pediatric Neurosurgery (E.A.S.), Nationwide Children's Hospital, Columbus, Ohio; Division of Pediatric Emergency Medicine (J.F.A.), Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Pediatric Anesthesiology (C.X.C.), Seattle Children's Hospital, Seattle, Washington; and Department of Emergency Medicine (E.B.L.), University at Buffalo, Buffalo, New York
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Schimpf J, Münster T. [Rare diseases in anesthesia : Knowledge mining and core points of perioperative anesthesiological care]. DIE ANAESTHESIOLOGIE 2023; 72:907-918. [PMID: 37947803 DOI: 10.1007/s00101-023-01353-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/02/2023] [Indexed: 11/12/2023]
Abstract
Due to refined and new diagnostic possibilities and improved medical care, in the future anesthesiologists will be more frequently confronted with patients suffering from rare diseases. As the physicians providing perioperative care often have little or no experience with the diseases of such patients, the access to high-quality specific literature is essential. In this respect they must be able to assess and classify the quality of the information which is predominantly available online, especially as when evidence-based knowledge is available, it is only available to a very limited extent. Patients with rare diseases mostly present with recurring problem constellations. A systematic assignment to the most important problem areas (airway, circulation, metabolism, etc.) as well as a structured and interdisciplinary approach are decisive for a successful perioperative treatment of these patients. Due to low prevalence, lack of personal experience and lack of evidence-based data, anesthesia in patients with SE is an absolute challenge, especially in time-critical situations.
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Affiliation(s)
- J Schimpf
- Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Augsburg, Stenglinstraße 2, 86156, Augsburg, Deutschland.
| | - T Münster
- Klinik für Anästhesiologie und operative Intensivmedizin, Krankenhaus Barmherzige Brüder Regensburg, Regensburg, Deutschland
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Hudec J, Prokopová T, Kosinová M, Gál R. Anesthesia and Perioperative Management for Surgical Correction of Neuromuscular Scoliosis in Children: A Narrative Review. J Clin Med 2023; 12:jcm12113651. [PMID: 37297846 DOI: 10.3390/jcm12113651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 05/17/2023] [Accepted: 05/20/2023] [Indexed: 06/12/2023] Open
Abstract
Scoliosis is the most frequent spinal deformity in children. It is defined as a spine deviation of more than 10° in the frontal plane. Neuromuscular scoliosis is associated with a heterogeneous spectrum of muscular or neurological symptoms. Anesthesia and surgery for neuromuscular scoliosis have a higher risk of perioperative complications than for idiopathic scoliosis. However, patients and their relatives report improved quality of life after the surgery. The challenges for the anesthetic team result from the specifics of the anesthesia, the scoliosis surgery itself, or factors associated with neuromuscular disorders. This article includes details of preanesthetic evaluation, intraoperative management, and postoperative care in the intensive care unit from an anesthetic view. In summary, adequate care for patients who have neuromuscular scoliosis requires interdisciplinary cooperation. This comprehensive review covers information about the perioperative management of neuromuscular scoliosis for all healthcare providers who take care of these patients during the perioperative period, with an emphasis on anesthesia management.
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Affiliation(s)
- Jan Hudec
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine, Masaryk University, University Hospital Brno, 601 77 Brno, Czech Republic
- Department of Simulation Medicine, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic
| | - Tereza Prokopová
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine, Masaryk University, University Hospital Brno, 601 77 Brno, Czech Republic
- Department of Simulation Medicine, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic
| | - Martina Kosinová
- Department of Simulation Medicine, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic
- Department of Pediatric Anesthesiology and Intensive Care Medicine, Faculty of Medicine, Masaryk University, University Hospital Brno, 625 00 Brno, Czech Republic
| | - Roman Gál
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine, Masaryk University, University Hospital Brno, 601 77 Brno, Czech Republic
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Fleishhacker ZJ, Bennion DM, Manaligod J, Kacmarynski D, Ropp BY, Kanotra S. Quality Improvement of Pediatric Airway Emergency Carts: Standardization, Streamlining, and Simulation. Cureus 2023; 15:e39727. [PMID: 37398737 PMCID: PMC10310310 DOI: 10.7759/cureus.39727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2023] [Indexed: 07/04/2023] Open
Abstract
Objective Pediatric airway emergencies are amongst the most tenuous scenarios faced by on-call providers, requiring quick access to the appropriate equipment and a timely response. In the present study, we report on the testing and improvement of pediatric airway carts at our institution. The primary objective was to optimize our pediatric airway emergency carts to improve response times. Secondarily, we aimed to implement a training scenario to improve providers' familiarity and confidence in attaining and assembling equipment. Methods Surveys of airway cart configuration at our hospital and others were used to identify differences. Volunteer otolaryngology physicians were tasked with responding to a mock scenario using an existing cart or one modified based on the survey. Outcomes included (1) time to arrival of the provider with the appropriate equipment, (2) time from arrival to complete assembly of equipment, and (3) time for re-assembly of the equipment. Results The survey revealed differences in cart equipment and location. The inclusion of a flexible bronchoscope and a video tower, as well as the placement of the carts directly within the ICU, resulted in improved time to arrival by an average of 181 seconds, and improved equipment assembly time by an average of 85 seconds. Discussion Standardization of pediatric airway equipment on the cart and location near critically ill patients improved response efficiency. Simulation led to improved confidence and reduced reaction time among providers at all levels of experience. Conclusion The present study provides an example for the optimization of airway carts, which can be adapted by healthcare systems to their local milieu.
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Affiliation(s)
- Zachary J Fleishhacker
- Otolaryngology - Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, USA
| | - Douglas M Bennion
- Otolaryngology - Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, USA
| | - Jose Manaligod
- Otolaryngology - Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, USA
| | - Deborah Kacmarynski
- Otolaryngology - Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, USA
| | - Bonita Y Ropp
- Nursing, University of Iowa Hospitals and Clinics, Iowa City, USA
| | - Sohit Kanotra
- Otolaryngology - Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, USA
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Shaylor R, Weiniger CF, Rachman E, Sela Y, Kohn A, Lahat S, Rimon A, Capua T. A Prospective Observational Crossover Study Comparing Intubation by Pediatric Residents Using Video Laryngoscopy and Direct Laryngoscopy on a Pierre Robin Simulation Manikin. Pediatr Emerg Care 2023; 39:159-161. [PMID: 36791027 DOI: 10.1097/pec.0000000000002923] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
INTRODUCTION Video laryngoscopy (VL) has been proposed to increase the likelihood of successful intubation in patients with predicted difficult airways such as those with Pierre Robin sequence (PRS). Prior studies have focused on the performance of anesthesiologists, who are generally considered airway experts. Our primary aim was to investigate the success rate of intubation using VL compared with direct laryngoscopy (DL) when attempted by pediatric residents on a PRS model. METHODS Participants were administered a 5-minute refresher video on 2 VL techniques (CMAC, conventional geometry VL, and McGrath, unconventional geometry VL) and DL. The participants were asked to intubate the AirSim PRS infant manikin. The order of VL and DL use was randomly selected. All intubations were video recorded, and the recordings were analyzed by 3 anesthesiologists blinded to the participant's identity and previous experience. RESULTS Seventeen of 23 residents succeeded in intubating the PRS model using DL. Only 9 residents succeeded in intubating the PRS model using VL (conventional or unconventional geometry). Intubation success rate was higher when comparing DL with VL ( P = 0.04) and similar when comparing VL devices ( P = 0.69). DISCUSSION Contrary to expectation, the intubation success rate was lower using VL than with DL among pediatric residents. This should be considered when designing residency training and in real-life resuscitation.
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Affiliation(s)
- Ruth Shaylor
- From the Department of Anesthesia, Tel Aviv Sourasky Medical Center
| | | | - Evgeny Rachman
- From the Department of Anesthesia, Tel Aviv Sourasky Medical Center
| | - Yarden Sela
- Medical Technology and Simulation Center, Tel Aviv Sourasky Medical Center, Affiliated to Ministry of Health
| | - Aryeh Kohn
- Medical Technology and Simulation Center, Tel Aviv Sourasky Medical Center, Affiliated to Ministry of Health
| | | | - Ayelet Rimon
- Pediatric Emergency Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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Vlatten A, Dumbarton T, Vlatten D, Law JA. Randomized trial of three airway management techniques for restricted access in a simulated pediatric scenario. Am J Emerg Med 2022; 59:67-69. [DOI: 10.1016/j.ajem.2022.06.059] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 06/28/2022] [Accepted: 06/28/2022] [Indexed: 10/17/2022] Open
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Impact of Intubator's Training Level on First-Pass Success of Endotracheal Intubation in Acute Care Settings: A Four-Center Retrospective Study. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9070960. [PMID: 35883944 PMCID: PMC9322935 DOI: 10.3390/children9070960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 06/22/2022] [Accepted: 06/24/2022] [Indexed: 11/21/2022]
Abstract
(1) Background: First-pass success (FPS) of endotracheal intubation is more challenging in children than in adults. We aimed to identify factors associated with FPS of intubation in acute care settings. (2) Methods: We analyzed data of children aged <10 years who underwent intubation within ≤24 h of arrival at four Korean emergency departments (2016−2019). Variables were compared according to FPS. A logistic regression was performed to quantify the association of factors with FPS. An experienced intubator was defined as a senior resident or a specialist. (3) Results: Of 280 children, 169 (60.4%) had FPS. The children with FPS were older (median age, 23.0 vs. 11.0 months; p = 0.018), were less frequently in their infancy (36.1% vs. 50.5%; p = 0.017), and were less likely to have respiratory compromise (41.4% vs. 55.0%; p = 0.030). The children with FPS tended to be more often intubated by experienced intubators than those without FPS (87.0% vs. 78.4%; p = 0.057). Desaturation was rarer in those with FPS. Factors associated with FPS were experienced intubators (aOR, 1.93; 95% CI, 1.01−3.67) and children’s age ≥12 months (1.84; 1.13−3.02). (4) Conclusion: FPS of intubation can be facilitated by deploying or developing clinically competent intubators, particularly for infants, in acute care settings.
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