1
|
Cabrera JM, Lagos-Villaseca A, Fuentes-López E, Rosenbaum A, Willson M, Palma S, Kattan E, Vera M, Aquevedo A, Napolitano C, Cabello P. Role of Prolonged Intubation in Vocal Fold Motion Impairment in Critically Ill Patients. J Voice 2024:S0892-1997(24)00149-8. [PMID: 38806325 DOI: 10.1016/j.jvoice.2024.04.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 04/26/2024] [Accepted: 04/26/2024] [Indexed: 05/30/2024]
Abstract
OBJECTIVE COVID-19 upsurge in orotracheal intubation (OTI) has opened a new opportunity for studying associated complications. Vocal fold motion impairment (VFMI) is a known complication of OTI. The present study sought to determine the impact of OTI and prolonged OTI on the risk of developing VFMI; to identify both risk and protective factors associated with it. STUDY DESIGN Retrospective cohort study. SETTING Multicenter. METHODS Medical charts were reviewed for all patients that received invasive mechanical ventilation with a subsequent flexible laryngoscopic assessment between March 2020 and March 2022. The main outcomes were the presence of VFMI, including immobility (VFI) and hypomobility (VFH). RESULTS A total of 155 patients were included, 119 (76.8%) COVID-19 and 36 (23.2%) non-COVID-19 patients; overall 82 (52.9%) were diagnosed with VFMI. Eighty (52.3%) patients underwent a tracheostomy. The median (IQR) intubation duration was 18 (11-24.25) days, while the median (IQR) time to tracheostomy was 22 (16-29). In the adjusted model, we observed there was a 68% increased risk for VFMI from day 21 of intubation (RR: 1.68; 95% CI 1.07-2.65; P = 0.025). CONCLUSIONS VFMI is a frequent complication in severely ill patients that undergo intubation. A prolonged OTI was associated with an increased risk of VFMI, highlighting the importance of timely tracheostomy. Further research is needed to confirm these findings in other subsets of critically ill patients.
Collapse
Affiliation(s)
- José María Cabrera
- Department of Otolaryngology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Antonia Lagos-Villaseca
- Department of Otolaryngology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Eduardo Fuentes-López
- Departamento de Ciencias de la Salud, Carrera de Fonoaudiología, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Andrés Rosenbaum
- Department of Otolaryngology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Matías Willson
- Department of Otolaryngology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile; Otolaryngology Service, Hospital Padre Hurtado, Santiago, Chile
| | - Soledad Palma
- Otolaryngology Service, Complejo Asistencial Dr. Sótero del Río, Santiago, Chile
| | - Eduardo Kattan
- Intensive Medicine Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Magdalena Vera
- Intensive Medicine Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Andrés Aquevedo
- Intensive Care Service, Complejo Asistencial Dr. Sótero del Río, Santiago, Chile
| | - Carla Napolitano
- Department of Otolaryngology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pablo Cabello
- Department of Otolaryngology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile; Otolaryngology Service, Complejo Asistencial Dr. Sótero del Río, Santiago, Chile.
| |
Collapse
|
2
|
ProDeM: A Process-Oriented Delphi Method for systematic asynchronous and consensual surgical process modelling. Artif Intell Med 2023; 135:102426. [PMID: 36628778 DOI: 10.1016/j.artmed.2022.102426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 08/10/2022] [Accepted: 10/11/2022] [Indexed: 11/22/2022]
Abstract
Surgical process models support improving healthcare provision by facilitating communication and reasoning about processes in the medical domain. Modelling surgical processes is challenging as it requires integrating information that might be fragmented, scattered, and not process-oriented. These challenges can be faced by involving healthcare domain experts during process modelling. This paper presents ProDeM: a novel Process-Oriented Delphi Method for the systematic, asynchronous, and consensual modelling of surgical processes. ProDeM is an adaptable and flexible method that acknowledges that: (i) domain experts have busy calendars and might be geographically dispersed, and (ii) various elements of the process model need to be assessed to ensure model quality. The contribution of the paper is twofold as it outlines ProDeM, but also demonstrates its operationalisation in the context of a well-known surgical process. Besides showing the method's feasibility in practice, we also present an evaluation of the method by the experts involved in the demonstration.
Collapse
|
3
|
Martínez JJ, Galvez-Yanjari V, de la Fuente R, Kychenthal C, Kattan E, Bravo S, Munoz-Gama J, Sepúlveda M. Process-oriented metrics to provide feedback and assess the performance of students who are learning surgical procedures: The percutaneous dilatational tracheostomy case. MEDICAL TEACHER 2022; 44:1244-1252. [PMID: 35544751 DOI: 10.1080/0142159x.2022.2073209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE Assessing competency in surgical procedures is key for instructors to distinguish whether a resident is qualified to perform them on patients. Currently, assessment techniques do not always focus on providing feedback about the order in which the activities need to be performed. In this research, using a Process Mining approach, process-oriented metrics are proposed to assess the training of residents in a Percutaneous Dilatational Tracheostomy (PDT) simulator, identifying the critical points in the execution of the surgical process. MATERIALS AND METHODS A reference process model of the procedure was defined, and video recordings of student training sessions in the PDT simulator were collected and tagged to generate event logs. Three process-oriented metrics were proposed to assess the performance of the residents in training. RESULTS Although the students were proficient in classic metrics, they did not reach the optimum in process-oriented metrics. Only in 25% of the stages the optimum was achieved in the last session. In these stages, the four more challenging activities were also identified, which account for 32% of the process-oriented metrics errors. CONCLUSIONS Process-oriented metrics offer a new perspective on surgical procedures performance, providing a more granular perspective, which enables a more specific and actionable feedback for both students and instructors.
Collapse
Affiliation(s)
- Juan José Martínez
- Department of Computer Science, School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Víctor Galvez-Yanjari
- Department of Computer Science, School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rene de la Fuente
- Department of Anaesthesiology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Catalina Kychenthal
- School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Eduardo Kattan
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Sebastián Bravo
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Jorge Munoz-Gama
- Department of Computer Science, School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Marcos Sepúlveda
- Department of Computer Science, School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile
| |
Collapse
|
4
|
Process Mining for Healthcare: Characteristics and Challenges. J Biomed Inform 2022; 127:103994. [DOI: 10.1016/j.jbi.2022.103994] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/16/2021] [Accepted: 01/10/2022] [Indexed: 12/23/2022]
|
5
|
Abbott F, Ortega M, Bravo S, Basoalto R, Kattan E. Can we improve teaching and learning of percutaneous dilatational tracheostomy's bronchoscopic guidance? SAGE Open Med 2021; 9:20503121211002321. [PMID: 33796301 PMCID: PMC7983236 DOI: 10.1177/20503121211002321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 02/22/2021] [Indexed: 12/14/2022] Open
Abstract
Percutaneous dilatational tracheostomy has become the technique of choice in multiple intensive care units. Among innovations to improve procedural safety and success, bronchoscopic guidance of percutaneous dilatational tracheostomy has been advocated and successfully implemented by multiple groups. Most published literature focuses on the percutaneous dilatational tracheostomy operator, with scarce descriptions of the bronchoscopic particularities of the procedure. In this article, we provide 10 suggestions to enhance specific procedural aspects of bronchoscopic guidance of percutaneous dilatational tracheostomy, and strategies to optimize its teaching and learning, in order to promote learners' competence acquisition and increase patient safety.
Collapse
Affiliation(s)
- Francisco Abbott
- Departamento de Medicina Intensiva,
Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago,
Chile
- Departamento de Enfermedades
Respiratorias, Facultad de Medicina, Pontificia Universidad Católica de Chile,
Santiago, Chile
| | - Marcos Ortega
- Departamento de Medicina Intensiva,
Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago,
Chile
- Departamento de Enfermedades
Respiratorias, Facultad de Medicina, Pontificia Universidad Católica de Chile,
Santiago, Chile
| | - Sebastian Bravo
- Departamento de Medicina Intensiva,
Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago,
Chile
| | - Roque Basoalto
- Departamento de Medicina Intensiva,
Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago,
Chile
| | - Eduardo Kattan
- Departamento de Medicina Intensiva,
Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago,
Chile
| |
Collapse
|