1
|
Kojima Y, Murouchi T, Asano K, Hirabayashi K. Comparison of Pressure Control Ventilation and Palpation Methods to Protect the Endotracheal Tube Cuff During Tracheotomy: A Manikin Simulation Study. Cureus 2024; 16:e53214. [PMID: 38425590 PMCID: PMC10902874 DOI: 10.7759/cureus.53214] [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: 01/29/2024] [Indexed: 03/02/2024] Open
Abstract
Objective This study aims to evaluate and compare the suitability and safety of palpation and pressure control ventilation (PCV) methods for the accurate positioning of an endotracheal tube (ETT) cuff. Methods We conducted a pilot simulation randomized crossover study using a medical manikin. Twenty junior resident physicians who had completed anesthesiology training participated in the study. Airway management was performed using a modified manikin designed to simulate palpation and PCV methods. Participants performed both methods in a randomized order. The primary outcome was the number of successful ETT placements. The secondary outcomes were procedure duration and the perceived difficulty of each procedure. Results Five successful procedures were observed in the palpation method group (PALG), while 19 were observed in the PCV method group (PCVG). The duration of the trial was 98 s (standard deviation [SD], 41) in the PALG and 93 s (SD, 49) in the PCVG. The visual analog scale score for difficulty encountered during the trial was 30 (SD, 21) in the PALG and 69 (SD, 19) in the PCVG. Conclusions Our findings suggest that the PCV method had a higher success rate than the palpation method. Thus, the PCV method may be more suitable for inexperienced physicians to perform the procedure with greater confidence.
Collapse
Affiliation(s)
- Yuki Kojima
- Anesthesiology, Asahi General Hospital, Asahi, JPN
- Dental Anesthesiology, Asahi General Hospital, Asahi, JPN
| | | | - Kazuma Asano
- Dentistry and Oral Surgery, Asahi General Hospital, Chiba, JPN
| | | |
Collapse
|
2
|
Choo EK, Strehlow M, Del Rios M, Oral E, Pobee R, Nugent A, Lim S, Hext C, Newhall S, Ko D, Chari SV, Wilson A, Baugh JJ, Callaway D, Delgado MK, Glick Z, Graulty CJ, Hall N, Jemal A, Kc M, Mahadevan A, Mehta M, Meltzer AC, Pozhidayeva D, Resnick-Ault D, Schulz C, Shen S, Southerland L, Du Pont D, McCarthy DM. Observational study of organisational responses of 17 US hospitals over the first year of the COVID-19 pandemic. BMJ Open 2023; 13:e067986. [PMID: 37156578 PMCID: PMC10410813 DOI: 10.1136/bmjopen-2022-067986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 03/14/2023] [Indexed: 05/10/2023] Open
Abstract
OBJECTIVES The COVID-19 pandemic has required significant modifications of hospital care. The objective of this study was to examine the operational approaches taken by US hospitals over time in response to the COVID-19 pandemic. DESIGN, SETTING AND PARTICIPANTS This was a prospective observational study of 17 geographically diverse US hospitals from February 2020 to February 2021. OUTCOMES AND ANALYSIS We identified 42 potential pandemic-related strategies and obtained week-to-week data about their use. We calculated descriptive statistics for use of each strategy and plotted percent uptake and weeks used. We assessed the relationship between strategy use and hospital type, geographic region and phase of the pandemic using generalised estimating equations (GEEs), adjusting for weekly county case counts. RESULTS We found heterogeneity in strategy uptake over time, some of which was associated with geographic region and phase of pandemic. We identified a body of strategies that were both commonly used and sustained over time, for example, limiting staff in COVID-19 rooms and increasing telehealth capacity, as well as those that were rarely used and/or not sustained, for example, increasing hospital bed capacity. CONCLUSIONS Hospital strategies during the COVID-19 pandemic varied in resource intensity, uptake and duration of use. Such information may be valuable to health systems during the ongoing pandemic and future ones.
Collapse
Affiliation(s)
- Esther K Choo
- Department of Emergency Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Matthew Strehlow
- Department of Emergency Medicine, Stanford University, Stanford, California, USA
| | - Marina Del Rios
- Department of Emergency Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Evrim Oral
- Department of Biostatistics, School of Public Health LSU Health Sciences Center, New Orleans, Louisiana, USA
| | - Ruth Pobee
- Department of Emergency Medicine, University of Illinois Chicago, Chicago, Illinois, USA
| | - Andrew Nugent
- Department of Emergency Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Stephen Lim
- Section of Emergency Medicine, Department of Medicine, University Medical Center New Orleans, LSU Health Sciences Center New Orleans, New Orleans, Louisiana, USA
| | - Christian Hext
- Department of Emergency Medicine, University of Wisconsin, Madison, Wisconsin, USA
| | - Sarah Newhall
- Department of Emergency Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Diana Ko
- Department of Radiology, Stanford University, Palo Alto, California, USA
| | - Srihari V Chari
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Amy Wilson
- Oregon Clinical and Translational Research Institute (OCTRI), Oregon Health & Science University, Portland, Oregon, USA
| | - Joshua J Baugh
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - David Callaway
- Department of Emergency Medicine, Atrium Health, Charlotte, North Carolina, USA
| | - Mucio Kit Delgado
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Zoe Glick
- Department of Emergency Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Christian J Graulty
- Department of Emergency Medicine, NYU Langone School of Medicine, New York, New York, USA
| | - Nicholas Hall
- Department of Emergency Medicine, Stanford University, Stanford, California, USA
| | - Abdusebur Jemal
- Department of Internal Medicine, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Madhav Kc
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center (COPPER) Center, Yale School of Medicine, New Haven, Connecticut, USA
| | - Aditya Mahadevan
- Department of Emergency Medicine, Stanford University, Stanford, California, USA
| | - Milap Mehta
- Department of Emergency Medicine, Ohio State University, Columbus, Ohio, USA
| | - Andrew C Meltzer
- Department of Emergency Medicine, George Washington University School of Medicine, Washington, DC, USA
| | - Dar'ya Pozhidayeva
- Oregon Clinical and Translational Research Institute (OCTRI), Oregon Health & Science University, Portland, Oregon, USA
| | - Daniel Resnick-Ault
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Christian Schulz
- Department of Emergency Medicine, Carolinas Medical Center, Charlotte, North Carolina, USA
| | - Sam Shen
- Department of Emergency Medicine Medicine, Stanford University, Palo Alto, California, USA
| | - Lauren Southerland
- Department of Emergency Medicine, Ohio State University, Columbus, Ohio, USA
| | - Daniel Du Pont
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Danielle M McCarthy
- Department of Emergency Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| |
Collapse
|
3
|
Abstract
PURPOSE OF REVIEW Anesthesia for pulmonological interventions is a demanding challenge. This article discusses recent innovations and the implications for periinterventional anesthetic management. RECENT FINDINGS Interventional pulmonology is a rapidly expanding specialty with very complex diagnostic and therapeutic approaches that include oncological staging, treatment of obstructive and restrictive lung diseases, recanalization of endobronchial obstructions, and retrieval of foreign bodies. With the development of advanced diagnostic and therapeutic interventions, the application is extended to critically ill patients. Current evidence focusing on the anesthetic techniques is presented here. SUMMARY The development of new pulmonological methods requires a tailored anesthesiological approach. Their specific impact must be taken into account to ensure patient safety, goal-oriented outcome diagnostics and -quality, successful interventions, and patient comfort.
Collapse
Affiliation(s)
- Axel Semmelmann
- Department of Anesthesiology and Critical Care, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg 79110, Germany
| | | |
Collapse
|
4
|
Ishida Y, Okada T, Kobayashi T, Uchino H. ORi™: a new indicator of oxygenation. J Anesth 2021; 35:734-740. [PMID: 33900455 PMCID: PMC8072303 DOI: 10.1007/s00540-021-02938-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 04/18/2021] [Indexed: 12/14/2022]
Abstract
In the perioperative period, hypoxemia and hyperoxia are crucial factors that require attention, because they greatly affect patient prognoses. The pulse oximeter has been the only noninvasive monitor that can be used as a reference of oxygenation in current anesthetic management; however, in recent years, a new monitoring method that uses the oxygen reserve index (ORi™) has been developed by Masimo Corp. ORi is an index that reflects the state of moderate hyperoxia (partial pressure of arterial oxygen [PaO2] between 100 and 200 mmHg) using a non-unit scale between 0.00 and 1.00. ORi monitoring performed together with percutaneous oxygen saturation (SpO2) measurements may become an important technique in the field of anesthetic management, for measuring oxygenation reserve capacity. By measuring ORi, it is possible to predict hypoxemia and to detect hyperoxia at an early stage. In this review, we summarize the method of ORi, cautions for its use, and suitable cases for its use. In the near future, the monitoring of oxygen concentrations using ORi may become increasingly common for the management of respiratory function before, after, and during surgery.
Collapse
Affiliation(s)
- Yusuke Ishida
- Department of Anesthesiology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023 Japan
| | - Toshio Okada
- Department of Anesthesiology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023 Japan
| | - Takayuki Kobayashi
- Department of Anesthesiology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023 Japan
| | - Hiroyuki Uchino
- Department of Anesthesiology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023 Japan
| |
Collapse
|
6
|
Abola RE, Schwartz J, Beg T, Gan TJ, Forrester J. In Response. Anesth Analg 2021; 133:e30-e31. [PMID: 34257213 DOI: 10.1213/ane.0000000000005613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Ramon E Abola
- Department of Anesthesiology, Stony Brook Medicine, Stony Brook, New York,
| | - Jonathon Schwartz
- Department of Anesthesiology, Stony Brook Medicine, Stony Brook, New York,
| | - Tazeen Beg
- Department of Anesthesiology, Stony Brook Medicine, Stony Brook, New York,
| | - Tong J Gan
- Department of Anesthesiology, Stony Brook Medicine, Stony Brook, New York,
| | - Joseph Forrester
- Department of Surgery, Stanford University, Stanford, California
| |
Collapse
|
7
|
Suehiro K. Preoperative assessment for scheduling surgery during the coronavirus disease pandemic. J Anesth 2021; 35:378-383. [PMID: 33502589 PMCID: PMC7838845 DOI: 10.1007/s00540-021-02896-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 01/08/2021] [Indexed: 12/19/2022]
Abstract
On Mar 11, 2020, the World Health Organization declared coronavirus disease (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), a pandemic. Because COVID-19 has a pre-symptomatic period of up to 2 weeks, SARS-CoV-2 infection has continued to spread. Some individuals with SARS-CoV-2 infection have a severe clinical course, while most individuals have mild or moderate symptoms. Because SARS-CoV-2 is transmitted via droplets and secretions, anesthesiologists have higher risks of infection, especially during airway management. Therefore, general anesthesia requiring airway management can be a challenging procedure for anesthesiologists. During the pandemic, many elective surgeries have been postponed or cancelled in most affected countries. Recently, the number of elective surgeries is gradually recovering from the effect of the COVID-19 pandemic, and hence, safe clinical practice and protocols to prevent SARS-CoV-2 transmission to medical staff should be established. This mini-review focuses on the preoperative assessment and decision with regard to scheduling surgery in elective and emergency cases during the COVID-19 pandemic. A standardized questionnaire and algorithm regarding COVID-19 should be used to assess surgical patients preoperatively as it increases the reproducibility and accuracy of the decision whether to proceed with surgery.
Collapse
Affiliation(s)
- Koichi Suehiro
- Department of Anesthesiology, Osaka City University Graduate School of Medicine, 1-5-7 Asahimachi, Abenoku, Osaka, Osaka, 545-8586, Japan.
| |
Collapse
|