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Pre-selection of primary intubation technique is associated with a low incidence of difficult intubation in patients with a BMI of 35 kg/m2 or higher

Abstract

Background: The incidence of difficult intubation (DI) in obese patients may reach a two-digit figure. No studies have assessed the effect of primary use of special intubation devices on lowering the incidence of DI. We assessed the effect of primary selection of special intubation techniques on the incidence of DI in patients with a BMI of 35 kg/m2 or higher. Patients and methods: Data from 546 patients with a BMI of 35 kg/m2 or higher who underwent bariatric surgery at Wolfson Medical Center from 2010 through 2014 was retrospectively extracted and analyzed for demographics, predictors of DI and intubation techniques employed. Difficult intubation was defined as the presence of at least one of the followings: laryngoscopy grade 3 or 4, need for >1 laryngoscopy or intubation attempt, need for changing the blade size, failed direct laryngoscopy (DL), difficult or failed videolaryngoscopy (VL-Glidescope), difficult or failed awake fiberoptic intubation (AFOI) and using VL or awake AFOI as rescue airway techniques. Primary intubation techniques were direct DL, VL and AFOI. We correlated the predictors of DI with the actual incidence of DI and with the choice of intubation technique employed. Results: The overall incidence of DI was 1.6% (1.5% with DL vs. 2.2 with VL + AFOI, p = 0.61). With logistic regression analysis, age was the only significant predictor of DI. Predictors of DI that affected the selection of VL or AFOI as primary intubation tools were Mallampati class 3 or 4, limited neck movement, age, male gender, body mass index and obstructive sleep apnea syndrome. Conclusion: The lower incidence of DI in our study group may stem from the primary use of special intubation devices, based on the presence of predictors of DI.

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Pulse Oximetry During the First 24 Hours as a Screening Tool For Congenital Heart Defects

Abstract

Introduction: Although screening for congenital heart defects (CHD) relies mainly on antenatal ultrasonography and clinical examination after birth, life-threatening cardiac malformations are often not diagnosed before the patient is discharged.

Aim: To assess the use of routine pulse oximetry in the delivery room and at 24 hours postpartum, and to study its feasibility as a screening test for CHD.

Material and Methods: In this prospective study, all infants born in “Cuza Voda” Maternity Hospital, Iasi, Romania, were enrolled over a thirteen-month period. Preductal oximetry was assessed during the first hour, and postductal oximetry was evaluated at twenty-four hours postpartum. Data were then analyzed to establish the sensitivity and specificity of pulse oximetry, as a screening test for CHD.

Results: 5406 infants were included in the study, with a mean gestational age of 38.2 weeks and a mean birth weight of 3175 grams. During the first minute, blood oxygen saturation varied between 40% and 90% and at 24 hours of life, it ranged between 90% and 100%. Following oximetry assessment, 14 infants with critical CHD were identified. Blood oxygen saturation values in infants with CHD were lower throughout the entire period of evaluation. Pulse oximetry had good sensitivity and specificity at 1 hour (Se=87.5%, Sp=95.5%) and 24 hours (Se=92.5%, Sp=97.4%) for the diagnosis of CHD. Blood oxygen saturation values at one minute, 1 hour and 24 hours are strong discriminative parameters for the early diagnosis of CHD.

Conclusion: Routine pulse oximetry during the first 24 hours postpartum represents an early indicator of CHD to facilitate timely intervention. Pulse oximetry provides excellent sensitivity and specificity and has tremendous potential as a standard screening test for CHD during the first 24 hours of life.

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Precision Medicine and its Role in the Treatment of Sepsis: A Personalised View

starting point in the treatment of an individual. Acknowledgement The research has been carried out within the project: The clinical relevance of coding genes polymorphisms cytokines (IL-6, IL-10, TNFalfa) and cellular receptors (CD14, TREM-1, TLR4) and PAI in sepsis, no. 17801/2/2015, funded through internal research grants by the University of Medicine and Pharmacy of Tîrgu Mures, Romania. Conflict of interest None to declare References 1 Vea A, Llorente-Cortes V, de Gonzalo-Calvo D. Circular RNAs: a novel tool in cardiovascular biomarker

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Improving Clinical Performance of an Interprofessional Emergency Medical Team through a One-day Crisis Resource Management Training

Abstract

Introduction: Errors are frequent in health care and Emergency Departments are one of the riskiest areas due to frequent changes of team composition, complexity and variety of the cases and difficulties encountered in managing multiple patients. As the majority of clinical errors are the results of human factors and not technical in nature or due to the lack of knowledge, a training focused on these factors appears to be necessary. Crisis resource management (CRM), a tool that was developed initially by the aviation industry and then adopted by different medical specialties as anesthesia and emergency medicine, has been associated with decreased error rates.

The aim of the study: To assess whether a single day CRM training, combining didactic and simulation sessions, improves the clinical performance of an interprofessional emergency medical team.

Material and Methods: Seventy health professionals with different qualifications, working in an emergency department, were enrolled in the study. Twenty individual interprofessional teams were created. Each team was assessed before and after the training, through two in situ simulated exercises. The exercises were videotaped and were evaluated by two assessors who were blinded as to whether it was the initial or the final exercise. Objective measurement of clinical team performance was performed using a checklist that was designed for each scenario and included essential assessment items for the diagnosis and treatment of a critical patient, with the focus on key actions and decisions. The intervention consisted of a one-day training, combining didactic and simulation sessions, followed by instructor facilitated debriefing. All participants went through this training after the initial assessment exercises.

Results: An improvement was seen in most of the measured clinical parameters.

Conclusion: Our study supports the use of combined CRM training for improving the clinical performance of an interprofessional emergency team. Empirically this may improve the patient outcome.

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Editorial. The Eleventh Hour: Neurosyphilis, Still Fashionable but a Controversial Diagnosis

Infect Dis. 2011;53(Suppl 3):S110-28 8. Sparling PF. Diagnosis of neurosyphilis: new tools. Sex Transm Dis. 2010;37(5):288-9

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Anaesthesia and Intensive Care Residents’ Perception of Simulation Training in Four Romanian Centres

R eferences 1. Lammers RL: Simulation: the new teaching tool. Ann Emerg Med. 2007;49:505-507. 2. Morgan PJ, Cleave-Hogg D: A worldwide survey of the use of simulation in anaesthesia. Can J Anaesth. 2002;49(7):659-62. 3. Okuda Y, Bryson EO, DeMaria S Jr et al.: The utility of simulation in medical education: what is the evidence? Mt Sinai J Med. 2009;76:330-3. 4. Meguerdichian DA, Heiner JD, Younggren BN: Emergency medicine simulation: a resident’s perspective. Ann Emerg Med. 2012;60(1):121-6. 5. Steadman RH, Coates WC, Huang YM et al

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A Fatal Case of Community Acquired Cupriavidus Pauculus Pneumonia

child on extracorporeal membrane oxygenation. ASAIO J. 2014;60:740-1. doi: 10.1097/MAT.0000000000000120. 10. Foxman B. Molecular Tools and Infectious Disease Epidemiology. California: San Diego. 2012, pp. 173. 11. Aydin B, Dilli D, Zenciroğlu A, Okumuş N, Ozkan S, Tanir G. A case of newborn with community acquired pneumonia caused by Cupriavidus pauculus. Tuberk Toraks. 2012;60:160-2. 12. Azcona-Gutiérrez JM, Buendia-Moreno B, Sáez-Nieto J, López-Brea-Calvo M. Cupriavidus pauculus isolation in the intensive care unit. Enferm Infecc Microbiol Clin

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Recent Advances Of Mucosal Capnometry And The Perspectives Of Gastrointestinal Monitoring In The Critically Ill. A Pilot Study

;118:1127-32. 37. Nakagawa Y, Weil MH, Tang W, Sun S, Yamaguchi H, Jin X, Bisera J. Sublingual capnometry for diagnosis and quantitation of circulatory shock. Am J Respir Crit Care Med. 1998;157:1838-43. 38. Boda D, Kaszaki J, Tálosi G. A new simple tool for tonometric determination of the PCO2 in the gastrointestinal tract: in vitro and in vivo validation studies. Eur J Anaesthesiol. 2006;23:680-5. 39. Chapman MJ, Deane AM. Gastrointestinal dysfunction relating to the provision of nutrition in the critically ill. Curr Opin Clin Nutr Metab Care

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Anemia in Intensive Care: A review of Current Concepts

-a prospective randomized controlled trial. Anaesth Intensive Care. 2006;34:434-7. 8. Arnold DM, Donahoe L, Clarke FJ, et al. Bleeding during critical illness: a prospective cohort study using a new measurement tool. Clin Invest Med. 2007;30:E93-E102. 9. Greinacher A, Selleng K. Thrombocytopenia in the intensive care unit patient. Hematology Am Soc Hematol Educ Program. 2010;2010:135-43. 10. Marks PW. Coagulation disorders in the ICU. Clin Chest Med. 2009;30:123-9. 11. Levi M, Toh CH, Thachil J, Watson HG

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Refractory Lactic Acidosis and an Approach to Its Management - A Case Report

arterial lactate sampling is the gold standard, but venous sampling also is advantageous in detecting hyperlactatemia and therefore should be used as a screening tool. However, they acknowledged that venous sampling was associated with higher lactate values compared to arterial values and that a universal cut-off value could not be established reliably by the study [ 19 ]. Bloom et al. (2014) concluded that peripheral venous sampling has a good correlation to arterial sampling within “normal” ranges, but a poor agreement exists between arterial and venous lactate at

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