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adverse event emergency endotracheal intubation

Elliot Long, Domenic Cincotta, Joanne Grindlay, Anastasia Pellicano, Michael Clifford, Stefan Sabato
Emergency airway management, particularly outside of the operating room, is associated with a high incidence of life-threatening adverse events. Based on the recommendations of the 4th National Audit Project, we aimed to develop hospital-wide systems changes to improve the safety of emergency airway management. We describe a framework for governance in the form of a hospital airway special interest group. We describe the development and implementation of the following systems changes: 1. A local intubation algorithm modified from the Difficult Airway Society's plan A-B-C-D approach, including clear pathways for airway escalation, and emphasizing the concepts of resuscitation prior to intubation, planning for failure, and avoidance of fixation error...
February 28, 2017: Paediatric Anaesthesia
Kalpana Shah
BACKGROUND: ProSeal laryngeal mask airways (PLMAs) are routinely used after failed tracheal intubation as airway rescue, facilitating tracheal intubation by acting as a conduit and to secure airway during emergencies. In long duration surgeries, use of endotracheal tube (ETT) is associated with various hemodynamic complications, which are minimally affected during PLMA use. However, except for few studies, there are no significant data available that promote the use of laryngeal mask during cardiac surgery...
January 2017: Annals of Cardiac Anaesthesia
David T Wong, Amanda J Yee, Siaw May Leong, Frances Chung
PURPOSE: During the process of tracheal intubation, patients are apneic or hypoventilating and are at risk of becoming hypoxemic. This risk is especially high in patients with acute or chronic respiratory failure and accompanying compromised respiratory reserve. To address this concern, apneic oxygenation can be administered during tracheal intubation to aid in maintaining arterial oxygen saturation. The objective of this narrative review is to examine the utilization of apneic oxygenation within the operating room, intensive care unit (ICU), emergency department, and pre-hospital settings and to determine its efficacy compared with controls...
April 2017: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
Hai-Yan Qian, Ji Huang, Yue-Jin Yang, Yan-Min Yang, Zhi-Zhong Li, Jing-Mei Zhang
OBJECTIVE: To explore the predictive value of heart-type fatty acid binding protein (H-FABP) in the stratification and prognosis of patients with acute pulmonary embolism (APE). METHODS: According to risk stratification, 69 patients with APE admitted into the emergency department within 24 hours after onset were divided into the following 3 groups: high-risk group, moderate-risk group and low-risk group. H-FABP- and cardiac troponin I (cTNI)-positive rates of all groups were analyzed and compared, and the correlation between major adverse events (death, endotracheal intubation and cardiopulmonary resuscitation) and the cardiac markers (heart rate, arterial partial pressure of oxygen, right ventricular dimension, pulmonary arterial pressure, etc...
December 2016: American Journal of the Medical Sciences
Linda A Hou, Loren Laine, Nima Motamedi, Ara Sahakian, Christianne Lane, James Buxbaum
OBJECTIVES: Acute cholangitis mandates resuscitation, antibiotic therapy, and biliary decompression. Our aim was to define the optimal timing of endoscopic retrograde cholangiopancreatography (ERCP) for patients with acute cholangitis. METHODS: Clinical data on all cases of cholangitis managed by ERCP were prospectively collected from September 2010 to July 2013. The clinical impact of the time to ERCP, defined as the time from presentation in the emergency department to the commencement of the ERCP, was determined...
November 21, 2016: Journal of Clinical Gastroenterology
Louise Park, Irene Zeng, Andrew Brainard
OBJECTIVE: Many EDs have begun to evaluate their airway performance. The first-pass success (FPS) rate is a commonly used marker of proficiency, and has been associated with rates of adverse events. The aim of this systematic review and meta-analysis is to quantify the ED FPS rates and summarise the rates of adverse events associated with endotracheal intubation. METHODS: A structured literature search was performed through MEDLINE and EMBASE. Research published since 2000 was included if it prospectively collected data on all patients intubated in the ED and reported the FPS rates...
February 2017: Emergency Medicine Australasia: EMA
Yang Li-Qiao, Zhang Jian-Wei, Li Jing-Jie, Zhang Cheng-Mi
BACKGROUND: This study aimed to investigate the risk factors of intraoperative anesthesia adverse events (IAAEs) in children with laryngeal diseases. METHODS: We retrospectively recruited 118 children with laryngeal diseases who underwent surgical therapy. Based on medical history and preoperative imaging diagnosis, the baseline data, including sex, age, weight, onset age, the number of operation, the degree of airway obstruction, the nature of disease, the location of disease, complications, tracheotomy, and trachea intubation, were defined and recorded...
November 2016: Journal of Clinical Anesthesia
Lucas Van Oeveren, Julie Donner, Andrea Fantegrossi, Nicholas M Mohr, Calvin A Brown
BACKGROUND: Intubation in rural emergency departments (EDs) is a high-risk procedure, often with little or no specialty support. Rural EDs are utilizing real-time telemedicine links, connecting providers to an ED physician who may provide clinical guidance. INTRODUCTION: We endeavored to describe telemedicine-assisted intubation in rural EDs that are served by an ED telemedicine network. MATERIALS AND METHODS: Prospective data were collected on all patients who had an intubation attempt while on the video telemedicine link from May 1, 2014 to April 30, 2015...
April 2017: Telemedicine Journal and E-health: the Official Journal of the American Telemedicine Association
Yuko Ono, Takuya Sugiyama, Yasuyuki Chida, Tetsuya Sato, Hiroaki Kikuchi, Daiji Suzuki, Masakazu Ikeda, Koichi Tanigawa, Kazuaki Shinohara
BACKGROUND: A reduction in medical staff such as occurs in hospitals during nights and weekends (off hours) is associated with a worse outcome in patients with several unanticipated critical conditions. Although difficult airway management (DAM) requires the simultaneous assistance of several appropriately trained medical caregivers, data are scarce regarding the association between off-hour presentation and endotracheal intubation (ETI)-related adverse events, especially in the trauma population...
August 30, 2016: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Adam Bullock, James M Dodington, Aaron J Donoghue, Melissa L Langhan
OBJECTIVE: Capnography is indicated as a guide to assess and monitor both endotracheal intubation and cardiopulmonary resuscitation (CPR). Our primary objective was to determine the effect of the 2010 American Heart Association (AHA) guidelines on the frequency of capnography use during critical events in children in the emergency department (ED). Our secondary objective was to examine associations between patient characteristics and capnography use among these patients. METHODS: A retrospective chart review was performed on children aged 0 to 21 years who were intubated or received CPR in 2 academic children's hospital EDs between January 2009 and December 2012...
July 23, 2016: Pediatric Emergency Care
Hamidreza Saber, Brian Silver, Alejandro Santillan, Mahmoud R Azarpazhooh, Vivek Misra, Réza Behrouz
OBJECTIVE: To use data from a large multicenter trial to assess the role and significance of chest radiograph (CXR) in the initial evaluation of acute stroke. METHODS: Predefined clinical characteristics of patients who had recorded data on CXR examination during the initial evaluation were collected. We compared features of patients who had a CXR done before IV thrombolytics with those who did not. Rates of adverse cardiopulmonary events, intubation, and in-hospital mortality were also compared...
August 23, 2016: Neurology
Pamela Hiltunen, Helena Jäntti, Tom Silfvast, Markku Kuisma, Jouni Kurola
BACKGROUND: Though airway management methods during out-of-hospital cardiac arrest (OHCA) remain controversial, no studies on the topic from Finland have examined adherence to OHCA recommendations in real life. In response, the aim of this study was to document the interventions, success rates, and adverse events in airway management processes in OHCA, as well as to analyse survival at hospital discharge and at follow-up a year later. METHODS: During a 6-month study period in 2010, data regarding all patients with OHCA and attempted resuscitation in southern and eastern Finland were prospectively collected...
April 12, 2016: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Henry E Wang, David K Prince, Shannon W Stephens, Heather Herren, Mohamud Daya, Neal Richmond, Jestin Carlson, Craig Warden, M Riccardo Colella, Ashley Brienza, Tom P Aufderheide, Ahamed H Idris, Robert Schmicker, Susanne May, Graham Nichol
Airway management is an important component of resuscitation from out-of-hospital cardiac arrest (OHCA). The optimal approach to advanced airway management is unknown. The Pragmatic Airway Resuscitation Trial (PART) will compare the effectiveness of endotracheal intubation (ETI) and Laryngeal Tube (LT) insertion upon 72-h survival in adult OHCA. Encompassing United States Emergency Medical Services agencies affiliated with the Resuscitation Outcomes Consortium (ROC), PART will use a cluster-crossover randomized design...
April 2016: Resuscitation
Chuanzhong Yang, Xiaoyu Zhu, Weibin Lin, Qianshen Zhang, Jinqiong Su, Bingchun Lin, Hongmao Ye, Renjie Yu
BACKGROUND: This study aimed to study the feasibility, efficacy and safety of using laryngeal mask (LM) ventilation compared with endotracheal intubation (ETI) during neonatal resuscitation. METHODS: Neonates with a heart rate below 60 beats per minute despite 30 s of face mask ventilation were assigned quasi-randomly (odd/even birth date) to LM (n = 36) or ETI (n = 32) ventilation. Differences in first attempt insertion success, insertion time, Apgar score, resuscitation outcome, and adverse effects were compared...
January 25, 2016: BMC Pediatrics
Robert S Green, Michael B Butler
BACKGROUND: Postintubation hypotension (PIH) is an adverse event associated with poor outcomes in emergency department endotracheal intubations. Study objective was to determine the incidence of PIH and its impact on outcomes following tracheal intubation in a general anesthesia population. METHODS: Structured chart audit of adult patients intubated for a vascular surgery procedure at a tertiary care center over a 3-year period. Outcomes included in-hospital mortality, extended intensive care unit length of stay (ICU LOS), and requirement for postoperative (postop) hemodialysis or mechanical ventilation...
July 27, 2015: Journal of Intensive Care Medicine
L Dupree Hatch, Peter H Grubb, Amanda S Lea, William F Walsh, Melinda H Markham, Gina M Whitney, James C Slaughter, Ann R Stark, E Wesley Ely
OBJECTIVE: To determine the rate of adverse events associated with endotracheal intubation in newborns and modifiable factors contributing to these events. STUDY DESIGN: We conducted a prospective, observational study in a 100-bed, academic, level IV neonatal intensive care unit from September 2013 through June 2014. We collected data on intubations using standardized data collection instruments with validation by medical record review. Intubations in the delivery or operating rooms were excluded...
January 2016: Journal of Pediatrics
Steven Deem, David Yanez, Laura Sissons-Ross, Jo Ann Elrod Broeckel, Stephen Daniel, Miriam Treggiari
RATIONALE: Ventilator-associated pneumonia (VAP) is a prevalent and costly nosocomial infection related to instrumentation of the airway with an endotracheal tube (ETT), enabling microaspiration of contaminated secretions. Modification of the ETT design to reduce microaspiration and/or biofilm formation may play an important role in VAP prevention. However, there is insufficient evidence to provide strong recommendations regarding the use of modified ETT and unaddressed safety concerns...
January 2016: Annals of the American Thoracic Society
Israel Green-Hopkins, Heidi Werner, Michael C Monuteaux, Joshua Nagler
OBJECTIVES: Using recordings of endotracheal intubation attempts obtained with a video-enabled laryngoscope with Miller and Macintosh blades, the authors sought to evaluate the association between laryngoscopic approach (right-sided vs. midline) and intubation success, as well as adverse event rates in the pediatric emergency department (ED). METHODS: This was a retrospective cohort study of children younger than 21 years who underwent endotracheal intubation with a C-MAC video laryngoscope in a tertiary care ED between August 2009 and May 2013...
November 2015: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Jean-Michel Liet, Thierry Ducruet, Vineet Gupta, Gilles Cambonie
BACKGROUND: Bronchiolitis is the leading cause of hospitalisation among infants in high-income countries. Acute viral bronchiolitis is associated with airway obstruction and turbulent gas flow. Heliox, a mixture of oxygen and the inert gas helium, may improve gas flow through high-resistance airways and decrease the work of breathing. In this review, we selected trials that objectively assessed the effect of the addition of heliox to standard medical care for acute bronchiolitis. OBJECTIVES: To assess heliox inhalation therapy in addition to standard medical care for acute bronchiolitis in infants with respiratory distress, as measured by clinical endpoints (in particular the rate of endotracheal intubation, the rate of emergency department discharge, the length of treatment for respiratory distress) and pulmonary function testing (mainly clinical respiratory scores)...
September 18, 2015: Cochrane Database of Systematic Reviews
Chaoliang Tang, Xiaoqing Chai, Fang Kang, Xiang Huang, Tao Hou, Fei Tang, Juan Li
BACKGROUND: The adverse events induced by intubation and extubation may cause intracranial hemorrhage and increase of intracranial pressure, especially in posterior fossa surgery patients. In this study, we proposed that I-gel combined with tracheal intubation could reduce the stress response of posterior fossa surgery patients. METHODS: Sixty-six posterior fossa surgery patients were randomly allocated to receive either tracheal tube intubation (Group TT) or I-gel facilitated endotracheal tube intubation (Group TI)...
2015: Mediators of Inflammation
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