{"title":"Napping: is it really a means by which short sleepers can have their cake and eat it too?","authors":"Marie-Pierre St-Onge, Brooke Aggarwal, Sanja Jelic","doi":"10.21037/jeccm.2019.05.02","DOIUrl":"https://doi.org/10.21037/jeccm.2019.05.02","url":null,"abstract":"","PeriodicalId":73727,"journal":{"name":"Journal of emergency and critical care medicine (Hong Kong, China)","volume":"3 ","pages":"24"},"PeriodicalIF":0.0,"publicationDate":"2019-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/jeccm.2019.05.02","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10520692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-04-24DOI: 10.21037/JECCM.2019.04.01
C. Sarda, A. Tabah, D. Mokart, E. Alp, K. Arvaniti, M. Akova, J. Rello
Background: Critically Hematological Ill Patients Antimicrobial Stewardship (C.H.I.P.S) is a global cross-sectional survey will describe the most clinical relevant bacteria and antimicrobial pattern of resistance among hematological patients admitted to intensive care units (ICU). At the same time, a global expert challenges on infection control and treatment will be provided. Methods: A global survey will be performed using an electronic platform (SurveyMonkey ® ). The survey will compile data on key aspects of the current treatment of antimicrobial-resistant bacteria infections among hematological patients admitted in ICU worldwide. All responses to survey questions will be presented as summary statistics and reporting proportions. Statistical analysis by Chi-square test or Fisher’s exact test will be performed to evaluate potential associations. Discussion: Efforts on the development of recommendations and antimicrobial stewardship (AMS) programs focused on critical hematological patients should be directed in the near future. Prevention strategies, type and, timing of antimicrobial therapy, de-escalation (ADE) approach have to be tailored to these patients.
{"title":"Critically Hematological Ill Patients Antimicrobial Stewardship (C.H.I.P.S) in intensive care unit: a global cross-sectional survey—an international research project within the Nine-i investigators network","authors":"C. Sarda, A. Tabah, D. Mokart, E. Alp, K. Arvaniti, M. Akova, J. Rello","doi":"10.21037/JECCM.2019.04.01","DOIUrl":"https://doi.org/10.21037/JECCM.2019.04.01","url":null,"abstract":"Background: Critically Hematological Ill Patients Antimicrobial Stewardship (C.H.I.P.S) is a global cross-sectional survey will describe the most clinical relevant bacteria and antimicrobial pattern of resistance among hematological patients admitted to intensive care units (ICU). At the same time, a global expert challenges on infection control and treatment will be provided. Methods: A global survey will be performed using an electronic platform (SurveyMonkey ® ). The survey will compile data on key aspects of the current treatment of antimicrobial-resistant bacteria infections among hematological patients admitted in ICU worldwide. All responses to survey questions will be presented as summary statistics and reporting proportions. Statistical analysis by Chi-square test or Fisher’s exact test will be performed to evaluate potential associations. \u0000 Discussion: Efforts on the development of recommendations and antimicrobial stewardship (AMS) programs focused on critical hematological patients should be directed in the near future. Prevention strategies, type and, timing of antimicrobial therapy, de-escalation (ADE) approach have to be tailored to these patients.","PeriodicalId":73727,"journal":{"name":"Journal of emergency and critical care medicine (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/JECCM.2019.04.01","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43045529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-04-09DOI: 10.21037/jeccm.2019.08.01
A. Pyrpasopoulou, E. Iosifidis, C. Antachopoulos, E. Roilides
Critically ill patients suffer from invasive fungal infections, mainly due to Candida spp., but also to Aspergillus spp., Cryptococcus spp. and other more rare yeasts or filamentous fungi. These infections are prevented or treated with various antifungal agents belonging to one of the following classes: polyenes (mainly amphotericin B formulations with liposomal amphotericin B as the most frequently used compound), azoles (fluconazole, itraconazole, voriconazole, posaconazole and isavuconazole) or echinocandins (caspofungin, micafungin and anidulafungin). Administration of these agents may be challenging due to various factors in patients hospitalized in the intensive care unit (ICU). Such factors frequently found in these patients are renal and liver insufficiencies, extreme ages (prematurely born infants or elderly patients), obesity, thermal injury, other co-morbidities, and interactions with many simultaneously administered other drugs. In addition, sepsis itself may cause such hemodynamic changes resulting in increased clearance of antifungal agents. The use of continuous renal replacement therapy and extracorporeal membrane oxygenation needs special attention when antifungal agents are administered. It is very important that the physicians caring for these patients are aware of the impact of such factors on the pharmacokinetics and pharmacodynamics of the antifungal agents administered in the ICU. In addition, they should be aware of the adverse effects of these agents that they administer on the biology and physiology of host’s various organs and the metabolism of other co-administered drugs occurring through these organs. This knowledge may lead to optimization of dosing of the antifungal agents and other interacting medications in order to maximize antifungal effect in the care of critically ill patients.
{"title":"Antifungal drug dosing adjustment in critical patients with invasive fungal infections","authors":"A. Pyrpasopoulou, E. Iosifidis, C. Antachopoulos, E. Roilides","doi":"10.21037/jeccm.2019.08.01","DOIUrl":"https://doi.org/10.21037/jeccm.2019.08.01","url":null,"abstract":"Critically ill patients suffer from invasive fungal infections, mainly due to Candida spp., but also to Aspergillus spp., Cryptococcus spp. and other more rare yeasts or filamentous fungi. These infections are prevented or treated with various antifungal agents belonging to one of the following classes: polyenes (mainly amphotericin B formulations with liposomal amphotericin B as the most frequently used compound), azoles (fluconazole, itraconazole, voriconazole, posaconazole and isavuconazole) or echinocandins (caspofungin, micafungin and anidulafungin). Administration of these agents may be challenging due to various factors in patients hospitalized in the intensive care unit (ICU). Such factors frequently found in these patients are renal and liver insufficiencies, extreme ages (prematurely born infants or elderly patients), obesity, thermal injury, other co-morbidities, and interactions with many simultaneously administered other drugs. In addition, sepsis itself may cause such hemodynamic changes resulting in increased clearance of antifungal agents. The use of continuous renal replacement therapy and extracorporeal membrane oxygenation needs special attention when antifungal agents are administered. It is very important that the physicians caring for these patients are aware of the impact of such factors on the pharmacokinetics and pharmacodynamics of the antifungal agents administered in the ICU. In addition, they should be aware of the adverse effects of these agents that they administer on the biology and physiology of host’s various organs and the metabolism of other co-administered drugs occurring through these organs. This knowledge may lead to optimization of dosing of the antifungal agents and other interacting medications in order to maximize antifungal effect in the care of critically ill patients.","PeriodicalId":73727,"journal":{"name":"Journal of emergency and critical care medicine (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/jeccm.2019.08.01","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45977805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-04-09DOI: 10.21037/jeccm.2019.08.05
H. Kapoor, James T Lee, Ahmed A. Farag, B. Tucker, A. Pereira
Blunt torso trauma leading to translational thoracolumbar injury is a rare and serious injury requiring high amount of energy to produce this injury pattern. Translational thoracolumbar injuries have high association with spinal dural tears and traumatic aortic injuries however, associated traumatic ureteral injury is rare. This case report presents a unique combination of traumatic ureteral and dural injury resulting in an abnormal fistulous communication between the two, in a patient with translational thoracolumbar injury after motor vehicular collision. Unexpected “myelogram-like” appearance was seen with excreted urinary contrast mixing with the CSF in the spinal and intracranial subarachnoid spaces. No other reports of such a traumatic uretero-thecal fistula were found in our comprehensive search through the published English literature.
{"title":"Translational thoracolumbar injury after motor vehicle collision with uretero-thecal fistulization: a case report","authors":"H. Kapoor, James T Lee, Ahmed A. Farag, B. Tucker, A. Pereira","doi":"10.21037/jeccm.2019.08.05","DOIUrl":"https://doi.org/10.21037/jeccm.2019.08.05","url":null,"abstract":"Blunt torso trauma leading to translational thoracolumbar injury is a rare and serious injury requiring high amount of energy to produce this injury pattern. Translational thoracolumbar injuries have high association with spinal dural tears and traumatic aortic injuries however, associated traumatic ureteral injury is rare. This case report presents a unique combination of traumatic ureteral and dural injury resulting in an abnormal fistulous communication between the two, in a patient with translational thoracolumbar injury after motor vehicular collision. Unexpected “myelogram-like” appearance was seen with excreted urinary contrast mixing with the CSF in the spinal and intracranial subarachnoid spaces. No other reports of such a traumatic uretero-thecal fistula were found in our comprehensive search through the published English literature.","PeriodicalId":73727,"journal":{"name":"Journal of emergency and critical care medicine (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/jeccm.2019.08.05","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47407608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-04-05DOI: 10.21037/JECCM.2019.04.02
T. Z. Tan, Y. Hao, A. Ho, N. Shahidah, S. Yap, Y. Ng, N. Doctor, B. Leong, H. N. Gan, D. Mao, M. Y. Chia, S. O. Cheah, M. Ong
Background: Variability in post-resuscitation care of out-of-hospital cardiac arrests (OHCA) contributes to differences in survival outcomes. Interventions of significance include targeted temperature management (TTM) and percutaneous coronary intervention (PCI). In this study, we sought to determine the magnitude and factors involved. Methods: From April 2010 to December 2014, all consecutive OHCAs presenting to hospitals across Singapore were considered for analysis. Primary outcome was survival to discharge or 30 days. Secondary outcomes included survival to admission, and neurological outcome (Glasgow-Pittsburgh Cognitive Performance Categories ≤2). The effects of hospital-based resuscitative interventions and admitting hospital on outcome were compared using Chi-squared tests and multivariate logistic regression models. Results: A total of 7,609 OHCA cases were included from six hospitals in Singapore. TTM and PCI usage varied significantly (P<0.001). Hospitals B, C, D had a lower survival to discharge or 30 days post-arrest [adjusted odds ratio (AOR) 0.392, 95% CI: 0.229–0.671, P=0.0006; AOR 0.499, 95% CI: 0.298–0.837, P=0.008; AOR 0.495, 95% CI: 0.304–0.805, P=0.005, respectively]. Hospitals B, D had lower survival to discharge with good neurological function (AOR 0.390, 95% CI: 0.206–0.738, P=0.004; AOR 0.443, 95% CI: 0.249–0.791, P=0.006 respectively). Hospitals B, C, D, E had lower survival to ED admission (AOR 0.582, 95% CI: 0.462–0.733, P<0.0001; AOR 0.600, 95% CI: 0.474–0.759, P<0.001; AOR 0.678, 95% CI: 0.542–0.847, P=0.0007; AOR 0.620, 95% CI: 0.494–0.777, P<0.0001 respectively). Both teaching status and bed number (≥1,000 beds) are associated with improved survival to discharge or 30 days (OR 1.488, P=0.007; OR 1.536, P=0.005). Conclusions: TTM and PCI usage, and OHCA outcomes vary between hospitals. This is associated with teaching status, bed number, and post-resuscitation care.
{"title":"Inter-hospital variations in resuscitation processes and outcomes of out-of-hospital cardiac arrests in Singapore","authors":"T. Z. Tan, Y. Hao, A. Ho, N. Shahidah, S. Yap, Y. Ng, N. Doctor, B. Leong, H. N. Gan, D. Mao, M. Y. Chia, S. O. Cheah, M. Ong","doi":"10.21037/JECCM.2019.04.02","DOIUrl":"https://doi.org/10.21037/JECCM.2019.04.02","url":null,"abstract":"Background: Variability in post-resuscitation care of out-of-hospital cardiac arrests (OHCA) contributes to differences in survival outcomes. Interventions of significance include targeted temperature management (TTM) and percutaneous coronary intervention (PCI). In this study, we sought to determine the magnitude and factors involved. \u0000 Methods: From April 2010 to December 2014, all consecutive OHCAs presenting to hospitals across Singapore were considered for analysis. Primary outcome was survival to discharge or 30 days. Secondary outcomes included survival to admission, and neurological outcome (Glasgow-Pittsburgh Cognitive Performance Categories ≤2). The effects of hospital-based resuscitative interventions and admitting hospital on outcome were compared using Chi-squared tests and multivariate logistic regression models. \u0000 Results: A total of 7,609 OHCA cases were included from six hospitals in Singapore. TTM and PCI usage varied significantly (P<0.001). Hospitals B, C, D had a lower survival to discharge or 30 days post-arrest [adjusted odds ratio (AOR) 0.392, 95% CI: 0.229–0.671, P=0.0006; AOR 0.499, 95% CI: 0.298–0.837, P=0.008; AOR 0.495, 95% CI: 0.304–0.805, P=0.005, respectively]. Hospitals B, D had lower survival to discharge with good neurological function (AOR 0.390, 95% CI: 0.206–0.738, P=0.004; AOR 0.443, 95% CI: 0.249–0.791, P=0.006 respectively). Hospitals B, C, D, E had lower survival to ED admission (AOR 0.582, 95% CI: 0.462–0.733, P<0.0001; AOR 0.600, 95% CI: 0.474–0.759, P<0.001; AOR 0.678, 95% CI: 0.542–0.847, P=0.0007; AOR 0.620, 95% CI: 0.494–0.777, P<0.0001 respectively). Both teaching status and bed number (≥1,000 beds) are associated with improved survival to discharge or 30 days (OR 1.488, P=0.007; OR 1.536, P=0.005). \u0000 Conclusions: TTM and PCI usage, and OHCA outcomes vary between hospitals. This is associated with teaching status, bed number, and post-resuscitation care.","PeriodicalId":73727,"journal":{"name":"Journal of emergency and critical care medicine (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49203086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-03-26DOI: 10.21037/JECCM.2019.03.02
Chunhui Xu, Shu Li, Mi Zhou, Yuetian Yu
A 52-year-old female was admitted to our hospital with cough, fever and fatigue for a week. Her medical history included leukocytosis and myeloproliferative neoplasma for about 3 months. On physical examination, she appeared shallow breathing with fever up to 38.5 ℃ and moist rale could be clearly heard on the left lower lobe.
{"title":"Pulmonary infection caused by Aspergillus glaucus in patient with leucocythemia","authors":"Chunhui Xu, Shu Li, Mi Zhou, Yuetian Yu","doi":"10.21037/JECCM.2019.03.02","DOIUrl":"https://doi.org/10.21037/JECCM.2019.03.02","url":null,"abstract":"A 52-year-old female was admitted to our hospital with cough, fever and fatigue for a week. Her medical history included leukocytosis and myeloproliferative neoplasma for about 3 months. On physical examination, she appeared shallow breathing with fever up to 38.5 ℃ and moist rale could be clearly heard on the left lower lobe.","PeriodicalId":73727,"journal":{"name":"Journal of emergency and critical care medicine (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45111165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-03-20DOI: 10.21037/JECCM.2019.02.06
Kimberly M. Gorman, R. Dumire
Trauma is the leading cause of death in those age 1–45 and the 3rd leading cause of death overall in all groups in the United States and is associated with an annual cost of 671 billion dollars. Education remains one of our most valuable tools in combatting this public health epidemic called “Trauma” and must, therefore, be provided in an efficient manner not only for nursing personnel but for all healthcare providers involved in the care of trauma patients. An on-line educational platform was utilized to introduce updates and revisions to our institutional traumatic brain injury (TBI) guidelines and protocols to a multidisciplinary group of nurses and surgical residents. In addition, a hands-on module was also utilized to ensure accuracy and consistency across all disciplines. Utilizing the NetLearning® educational process, an active learning platform, resulted in an improvement in test scores which was sustained at the 6-month point for both nurses and resident physicians. There was a statistically significant improvement in the nurse and resident physician combined scores between the pre-test and immediate post-test mean scores (74%±9.35% pre vs. 88%±6.23% post, P<0.0005), and no meaningful change between the immediate post-test and 6-month post-test scores, indicating sustained improvement. Multidisciplinary health care education via and on-line educational platform utilizing pre and posttest was found to be an effective teaching as well a process improvement methodology with sustained knowledge out to 6 months at a community based academic Level 1 trauma center.
{"title":"Knowledge retention of the traumatic brain injury guidelines at a Level 1 trauma center","authors":"Kimberly M. Gorman, R. Dumire","doi":"10.21037/JECCM.2019.02.06","DOIUrl":"https://doi.org/10.21037/JECCM.2019.02.06","url":null,"abstract":"Trauma is the leading cause of death in those age 1–45 and the 3rd leading cause of death overall in all groups in the United States and is associated with an annual cost of 671 billion dollars. Education remains one of our most valuable tools in combatting this public health epidemic called “Trauma” and must, therefore, be provided in an efficient manner not only for nursing personnel but for all healthcare providers involved in the care of trauma patients. An on-line educational platform was utilized to introduce updates and revisions to our institutional traumatic brain injury (TBI) guidelines and protocols to a multidisciplinary group of nurses and surgical residents. In addition, a hands-on module was also utilized to ensure accuracy and consistency across all disciplines. Utilizing the NetLearning® educational process, an active learning platform, resulted in an improvement in test scores which was sustained at the 6-month point for both nurses and resident physicians. There was a statistically significant improvement in the nurse and resident physician combined scores between the pre-test and immediate post-test mean scores (74%±9.35% pre vs. 88%±6.23% post, P<0.0005), and no meaningful change between the immediate post-test and 6-month post-test scores, indicating sustained improvement. Multidisciplinary health care education via and on-line educational platform utilizing pre and posttest was found to be an effective teaching as well a process improvement methodology with sustained knowledge out to 6 months at a community based academic Level 1 trauma center.","PeriodicalId":73727,"journal":{"name":"Journal of emergency and critical care medicine (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44259877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-03-18DOI: 10.21037/JECCM.2019.02.08
A. Cancelliere
Pneumocephalus is a rare condition caused by abnormal air entrapment in the intracranial compartment following disruption of the meninges. Most cases self-resolve and typically do not cause neurological sequelae. However, excessive expansion of the pneumocele results in rapid neurological deterioration, termed tension pneumocephalus. Left untreated, this leads to tissue ischemia, herniation syndromes, and death. Rapid differentiation between the above entities and immediate multimodal management dictate the success of recovery. The author reports an exceptional case of an 82-year-old male who presented to an outside hospital with focal neurological deficits in the early postoperative period following endoscopic sinus surgery. Computed tomography imaging revealed a large pneumocele resulting in severe mass-effect on the underlying brain parenchyma. Prompt surgical evacuation of the pneumocele resulted in dramatic recovery with only minor disability from the initial ischemic insult. Tension pneumocephalus is an uncommon, albeit life-threatening neurosurgical emergency wherein the developing pneumocele results in abnormally high intracranial pressure. Prompt recognition by emergency physicians and appropriate management are critical to limit further morbidity and mortality.
{"title":"Nothing to sneeze at: tension pneumocephalus causing an acute stroke following endoscopic sinus surgery","authors":"A. Cancelliere","doi":"10.21037/JECCM.2019.02.08","DOIUrl":"https://doi.org/10.21037/JECCM.2019.02.08","url":null,"abstract":"Pneumocephalus is a rare condition caused by abnormal air entrapment in the intracranial compartment following disruption of the meninges. Most cases self-resolve and typically do not cause neurological sequelae. However, excessive expansion of the pneumocele results in rapid neurological deterioration, termed tension pneumocephalus. Left untreated, this leads to tissue ischemia, herniation syndromes, and death. Rapid differentiation between the above entities and immediate multimodal management dictate the success of recovery. The author reports an exceptional case of an 82-year-old male who presented to an outside hospital with focal neurological deficits in the early postoperative period following endoscopic sinus surgery. Computed tomography imaging revealed a large pneumocele resulting in severe mass-effect on the underlying brain parenchyma. Prompt surgical evacuation of the pneumocele resulted in dramatic recovery with only minor disability from the initial ischemic insult. Tension pneumocephalus is an uncommon, albeit life-threatening neurosurgical emergency wherein the developing pneumocele results in abnormally high intracranial pressure. Prompt recognition by emergency physicians and appropriate management are critical to limit further morbidity and mortality.","PeriodicalId":73727,"journal":{"name":"Journal of emergency and critical care medicine (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44375266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-03-14DOI: 10.21037/JECCM.2019.02.07
V. Patil, S. Bhosale, A. Kulkarni, N. Prabu, Vikas Bhagat, Harish K. Chaudhary, Suhail Sarawar, Amit M Narkhede, J. Divatia
Background: Endotracheal intubation in the intensive care unit (ICU) is an extremely high risk procedure. Rapid confirmation of endotracheal tube (ETT) placement and position to the correct depth is vitally important. Various methods are used to confirm placement of ETT. Capnography is the gold standard for confirmation of ETT placement in the trachea, but is not useful for ETT placement at the correct depth in the trachea. We conducted this study to evaluate the utility of airway ultrasonography for real time confirmation of ETT placement and also to confirm appropriate depth of the ETT. Methods: In this prospective, single-centre study, we included all adult patients intubated in the ICU. We obtained deferred consent from the Institutional Ethics Committee. We performed airway ultrasonography real time during intubation and detected ETT placement by loss of snow storm sign. Tracheal placement was also confirmed by capnography. We used saline filled cuff method to place ETT cuff depth at 3 rd and 4 rd tracheal ring and confirmed the appropriateness of the ETT depth on chest X-ray. We calculated the sensitivity and specificity of this technique. Results: We included 89 patients for the study. The ultrasound detection of the placement of the tube with the loss of snow storm sign was seen in 86 patients. The incidence of esophageal intubations was 2.0%. The overall sensitivity of airway ultrasound for confirmation of ETT placement was 96% (CI: 0.89–0.99) and specificity was 100%. The PPV was 100% (CI: 0.94–1.00). The accuracy for appropriateness of final position of ETT by airway ultrasound as compared to X-ray was found to be 96% (CI: 0.71–0.87). No complications were observed related to cuff inflation and deflation and to the use of airway ultrasound. Conclusions: Airway ultrasonography can be used for rapidly detecting ETT placement in the trachea as well as for determining appropriate depth insertion of the ETT with saline filled cuff technique.
{"title":"Utility of ultrasound of upper airway for confirmation of endotracheal intubation and confirmation of the endotracheal tube position in the intensive care unit patients","authors":"V. Patil, S. Bhosale, A. Kulkarni, N. Prabu, Vikas Bhagat, Harish K. Chaudhary, Suhail Sarawar, Amit M Narkhede, J. Divatia","doi":"10.21037/JECCM.2019.02.07","DOIUrl":"https://doi.org/10.21037/JECCM.2019.02.07","url":null,"abstract":"Background: Endotracheal intubation in the intensive care unit (ICU) is an extremely high risk procedure. Rapid confirmation of endotracheal tube (ETT) placement and position to the correct depth is vitally important. Various methods are used to confirm placement of ETT. Capnography is the gold standard for confirmation of ETT placement in the trachea, but is not useful for ETT placement at the correct depth in the trachea. We conducted this study to evaluate the utility of airway ultrasonography for real time confirmation of ETT placement and also to confirm appropriate depth of the ETT. \u0000 Methods: In this prospective, single-centre study, we included all adult patients intubated in the ICU. We obtained deferred consent from the Institutional Ethics Committee. We performed airway ultrasonography real time during intubation and detected ETT placement by loss of snow storm sign. Tracheal placement was also confirmed by capnography. We used saline filled cuff method to place ETT cuff depth at 3 rd and 4 rd tracheal ring and confirmed the appropriateness of the ETT depth on chest X-ray. We calculated the sensitivity and specificity of this technique. \u0000 Results: We included 89 patients for the study. The ultrasound detection of the placement of the tube with the loss of snow storm sign was seen in 86 patients. The incidence of esophageal intubations was 2.0%. The overall sensitivity of airway ultrasound for confirmation of ETT placement was 96% (CI: 0.89–0.99) and specificity was 100%. The PPV was 100% (CI: 0.94–1.00). The accuracy for appropriateness of final position of ETT by airway ultrasound as compared to X-ray was found to be 96% (CI: 0.71–0.87). No complications were observed related to cuff inflation and deflation and to the use of airway ultrasound. \u0000 Conclusions: Airway ultrasonography can be used for rapidly detecting ETT placement in the trachea as well as for determining appropriate depth insertion of the ETT with saline filled cuff technique.","PeriodicalId":73727,"journal":{"name":"Journal of emergency and critical care medicine (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/JECCM.2019.02.07","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42875299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-03-02DOI: 10.21037/JECCM.2019.01.06
Shawna L. Morrissey, R. Dumire, T. Causer, A. Colton, E. Oberlander, D. Frye, Kosie Shepherd-Porada, L. Frye
The majority of concussion research has focused on timely diagnosis and treatment, yet little has been reported on primary prevention. The goal of this study is to examine the use of core training as a preventative tool. We performed a non-randomized prospective study involving high school athletes. They participated in a 10-week training session with exercises focused on increasing core strength [mobility, agility, stability, strength and flexibility (MASSf)]. Logs were kept of all concussions diagnosed using ImPACT concussion testing. Statistical analysis was done using Chi-square to calculate expected/observed frequency and Chi-squared test statistic, χ 2 . Test significance was accepted at a P 2 =9.84, corresponds to a P value of 0.0017. The MASSf program was repeated in the 2015 season with 2 concussions in 121 participants. Our study showed a statistically significant decrease in concussion rates after participating in MASSf training. This program shows a promise as a primary prevention method to reduce sports related concussions.
{"title":"The missing piece of the concussion discussion: primary prevention of mild traumatic brain injury in student athletes","authors":"Shawna L. Morrissey, R. Dumire, T. Causer, A. Colton, E. Oberlander, D. Frye, Kosie Shepherd-Porada, L. Frye","doi":"10.21037/JECCM.2019.01.06","DOIUrl":"https://doi.org/10.21037/JECCM.2019.01.06","url":null,"abstract":"The majority of concussion research has focused on timely diagnosis and treatment, yet little has been reported on primary prevention. The goal of this study is to examine the use of core training as a preventative tool. We performed a non-randomized prospective study involving high school athletes. They participated in a 10-week training session with exercises focused on increasing core strength [mobility, agility, stability, strength and flexibility (MASSf)]. Logs were kept of all concussions diagnosed using ImPACT concussion testing. Statistical analysis was done using Chi-square to calculate expected/observed frequency and Chi-squared test statistic, χ 2 . Test significance was accepted at a P 2 =9.84, corresponds to a P value of 0.0017. The MASSf program was repeated in the 2015 season with 2 concussions in 121 participants. Our study showed a statistically significant decrease in concussion rates after participating in MASSf training. This program shows a promise as a primary prevention method to reduce sports related concussions.","PeriodicalId":73727,"journal":{"name":"Journal of emergency and critical care medicine (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/JECCM.2019.01.06","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46920032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：