Anaesthesia and Intensive Care最新文献

Simulation-based training can be valuable for teaching bronchoscopy to intensivists, providing a risk-free training environment. We developed, implemented and evaluated a simulation-based flexible bronchoscopy training program for intensive care Fellows and intensivists. This paper presents the development of its design and lessons learned. We used the Analyse, Design, Develop, Implement and Evaluate model for developing and evaluating the training program (Analysis and Design - phase 1, Development - phase 2, Implementation - phase 3, Evaluation - phase 4). In phase 1, two intensivists formulated learning objectives for bronchoscopy in an intensive care setting, which guided the identification and development of training materials and the preliminary training program (phase 2). In phase 3, we tested this program and gathered feedback from participants to guide program modifications. After implementing the adjusted training, we measured participants' satisfaction using a survey based on closed- and open-ended questions (phase 4). Fifty-seven participants attended the training, with 18 (32%) responding to the questionnaire. Respondents highly appreciated the training program, with median satisfaction scores of 4 or higher on a five-point scale for all closed-ended questions. Respondents appreciated the supervision and feedback and found the simulator equipment relevant for learning bronchoscopy. This description of the program's development and its evaluation results can serve as a valuable resource for those wishing to establish similar training programs. We recognise that further implementation of evidence-based instructional design principles might enhance the training program's scientific foundation and effectiveness. We therefore recommend a more evidence-based approach for the design of future bronchoscopy simulation training programs.

There is limited data regarding the mortality risk factors for Australian nonagenarians requiring intensive care unit admission. The objectives of the study were to determine the mortality rates, length of stay, and indicators of poor outcomes in nonagenarian patients admitted to the intensive care unit. Data were retrospectively collected from a single-centre university hospital in Australia over a 10-year period. Cox regression survival analysis, hazard ratios (HRs) and receiver operating characteristic curves were used to assess characteristics and associated survival. A total of 25,766 adult patients were admitted to the intensive care unit during the study period, of whom 89 (0.35%) were nonagenarians. The intensive care unit and hospital mortality rates of nonagenarians were 10.1% and 22.5%, respectively. The Australian and New Zealand risk of death model was the most significant predictor of mortality among the risk scoring systems. Nonagenarians who experienced a cardiac arrest had the highest hazard of death in the intensive care unit (HR 7.60, 95% confidence interval (CI) 1.49 to 38.66, P = 0.015) and throughout their hospital admission (HR 6.77, 95% CI 1.52 to 30.28, P = 0.012). Acute renal failure and invasive ventilation had a significantly increased hazard of death in the intensive care unit and hospital admission. Lactate levels also demonstrated a significant increase in the hazard of death per 1 mmol/l increase (HR 1.64, 95% CI 1.3 to 2.08, P < 0.001). Over the study follow-up period of a minimum of 3.5 years, 50 of 89 patients (56.2%) died. Intensive care unit and hospital mortality among nonagenarians admitted to the intensive care unit was relatively low. These findings support early identification of mortality risk factors, allowing for the timely implementation or withdrawal of interventions.

Smoking increases anaesthetic and surgical complications. The perioperative period provides an opportunity to give advice and initiate ongoing support to patients who smoke. Our aims were to determine perioperative smoking patterns and how well patients were supported to reduce smoking as well as compliance with the Australian and New Zealand College of Anaesthetists guidelines on smoking. We surveyed all adults having non-emergency surgery at Wollongong Hospital over an 8-week period in 2021. For those who smoked, we analysed their medical record for identification of smoking status and smoking cessation pharmacotherapy prescription. Sixteen per cent of patients (n = 111) had smoked in the 30 days before surgery. Of that group, 83% did not think that smoking might cause a problem with their surgery or anaesthetic, and 46% did not report receiving advice to stop smoking. When advice to stop smoking was given, it was associated with an attempt to quit, especially when given by a surgeon. Attendance at the preadmission clinic was associated with the provision of smoking cessation advice but not a quit attempt. Nicotine replacement therapy was used by 11% prior to surgery, and only 7% immediately post-surgery. Our findings show low rates of perioperative smoking cessation advice and nicotine replacement therapy prescription, similar to those reported by other studies over the past two decades in Australia. It provides further evidence that the Australian and New Zealand College of Anaesthetists and other society guidelines alone have not led to major improvements in our management of perioperative smoking, and that hospital-specific routine interventions are needed.

Central venous catheter (CVC) line insertion packs contain single-use plastic and metal items that are disposed of after the pack is opened, regardless of whether the item was used. This study aimed to collect data on the experiences and views of Australian clinicians who use CVC line insertion packs in paediatric critical care, elicit possible solutions to reduce waste associated with these packs, and to estimate the potential for financial and carbon footprint savings from a refined pack. This study was performed in two large paediatric tertiary referral hospitals in Sydney, Australia. Clinicians were invited to a survey and an interview to determine if and what items from a CVC line insertion pack could be excluded. Outcome measures included financial costs and embodied carbon emissions (CO_2e). Of approximately 200 eligible clinicians who were invited, 25 (12.5%) completed the survey and 18 (9%) were interviewed (five did both). All survey respondents were willing to use a new pack that had less waste. They identified five items within the existing CVC pack as commonly non-essential. Interview data identified additional strategies for waste minimisation, including use of a trolley that allowed choice of items to use. Many clinicians expressed moral distress concerning healthcare's impact on the environment. We calculated that a refined CVC pack without these five items would save the two participating hospitals approximately A$1400 and 230 kg CO_2e per year. Financial and carbon savings may be achieved through removing items that are infrequently used and/or through use of a trolley.