scholarly journals Endotracheal Intubation Using a Direct Laryngoscope and the Protective Performances of Respirators: A Randomized Trial

2017 ◽  
Vol 2017 ◽  
pp. 1-8
Author(s):  
Taeho Lim ◽  
Sanghyun Lee ◽  
Jaehoon Oh ◽  
Hyunggoo Kang ◽  
Chiwon Ahn ◽  
...  
Keyword(s):  
Endotracheal Intubation ◽  
Primary Outcome ◽  
Intubation Time ◽  
Emergency Physicians ◽  
Invasive Procedures ◽  
Direct Laryngoscope ◽  
Fold Type ◽  
Secondary Outcomes ◽  
Protective Performance ◽  
Randomized Crossover Study

Purpose. Emergency physicians are at risk for infection during invasive procedures, and the respirators can reduce this risk. This study aimed to determine whether endotracheal intubation using direct laryngoscopes affected protection performances of respirators. Methods. A randomized crossover study of 24 emergency physicians was performed. We performed quantitative fit tests using respirators (cup type, fold type without a valve, and fold type with a valve) before and during intubation. The primary outcome was respirators’ fit factors (FF), and secondary outcomes were acceptable protection (percentage of scores above 100 FF [FF%]). Results. 24 pieces of data were analyzed. Compared to fold-type respirator without a valve, FF and FF% values were lower when participants wore a cup-type respirator (200 FF [200-200] versus 200 FF [102.75–200], 100% [78.61–100] versus 74.16% [36.1–98.9]; all P<0.05) or fold-type respirator with a valve (200 FF [200-200] versus 142.5 FF [63.50–200], 100% [76.10–100] versus 62.50% [8.13–100]; all P<0.05). There were no significant differences in intubation time and success rate according to respirator types. Conclusions. Motion during endotracheal intubation using direct laryngoscopes influenced the protective performance of some respirators. Therefore, emergency physicians should identify and wear respirators that provide the best personalized fit for intended tasks.

scholarly journals Flexible endoscopy versus direct laryngoscopy for localising impacted pharyngeal foreign bodies in emergency department: A randomised cross-over manikin pilot study

2021 ◽  
pp. 102490792110333
Author(s):  
Chi-Kit Sin ◽  
Bun Young
Keyword(s):  
Direct Laryngoscopy ◽  
Primary Outcome ◽  
Foreign Bodies ◽  
Flexible Endoscopy ◽  
Interquartile Range ◽  
Emergency Physicians ◽  
Success Rates ◽  
Direct Laryngoscope ◽  
Secondary Outcomes ◽  
Difficulty Score

Background: Direct laryngoscopy is often poorly tolerated in patients with foreign body ingestion. The use of flexible endoscopes, which are reported to be better tolerated, was described. However, studies on endoscopy usage by emergency physicians are lacking. Objective: This study evaluates whether using a bronchoscope is as effective as the direct laryngoscopy for localising pharyngeal foreign bodies by emergency physicians. Methods: This was a randomised cross-over manikin study conducted on 32 emergency physicians. Four foreign bodies were placed at the oropharynx, vallecula, arytenoid and post-cricoid area of a manikin. Participants, being randomised into two groups, examined the pharynx with a bronchoscope and a direct laryngoscope in designated orders. The primary outcome was the complete visualisation rate defined as visualising all the four foreign bodies within the time limit. Secondary outcomes included participants-rated difficulty scores, device preferences, the time needed for complete visualisation and cumulative success rates. Results: Complete visualisation rate was significantly higher using the bronchoscope (93.8%) than the direct laryngoscope (62.5%) p = 0.02. The overall difficulty score was lower using the bronchoscope (median 4, interquartile range: 3–5) than the direct laryngoscope (median 6, interquartile range: 5–8), p < 0.001. The bronchoscope was the preferred method for overall examination (71.9%) over the direct laryngoscope (28.1%), p = 0.001. There were no significant differences in times needed for complete examination for the bronchoscope (median 73.6 s, interquartile range: 54.7–97.7 s) and the direct laryngoscope (median 82.2 s, interquartile range: 40.1–120 s), p = 0.9, and cumulative success rates, p = 0.081. Conclusion: The bronchoscope was associated with an increased complete visualisation rate and was the easier and preferred method for pharyngeal examination.

scholarly journals Comparison between video-lighted stylet (Intular Scope™) and direct laryngoscope for endotracheal intubation in patients with normal airway

2020 ◽  
Vol 48 (11) ◽  
pp. 030006052096953
Author(s):  
Ji Yeon Lee ◽  
Ho Jin Hur ◽  
Hee Yeon Park ◽  
Wol Seon Jung ◽  
Jiro Kim ◽  
...  
Keyword(s):  
Sore Throat ◽  
Endotracheal Intubation ◽  
Primary Outcome ◽  
Glottic Opening ◽  
Hemodynamic Changes ◽  
Direct Laryngoscope ◽  
Normal Airway ◽  
The Mean ◽  
Secondary Outcomes ◽  
Lighted Stylet

Objective The Intular Scope™ (Medical Park, South Korea) (IS) is a video-lighted stylet that can be used for endotracheal intubation with excellent visualization by adding a camera to its end. We compared the efficacy of a direct laryngoscope (DL) with that of the IS based on hemodynamic changes, ease of intubation, and postoperative airway morbidities. Methods Seventy patients with expected normal airways were randomized for intubation using an IS (n = 35) or DL (n = 35). The primary outcome was the mean arterial pressure during intubation. The secondary outcomes were the time to intubation (TTI), percentage of glottic opening (POGO) score, and number of intubation attempts. The incidence and severity of bleeding, hoarseness, and sore throat after intubation were also recorded. Results Hemodynamic changes during intubation were not significantly different between the groups. The TTI was longer in the IS than DL group. The POGO score was higher in the IS than DL group. Hoarseness and sore throat were significantly less severe in the IS than DL group. Conclusions Using the IS did not significantly improve hemodynamics and resulted in a longer TTI. However, the IS was associated with less severe postoperative airway morbidities compared with the DL.

scholarly journals First attempt success of video versus direct laryngoscopy for endotracheal intubation by ambulance nurses: a prospective observational study

2020 ◽  
Vol 46 (5) ◽  
pp. 1039-1045 ◽  
Author(s):  
Wim Breeman ◽  
Mark G. Van Vledder ◽  
Michael H. J. Verhofstad ◽  
Albert Visser ◽  
Esther M. M. Van Lieshout
Keyword(s):  
Success Rate ◽  
Endotracheal Intubation ◽  
Direct Laryngoscopy ◽  
Prospective Observational Study ◽  
Primary Outcome ◽  
Spontaneous Circulation ◽  
Video Laryngoscope ◽  
Video Laryngoscopy ◽  
Direct Laryngoscope ◽  
Positive Effect

Abstract Purpose The aim of this study was to compare the rate of first attempt success of endotracheal intubation performed by ambulance nurses in patients with a Glasgow Coma Scale (GCS)  of 3 using video laryngoscopy versus direct laryngoscopy. Methods A prospective cohort study was conducted in a single, independent ambulance service. Twenty of a total of 65 nurse-staffed ambulances were equipped with a video laryngoscope; a classic direct laryngoscope (Macintosh) was available on all 65 ambulances. The primary outcome was first attempt success of the intubation. Secondary outcomes were overall success, time needed for intubation, adverse events, technical or environmental issues encountered, and return of spontaneous circulation (ROSC). Ambulance nurses were asked if the intubation device had affected the outcome of the intubation. Results The first attempt success rate in the video laryngoscopy group [53 of 93 attempts (57%)] did not differ from that in the direct laryngoscopy group [61 of 126 (48%); p = 0.221]. However, the second attempt success rate was higher in the video laryngoscopy group [77/93 (83%) versus 80/126 (63%), p = 0.002]. The median time needed for the intubation (53 versus 56 s) was similar in both groups. Ambulance nurses more often expected a positive effect when performing endotracheal intubation with a video laryngoscope (n = 72, 81%) compared with a direct laryngoscope (n = 49, 52%; p < 0.001). Conclusion Although no significant effect on the first attempt success was found, video laryngoscopy did increase the overall success rate. Ambulance nurses had a more positive valuation of the video laryngoscope with respect to success chances.

scholarly journals Airway managed by emergency physicians or anaesthesiologists in trauma patients: A retrospective cohort analysis of outcomes

2020 ◽  
pp. 102490792093171
Author(s):  
Tsz Ha Tang ◽  
Marc LC Yang ◽  
On Yee Chan ◽  
Lily PS Chan ◽  
Hiu Fai Ho
Keyword(s):  
Logistic Regression ◽  
Cardiac Arrest ◽  
Endotracheal Intubation ◽  
Statistical Tests ◽  
Stepwise Logistic Regression ◽  
Trauma Patients ◽  
Emergency Physicians ◽  
All Cause Mortality ◽  
Secondary Outcomes ◽  
Post Intubation

Objectives: In some trauma centres, anaesthesiologists have the primary responsibility of managing airway in trauma resuscitation. However, as emergency physicians establish a separate specialty with airway management and endotracheal intubation being one of the core skills, role delineation within trauma members may vary. In this cohort study, we aim to determine the difference in mortality of trauma patients requiring intubation in the emergency department between emergency physicians and anaesthesiologists. Methods: We screened all 1588 patients in the hospital trauma registry from 2015 to 2018. We included all patients requiring endotracheal intubation and aged 18 or above but excluded those with pregnancy, presented with cardiac arrest and secondarily transferred from other hospitals. A total of 349 eligible patients were sorted into two cohorts according to the physicians who performed intubations (anaesthesiologists = 205 patients, emergency physicians = 144 patients). Patients’ baseline demographics, 30-day all-cause mortality and other predefined secondary outcomes were compared by statistical tests. Stepwise logistic regression of 30-day all-cause mortality was performed. Results: Our study has shown that intubation by emergency physicians was not associated with higher 30-day all-cause mortality after potential confounders were controlled by logistic regression (adjusted odds ratio = 1.253, p = 0.607). Both groups also did not differ in other clinical important secondary outcomes, including proportion of successful intubations, use of surgical airway or rescue manoeuvres, respiratory and airway complications, mortality in intensive care or high-dependency unit, post-intubation cardiac arrest, post-intubation hypotension and post-intubation hypoxia. Conclusion: Endotracheal intubation by emergency physicians is not associated with increased 30-day all-cause mortality when compared to anaesthesiologists after accounting for confounders.

scholarly journals Comparison of a New Video Intubation Stylet and McGrath® MAC Video Laryngoscope for Intubation in an Airway Manikin with Normal Airway and Cervical Spine Immobilization Scenarios by Novice Personnel: A Randomized Crossover Study

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Jin-Woo Park ◽  
Sungmin An ◽  
Seongjoo Park ◽  
Francis Sahngun Nahm ◽  
Sung-Hee Han ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Endotracheal Intubation ◽  
Odds Ratio ◽  
Video Laryngoscope ◽  
Intubation Time ◽  
Normal Airway ◽  
Intubation Stylet ◽  
Novice Users ◽  
Cervical Immobilization ◽  
Randomized Crossover Study

The use of both a video laryngoscope and a video intubation stylet, compared with the use of a direct laryngoscope, is not only easier to learn but also associated with a higher success rate in performing endotracheal intubation for novice users. However, data comparing the two video devices used by novice personnel are rarely found in literature. Nondelayed intubation is an important condition to determine the prognosis in critically ill patients; hence, exploring intubation performance in various situations is of clinical significance. This study is aimed at comparing a video stylet and a video laryngoscope for intubation in an airway manikin with normal airway and cervical spine immobilization scenarios by novice personnel. We compared the performance of intubation by novices between the Aram Video Stylet and the McGrath® MAC video laryngoscope in an airway manikin. Thirty medical doctors with minimal experience of endotracheal intubation attempted intubation on a manikin five times with each device in each setting (normal airway and cervical spine immobilization scenarios). The order of use of the devices in each scenario was randomized for each participant. In the normal airway scenario, the Aram stylet showed a significantly higher rate of successful intubation than the McGrath® (98.7% vs. 92.0%; odds ratio (95% CI): 6.4 (1.4–29.3); p = 0.006 ). The intubation time was shorter using the Aram Stylet than that using the McGrath® video laryngoscope ( p < 0.001 ). In the cervical immobilization scenario, successful endotracheal intubation was also more frequent using the Aram stylet than with the McGrath® (96.0% vs. 87.3%; odds ratio (95% CI): 3.5 (1.3–9.0); p = 0.007 ). The Aram Stylet intubation time was shorter ( p < 0.001 ). In novice personnel, endotracheal intubation appears to be more successful and faster using the Aram Video Stylet than the McGrath® MAC video laryngoscope.

scholarly journals Simulated workplace protection factors for respirators with N95 or higher filters for health care providers in an emergency medical centre: A randomized crossover study

2017 ◽  
Vol 24 (6) ◽  
pp. 282-289 ◽  
Author(s):  
Sanghyun Lee ◽  
Hongjung Kim ◽  
Taeho Lim ◽  
Jaehoon Oh ◽  
Hyunggoo Kang ◽  
...  
Keyword(s):  
Health Care ◽  
Crossover Study ◽  
Health Care Providers ◽  
Medical Procedures ◽  
Care Providers ◽  
Emergency Medical ◽  
Fold Type ◽  
Protective Performance ◽  
Randomized Crossover Study ◽  
Normal Respiration

Introduction: Health care providers in emergency medical centres often encounter infected sources during medical procedures; these sources can generate droplets. Wearing respirators could help to protect against infection risk. However, to the best of our knowledge, no previous study has reported the efficacy of N95 or higher respirators for health care providers in emergency medical centres. Methods: A randomized, crossover study of 26 health care providers was conducted to examine the protective performance of respirators. Quantitative fit tests with three types of respirators (cup type, fold type without valve and fold type with valve) were performed using seven exercises. Primary outcomes were the fit factors. Secondary outcomes included the percentage of fit factors above 100 and respirator preference. Results: After excluding one participant, data for 25 participants were analysed. The fit factors and the percentage of fit factors above 100 were higher when participants wore a fold-type respirator (200 fit factors [38.6–200], 100% [0–100]) relative to those for the cup-type respirator (114.0 fit factors [16.0–185.2], 60% [0–100]) and valve-type respirator (84.9 fit factors [14.2–170.8], 23.8 % [0–100]) in normal respiration. There was no clear preference regarding the type of respirator. Conclusion: The type of respirator could influence protective performance for health care providers. Health care providers in emergency medical centres should be aware of and wear the type of respirator that is well-fitted for them in advance.

scholarly journals Airway managed by emergency physicians or anaesthesiologists in trauma patients: A retrospective cohort analysis of outcomes

2020 ◽  
Author(s):  
Cathy Tang ◽  
Marc L.C. Yang ◽  
Annie Chan ◽  
Paul H.F. Ho
Keyword(s):  
Logistic Regression ◽  
Cardiac Arrest ◽  
Endotracheal Intubation ◽  
Statistical Tests ◽  
Stepwise Logistic Regression ◽  
Trauma Patients ◽  
Emergency Physicians ◽  
All Cause Mortality ◽  
Secondary Outcomes ◽  
Post Intubation

Abstract Objectives In some trauma centres, anaesthesiologists (AN) has the primary responsibility of managing airway in trauma resuscitation. However, as emergency physicians(EP) establishes a separate specialty with airway management and endotracheal intubation being one of the core skills, role delineation within trauma members may vary. In this cohort study, we aim to determine the difference in mortality of trauma patients requiring intubation in the Emergency Department between EP and AN. Methods We screened all 1588 patients in the hospital trauma registry from 2015 to 2018. We included all patients requiring endotracheal intubation and aged 18 or above but excluded those with pregnancy, presented with cardiac arrest and secondarily transferred from other hospitals. 349 eligible patients were sorted into two cohorts according to the physicians who performed intubations (AN 205 patients, EP 144 patients). Patients' baseline demographics, 30-day all-cause mortality, and other predefined secondary outcomes were compared by statistical tests. Stepwise logistic regression of 30-day all-cause mortality were performed. Results Our study has shown that intubation by emergency physicians was not associated with higher 30-day all-cause mortality after potential confounders were controlled by logistic regression. (adjusted OR 1.253, p = 0.607) Both group also did not differ in other clinical important secondary outcomes, including proportion of successful intubations, use of surgical airway or rescue manoeuvres, respiratory and airway complications , mortality in intensive care or high-dependency unit, post-intubation cardiac arrest , post-intubation hypotension and post-intubation hypoxia. Conclusion Endotracheal intubation by EP is not associated with increased 30-day all-cause mortality when compared to AN after accounting for confounders.

scholarly journals Pain management practices surrounding lumbar punctures in children: A survey of Canadian emergency physicians

CJEM ◽  
2018 ◽  
Vol 21 (2) ◽  
pp. 199-203 ◽  
Author(s):  
Naveen Poonai ◽  
Victoria Brzozowski ◽  
Antonia S. Stang ◽  
Amy L. Drendel ◽  
Philippe Boisclair ◽  
...  
Keyword(s):  
Pain Management ◽  
Primary Outcome ◽  
Management Practices ◽  
Young Infant ◽  
Pediatric Emergency ◽  
Emergency Physicians ◽  
Emergency Research ◽  
Canadian Association ◽  
Secondary Outcomes ◽  
Specific Barriers

AbstractObjectivesLumbar punctures (LPs) are painful for children, and analgesia is recommended by academic societies. However, less than one-third of pediatric emergency physicians (EPs) adhere to recommendations. We assessed the willingness to provide analgesia among pediatric and general EPs and explored patient and provider-specific barriers.MethodsWe surveyed physicians in the Pediatric Emergency Research Canada (PERC) or Canadian Association of Emergency Physicians (CAEP) databases from May 1 to August 1, 2016, regarding hypothetical scenarios for a 3-week-old infant, a 3-year-old child, and a 16-year-old child requiring an LP. The primary outcome was the willingness to provide analgesia. Secondary outcomes included the type of analgesia, reasons for withholding analgesia, and their perceived competence performing LPs.ResultsFor a 3-week old infant, 123/144 (85.4%) pediatric EPs and 231/262 (88.2%) general EPs reported a willingness to provide analgesia. In contrast, the willingness to provide analgesia was almost universal for a 16-year-old (144/144 [100%] of pediatric EPs and 261/262 [99.6%] of general EPs) and a 3-year-old (142/144 [98.6%] of pediatric EPs and 256/262 [97.7%] of general EPs). For an infant, the most common barrier cited by pediatric EPs was the perception that it produced additional discomfort (13/21, 61.9%). The same reason was cited by general EPs (12/31, 38.7%), along with unfamiliarity surrounding analgesic options (13/31, 41.9%).ConclusionCompared to a preschool child and adolescent, the willingness to provide analgesia for an LP in a young infant is suboptimal among pediatric and general EPs. Misconceptions and the lack of awareness of analgesic options should be targets for practice-changing strategies.

scholarly journals Endotracheal intubation of COVID-19 patients by paramedics using a box barrier: A randomized crossover manikin study

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0248383
Author(s):  
Oren Feldman ◽  
Nir Samuel ◽  
Noa Kvatinsky ◽  
Ravit Idelman ◽  
Raz Diamand ◽  
...  
Keyword(s):  
Endotracheal Intubation ◽  
Personal Protective Equipment ◽  
Primary Outcome ◽  
Protective Equipment ◽  
Intubation Time ◽  
Success Rates ◽  
Clinical Environment ◽  
Aerosol Delivery ◽  
The Mean ◽  
Study Participants

Background In the prehospital setting, endotracheal intubation (ETI) may be required to secure the coronavirus disease 2019 (COVID-19) patient airway. It has been suggested that the use of a protective barrier can reduce possible aerosol delivery from patients to clinicians during ETI. We sought to assess the performance of ETI by paramedics wearing personal protective equipment with and without the use of a box barrier. Methods A randomized, crossover simulation study was performed in a simulation laboratory. Study participants were 18 paramedics actively working in the clinical environment. Participants’ performance of ETI via direct laryngoscopy (DL) with and without the use of a box barrier was assessed. The sequence of intubation was randomized to either BoxDL-first or DL-first. The primary outcome was the success rate of ETI on first-attempt. The secondary and tertiary outcomes were ETI success rates on three attempts and total intubation time, respectively. Results There were no differences between the DL group and the BoxDL group in one-attempt success rates (14/18 vs 12/18; P = 0.754), and in overall success rates (16/18 vs 14/18; P = 0.682). The mean (standard deviation) of the total intubation times for the DL group and the BoxDL group were 27.3 (19.7) seconds and 36.8 (26.2) seconds, respectively (P < 0.015). Conclusions The findings of this pilot study suggest that paramedics wearing personal protective equipment can successfully perform ETI using a barrier box, but the intubation time may be prolonged. The applicability of these findings to the care of COVID-19 patients remain to be investigated.

scholarly journals Healthy eating and lifestyle in pregnancy (HELP): a cluster randomised trial to evaluate the effectiveness of a weight management intervention for pregnant women with obesity on weight at 12 months postpartum

2021 ◽  
Author(s):  
Sharon A. Simpson ◽  
Elinor Coulman ◽  
Dunla Gallagher ◽  
Karen Jewell ◽  
David Cohen ◽  
...  
Keyword(s):  
Weight Management ◽  
Healthy Eating ◽  
Primary Outcome ◽  
Intervention Group ◽  
Control Group ◽  
Risky Drinking ◽  
Management Intervention ◽  
Cluster Randomised ◽  
Secondary Outcomes ◽  
Weight Management Intervention

Abstract Objective To assess whether a weight management intervention for pregnant women with obesity was effective in reducing body mass index (BMI) 12 months after giving birth. Methods Pragmatic, cluster randomised controlled trial (RCT) with embedded cost-effectiveness analysis. 598 women with a BMI of ≥30 kg/m2 (between 12 and 20 weeks gestation) were recruited from 20 secondary care maternity units in England and Wales. BMI at 12 months postpartum was the primary outcome. A range of clinical and behavioural secondary outcomes were examined. Interventions Women attending maternity units randomised to intervention were invited to a weekly weight management group, which combined expertise from a commercial weight loss programme with clinical advice from midwives. Both intervention and control participants received usual care and leaflets on diet and physical activity in pregnancy. Results Mean (SD) BMI at 12 months postpartum was 36.0 kg/m2 (5.2) in the control group, and 37.5 kg/m2 (6.7) in the intervention group. After adjustment for baseline BMI, the intervention effect was −0.02 (95% CI −0.04 to 0.01). The intervention group had an improved healthy eating score (3.08, 95% CI 0.16 to 6.00, p < 0.04), improved fibre score (3.22, 1.07 to 5.37, p < 0.01) and lower levels of risky drinking at 12 months postpartum compared to the control group (OR 0.45, 0.27 to 0.74, p < 0.002). The net incremental monetary benefit was not statistically significantly different between arms, although the probability of the intervention being cost-effective was above 60%, at policy-relevant thresholds. Conclusions There was no significant difference between groups on the primary outcome of BMI at 12 months. Analyses of secondary outcomes indicated improved healthy eating and lower levels of risky drinking. Trial registration: Current Controlled Trials ISRCTN25260464.

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