Bag-valve-mask Research Articles

Bispectral Index Guidance Reduced Target Plasma Propofol Concentration During ERCP in Patients with Liver Cirrhosis.

The primary aim of this study was to investigate the guidance effect of the bispectral index (BIS) on the target plasma concentration (TPC) of propofol required for deep sedation during endoscopic retrograde cholangiopancreatography (ERCP). Second, to identify propofol consumption, recovery time, and adverse events. A total of 42 consecutive patients with liver cirrhosis and 43 consecutive patients with healthy livers were enrolled. Propofol was administered via a target control infusion (TCI) syringe pump (Marsh Model) at BIS 60-70. Patients were not intubated, were placed in the prone position, and underwent spontaneous breathing. Propofol TPCs (μg mL-1) and BIS values were recorded at T0 (baseline), T1 (5 min after induction), T2 (5 min into ERCP), T3 (15 min), T4 (30 min), and T5 (recovery). TPCs and propofol consumption were lower in patients with cirrhosis than in those without cirrhosis (T4: 2.7±0.5 vs. 3.3±0.4 μg mL-1), P=0.001, and 270.4±6.9 mg vs. 390.8±13.4 mg, P=0.001), respectively. Patients with cirrhosis required more time to recover (8.5±2 vs. 6.2±0.9 min, P=0.001), despite comparable ERCP durations (31.1±11.1 vs. 34±12.5 min, P=0.28). A significant decline in TPC values among patients with cirrhosis with time (T1: 3.3±0.3, T2: 3.1±0.3, T3: 2.9±0.4, T4: 2.7±0.5 μg mL-1, P=0.001), indicating a cumulative effect. One patient with cirrhosis required bag-mask ventilation, while three patients without cirrhosis were converted to general anaesthesia. Combining the TCI Marsh pharmacokinetic model with BIS monitoring lowered the TPC levels required for deep sedation in patients with cirrhosis compared with healthy patients and allowed for individual variations. The prone position in deeply sedated and non-intubated spontaneous breathing patients is not without the risk of hypoxia.

Diabetes Mellitus Is Not a Risk Factor for Difficult Intubation Among Critically Ill Adults: A Secondary Analysis of Multicenter Trials

Objectives: Diabetes mellitus has been associated with greater difficulty of tracheal intubation in the operating room. This relationship has not been examined for tracheal intubation of critically ill adults. We examined whether diabetes mellitus was independently associated with the time from induction of anesthesia to intubation of the trachea among critically ill adults. Design: A secondary analysis of data from five randomized trials completed by the Pragmatic Critical Care Research Group (PCCRG). Setting: Emergency departments (EDs) or ICUs at 11 centers across the United States that enrolled in randomized trials of a pre-intubation checklist, fluid bolus administration, bag-mask ventilation between induction and laryngoscopy, and intubation using a bougie vs. stylet. Patients: Critically ill adults undergoing tracheal intubation with a laryngoscope in an ED or an ICU. Interventions: None. Measurements and Main Results: A total of 2654 patients were included in this analysis, of whom 638 (24.0%) had diabetes mellitus. The mean time from induction of anesthesia to intubation of the trachea was 169 seconds (sd, 137s). Complications occurred during intubation in 1007 patients (37.9%). Diabetes mellitus was not associated with the time from induction of anesthesia to intubation of the trachea (–4.4 s compared with nondiabetes; 95% CI, –17.2 to 8.3 s; p = 0.50). Use of a video vs. direct laryngoscope did not modify the association between diabetes mellitus and the time from induction to intubation (p for interaction = 0.064). Diabetes mellitus was not associated with the probability of successful intubation on the first attempt (85.6% vs. 84.3%; p = 0.46) or complications during intubation (39.8% vs. 37.4%; p = 0.52). Conclusions: Among 2654 critically ill patients undergoing tracheal intubation in an ED or an ICU, diabetes mellitus was not independently associated with the time from induction to intubation, the probability of successful intubation on the first attempt, or the rate of complications during intubation.

Comparison of Point-of-Care Ultrasound Guidance and the Traditional Approach in Performing Simulated Emergent Cricothyroidotomy Among Emergency Medicine Physicians, Residents, and Students.

Objective Emergency cricothyroidotomy (EC) is a rare procedure used to establish airway access when both endotracheal intubation and bag-mask ventilation have failed. Point-of-care ultrasound (POCUS) has been proposed as an adjunct to aid in identifying anatomical landmarks. However, its impact on emergency physicians when performing EC remains unclear. This study compared emergency physician and student confidence, preference, and procedure time between POCUS and traditional palpation for EC. Methods Our study utilized a randomized controlled crossover design. Emergency medicine providers attended a didactic lecture demonstrating traditional palpation and POCUS techniques for EC. The participants were randomly allocated to two simulation groups. One group started with the palpation of landmarks, while the other group started with POCUS landmark identification. A randomized crossover design was employed, and in a subsequent simulation, the reverse technique was utilized. Time to anatomic landmark identification was recorded. Participants completed a survey assessing their confidence and preference. Procedure times and confidence level differences were examined via Wilcoxon signed-rank tests. Results Sixteen participants completed the survey and were included in the final analysis. All participants successfully performed EC with the two landmark identification techniques. There was no significant difference in self-reported confidence between POCUS and palpation (p = 0.17). Landmark identification by palpation was significantly faster than POCUS (p = 0.001). A total of 10 (63%) participants preferred palpation over POCUS. Conclusions Both POCUS and traditional palpation were effective in identifying anatomical landmarks for EC. Although palpation was significantly quicker, confidence and preference between the two techniques were similar. The results suggest that both approaches can benefit clinical practice, depending on the context and provider familiarity. Further studies with larger cohorts and real-world scenarios are recommended to explore the effectiveness and safety of POCUS in EC.

Status of the Respiratory Therapy Profession in Ghana: A Cross-Sectional Study.

The respiratory therapy (RT) profession in Ghana is a new and emerging field. Therefore, the purpose of this study was to assess and evaluate the RT profession as a needs assessment to help policymakers and key stakeholders shape the profession in Ghana. We conducted a cross-sectional study approved by the Institutional Review Board at Loma Linda University. Participants included RTs, RT students, faculty, physicians, nurses, and midwives, who were recruited via email, WhatsApp, and snowball sampling. Data were collected through an anonymous survey consisting of demographic, professional, and attitudinal questions. We analyzed the data using descriptive statistics and inferential tests, employing IBM Corp. Released 2023. IBM SPSS Statistics for Windows, Version 29.0.2.0 Armonk, NY: IBM Corp. A total of 195 participants were involved in the study from Ghana, with 83 men (42.6%) and 112 women (57.4%), with an average age of 32.33 (SD ± 8.83) years. A majority (56.4%) held bachelor's degrees, with nurses (35.9%) and physicians (21.9%) forming the largest professional groups. The survey found that 64.2% of participants acknowledged a high demand for RTs, yet interaction with RTs was limited due to their limited availability in the region. Notably, 86.8% were familiar with nebulizers, and 80.6% with Ambu bags. The study also highlighted significant challenges in the profession, including overwhelming workloads (64.3%), lack of recognition (100%), and resource shortages. Asthma emerged as the top respiratory condition treated by RTs. The Net Promoter Score for the respiratory therapy profession, at 26.92, demonstrates a moderately positive response, suggesting an increasing need for enhanced interest among professionals in the field of respiratory therapy in Ghana. To our knowledge, this was the first needs assessment study that evaluated the field of the RT profession in Ghana. The findings indicate robust support for the necessity, development, and expansion of the RT field in the country. Future prospective studies are recommended to further evaluate the impact and effectiveness of the RT profession on patient care outcomes.

Assessment of an Airway Curriculum in a Pulmonary and Critical Care Fellowship Program.

Endotracheal intubations (EIs) in the intensive care unit are high-risk procedures often performed by pulmonary and critical care medicine (PCCM) providers. The Accreditation Council for Graduate Medical Education mandates PCCM fellows' competency in this procedure; however, the learning experiences vary across programs. After conducting a needs assessment, we developed a curriculum unique to our institution to supplement our fellows' existing EI experiences in the operating room and the intensive care unit. To assess the curriculum's short-term objectives: knowledge acquisition, maintenance, and practical skills 1 year after participation. We administered a survey to the graduating PCCM fellows for two consecutive years. We designed the comprehensive airway curriculum to include didactic lectures and simulation-based education. The knowledge acquisition and maintenance were measured by administering a 26-question knowledge survey before and after curriculum participation and after 1 year. The fellows also received a practical examination 1 year after participation. To compare knowledge survey scores, we used paired t tests and permutation tests. In the needs assessment, 56% of graduating fellows believed they were proficient in performing EI, whereas 33% were undecided and 11% believed they were unprepared. Most believed they would need more than two courses after graduation to be confident in independently performing EIs. Most will only occasionally have backup for EI from anesthesiology or emergency medicine in their future jobs. One identified barrier to learning EI was the lack of a formal curriculum. In the knowledge assessment, nine first-year fellows participated in the curriculum. The cohort's mean presurvey score was 13.0 (standard deviation [SD], 4.5) versus 18.6 (SD, 3.6) mean postsurvey score. One year after participation, the mean survey score was 17 (SD, 1.2). The postsurvey and 1-year postparticipation survey scores were significantly higher than the presurvey scores (P < 0.05). One year after participation, the practical examination showed most fellows retained skills in EI using ramped position, video and direct laryngoscopy, bag-mask ventilation, and oropharyngeal airway placement. The airway curriculum enhances fellows' knowledge acquisition and maintenance 1 year after participation. The practical examination 1 year after participation highlighted the skills retained and those still needing improvement.

Teleneonatal or routine resuscitation in extremely preterm infants: a randomized simulation trial.

Teleneonatology, the use of telemedicine for newborn resuscitation and care, can connect experienced care providers with high-risk deliveries. In a simulated resuscitation, we hypothesized that teleneonatal resuscitation, compared to usual resuscitation, would reduce the no-flow fraction. This was a single-center, randomized simulation trial in which pediatric residents were randomized to teleneonatal or routine resuscitation. The primary outcome was no-flow fraction defined as time without chest compressions divided by the time during which the heart rate was <60. Secondary outcomes included corrective modifications of bag-mask ventilation and times to intubation and epinephrine administration. Fifty-one residents completed the scenario. The no-flow fraction (median [IQR]) was significantly better in the teleneonatal group (0.06[0.05]) compared to the routine resuscitation group (0.07[0.82]); effect (95% CI): -16 (-43 to 0). Participants in the teleneonatal resuscitation group more frequently performed corrective modifications to bag-mask ventilation (60% vs 15%; p < 0.001). Time to intubation (214 s vs 230 s; p = 0.58) and epinephrine (395 s vs 444 s; p = 0.21) were comparable between groups. In this randomized simulation trial of neonatal resuscitation, teleneonatal resuscitation reduced adverse delivery outcomes compared to routine care. Further in hospital evaluation of teleneonatology may substantiate this technology's impact on delivery outcomes. NCT04258722 IMPACT: Whereas telemedicine-supported neonatal resuscitation may improve the quality of resuscitation within hospital settings, unique challenges include the need for real-time, high-fidelity audio-video communication with a low failure rate. The no-flow fraction, which evaluates the quality of chest compressions when indicated, has been associated with survival in other clinical contexts. We report a reduction in no-flow fraction in neonatal resuscitations supported with telemedicine, in addition to improvements in the quality of neonatal resuscitation. Telemedicine-supported neonatal resuscitation may improve the quality of resuscitation within hospital settings without direct access to neonatologists.

Enhanced Manual Ventilation with a Handheld Audiovisual Device - BENGI - Insights from a Pilot Study in Special Operations Medicine.

In emergency casualty and evacuation situations, manual ventilation using self-inflating bags remains a critical skill; however, significant challenges exist in ensuring safety and effectiveness, since inaccurate manual ventilation is associated with life-threatening risks (e.g., gastric insufflation with aspiration, barotrauma, and reduced venous return). This study assessed the impact of audiovisual feedback from the bag-valve-mask (BVM) emergency narration guided instrument (BENGI), a handheld manual ventilation guidance device, on improving performance and safety, immediately and 2 weeks after, with no additional manual ventilation training. In a crossover manikin simulation study with 20 participants, BENGI immediately and significantly improved tidal volume and respiratory rate accuracy. Intraand inter-participant variations were lower with BENGI, with Poincaré plot analysis showing improved performance that remained for at least 2 weeks following BENGI training. BENGI's audiovisual feedback improves manual immediately and persistently, making it invaluable for training and clinical use in diverse scenarios, from battlespace to civilian emergencies.

Comparison of self-efficacy in cardiopulmonary resuscitation position by a single rescue: over-the-head or lateral position?

Self-efficacy can speed up and improve quality of cardiopulmonary resuscitation (CPR), but it will be difficult to achieve if using a bag-valve-mask (BVM) by a single rescue. This study aimed to compare the differences of self-efficacy when performing CPR in the lateral and over-the-head (OTH) positions using a BVM device in a single rescue. A quasi-experimental with a post-test-only group design approach. This study involved 100 respondents divided into two groups, namely 50 respondents in the lateral position and 50 in the OTH position. Respondents' self-efficacy was assessed using the resuscitation self-efficacy scale (RSES). The statistical test used was Mann-Whitney. The results of this study showed that the OTH group had a higher level of self-efficacy, 46 (92%), than the lateral group, 40 (80%). In addition, the results of the Mann-Whitney statistical test also obtained p-value=0.000 (α=0.05) and mean rank value (OTH=63.30, lateral=37.70), indicating that there was a difference in self-efficacy between the OTH and lateral positions, with the OTH group having higher self-efficacy compared to the lateral group. Therefore, if CPR is performed by a single rescue with a BVM device, it can be performed with the OTH position.

Gastric Perforation from Bag-Valve-Mask Ventilation Resulting in Tension Pneumoperitoneum and Arterial Insufficiency

We report the case of a 44-year-old woman who suffered gastric perforation after receiving bag-valve-mask (BVM) ventilation in the setting of alcohol intoxication. She had a markedly distended abdomen and cold, dusky lower extremities upon arrival to the emergency department. Imaging revealed a large volume intra-abdominal accumulation of air with compression of the aorta. Needle decompression relieved symptoms of lower extremity arterial insufficiency. However, the patient quickly decompensated and subsequent exploratory laparotomy confirmed gastric rupture. A subtotal gastrectomy was performed but the patient ultimately passed on post-operative day two due to multi-organ dysfunction. Although BVM ventilation is commonplace in both the hospital and field, there is a lack of awareness of the serious complications of abdominal air accumulation due to their rareness in the adult population. Checking for abdominal distention during resuscitation ought to be routine in all patients. Signs of arterial insufficiency accompanying abdominal distention, once confirmed by diagnostic imaging that shows extensive pneumoperitoneum, are indicators of having reached a life-threatening level of air accumulation, calling for immediate needle decompression and exploratory laparotomy.

Novel High-tech, Low-cost Ventilation for Military Use, Mass Casualty Incidents, Stockpiling, and Underserved Communities.

Despite the significant need for mechanical ventilation in- and out-of-hospital, mechanical ventilators remain inaccessible in many instances because of cost or size constraints. Mechanical ventilation is especially critical in trauma scenarios, but the impractical size and weight of standard mechanical ventilators restrict first responders from carrying them in medical aid bags, leading to reliance on imprecise manual bag-mask ventilation. This is particularly important in combat-related injury, where airway compromise and respiratory failure are leading causes of preventable death, but medics are left without necessary mechanical ventilation. To address the serious gaps in mechanical ventilation accessibility, we are developing an Autonomous, Modular, and Portable Ventilation platform (AMP-Vent) suitable for austere environments, prolonged critical care, surgical applications, mass casualty incidents, and stockpiling. The core system is remarkably compact, weighing <2.3 kg, and can fit inside a shoebox (23.4 cm × 17.8 cm × 10.7 cm). Notably, this device is 65% lighter than standard transport ventilators and astoundingly 96% lighter than typical intensive care unit ventilators. Beyond its exceptional portability, AMP-Vent can be manufactured at less than one-tenth the cost of conventional ventilators. Despite its reduced size and cost, the system's functionality is uncompromised. The core system is equipped with closed-loop sensors and advanced modes of ventilation (pressure-control, volume-control, and synchronized intermittent mandatory ventilation), enabling quality care in a portable form factor. The current prototype has undergone preliminary preclinical testing and optimization through trials using a breathing simulator (ASL 5000) and in a large animal model (swine). This report aims to introduce a novel ventilation system and substantiate its promising performance through evidence gathered from preclinical studies. Lung simulator testing was performed using the ASL 5000, in accordance with table201.105 "pressure-control inflation-type testing" from ISO 80601-2-12:2020. Following simulations, AMP-Vent was tested in healthy 10-kg female domestic piglets. The Children's Hospital of Philadelphia Institutional Animal Care and Use Committee approved all animal procedures. Swine received 4-min blocks of alternating ventilation, where AMP-Vent and a conventional anesthesia ventilator (GE AISYS CS2) were used to titrate to varied end-tidal carbon dioxide (EtCO2) goals with the initial ventilator switching for each ascending target (35, 40, 45, 50, 55 mmHg). During ASL 5000 simulations, AMP-Vent exhibited consistent performance under varied conditions, maintaining a coefficient of variation of 2% or less within each test. In a large animal study, AMP-Vent maintained EtCO2 and SpO2 targets with comparable performance to a conventional anesthesia ventilator (GE AISYS CS2). Furthermore, the comparison of minute ventilation (Ve) distributions between the conventional anesthesia ventilator and AMP-Vent at several EtCO2 goals (35, 40, 45, 50, and 55 mmHg) revealed no statistically significant differences (p = 0.46 using the Kruskal-Wallis rank sum test). Preclinical results from this study highlight AMP-Vent's core functionality and consistent performance across varied scenarios. AMP-Vent sets a benchmark for portability with its remarkably compact design, positioning it to revolutionize trauma care in previously inaccessible medical scenarios.

Anesthetic Challenges in Hirayama Disease Patients Undergoing Cervical Spine Surgery—A Case Series

AbstractHirayama disease (HD) is a rare disease, resulting from cervical compressive myelopathy, manifesting as upper limb muscular atrophy, and rarely autonomic and upper motor neuron signs. Anesthesia management is challenging—careful neck positioning during bag-mask ventilation and endotracheal intubation, avoidance of drugs that release histamine, multimodal monitoring to avoid delayed recovery, anticipation of hypotension, and blood loss due to autonomic dysfunction—all this is necessary for successful outcome of general anesthesia in HD patients. This case series demonstrates that preexisting autonomic dysfunction in HD patients should alert the anesthesiologists regarding higher likelihood of hemodynamic perturbations and blood loss, compared with patients who have normal autonomic functions, and henceforth take appropriate precautionary measures.

A prospective crossover study comparing six current generation supraglottic airway device's ability to seal during CPR in human cadavers.

BackgroundSupraglottic Airway (SGA) devices are frequently used during CPR, but little is known about their ability to consistently seal the airway during CPR. Aim of StudyThe objective of this prospective crossover human cadaver study was a comparison of intrathoracic pressures generated during automated CPR (aCPR) with an ITD (Impedance Threshold Device, Zoll™) with six currently available SGAs to a standard endotracheal tube (ETT). The hypothesis was that current SGAs would vary in their ability to develop intrathoracic pressures compared to the ETT. MethodsAirway pressures (AP) and negative intrathoracic pressures (ITP) were measured in six recently deceased human cadavers of varying body habitus. After placement of an ETT and six different SGAs, we assessed airway and intrathoracic pressures during automated CPR and manual positive pressure ventilation using bag valve mask (BVM). The ETT served as the control for airway seal and was placed first followed by each SGA. Primary outcome compared airway and ITP between all groups. ResultsSGAs varied in their ability to create negative airway pressure and negative ITP. ConclusionIn this human cadaver model, the ability to generate negative ITP varied with different SGAs during aCPR with an ITD.

Improving Emergency Skills: Training Program at Medono Health Center, Pekalongan City

First aid is crucial and essential for providing emergency assistance. Early treatment of injured individuals at home can significantly reduce morbidity and mortality rates. Community health center staff, as primary service providers to the community, must be proficient in first aid since emergencies can happen anytime and anywhere. This study assessed the effectiveness of Cardiopulmonary Resuscitation (CPR) training at the Medono Community Health Center in enhancing the knowledge and skills of healthcare workers. Initially, 76.2% of participants had inadequate knowledge about CPR, but after training, 86% showed a substantial improvement in knowledge. Furthermore, the training reduced errors in using the Bag Valve Mask (BVM) and performing chest compressions. Mistakes in ventilation decreased after proper instruction, and errors in compression positioning dropped from 57.8% to nearly zero. These findings highlight the critical role of CPR training in enhancing the preparedness and competence of healthcare workers in emergencies. The Medono Health Center is dedicated to regularly conducting CPR training to ensure the continuous improvement of healthcare quality and patient safety.

IntelliVent: A Review on Enhancing Patient Care with Advanced Ventilation Systems

IntelliVent: Enhancing Patient Care with Advanced Ventilation System intends to revolutionize mechanical ventilation by creating an automated ventilator that uses an Ambu bag and has complete monitoring features. The system precisely sets and controls respiratory parameters such as tidal volume, respiratory rate, minute ventilation, peak and plateau pressures, I:E ratio, and FiO2 levels utilizing a DC motor-driven cam lever mechanism for precision Ambu bag compression. IntelliVent uses modern sensors to monitor important patient characteristics such as blood pressure, glucose levels, oxygen saturation, body temperature, and platelet count, allowing for dynamic modifications to match unique patient demands. The complex control software offers different ventilation modes and real-time feedback loops, which improves system adaptability and responsiveness. IntelliVent's user-friendly interface, which includes real-time visualization of critical parameters and vital signs, helps clinicians make informed judgments. This project seeks to provide a cost-effective, dependable, and adjustable ventilation solution that will improve patient care quality and efficiency in critical care settings. IntelliVent aims to ensure safety, efficacy, and regulatory compliance through thorough calibration, bench testing, and clinical trials, thereby setting a new standard in mechanical ventilation technology.

Detecting Intrathoracic Airway Closure during Prehospital Cardiopulmonary Resuscitation Using Quasi-Static Pressure-Volume Curves: A Pilot Study.

Background: Intrathoracic airway closure frequently occurs during cardiac arrest, possibly impairing ventilation. Previously, capnogram analysis was used to detect this pathophysiological process. In other populations, quasi-static pressure-volume curves obtained during constant low-flow inflations are routinely used to detect intrathoracic airway closure. This study reports the first use of quasi-static pressure-volume curves to detect intrathoracic airway closure during prehospital cardiopulmonary resuscitation. Methods: Connecting a pressure and flow sensor to the endotracheal tube enabled the performance of low-flow inflations during cardiopulmonary resuscitation using a manual resuscitator. Users connected the device following intubation and performed a low-flow inflation during the next rhythm analysis when chest compressions were interrupted. Determining the lower inflection point on the resulting pressure-volume curves allowed for the detection and quantification of intrathoracic airway closure. Results: The research device was used during the prehospital treatment of ten cardiac arrest patients. A lower inflection point indicating intrathoracic airway closure was detected in all patients. During cardiac arrest, the median pressure at which the lower inflection point occurred was 5.56 cmH20 (IQR 4.80, 8.23 cmH20). This value varied considerably between cases and was lower in patients who achieved return of spontaneous circulation. Conclusions: In this pilot study, quasi-static pressure-volume curves were obtained during prehospital cardiopulmonary resuscitation. Intrathoracic airway closure was detected in all patients. Further research is needed to determine whether the use of ventilation strategies to counter intrathoracic airway closure could lead to improved outcomes and if the degree of airway closure could serve as a prognostic factor.

Assessment of the Impact of Technical Incidents in Critical Situations Using High-Fidelity Simulation Techniques in Pediatric Intensive Care.

Introduction In certain fields such as anesthesia and critical care, technical incidents are rare events; however, when they occur, they disrupt workflow, optimal patient care, and survival, with human factors often implicated. In pediatric resuscitation, the impact of these incidents on patient care has not yet been thoroughly explored through simulation. Consequently, we investigated how healthcare teams integrate technical incidents in critical situations and whether this interferes with the adequate management of patients. Materials & methods In a single-blind randomized study utilizing high-fidelity simulation, we incorporated a pediatric scenario involving hypoxemia in an intubated and ventilated infant where the endotracheal tube (ETT) was obstructed. A technical incident (disconnected oxygen supply) was either present (TI+) or absent (TI-) in the scenario. We compared reaction times for "removal of the obstructed ETT" between the two groups (TI+ and TI-). Additionally, we recorded and analyzed reaction times for "bagventilation" and "repair of the technical incident" in the TI+ group. To assess the scenario's credibility, we conducted an analysis comparing the medians of evaluation forms that were anonymously completed by participants at the end of the sessions. Results In total, 10 simulation sessions were conducted, five TI+ and five TI-. The time required for removal of the obstructed ETT in the presence of a technical incident was significantly prolonged compared to controls (Mann-Whitney test, p=0.03). Furthermore, bagventilation precedes tube removal in the TI+ group, a contrast to the TI- group, which quickly removes the obstructed ETT before stabilizing the patient with bag-mask ventilation. Conclusion Technical incidents in simulated pediatric scenario adversely affect urgent care in ventilated children. Developing and validating a procedural response to these situations through further simulation is imperative.

Comparison between the Standard Teaching and the Thai Version of Blended Teaching on Basic Airway Management in Siriraj Medical Students

Objective: To compare the basic airway management skill score of Thai medical students who learned airway management utilizing blended peer-to-peer teaching with those who learned by the standard face-to-face approach. The learners’ pre- and post-learning confidence, satisfaction with the learning, and stress levels were evaluated. Materials and Methods: A randomized crossover study was conducted with third-year medical students in Thailand. Basic airway management was taught, including oropharyngeal and nasopharyngeal airway insertion, and bag-mask ventilation skills. After the learning, two blinded and independent experts rated the learners on performing the procedures. Results: In total, 32 participants took part in the study. The blended group had significantly lower skill scores for oropharyngeal airway (8.69 ±1.078 and 9.69 ± 0.479, p-value 0.004) and nasopharyngeal airway (7.87 ± 1.408 and 9.38 ± 0.500, p-value 0.001) management, respectively. The bag-mask ventilation skills scores were also lower in the blended group. The confidence level was increased in both groups. Learning with the face-to-face method was found to be slightly less stressful. Overall, the majority of the students preferred learning by the standard method. Conclusion: Unlike Western students, Thai learners can learn basic airway management skills more effectively with the face-to-face instructor-led method than with the peer-oriented blended method.

2024 RECOVER Guidelines: Updated treatment recommendations for CPR in dogs and cats.

After the 2012 Reassessment Campaign on Veterinary Resuscitation (RECOVER) CPR Guidelines, this is an update of evidence-based consensus guidelines for Basic Life Support (BLS), advanced life support (ALS), and periarrest monitoring. These RECOVER CPR Guidelines were generated using a modified version of the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system for evidence evaluation and translation of this evidence into clear and actionable clinical instructions. Prioritized clinical questions in the Population, Intervention, Comparator, and Outcome (PICO) format were used as the basis to conduct systematic literature searches by information specialists, to extract information from relevant publications, to assess this evidence for quality, and finally to translate the findings into treatment recommendations. These recommendations were reviewed by the RECOVER writing group and opened for comment by veterinary professionals for 4weeks. Transdisciplinary, international collaboration in university, specialty, and emergency practice. A total of 40 worksheets were prepared to evaluate questions across the 3 domains of BLS, ALS and Monitoring, resulting in 90 individual treatment recommendations. High-dose epinephrine is no longer recommended, and atropine, if used, is only administered once. Bag-mask ventilation is prioritized over mouth-to-nose ventilation in nonintubated animals. In addition, an algorithm for initial assessment, an updated CPR algorithm, a rhythm diagnosis tool, and an updated drug dosing table are provided. While the majority of the BLS and ALS recommendations remain unchanged, some noteworthy changes were made due to new evidence that emerged over the past 10years. Indirectness of evidence remains the largest impediment to the certainty of guidelines formulation and underscores an urgent need for more studies in the target species of dogs and cats.

2024 RECOVER Guidelines: Basic Life Support. Evidence and knowledge gap analysis with treatment recommendations for small animal CPR.

To systematically review evidence and devise treatment recommendations for basic life support (BLS) in dogs and cats and to identify critical knowledge gaps. Standardized, systematic evaluation of literature pertinent to BLS following Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. Prioritized questions were each reviewed by 2 Evidence Evaluators, and findings were reconciled by BLS Domain Chairs and Reassessment Campaign on Veterinary Resuscitation (RECOVER) Co-Chairs to arrive at treatment recommendations commensurate to quality of evidence, risk to benefit relationship, and clinical feasibility. This process was implemented using an Evidence Profile Worksheet for each question that included an introduction, consensus on science, treatment recommendations, justification for these recommendations, and important knowledge gaps. A draft of these worksheets was distributed to veterinary professionals for comment for 4weeks prior to finalization. Transdisciplinary, international collaboration in university, specialty, and emergency practice. Twenty questions regarding animal position, chest compression point and technique, ventilation strategies, as well as the duration of CPR cycles and chest compression pauses were examined, and 32 treatment recommendations were formulated. Out of these, 25 addressed chest compressions and 7 informed ventilation during CPR. The recommendations were founded predominantly on very low quality of evidence and expert opinion. These new treatment recommendations continue to emphasize the critical importance of high-quality, uninterrupted chest compressions, with a modification suggested for the chest compression technique in wide-chested dogs. When intubation is not possible, bag-mask ventilation using a tight-fitting facemask with oxygen supplementation is recommended rather than mouth-to-nose ventilation. These updated RECOVER BLS treatment recommendations emphasize continuous chest compressions, conformation-specific chest compression techniques, and ventilation for all animals. Very low quality of evidence due to absence of clinical data in dogs and cats consistently compromised the certainty of recommendations, emphasizing the need for more veterinary research in this area.

Effectiveness of Simulation Based Education on Nurses Knowledge Regarding Paediatric Basic Life Support.

Background: Pediatric basic life support (BLS) involves administering cardiopulmonary resuscitation (CPR) to children experiencing cardiac arrest without the use of equipment, relying on bag-mask ventilation or barrier devices until advanced life support (ALS) is available. Objective: The purpose of this study was to determine the effect of simulation-based education on nurses’ knowledge in Pediatric Basic Life Support (PBLS). . Method: A quasi-experimental pretest-posttest study was carried out with 50 nurses from pediatric wards of two general hospitals in Al_Najaf City, Iraq, fromSeptember16,2023,toJanuary20,2024. Study subject: A convenience sample of 50 nurses was randomly assigned to two groups of 25, to be treated as intervention or control groups. The intervention group received simulation-based educational program while the control group received no intervention. Descriptive and inferential statistics were calculated. Data collection tools: A structured self-administered questionnaire with two parts related to socio-demographic characteristics and nurses' knowledge of paediatric basic life support. The education passed through 3 phases e, pre-test, implementation and post-test phase. Results: The study's findings showed that the implementation of a simulation education program led to an improvement in the knowledge of the study group . Conclusions: The study concluded that simulation based education improved nurses' knowledge related pediatric basic life support and the study provides aline to enhance the simulation integration as active education strategies to develop nurses' knowledge in applying clinical skills. Recommendations: Further studies are recommended to evaluate the impact of simulation on nurses' education outcomes, providing more evidence that simulation would be beneficial for nurses' improvement. The researcher also suggests encouraging nurses to improve their knowledge and performances through increased participation in Basic Life Support (BLS) and Cardiopulmonary Resuscitation (CPR) courses, at least every six months.