Intubation Rate Research Articles

Clinical research progress in non-invasive positive pressure ventilation from 2023 to 2024

The present review conducted a comprehensive search and retrieval of clinical studies related to non-invasive positive pressure ventilation (NPPV) for acute respiratory failure (ARF) and chronic respiratory failure (CRF) retrieved from Medline between October 1, 2023 and September 30, 2024. In the treatment of ARF with NPPV, experiments using Digital Twins had shown that excessive tidal volumes associated self-inflicted lung injury might contribute to NPPV failure. The administration of sedation and analgesia during NPPV was found to correlate with increased mortality. In patients with acute exacerbations of chronic obstructive pulmonary disease, high-intensity NPPV significantly reduced intubation rates. However, high-flow nasal cannula oxygen therapy (HFNC) was less effective than NPPV when used as an initial treatment. In the management of CRF patients, a Franch study examined the pre-NPPV health trajectory of COPD patients receiving home NPPV based on French national health insurance reimbursement system database and suggested that the timing of initiation of home NPPV treatment significantly influenced prognosis. In addition, the research found that remote management utilizing Internet of Things technology enhanced patients' health-related quality of life and reduced the risk of hospital readmission. In terms of preventing re-intubation, different underlying conditions exhibited different responses to NPPV treatment. Specifically, prophylactic use of NPPV was found to reduce the risk of reintubation in obese surgical patients, but not in those with acute brain injury. In terms of technological advancements, Bag-CPAP, a device consisting of an oxygen storage bag and medium flow oxygen, has been validated as an alternative ventilation choice suitable for resource-limited settings.

Water or saline? Exploring mucus production and polyp detection in watter-assisted colonoscopy.

In recent years there has been a growing body of evidence on water-assisted colonoscopy (WAC). Water exchange (WE) colonoscopy, one of the WAC techniques, has demonstrated higher intubation rate, higher adenoma detection rate (ADR), and reduced patient discomfort compared to gas insufflation colonoscopy. In our clinical practice, we have observed increased mucus production in the rectosigmoid segments during withdrawal when WAC techniques are used with water infusion compared to saline infusion. This white, opaque mucus often requires further mucosal lavage and removal, which can be time-consuming and could decrease polyp detection rates. Since low ADR is correlated with the risk of interval colorectal cancer (CRC), further attempts to improve ADR are needed. Two recent studies have explored this phenomenon. In 2020 Rahyel et al. reported higher mucus production with room-temperature water compared to saline infusion during colonoscopy insertion. In 2023 Cheng et al. randomized patients to colonoscopy with CO2 insufflation or WE colonoscopy with warm water, 25% saline or 50% saline. Mucus production was highest in the water group, followed by the 25% saline, 50% saline, and CO2 groups.

Implementation of a Modified Pain, Inspiration, Cough Protocol in Patients With Traumatic RibFractures.

Patients with blunt chest wall injuries and rib fractures are known to have high rates of atelectasis, pneumonia, pulmonary contusion, and can develop acute respiratory distress syndrome. This can lead to ventilator requirement and dependence, deconditioning secondary to uncontrolled pain, and increased hospital length of stay (LOS). Many studies in the literature have developed triage algorithms in patients with rib fractures to guide disposition and management, and several institutions have gone on to describe their institution-specific management protocols to decrease complications related to traumatic rib fractures. The purpose of our study was to examine rates of in-hospital complications in patients with traumatic rib fractures before and after the implementation of a modified PIC (pain, inspiration, cough, designated as mPIC) protocol at our institution. A retrospective review of patients presenting to our hospital with traumatic rib fractures were reviewed between 2019 and 2022, with inclusion of 820 patients. Information was collected on patients' demographics, mPIC score, components of their multimodal pain regimen, whether a local nerve block was performed, LOS, intubation rates, and early mobilization. Statistical analyses were performed and all results with a value of P value of <0.05 deemed statistically significant. Our results show that implementation of our mPIC protocol was associated with dramatically reduced rates of intubation in patient with traumatic rib fractures (18.2% versus 3.0%, P<0.001), regardless of patient's age, sex, race, or number of rib fractures. Furthermore, we also observed that patients with an Injury Severity Score (ISS) greater than 25 were less likely to be intubated after protocol implementation, (65.0% versus 16.7%, P<0.001). We were able to see an associated significant decrease in overall LOS after implementation of the protocol, 5d versus 4d (P<0.001); this association was seen even when stratified by race, age, number of rib fractures, sex, and ISS. We noted that with the addition of a multimodal pain regimen, other than the use of oxycodone, there was no associated overall difference in LOS preprotocol or postprotocol implementation. We also found that the implementation of early mobilization also correlated with a decreased overall LOS (P<0.001). Patients with traumatic rib fractures have many pulmonary complications that lead to increased use of hospital resources, increased hospital LOS and increased ventilator dependence. With implementation of our standardized mPIC protocol at our institution, we observed factors such as multimodal analgesia and early mobilization contributed to an associated statistically significant decrease in hospital LOS, even when stratified by age, sex, race, number of rib fractures, and moderate ISS or higher. We were also able to see an associated decrease in intubation rates among patients with traumatic rib fractures. Implementing such a protocol can, therefore, aid in diminishing the potential morbidities associated with traumatic rib fractures.

Hospital level of service, rural-urban location, and neonatal resuscitation interventions: A population study in Alberta Canada from 2000 to 2020.

Advanced neonatal resuscitation interventions (ANRIs) are rarely performed for late preterm and term infants. However, healthcare providers in community hospitals may need to perform ANRIs, while having limited experience and resources. Understanding practice differences between hospitals of different levels of service (LoS) and rural/urban location may inform quality improvement. Our objective are to a) examine how hospital LoS and rural/urban location relate to ANRI rates in Alberta, Canada, a public health system with standardized Neonatal Resuscitation Program® training and b) describe trends in neonatal resuscitation interventions and outcomes. All live births≥34weeks in Alberta from 2000 to 2020 were examined using retrospective, administrative data. Hospitals (n=97) were categorized based on availability of delivery support, cesarian sections, pediatricians/obstetricians, and NICUs, then subcategorized by population and proximity to metropolitan centres. Rates of individual interventions or any ANRI were compared. 966,475 births were included. ANRI rates were: intubation for ventilation (0.8%), chest compression (0.2%), epinephrine (0.02%), any ANRI (0.95%). While ANRIs were lower in community hospitals and home births, with lower hospital level of service, intubation rates decreased and chest compressions rates increased. Level 1A (OR:4.52, 95% CI 3.59-5.62) and home births (OR:3.09, 95% CI 2.52-3.76) had much higher odds of chest compressions. No pattern was observed between rural/remote sites of similar LoS. In this population study, there were higher chest compressions rates and lower intubation rates at hospitals without NICUs, despite standardized training. Reasons for this difference require further investigation.

Nasal Intermittent Positive Pressure Ventilation During Neonatal Endotracheal Intubation: A Randomized Controlled Trial.

This prospective, multicenter, randomized controlled trial aimed to determine whether the use of nasal intermittent positive pressure ventilation (NIPPV) during neonatal endotracheal intubation increased the rate of successful intubation without physiological instability during all intubation attempts. In total, 150 infants were randomly assigned to either an NIPPV or standard care group (n = 75 each). The primary outcome was successful intubation without physiological instability (defined as ≥ 20% decline in the peripheral oxygen saturation [SpO2] from preintubation value or bradycardia with a heart rate < 100 beats/min) during all intubation attempts. The mean postmenstrual age of the infants was 32.5 weeks, with a median weight of 1552 g at the time of intubation. The incidence of successful intubation without physiological instability during all intubation attempts was significantly higher in the NIPPV group (64%) than that in the standard care group (42.7%) (p = 0.009). This difference was particularly significant when inexperienced practitioners were involved. In the NIPPV group, the rates of bradycardia (18.7% vs. 41.3%) and severe desaturation (30.7% vs. 49.3%) were significantly lower, whereas the lowest SpO2 (85% vs. 76%) and lowest heart rate (118 vs. 105 beats/min) were significantly higher. NIPPV during endotracheal intubation increased the incidence of successful intubation without physiological instability during intubation attempts in neonates while reducing the rate of hypoxia and bradycardia.

Mannitol for bowel preparation: Efficacy and safety results from the SATISFACTION randomised clinical trial

Bowel preparation represents a significant issue to high-quality colonoscopy. Oral mannitol requires a single dose, is of low volume, and has a pleasant taste and rapid action. This SATISFACTION study compared single-dose (same day) oral mannitol 100 g/750 mL with standard split-dose PEG-ASC2 L (MoviPrep®). The primary endpoint was the proportion of patients with adequate bowel cleansing. Secondary endpoints included efficacy (adenoma detection rate, caecal intubation rate, time of evacuation), safety (intestinal gases concentration, haemato-chemical parameters, adverse events), and patient satisfaction. The study included 703 patients (352 treated with mannitol and 351 with PEG-ASC). Mannitol was not inferior to PEG-ASC for the primary endpoint (91.1 % and 95.5 %, respectively; p-value for the non-inferiority =0.0131). There was no significant difference for secondary efficacy endpoints. The acceptability profile was significantly better in the mannitol group for ease of use, taste, and willingness to reuse (p < 0.0001 for all). The concentration of intestinal gases (H2, CH4) was similar between groups and well below those potentially critical. The SATISFACTION study indicated that low-volume, single-dose mannitol may satisfy an unmet clinical need since it was more acceptable to the patient and not inferior to the split-dose PEG-ASC for bowel cleansing efficacy.

Improving colonoscopy quality in the national VA healthcare system.

Colorectal cancer (CRC) prevention is a Veterans Affairs (VA) priority. Colonoscopy quality, especially adenoma detection rate (ADR), is critical for effective screening. Our research indicates considerable variation in ADR among VA providers. Even a slight increase in ADR can reduce fatal CRC rates, and audit and feedback strategies have improved ADR in other settings. A recent report identified deficiencies in VA colonoscopy quality, highlighting the need for standardized documentation and reporting. To address this, we developed the VA Endoscopy Quality Improvement Program (VA-EQuIP), which aims to improve colonoscopy quality through benchmarking and collaborative learning, aligning with VA's modernization priorities and HSR&D and QUERI goals of accelerating evidence-based implementation. We will conduct a stepped wedge cluster randomized trial to evaluate whether VA-EQuIP improves provider ADR compared to usual care, the implementation of VA-EQuIP, site-level factors associated with colonoscopy quality improvement, and components of provider behavior change. Using mixed methods our study will measure outcomes like reach, implementation, adoption, maintenance of VA-EQuIP, and provider behavior change. The analysis will include primary and secondary outcomes, such as overall and screening ADR, cecal intubation rate, and bowel preparation quality, using mixed effects generalized linear models and interrupted time-series analyses. Adoption and implementation will be evaluated through usage statistics, surveys, and qualitative interviews to identify factors influencing success. This study will assess the impact of VA-EQuIP on colonoscopy quality metrics and factors associated with effective implementation. VA-EQuIP infrastructure allows for national-scale implementation and evaluation of quality reporting with minimal manual labor, guiding future quality improvement efforts to ensure optimal patient care.

Nasotracheal intubation guided by an esophageal temperature probe in children

Nasotracheal intubation is commonly used to maintain airway function in children undergoing dental surgery. The present study aimed to evaluate the utility of an esophageal temperature probe (ETP) in guiding nasotracheal intubation in children. Children 3-12 years of age requiring nasotracheal intubation for dental surgery were randomly allocated to 2 groups: guidance (group G [n=21]) or conventional (group C [n=21]). After induction of general anesthesia, the nares were prepared with a topical vasoconstrictor, and the tracheal tube (TT) was thermosoftened. In group G, the ETP was first inserted into the TT and then through the nasal nostril until it passed into the oropharynx, after which the TT was advanced along the ETP. The ETP was then removed and intubation was performed using direct laryngoscopy. In group C, the TT was conventionally inserted without ETP. The success rate of nasotracheal intubation was 100% in both groups. The TT encountered fewer navigational issues in group G than in group C (38.1% vs. 71.4%; &lt;i&gt;P&lt;/i&gt;=0.030). The frequency of obvious epistaxis was also significantly lower in group G than that in group C (14.3% vs. 47.6%, &lt;i&gt;P&lt;/i&gt;=0.019). Nasotracheal intubation guided by an ETP was a simple and effective technique to facilitate smooth passage of the TT through the nasal passage and reduce epistaxis in children.

Comparison of success rates of endotracheal intubation using a neck height adjustment plate

Comparison of success rates of endotracheal intubation using a neck height adjustment plate

P-2053. Clinical Outcomes and Severity of Hospitalized COVID-19 Patients Among Partially and Fully Vaccinated Patients in Louisville, Kentucky

Abstract Background Despite COVID-19 vaccine availability, reducing disease severity and hospitalizations remains crucial. Persistent vaccine hesitancy necessitates studies comparing outcomes between partially and fully vaccinated individuals. Our study aims to evaluate clinical outcomes among hospitalized COVID-19 patients, distinguishing between partial and full vaccination. Multivariable logistic regression analysis for ICU admission among fully and partially vaccinated patients with COVID-19 CAP Methods We conducted a retrospective cohort study among hospitalized COVID-19 patients with community-acquired pneumonia (CAP) in Louisville, Kentucky. Clinical outcomes, including in-hospital mortality, cardiac events, ICU admission, and use of mechanical intubation and ventilation, were assessed. Statistical analyses included univariate and multivariable logistic regression to compare outcomes between vaccination statuses. Multivariable logistic regression analysis for Mechanical intubation and ventilation use among fully and partially vaccinated patients with COVID-19 CAP Results Of 142 eligible patients, 87% were fully vaccinated, with 13% partially vaccinated. The fully vaccinated group had less patients with a CURB-65 score &amp;gt;3 compared to the partially vaccinated group (63% vs. 53%, P=0.55). In addition, partially vaccinated patients exhibited increased rates of ARDS (6% vs 1%, P=0.61), septic shock (11% vs 3%, P=0.37), intubation (16% vs 8%, P=0.20) and mortality (21% vs 7%, P=0.09). Fully vaccinated patients exhibited lower rates of ICU admission compared to partially vaccinated patients (40% vs 15%, P=0.04). After adjusting for confounders, fully vaccinated patients had significantly lower odds of ICU admission (OR: 0.28, 95%CI: 0.15, 0.56) and intubation (OR: 0.22, 95%CI: 0.06, 0.81). However, fully vaccinated individuals had more in-hospital cardiac events (12% vs. 1%, P=0.61) and a lower odds of in-hospital mortality (OR: 0.18, 95%CI: 0.02, 1.66), but these were not statistically significant. Multivariable logistic regression analysis for in-hospital mortality among fully and partially vaccinated patients with COVID-19 CAP Conclusion This study highlights full vaccination's importance in reducing COVID-19 severity among hospitalized patients. Male gender and cancer were associated with higher mortality rates. Fully vaccinated patients had lower odds of ICU admission and intubation compared to partially vaccinated counterparts. Being fully vaccinated was not found to be associated with less cardiac events or mortality. These findings emphasize the need for comprehensive vaccination strategies and targeted public health initiatives. Disclosures All Authors: No reported disclosures

CT scan-derived pectoralis muscle parameters are closely associated with COVID-19 outcomes: A systematic review and meta-analysis.

The relationships between pectoralis muscle parameters and outcomes in patients with coronavirus disease 2019 (COVID-19) remain uncertain. We systematically searched PubMed, Embase, Web of Science and the Cochrane Library from 1 January 2019 to 1 May 2024 to identify non-overlapping studies evaluating pectoralis muscle-associated index on chest CT scan with clinical outcome in COVID-19 patients. Random-effects and fixed-effects meta-analyses were performed, and heterogeneity between studies was quantified using the I2 statistic. The risk of study bias was assessed using the Newcastle-Ottawa scale. Funnel plots for detecting small-study effects. A total of 9 studies with 4109 COVID-19 patients were included. The meta-analysis findings revealed a correlation between pectoralis muscle parameters and COVID-19 prognosis. Specifically, patients with higher pectoralis muscle density (PMD) exhibited a lower mortality risk, with an odds ratio (OR) of 0.95 (95% CI: 0.92-0.99). The rate of intubation was lower in COVID-19 patients with a high pectoralis muscle index (PMI) (OR = 0.96, 95% CI: 0.92-1.00). In summary, a low PMD is associated with a marginally elevated risk of mortality, whereas a decreased PMI represents a risk factor for intubation in COVID-19 patients. These findings suggest that pectoralis muscle parameters on chest CT may be a useful prognostic tool for COVID-19 patients.

Real-world effectiveness and safety of 1L polyethylene glycol and ascorbic acid for bowel preparation in patients aged 80 years or over

Background and study aim: Clinical trials and real-world studies show a 1L polyethene glycol and ascorbic acid solution (1L PEG-ASC) to be an effective and safe bowel preparation for colonoscopy in the general population. Here, the effectiveness and safety of 1L PEG-ASC were evaluated in patients aged 80 years or over in a real-world setting. Patients and methods: A post-hoc analysis of an observational, multicentre, retrospective study assessed the effectiveness and safety of 1L PEG-ASC on out-patients aged ≥80 years old undergoing a colonoscopy at 8 centres in Spain and Portugal. Cleansing quality was assessed using the Boston Bowel Preparation Scale, with overall scores ≥6 and all segmental scores ≥2 considered adequate colon cleansing, and overall scores ≥8 or 3 in the right colon considered high-quality cleansing. The caecal intubation rate, withdrawal time, polyp and adenoma detection rates, and adverse events (AEs) were also monitored. Results: Data were analysed from 423 patients aged ≥80 years; mean age 83.5 (±3.2) years and 49.2% males. The adequate colon cleansing success rate was 88.9%, with high-quality cleansing of the overall and right colon achieved in 54.1% and 46.1% of the patients, respectively. Colonoscopy was complete in 94.1% of cases, and the adenoma detection rate was 51.3%. At least one AE was experienced by 4.5% of participants, the most frequent being mild dehydration (2.8%) and nausea (1.2%). Conclusions: This post-hoc analysis confirms 1L PEG-ASC to be an effective and safe bowel cleansing preparation for patients aged 80 years or over in a real-world setting.

Surgical stabilisation of rib fractures in non-ventilated patients: a retrospective propensity-matched analysis using the data from the trauma registry of the German Trauma Society (TraumaRegister DGUⓇ)

PurposeSevere thorax trauma including multiple rib fractures and flail chest deformity are leading causes of death in trauma patients. Increasing evidence supports the use of surgical stabilisation of rib fractures (SSRF) in these patients. However, there is currently a paucity of evidence for its use in non-ventilator-dependent patients.MethodsA retrospective propensity-matched analysis of the data of the TraumaRegister DGU® for non-ventilator-dependent patients with severe rib injury (abbreviated injury score ≥ 3) was performed. Subgroup analyses with respect to injury severity score, American society of anaesthesiologists physical status classification and age were performed. Furthermore, the effect of time to surgery was analysed.RegistrationTR-DGU project ID 2023-007; ClinicalTrials.gov protocol ID: NCT06464289.ResultsSSRF led to reduced mortality compared to conservative treatment (1.6% vs. 4.8%; p = 0.002) and in comparison to the mortality prognosis of the revised injury severity classification II (RISC II) of 5.2%. Interestingly, SSRF was associated with increased length of hospital and intensive care unit stay, higher rates of organ failure and secondary intubation. The patients with organ failure received SSRF later than those without organ failure.ConclusionHere we report on the largest currently published dataset of non-intubated patients receiving SSRF, which showed reduced mortality in the SSRF cohort. The data indicates that SSRF is a viable treatment option for non-intubated patients. The observed late surgical time points, which may be due to cross over after failed conservative treatment, might be the cause for the observed increased rate of organ failure.

Comparison of search and rescue operations involving emergency physicians in devastating earthquakes in Turkey: a 24-year experience study

BackgroundIn the 21st century, disasters (particularly earthquakes, which remain the leading cause of death) continue to be among the foremost issues requiring global emergency response. While the impact of advancing technologies on the environmental and human damage caused by earthquakes is still a subject of debate, search and rescue (SAR) teams and emergency departments (ED), specifically emergency physicians (EPs), play a crucial role in the most acute management of the effects of these earthquakes on human life. This study aims to examine the injury dynamics of two catastrophic earthquakes that occurred in Turkey 24 years apart from the perspective of EPs, utilizing archival records from the SAR teams in which EPs served.MethodThis study is a cross-sectional investigation analyzing the injury and SAR dynamics of casualties, based on the archives of SAR teams that included 12 EPs, during the 1999 Marmara and 2023 Kahramanmaraş (Maraş) earthquakes (groups).ResultsIn this study, a total of 160 injured individuals who were rescued alive from the rubble were included, with 26.3% (n = 42) from the Maraş group and 73.8% (n = 118) from the Marmara group. Identification of the injured was achieved in 54.8% (n = 23) of the Maraş group and 88.1% (n = 104) of the Marmara group, with an overall identification rate of 79.4% (n = 127) (p < 0.001). The most common injuries among the injured were lower extremity injuries (53.1%, n = 85) and upper extremity injuries (49.4%, n = 79), with the most frequent scenario being the extraction of two individuals from the same location (33.8%, n=54). The most common interventions provided to the injured were intravenous fluid therapy (63.8%, n =102) and oxygen support (57.5%, n =92). The rate of intubation at the scene was 16.1% (n = 19) in the Marmara group and 4.8% (n = 2) in the Maraş group (p < 0.05). Additionally, cardiopulmonary resuscitation (CPR) was administered at the scene in 13.6% (n = 16) of the Marmara group, compared to 2.4% (n = 1) in the Maraş group (p < 0.05). When examining the challenges encountered during SAR operations, the most frequent issue in the Maraş group was identification, affecting 57.1% of the cases (p < 0.001), whereas the most common issue in the Marmara group was entrapment, occurring in 50.0% of cases (p < 0.001). Lighting difficulties were observed at similar rates in both earthquakes (19.0% in Maraş, 19.5% in Marmara; p = 1.000). Additionally, weather conditions posed a challenge in 11.9% of cases in the Maraş group, whereas this issue was not encountered in the Marmara group (p < 0.001).ConclusionThe 24 years of experience and expertise gained by EPs who served in Türkiye in these operations constitute a valuable global resource. Disseminating this knowledge is crucial not only for managing earthquakes but also for preparing for other catastrophic events that could cause widespread destruction. Harnessing this accumulated experience can significantly enhance knowledge-sharing and the development of more effective preparedness strategies.

The relationships of plasma profenofos and ethanol concentrations to clinical outcome in acute profenofos self-poisoning

Introduction Many patients acutely self-poisoned with organophosphorus insecticides have co-ingested ethanol. Currently, profenofos 50% emulsifiable concentrate (EC50) is commonly ingested for self-harm in Sri Lanka. Clinical experience suggests that ethanol co-ingestion makes management more difficult. Therefore, we aimed to determine the relationships between plasma ethanol concentration, plasma profenofos concentration and its toxicokinetics, and clinical outcome in acute profenofos self-poisoning. Methods Demographic and clinical data, including a history of ethanol ingestion and blood samples, were prospectively collected from all cases of acute poisoning with profenofos EC50 presenting to Teaching Hospital Peradeniya, Sri Lanka, over four years. Plasma samples were analyzed by gas chromatography–mass spectrometry to quantify the ethanol (n = 99) and profenofos (n = 30 [15 with ethanol, 15 without ethanol]) concentrations. The PKSolver program was used to calculate the toxicokinetic parameters. Results Of 99 patients (male 78/99) with acute profenofos self-poisoning, 50 reported a history of ethanol co-ingestion. Plasma from 44 of 99 profenofos-poisoned patients had detectable ethanol concentrations. No statistical difference was observed between the mortality in the ethanol group and the no ethanol group (5/44 [11.4%] versus 3/55 [5.5%]; P = 0.461). Similarly, the median half-lives of plasma profenofos absorption in the ethanol and no ethanol groups (0.1 h and 0.1 h, respectively; time 0–24 h) were not statistically different (P = 0.6594). However, the median half-life of plasma profenofos elimination was significantly longer in the ethanol group than the no ethanol group (23.1 h and 9.9 h, respectively; time 0–24 h; P = 0.0002). According to the regression analysis, the half-life of plasma profenofos elimination was longer by 29.4 h in the ethanol group (P = 0.013). Discussion No significant differences in outcomes, including death and endotracheal intubation rates, were found between those who did and did not co-ingest ethanol. No differences were found in toxicokinetic variables between the ethanol and no ethanol groups, but the ethanol group had a longer elimination half-life. Conclusion The co-ingestion of ethanol leads to a slowing of the elimination kinetics of profenofos. However, the study did not reveal a significant impact of ethanol co-ingestion on clinical outcomes.

Pleural and Primary Mediastinal Complications and Treatment of COVID-19 Patients

The persistent disease 2019 (COVID-19) presents prodigious challenges for research and medical practice, mainly due to its specific epidemiological and clinical characteristics. Patients with COVID-19 pneumonia may have conditions ranging from asymptomatic to death due to respiratory failure. COVID-19 pneumonia may be associated with pleural complications such as pneumothorax (PT), pneumomediastinum (PM), pleural effusion, and empyema. This study investigates primary Pleural and Mediastinal Complications (PPMCs) and their treatment in patients with COVID-19. In this cross-sectional study, 10,000 patients with COVID-19 were investigated for the incidence of mediastinal and pleural effusions between the beginning of the second half of 2019 and the end of the first half of 2020. The average age of patients with PPMCs was 54.29 ± 14.69 years. 62% (124 patients) were male and 38% (76 patients) were female. Among 10,000 patients with COVID-19, 600 patients (6%) had pleural effusion, of which 456 (4.56%) had mild pleural effusion, and 144 (1.44%) had moderate to severe pleural effusion. The frequency of PPMCs in COVID-19 patients was as follows: 0.53% (53 cases) PT, 0.09% (9 cases) hemothorax, 0.06% (6 cases) empyema, 0.96% (96 cases) PM, 0.12% (12 cases) pericardial effusion, 0.17% (17 cases) atelectasis, and 0.04% (4 cases) emphysema. The most frequent pleural complication was pleural effusion, with a frequency of 6%, and the second most common complication was PM, with a prevalence of 0.96%. Being elderly was strongly associated with the rate of intubation and mortality in the hospital (P&lt;0.05). No significant relationship existed between patients’ age and PPMCs (p&gt;0.05). There was no significant difference in PPMCs between men and women (p&gt;0.05). The results of our study show that PPMCs in patients with COVID-19 have a low prevalence, and if they do occur, the most frequent are related to pleural effusion and PM.

Comparison of video laryngoscopy and direct laryngoscopy for urgent intubation in newborn infants: A meta-analysis.

Securing a stable airway is a critical component in neonatal resuscitation. Compared to direct laryngoscopy, video laryngoscopy provides improved visualization of the glottis, potentially enhancing the success rate of intubation. This systematic review and meta-analysis were conducted to assess and compare the efficacy and safety of video laryngoscopy versus direct laryngoscopy in neonatal intubation. A thorough search was performed across CENTRAL, Embase, and PubMed databases to identify relevant randomized controlled trials (RCTs) that evaluated the use of video laryngoscopy in comparison with direct laryngoscopy for neonatal intubation. The data extraction and analysis were conducted in alignment with Cochrane guidelines. The primary outcome of interest was the time required for intubation, while secondary outcomes included the number of intubation attempts and the success rate on the first attempt. The meta-analysis included nine RCTs, encompassing a total of 719 neonates. The findings revealed that video laryngoscopy was associated with a longer intubation time (mean difference [MD] 3.23s, 95% confidence interval [CI] 2.42 to 4.04; I2=96%). However, it also significantly improved the first-attempt success rate (risk ratio [RR] 1.31, 95% CI 1.20 to 1.44; I2=76%) and borderline reduced the total number of intubation attempts (MD -0.08, 95% CI -0.15 to 0.00; I2=53%). While video laryngoscopy is associated with a modest increase in intubation time, it provides clear benefits by enhancing the success rate of first-attempt intubations and reducing the need for multiple attempts in neonatal intubation procedures.

Impact of COVID-19 on resuscitation after hospital arrival for patients with out-of-hospital cardiac arrest: An interrupted time series analysis.

In this study, we aimed to determine the effects of the coronavirus disease 2019 (COVID-19) pandemic on in-hospital cardiopulmonary resuscitation (CPR) in patients with out-of-hospital cardiac arrest (OHCA). Using the Japanese Diagnosis Procedure Combination inpatient database, we included patients with OHCA who were transported to hospitals between April 2018 and March 2021. Patients were categorized into groups, before and during the COVID-19 pandemic, according to the day of admission (before or after April 1, 2020, respectively). The primary outcome was in-hospital CPR duration after hospital arrival, and secondary outcomes included in-hospital death, intubation, and other resuscitation-related treatments. We examined the impact of the pandemic using interrupted time series (ITS) analyses. Among 144,867 patients with OHCA, 82,425 died in the outpatient department (53,286 before the pandemic and 29,139 during the pandemic) during the study period. The ITS analyses for patients who died in the outpatient department showed no significant level change in CPR duration after hospital arrival (0.41 min increase; 95% confidence interval [CI]: -0.54 to 1.4; p = 0.39), but the intubation rate was significantly lower (-5.9%; 95% CI: -8.4 to 3.4; p < 0.001). In-hospital death among all patients with OHCA showed a significant increase in trend (0.41% per month; 95% CI: 0.081-0.74; p = 0.016). The COVID-19 pandemic had little impact on CPR duration after hospital arrival; however, there was a marked decrease in intubation for patients with OHCA after hospital arrival.

British Society of Gastroenterology National Evaluation of Colonoscopy Quality: Findings from the National Endoscopy Database.

Analysis of national colonoscopy quality using automatically uploaded data from a national database, including exploring performance variation. Data on all colonoscopies performed in the UK 01/03/2019-29/02/2020 and recorded in the National Endoscopy Database were analysed. Unadjusted key performance indicators were calculated and proportions of endoscopists achieving national standards were determined. Regression models tested associations between case-mix (patient age, sex, indication) and colonoscopy quality. Endoscopist factors (specialty, annual procedure numbers, withdrawal times) were added to case-mix adjusted models, with results presented as adjusted odds ratios (aOR) with 95% confidence intervals. 592,764 colonoscopies were analysed. Rates of caecal intubation (93.5%, 95% CI 93.4-93.6), polyp detection (37.3%, 95% CI 37.2-37.4), and moderate/severe patient discomfort (4.8%, 95% CI 4.7-4.8) had all improved since the 2011 national audit (p<0.01 for all). 63.9% of endoscopists met all minimum standards for caecal intubation, polyp detection, and discomfort, but only 46.4% did so among those performing fewer than 100 colonoscopies annually. Overall, surgeons recorded lower caecal intubation and polyp detection rates than gastroenterologists (p<0.01); however, those performing over 100 annual colonoscopies achieved KPIs similar to gastroenterologists. Endoscopists with longer withdrawal times were almost twice as likely to identify polyps (aOR 1.9, 95% CI 1.7-2.2) and detected more large polyps (aOR 1.6, 95% CI 1.3-2.0). UK colonoscopy quality has improved, yet almost 40% of endoscopists still fell short of minimum standards. Variation in quality was strongly associated with endoscopist procedure volumes; mandating minimum annual procedures and emphasising longer withdrawal times could improve overall quality.

Video Laryngoscopy for Endotracheal Intubation: A Consideration for Manual In-Line Stabilization Without Cervical Collar Versus Full Immobilization.

Traumatic patients with cervical spine motion restriction have difficulty with endotracheal intubation (ETI) due to the limitations of neck movement and mouth opening. Nevertheless, the removal of the cervical collar for ETI in a prehospital setting may lead to a deterioration in neurological outcomes. This study compares the success rate of ETI utilizing a video laryngoscope (VL) on a manikin, contrasting manual in-line stabilization (MILS) without a cervical hard collar against full immobilization. A randomized, non-crossover study was conducted involving 56 paramedic students assigned by SNOSE to utilize various box sizes for VL intubation with MILS without a cervical hard collar or full immobilization technique on a manikin. The primary outcome was the intubation success rate. Secondary outcomes included attempts, time for successful intubation, and Cormack-Lehane classification. Fifty-six participants were evaluated; 28 were in the full immobilization group, and another 28 were in the MILS without cervical hard collar group. Baseline characteristics showed no difference between both groups. The success rate of VL intubation showed no difference between the full immobilization group and the MILS without a cervical hard collar group (28 [100%] vs 28 [100%]; 24 [85.71%] vs 27 [96.43%] on first attempt; 4 [14.29%] vs 1 [3.57%] on second attempt; p-value 0.352). Time required to perform successful intubation (median [IQR] 17.20 [12.53, 24.40] vs 17.53 [14.06, 23.73], p-value 0.694) and Cormack-Lehane classification (11 [39.29%] vs 10 [35.71%] in grade I; 16 [57.14%] vs 17 [60.71%] in grade II; 1 [3.57%] vs 1 [3.57%] in grade III, p-value 1.000) showed no statistical difference between the two groups. It is unnecessary to remove the cervical hard collar when performing endotracheal intubation while using a video laryngoscope.