Success Of Attempts Research Articles

691: VISUALIZING PEDIATRIC CRITICAL CARE FELLOW TRACHEAL INTUBATION LEARNING CURVES

Introduction: Tracheal intubation (TI) is a life-saving procedure for pediatric intensivists. Developing proficiency in TI is one of the goals in the PCCM fellowship. We aim to develop a dashboard for PCCM fellows to visualize their own learning curves and proactively identify educational needs. We hypothesize majority of the fellows will achieve TI competence during first 12 months of training. Methods: Using the local airway management quality improvement database (a part of National Emergency Airway Registry for Children: NEAR4KIDS), we built a data field for each fellow’s training ID. Using REDCap and R, we developed a cumulative sum (CUSUM) learning curve visualization to achievement of competence level. We piloted the data visualization in a cohort of first year PCCM fellows starting in one of academic year 2019-2021 for their TIs in the PICU for first 12 months. Two levels of TI competence thresholds were a priori defined: 80% success for the first attempt, and 80% success for the course (course is defined as one approach to secure an airway) with both alpha and beta at 0.1. Results: Seventy-one TI courses were performed by six first year fellows (mean 22 TIs, range 14-30 per fellow) with 87 intubation attempts. First attempt success rate was mean 73% (range 57-85%), course success rate was 85% (range 79-93%). CUSUM curves were successfully plotted from the database. Three of six fellows (50%) achieved the competence threshold for the first attempt (80% first attempt success) after 12, 15, and 18 TIs. Five fellows (83%) achieved the competence threshold for the TI course (80% overall success) after 8, 8, 12, 12, 12 TIs. One fellow who did not achieve competence had the lowest number of intubations (n=14). When an alternative competence threshold at 70% for first attempt success is used, five fellows achieved the first attempt competence after 4,4,4,4,7 TIs. Conclusions: The number of tracheal intubations needed to achieve procedural competence amongst first year pediatric critical care fellows is likely variable. Only half of the first year PCCM fellows met the criteria for competence level (80% first attempt success). While repeated procedural attempts may lead to competency for some fellows, individualized educational strategies may be necessary for others.

840: TO BOUGIE OR NOT TO BOUGIE: META-ANALYSIS COMPARING FIRST-ATTEMPT INTUBATION WITH BOUGIE AND STYLET

Introduction: Endotracheal intubation is a life-saving procedure with several indications. Successful placement of the endotracheal tube on the first attempt greatly reduces the risk of complications. The endotracheal introducer (commonly known as the bougie) and the stylet are two different devices used to facilitate orotracheal intubations in various settings. The aim of this systematic review and meta-analysis is to compare the likelihood of successful first attempt intubation using either of the two devices. Methods: A search was performed on PubMed, Cochrane, and Web of Science. We used the following mesh terms, “(endotracheal intubation) OR (orotracheal intubation) AND (bougie) OR (gum elastic bougie) OR (endotracheal introducer) OR (stylet)” from the 01/01/2000 to 07/15/2022. We screened 3100 articles out of which 4 randomized controlled trials comparing the use of bougie and stylet were included in this systematic review. Studies performed on cadavers/mannequins, population age less than 18, and out-of-hospital intubations were excluded from this review. Results: This systematic review and meta-analysis consisted of 4 randomized controlled trials with a total population of 1962. The mean age for the bougie group was 52.7 years and the stylet group was 52.8 years. The average body mass index for the bougie and stylet groups was 26.8 Kg/m2 and 27.1 Kg/m2, respectively. When a random effects model was applied, the metanalysis did not show any significant differences in the first attempt success rate with a risk ratio of 0.957; 95% confidence interval, 0.833 to 1.100. Reported complications included hypoxemia, esophageal intubation, pneumothorax, and cardiovascular collapse with no significant differences in the two groups. Conclusions: The bougie and stylet had comparable rates of first attempt intubation with neither being superior to the other. The healthcare provider should take into consideration their ease and comfort of intubation with each technique before opting for one during intubation.

Near Infrared Light Source Versus Naked Eye Visualization for Establishing Intravenous Access in Neonates: A Randomized Control Trial

Objective: To compare efficacy of near infrared light (NIR) versus naked eye (NE) visualization for intravenous access in the neonates. Methods: This was a randomized controlled trial carried out in a tertiary care center in New Delhi, India from 2015 to 2017. A total of 480 admitted neonates, who required placement of intravenous catheter were randomized to receive intravenous access attempt with NE group or using NIR source group. Primary outcome was first attempt success rate of establishing intravenous access. Secondary outcomes were to compare the time to establish intravenous access, number of pricks taken, and cost of consumables used.Results: Of 240 neonates in each group the mean birth weight of neonates in NE group and NIR group being 1665 ± 820 grams and 1600 ± 778 grams, respectively (p-value = 0.363). Mean gestational age of neonates were 31.78 ± 3.9 weeks in NE group and 31.79 ± 3.9 weeks in NIR group (p-value= 0.972). First-attempt success rate in NE group and NIR group was 122 (50.8%) and 124 (51.7%) respectively. The median(IQR) of time taken to establish intravenous access was 37.5 (13- 134.7) sec and 43 (17-221.2) sec in the NE group and NIR group, respectively (p-value = 0.307). There was no significant difference between the groups for secondary outcomes. Conclusion: Use of NIR source as compared to NE visualization, for establishment of intravenous access in neonates, does not improve first attempt success rate. Keywords: Near Infrared Light, Neonate, Vein Viewer. Clinical Trial Registry #: CTRI/2017/01/007693

2022 Association for Vascular Access Scientific Meeting: Poster Abstracts

2022 Association for Vascular Access Scientific Meeting: Poster Abstracts

Use of an ultrasound-guided intravenous catheter insertion simulation-based mastery learning curriculum to improve paediatric anaesthesia care.

We previously showed that an ultrasound-guided i.v. catheter insertion (USGIV) simulation-based mastery learning (SBML) curriculum improves the simulated USGIV skills of paediatric anaesthesiologists. It remains unclear if improvements in simulated USGIV skills translate to improved patient care. A cohort study was conducted from August 2018 to August 2020 to evaluate paediatric anaesthesiologists' USGIV performance in the operating theatre before and after they participated in the USGIV SBML curriculum. Paediatric anaesthesiologists' use of ultrasound for successful i.v. insertion and first-attempt i.v. insertion success rate with ultrasound were compared before and after training. Twenty-nine paediatric anaesthesiologists completed training. Unadjusted analysis showed a significant increase in the percentage of i.v. catheters inserted with ultrasound for successful i.v. catheter insertion (9.5-14.5%; P<0.001) and first i.v. catheter insertion attempt success with ultrasound (5.5-8.9%; P<0.001) from before to after training. Multivariable regression analysis showed higher odds of ultrasound use for a successful i.v. catheter attempt (1.79; 95% confidence interval [CI]: 1.11-2.90; P=0.018) and first-attempt success with ultrasound (4.11; 95% CI: 2.02-8.37; P<0.001) after training. After completing the USGIV SBML curriculum, paediatric anaesthesiologists increased their ultrasound use for successful i.v. catheter insertion and first-attempt success rate with ultrasound for patients in the operating theatre.

Endotracheal intubation performance at a large obstetric hospital delivery room, Hanoi, Vietnam

IntroductionIntrapartum-related events account for nearly 700,000 neonatal deaths globally yearly. Endotracheal intubation is a cornerstone in preventing many of these deaths, but it is a difficult skill to acquire. Previous studies have described intubation performances in high-income countries, but data from low- and middle-income countries are lacking. We aimed to assess the performance of delivery room intubation in a lower middle-income country. MethodsThis prospective observational study was conducted at the Phu San Hanoi Hospital, Vietnam, from September 2020 to January 2021. Video cameras were positioned above the resuscitation tables and data were extracted using adopted software (NeoTapAS). All neonates requiring positive pressure ventilation were included. Our main variables of interest were time to first intubation attempt, first intubation attempt duration, and successful first intubation attempt. Results18,107 neonates were born during the five months. Of these, 75 (0.4%) received positive pressure ventilation, and 36 (0.2%) required endotracheal intubation of whom 24 were captured on video. The median time to the first intubation attempt was 252 seconds (range 91–771 seconds), the median first attempt duration was 49 seconds (range 10–105 seconds), and the first attempt success rate was 75%. ConclusionIncidences of positive pressure ventilation and endotracheal intubation were low in comparison to global estimates. Three out of four intubations were successful at the first attempt and the procedural duration was often longer than recommended. Future studies should focus on how to achieve and maintain intubation skills and could include considering alternative devices for airway management at birth.

Does the antimicrobial-impregnated peripherally inserted central catheter decrease the CLABSI rate in neonates? Results from a retrospective cohort study.

The use of antimicrobial-impregnated peripherally inserted central catheters (PICCs) has been introduced in the last few years to neonatal units aiming to reduce central line-associated bloodstream infection (CLABSI). This retrospective observational study aimed to compare the CLABSI rates and other catheter-related parameters including the insertion success rates and catheter-related complications in the antimicrobial-impregnated and conventional (ordinary) PICCs in NICU between 2017 and 2020. Our dedicated PICC team including physicians and nurses inserted 1,242 conventional (PremiCath and NutriLine) and 791 antimicrobial-impregnated PICCs (PremiStar) over the study period from 2017 to 2020. Of those 1,242 conventional PICCs, 1,171 (94.3%) were 1 Fr single lumen and only 71 (5.7%) were 2 Fr double lumen. The mean ± SD [median (IQR)] for the birth weight in all babies who had a PICC line was 1,343.3 ± 686.75 [1,200 (900, 1,500)] g, while the mean ± SD for the gestational age was 29.6 ± 4.03 [29 (27, 31)] weeks. The mean ± SD [median (IQR)] age at the time of insertion for all catheters was 9.3 ± 21.47 [2 (1, 9)] days, while the mean ± SD [median (IQR)] dwell time was 15.7 ± 14.03 [12 (8, 17)] days. The overall success rate of the PICC insertion is 1,815/2,033 (89.3%), while the first attempt success rate is 1,290/2,033 (63.5%). The mean ± SD [median (IQR)] gestational age, birth weight, age at catheter insertion, and catheter dwell time were 28.8 ± 3.24 [29, (26, 31)] weeks, 1,192.1 ± 410.3 [1,150, (900, 1,450)] g, 6.3 ± 10.85 [2, (1, 8)] days, and 17.73 ± 17.532 [13, (9, 18)] days in the antimicrobial-impregnated catheter compared with 30.1 ± 4.39 [29, (27, 32)] weeks (P < 0.001), 1,439.5 ± 800.8 [1,240, (920, 1,520)] g (P < 0.001), 11.1 ± 25.9 [1, (1, 9)] days (P < 0.001), and 14.30 ± 10.964 [12, (8, 17)] days (P < 0.001), respectively, in the conventional PICCs. The use of the antimicrobial-impregnated catheter was not associated with any significant reduction in the CLABSI rate (per 1,000 days dwell time), either the overall [P = 0.11, risk ratio (RR) (95% CI): 0.60 (0.32, 1.13)] or the yearly CLABSI rates. The use of miconazole and rifampicin-impregnated PICCs did not reduce the CLABSI rate in neonates compared with conventional PICCs. However, it has a higher overall rate of elective removal after completion of therapy and less extravasation/infiltration, occlusion, and phlebitis compared with the conventional PICCs. Further large RCTs are recommended to enrich the current paucity of evidence and to reduce the risk of bias. Neonatal PICCs impregnation by other antimicrobials is a recommendation for vascular access device manufacturers.

A study of BlockBuster laryngeal mask airway versus Fastrach/Intubating laryngeal mask airway as a conduit for blind oro-tracheal intubation: A prospective randomized controlled study

A Laryngeal Mask Airway (LMA) has two parts, a simple breathing tube and a mask. The mask at the laryngeal end of the tube aligns against the glottis and provides better channel of ventilation than the face mask. There have been modifications in the basic design of the LMA to incorporate gastric drainage channel and some devices are also equipped with a channel for intubation to secure airway by guiding endotracheal tube (ETT) through it. In this study we evaluated the performance of two LMA devices that can aid in rescue ventilation and are also equipped with a channel for intubation namely the BlockBuster LMA(2012) and the Fastrach/ Intubating LMA(1997) for blind oro-tracheal intubation in terms of First attempt success rate and Over-all success rate of intubation. A hundred consenting patients of age group 18-60 years and ASA status I or II, were randomly allocated into two groups Group BB (BlockBuster LMA) and Group FT (Fastrach LMA) with 50 patients each. Standard anesthesia technique was used for both groups. After insertion of airway device, cuff was inflated and ventilation was attempted (maximum 2 attempts). Once ventilation was achieved, ETT of appropriate size was inserted through LMA (maximum 2 attempts). The correct placement of ETT was confirmed by capnography. Data was collected for number of attempts of tracheal intubation, time taken for intubation and complications. First attempt success rate of intubation was more in Blockbuster LMA than Fastrach LMA. Over-all success rate of Intubation was 100% for both devices. Time taken for intubation and incidence of post-operative sore throat was less in BlockBuster LMA than Fastrach LMA(p-value&amp;#60;0.05). Blockbuster LMA is better conduit for oro-tracheal intubation than Fastrach LMA in terms of higher first attempt success rate, lesser time taken for intubation and lesser post-operative complications.

A Narrative Review of the Uses of Ultrasound in the Evaluation, Analgesia, and Treatment of Distal Forearm Fractures

BackgroundDistal forearm fractures are a commonly encountered injury in the emergency department (ED), accounting for 500,000 to 1.5 million visits and 17% of ED fractures. The evaluation and management of these fractures frequently employs x-ray studies, conscious sedation, closed reduction, and splinting. Point-of-care ultrasound (POCUS) can offer significant benefit in the diagnosis and management of these common injuries. Objective of the ReviewTo review the clinical utility of POCUS in the diagnosis of distal forearm fractures, as well as to demonstrate the performance of ultrasound-guided analgesia delivery and ultrasound-guided reduction technique. DiscussionThe initial evaluation of forearm injuries frequently includes x-ray studies. However, multiple studies have shown ultrasound to be sensitive and specific for distal radius fractures, with the added value of detecting soft tissue injuries missed by conventional radiography. POCUS may also facilitate analgesia through the use of ultrasound-guided hematoma blocks, which removes the need for conscious sedation prior to manipulation. Finally, POCUS can be used after manipulation to assess cortical realignment of the bone fragments and spare the patient multiple reduction attempts and repeat radiographs. ConclusionDistal forearm fractures are common, and the emergency physician should be adept with the evaluation and management of these injuries. POCUS can be a reliable modality in the detection of these fractures and can be used to facilitate analgesia and augment success of reduction attempts. These techniques may decrease length of stay, improve patient pain, and decrease reduction attempts.

Risk of peri-intubation adverse events during emergency department intubation of overdose patients: a national emergency airway registry (near) analysis

Background More than 20,000 emergency department (ED) patients undergo intubation for overdose each year. While the characteristics of patients intubated for overdose and poisoning are well described, little is known about the intubation outcomes of overdose patients in the ED. Objectives We quantify the frequency of peri-intubation adverse events for patients intubated in the ED for overdose, and determine whether first attempt success without adverse events differs between patients intubated for overdose and patients intubated for other reasons. Methods We analyzed data from the National Emergency Airway Registry (NEAR), a prospective multicenter registry of ED intubations collected from an international network of 22 academic and community hospitals. We included patients 14 years and older whose first attempt was oral intubation, with data entered into NEAR between 1 January 2016 and 31 December 2018. The primary outcome was successful intubation on the first attempt. We used multivariable logistic regression to determine whether indication was independently associated with successful intubation on the first attempt after adjusting for age, gender, obesity, initial impression of difficult airway, presence of difficult airway characteristics, and use of video laryngoscopy. Secondary outcomes included successful intubation on the first attempt without adverse events, the occurrence of rescue surgical airways, and the occurrence of adverse events. Adverse events included hypoxemia, hypotension, peri-intubation cardiac arrest, bradycardia, mechanical injury to oral or airway structures, vomiting, tachydysrhythmia, esophageal intubation, laryngospasm, and pneumothorax. Results We analyzed 17,984 patients, including 1,983 (11%) intubated for overdose, and 16,001 (89%) intubated for other indications. Patients intubated for overdose were younger (median age 38 vs 55 years), were less frequently obese (26% vs 34%), and fewer had difficult airway characteristics (38% vs 53%). Overdose patients were more likely to have preoxygenation performed (45% vs 35%), more likely to have apenic oxygenation (39% vs 31%), and more likely to have bougie used (33% vs 17%). First attempt success was 90.5% in patients intubated for overdose and 87.5% in patients intubated for other reasons (absolute difference 3.0%; 95% CI: −1.3 to 7.3). First attempt success without adverse events was higher in overdose patients (85.0%) compared to other patients (78.7%) (absolute difference, 6.3%; 95% CI 1.0 to 11.7%). Overdose patients experienced significantly less hypotension (1.5% vs 4.1%), and tended to have fewer adverse events overall. Multivariable model results were consistent with the unadjusted results including no difference in first pass success (adjusted odd ratio 1.02 [95% CI 0.86–1.23]). There was a higher first pass success without complication in patients intubated for overdose (adjusted odds ratio 1.23; 95% CI 1.07 to1.43). Conclusion For patients in whom the primary indication for intubation is overdose there is an increased chance of first attempt success without adverse event.

Attitudes and practices of health care providers towards improving adherence to smoking cessation medications in Australia: A descriptive study.

Adherence to smoking cessation medications is low and predicts the success of quit attempts. Health care providers (HCPs) role in delivering smoking cessation support is crucial. HCPs support to improve adherence to smoking cessation medication has not been evaluated in Australia. This study describes the attitudes and practices of HCPs in Australia towards adherence to smoking cessation medications (nicotine replacement therapies, varenicline and bupropion) and intervention options. A descriptive cross-sectional study was conducted using a convenience sample of 70 HCPs in Australia. Participants were recruited through the social media platforms of professional societies in Australia. Data was collected in the periods between November 2020 and September 2021. Descriptive statistics were performed using SPSS statistical software version 27.0 and data was presented using proportions and percentages. The majority of participants were doctors, nurses and midwives (82.8%). Almost two-thirds of the participants (68.6%) self-reported that they provided adequate adherence support to individuals taking smoking cessation medications. The majority of participants (87.1%) identified adherence support service as part of their professional role. Only 11.1% of the participants who did not believe supporting medication adherence to be their role reported providing adherence support. The main perceived barriers to adherence support are lack of skill, knowledge, time and resources. HCPs believed that providing additional counselling and monitoring of adherence can improve adherence rates. In an online survey conducted in Australia, HCPs indicated multiple barriers to providing adherence support and intervention strategies that should be considered for smoking cessation programs. A higher proportion of participants who perceived adherence support as their professional role reported supporting adherence to smoking cessation medications. SO WHAT?: Considerations should be given to improve HCPs attitudes and practices towards smoking cessation medications adherence support. Smoking cessation programs should consider the issue of adherence support. Further studies with a larger sample size across a broader range of HCPs are needed to extensively understand adherence service provision among HCPs in Australia.

Improving First Attempt Success Rates in Neonatal and Pediatric Critical Care Transport Field Intubations

<h3>Aim</h3> To improve first attempt success rates to meet or exceed the national benchmark of 60% for neonatal and 77% for pediatric field intubations by December 2020. Historically, over a ten-year time span (2010 to 2020) the team has averaged 53% and 69% for neonates and pediatrics, respectively. The secondary aim is to establish a group of dedicated providers with additional training in advanced airway management within the team. <h3>Methods</h3> We implemented a quality improvement process aimed to improve first attempt intubation success rates to meet or exceed national benchmarks. CMAC video laryngoscopes were introduced in 2014 and were required as first line for all intubations by 2016. An anesthesia liaison was established, and our team members were provided with dedicated time with anesthesiologists in the operating room starting in 2017. In 2019, we implemented a single discipline (Respiratory therapist) practice for all field intubations and started an annual 3-day OR experience with anesthesia to maintain and enhance their airway skills. Balancing measures included CMAC unavailability or failure, decreased number of providers with airway training, and an educational environment translatable to the field environment. <h3>Results/Conclusions</h3> Over a five-year period, first attempt intubation success rates for our team improved to 60% for neonates and 85% for pediatrics, with the sustained improvement over time. Implementation of consistent time in the operating room with anesthesiology demonstrated the largest improvement in intubation success rates. <h3>Discussion</h3> Our team improved first attempt field intubation success rates by implementation of a standardized competency training program. This process has been sustained over time and remains successful even with a smaller number of crew members trained in airway management skills.

Comparative study of intubating LMA and I-gel for ease of insertion and as a conduit for endotracheal intubation

Background: A recently introduced supraglottic airway device (SAD) has been claimed to be an efficient supraglottic airway. It can also be used as a conduit for endotracheal intubation. However, LMA frequently used for this purpose; hence in this randomized study, success rate of blind tracheal intubation through two different SADs i-gel and LMA was evaluated. Methods: This is a prospective study was conducted in the Department of Anesthesia at Sapthagiri Institute of Medical Sciences &amp; Research Centre among 140 patients fulfilling the criteria. Fasting patients with ages 20-50 years undergoing elective procedures under general anesthesia with ASA physical status 1 and 2 and Mallampatti class I and II were included in the study. Whereas patients with ASA physical status 3 or 4, and having contraindications to insertion of LMA or i-gel™ such as; mouth opening less than 2 cm, increased risk of aspiration, anticipated difficult intubation and facemask ventilation, with Mallampatti class III to IV were excluded. Results: One of the groups was administered the I-gel (Group G) and the other group was given I-LMA (Group L). Two groups were statistically similar in terms of distribution of ASA physical status grading (p&lt;0.05). Two groups were statistically similar in terms of mallampati score distribution. Distribution of duration of surgery was not statistically significant in both the groups (p&gt;0.05). It was observed that insertion I-gel was easy in 50 out of 70 patients. Difficulin 56 out of 70 patients. Difficult to insertion took place in 14 patients. The comparison of ease of insertion between the two groups did not reveal any statistical significance (p&gt;0.05). Conclusion: We concluded I-gel aids easy and rapid insertion as a supraglottic airway device, but when it is used as a conduit for blind endotracheal intubation, the failure rate is high as there is more incidence of oesophageal intubation. On the contrary, ILMA being a gold standard device meant for intubation guide has a high first attempt success rate for blind endotracheal intubation.

The incidence of awake tracheal intubation in anesthetic practice is decreasing: a historical cohort study of the years 2014-2020 at a single tertiary care institution.

PurposeAwake tracheal intubation (ATI) is recommended in airway management guidelines when significant difficulty is predicted with airway management. Use of the technique may be declining, which may have implications for patient safety or for skills acquisition and maintenance. This historical cohort database study sought to determine if the use of ATI was decreasing in our adult tertiary care center.MethodsWith institutional research ethics board approval, we queried our anesthesia information management system for cases with ATI descriptors for each year from 2014 to 2020. Records of the retrieved cases were independently reviewed by all three authors to verify they met inclusion criteria for the ATI cohort prior to analysis for the primary outcome. Secondary outcome measures included airway device and route used for ATI, first attempt and ultimate success rates, and reported adverse issues recorded in cases of failed ATI or those requiring more than one attempt.ResultsA total of 692 cases of ATI were identified between 2014 and 2020. There was a statistically significant decrease in yearly ATIs over the seven-year study period (Chi square goodness of fit, P < 0.001), with ATI use decreasing by about 50%. First attempt success was significantly greater with use of flexible bronchoscopy vs video laryngoscopy to facilitate ATI (84% vs 60%; P < 0.001), while there was no difference in first attempt success with the oral vs nasal route (82% vs 82%; P = 1.0).ConclusionIn this single-center historical cohort study, the use of ATI decreased significantly from 2014 to 2020. Whether this decrease will result in morbidity or mortality related to airway management is currently unclear. Regardless, it has implications for training opportunities and maintenance of competence in performing the procedure.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12630-022-02344-8.

The effect of transilluminator device on successful peripheral venous catheter placement in children: A systematic review and meta-analysis.

Peripheral venous catheter placement (PVCP) is difficult for children due to the small diameter of their veins in adipose tissue. The transilluminator device (TD) is proposed as the effective method for PVCP. Therefore, this meta-analysis aimed to assess the effect of TD on first attempt success rate (FASR), mean the number of attempts (MNA), and mean duration of successful PVC placement (MDSPP) in children. In a systematic review and meta-analysis, an extensive search of online databases including PubMed, Scopus, Science Direct, Web of sciences, Cochrane, Clinical trial.gov, ProQuest, and Google scholar search engine was conducted. Keywords were combined and searched from the earliest records up to December 2021. The current meta-analysis was performed using STATA V.14.0 software. Six studies (four RCTs and two non-RCTs design) were included in the present meta-analysis. Analysis showed using of TD significantly led to FASR to 34% in studies with RCTs design (RR = 1.34; CI = 1.18-1.53) although, non-RCT studies did not indicate it (RR: 0.95; CI = 0.50-1.79). Also, one RCT (WMD = -0.24; CI = -0.4 -0.08) and two non-RCTs 0.05 (WMD = -0.05; 95% CI = -0.46-0.37) reported the MNA. Two RCTs (WMD: -24.30; CI = -53.50-4.89) and one non-RCT (WMD: -295.20; CI = -359.34 to -231.06) found TD decreased MDSSP. RCTs and non-RCTs studies showed different results in terms of some outcomes. Based on the results of four RCTs studies, the use of TD significantly increased the FASR of PVCP. The results of two non-RCTs also showed TD insignificantly decreased the FASR of PVCP. More evidence (RCT design) is required for decision-making about the effectiveness of TD on successful PVCP.

Central Venous Catheter Cannulation in Pediatric Anesthesia and Intensive Care: A Prospective Observational Trial.

Currently, ultrasound-guided central venous catheter (CVC) insertion is recommended in pediatric patients. However, the clinical practice may vary. The primary aim of this study was the overall success rate and the first attempt success rate in ultrasound-guided CVC insertion versus anatomic-based CVC insertion in pediatric patients. The secondary aim was the incidence of associated complications and the procedural time. The physician could freely choose the cannulation method and venous approach. Data were collected for 10 months. Overall, 179 patients were assessed for eligibility and 107 patients were included. In almost half of the patients (48.6%), the percutaneous puncture was performed by real-time ultrasound navigation. In 51.4% of the patients, the puncture was performed by the landmark method. The overall success rate was 100% (n = 52) in the real-time ultrasound navigation group, 96.4% (n = 53) in the landmark insertion group, (p = 0.496). The first percutaneous puncture success rate was 57.7% (n = 30) in the real-time ultrasound navigation group and 45.5% (n = 25) in the landmark insertion group, (p = 0.460). The data show a higher overall success rate and the first success rate in the US-guided CVC insertion group, but the difference was not statistically significant.

Device positioning with LISA vs. INSURE: a crossover randomized controlled manikin trial

Objective We aimed to compare time of device positioning, success of procedure and operator’s opinion with LISA vs. INSURE in a manikin simulating an extremely low birthweight infant. Methods A randomized controlled crossover (AB/BA) trial of surfactant administration with LISA vs. INSURE in a preterm manikin. Forty-two tertiary hospital consultants and pediatric residents with previous experience with LISA and INSURE participated. The primary outcome measure was the time of device positioning. The secondary outcome measures were: success of the first attempt, number of attempts, correct depth, and participant’s opinion on difficulty in using the device. Results Median time of device positioning was shorter with LISA vs. INSURE (median difference −8 s, 95% confidence interval −16 to −1 s; p = .04). Success at first attempt was 35/40 with LISA (83%) and 31/40 with INSURE (74%) (p = .42). Median number of attempts was 1 (IQR 1–1) with LISA and 1 (IQR 1–2) with INSURE (p = .08). Correct depth was achieved in 30/40 with LISA (71%) and 37/40 with INSURE (88%) (p = .12). Participants found LISA easier to insert in the trachea (p = .002) but INSURE easier to place at the correct depth (p = .008). Handling the device (p = .43), visualizing the glottis (p = .17) and overall difficulty in using the device (p = .13) were not statistically different. Conclusions In a preterm manikin model, positioning a thin catheter (LISA) was quicker and easier than a tracheal tube (INSURE), but the magnitude of the difference was unlikely to be clinically relevant and the tracheal tube was easier to place at the correct depth. Registration clinicaltrial.gov NCT04944108.

Associations Between E-cigarette Use and E-cigarette Flavors With Cigarette Smoking Quit Attempts and Quit Success: Evidence From a U.S. Large, Nationally Representative 2018-2019 Survey.

Although many studies have examined the association between e-cigarette use and smoking cessation, fewer have considered the impact of e-cigarette flavors on cessation outcomes. This study extends previous studies by examining the effects of e-cigarette use and e-cigarette flavors on quit attempts and quit success of smoking. We used data from the 2018-2019 Tobacco Use Supplement-Current Population Survey (TUS-CPS) survey. Multivariate logistic regression analyses were used to investigate the associations between flavored e-cigarette use with quit attempts and quit success of smoking among individuals who smoked 12 months ago. Two current e-cigarette use definitions were used in these logistic regression analyses; currently use every day or some days versus 20+ days in the past 30 days. Compared to those not using e-cigarettes, current every day or someday e-cigarette use with all nontobacco flavors had an adjusted odds ratio (AOR) of 2.9 (95% CI: 2.4 to 3.5) for quit attempts and 1.7 (95% CI: 1.3 to 2.2) for quit success. 20+ days e-cigarette use with flavors had stronger associations with quit attempts (AOR = 4.2, 95% CI: 3.1 to 5.5) and quit success (AOR = 4.0, 95% CI: 2.9 to 5.4). E-cigarette users with nontobacco flavors were more likely to succeed in quitting compared to those exclusively using non-flavored or tobacco-flavored e-cigarettes. Menthol or mint flavor users had slightly higher odds of quit attempts and success than users of other nontobacco flavors. E-cigarette use is positively associated with both making smoking quit attempts and quit success. Those using flavored e-cigarettes, particularly menthol or mint, are more likely to quit successfully. E-cigarette use is positively associated with both making a quit attempt and quit success, and those using flavored e-cigarettes are more likely to successfully quit smoking, with no statistically significant differences between the use of menthol or mint-flavored e-cigarettes versus the use of other nontobacco flavored products. This suggests that the potential for e-cigarettes to help people who currently smoke quit could be maintained with the availability of menthol or mint-flavored e-cigarettes, even if other nontobacco flavored products, which are associated with e-cigarette use among youth, were removed from the market.

Learning to quit: can reinforcement theories predict the success of smoking cessation attempts using nicotine replacement therapy patches in a general population sample of smokers at 8-weeks and 6-months follow-up?

ABSTRACT Primary, secondary, and tertiary reinforcement contribute to the maintenance of smoking behaviour and may influence the efficacy of different cessation treatments. This analysis examined these relationships in a large general population sample and investigated how previous experiences of the different reinforcement mechanisms impacted future quit attempts. Random digit telephone dialing was used to recruit a sample of Canadian adults who smoked and were interested in being part of a hypothetical program that would provide nicotine replacement therapy (NRT) patches free by mail and half of the eligible participants were randomized to actually receive a five-week supply of NRT patches. During the interviews, reasons for relapse to smoking during previous quit attempts were collected and coded by two reviewers (disagreements were settled by a third reviewer). Binary logistic regression was used to determine if type of reinforcer moderated the intervention effect of the patches. Participants who made cessation attempts in the past year were more likely to report negative (p = .039), secondary (p = .041), and tertiary (p = .010) reinforcers and less likely to report positive reinforcers (p = .016) compared to those who did not attempt to quit. Logistic regressions revealed no significant conditional effects of the intervention on the relationship between reinforcer type and quit attempts or 30-day smoking abstinence. Analysis including all three reinforcers showed negative reinforcers decreased but tertiary reinforcers increased the odds participants reported a cessation attempt before the baseline interview and between baseline and 8-weeks. Understanding the different ways nicotine reinforces smoking behaviour could help guide individuals to more effective treatment options.

A comparison of endotracheal intubation characteristics between Macintosh, CMAC, and Smart Trach Video laryngoscope: a randomized prospective clinical trial

ABSTRACT Background In this study, we compared the performance characteristics of Macintosh laryngoscope, CMAC videolaryngoscope with a recently developed videolaryngoscope called Smart Trach. Research design and methods Three hundred seventy-five patients belonging to mixed population without having anticipated difficult airways undergoing elective surgeries were randomly allocated to be intubated using either of the three laryngoscopes (Macintosh, CMAC, or Smart Trach). Time needed for successful intubation, number of attempts, Cormack Lehane’s (CL) grading, optimization maneuverers, intubation difficulty score (IDS), subjective ease of intubation (VAS), subjective lifting force, and complications were recorded. Results Demographic and anthropometric measurements (sex, height, weight, and body mass index) among the groups were comparable. CL grades, lifting force, IDS, VAS, and intubation times (seconds) were significantly different whereas need for maneuver, attempts, and complications was similar (p > 0.05 each). Intubation times (seconds) were significantly different between Macintosh [36(29–43) seconds], CMAC [30(24–37)], and Smart Trach [35(30–42] groups. (p < 0.001). Subjective ease of intubation based on VAS score was lowest in Smart trach group [1(1–2)] (p < 0.001). Conclusion Shortest intubation times were achieved with CMAC with least use of lifting force. First attempt success rates of were similar. Intubation was easiest subjectively using Smart Trach as manifested by lowest VAS and IDS. Trial Registration Clinical Trial registry of India (CTRI/2019/09/021279 dated 17/09/2019)