Current airway management practices after a failed intubation attempt in Australian and New Zealand emergency departments

Apnoeic oxygenation (ApOx) has been demonstrated to reduce the incidence of desaturation, although evidence of benefit has been conflicting depending on the technique used. The aim of this study was to compare the incidence of desaturation between patients who received ApOx via conventional nasal cannula (NC) and those who did not, using a large, multicentre airway registry.MethodsThis study is an analysis of 24 months of prospectively collected data in the Australia and New Zealand Emergency Department Airway Registry (June 2013–June 2015). The registry includes information on all intubated adults from 43 emergency departments. Patients intubated during cardiac arrest (n=393), those who received active ventilation prior to the first intubation attempt (n=486), and where the use of ApOx was not recorded either way (n=312) were excluded. The proportion of patients who desaturated (Sa02 <93) in the group that received ApOx and those that did not were compared. To evaluate the association of ApOx with patient desaturation, a logistic regression model based on factors expected to influence desaturation was performed.ResultsOf 2519 patients analysed, 1669 (66.3%) received ApOx via NC while 850 (33.7%) did not. Desaturation in the cohort receiving ApOx was 10.4% compared with standard care (no ApOx) 13.7%. ApOx had a protective effect for desaturation (OR 0.71 95% CI 0.53 to 0.95). Single intubation attempt was associated with reduced risk of desaturation of (OR 0.10, 95% CI 0.06 to 0.17); this was increased on second attempt (OR 0.37, 95% CI 0.21 to 0.68). Desaturation was also associated with the physician recording that they had anticipated a difficult airway (OR 1.83, 95% CI 1.34 to 2.48).ConclusionThis large multicentre registry study provides evidence that ApOx delivered through a conventional NC is associated with a lower incidence of desaturation in patients undergoing rapid sequence intubation.Trial registration numberACTRN12613001052729.

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Preparation for airway management in Australia and New Zealand ICUs during the COVID -19 pandemic

PLoS ONE ◽

10.1371/journal.pone.0251523 ◽

2021 ◽

Vol 16 (5) ◽

pp. e0251523

Author(s):

David J. Brewster ◽

Christopher P. Nickson ◽

Steve McGloughlin ◽

David Pilcher ◽

Vineet V. Sarode ◽

...

Keyword(s):

Intensive Care ◽

New Zealand ◽

Airway Management ◽

Management Practices ◽

National Guidelines ◽

Online Questionnaire ◽

Cognitive Aids ◽

Simulation Based ◽

Email Invitation ◽

Structured Questionnaire

Background This paper aimed to describe the airway practices of intensive care units (ICUs) in Australia and New Zealand specific to patients presenting with COVID-19 and to inform whether consistent clinical practice was achieved. Specific clinical airway guidelines were endorsed in March 2020 by the Australian and New Zealand Intensive Care Society (ANZICS) and College of Intensive Care Medicine (CICM). Methods and findings Prospective, structured questionnaire for all ICU directors in Australia and New Zealand was completed by 69 ICU directors after email invitation from ANZICS. The online questionnaire was accessible for three weeks during September 2020 and analysed by cloud-based software. Basic ICU demographics (private or public, metropolitan or rural) and location, purchasing, airway management practices, guideline uptake, checklist and cognitive aid use and staff training relevant to airway management during the COVID-19 pandemic were the main outcome measures. The 69 ICU directors reported significant simulation-based inter-professional airway training of staff (97%), and use of video laryngoscopy (94%), intubation checklists (94%), cognitive aids (83%) and PPE “spotters” (89%) during the airway management of patients with COVID-19. Tracheal intubation was almost always performed by a Specialist (97% of ICUs), who was more likely to be an intensivist than an anaesthetist (61% vs 36%). There was a more frequent adoption of specific airway guidelines for the management of COVID-19 patients in public ICUs (94% vs 71%) and reliance on specialist intensivists to perform intubations in private ICUs (92% vs 53%). Conclusion There was a high uptake of a standardised approach to airway management in COVID-19 patients in ICUs in Australia and New Zealand, likely due to endorsement of national guidelines.

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Exploring the lived experience of self-management practices of men, women and 2-spirited individuals living with type 2 diabetes in Canada, USA, Australia and New Zealand: a scoping review

Canadian Journal of Cardiology ◽

10.1016/j.cjca.2020.02.025 ◽

2021 ◽

Vol 37 (2) ◽

pp. e8-e9

Author(s):

H. Burnside ◽

M. Parry ◽

B. Downey ◽

M. Firestone

Keyword(s):

Type 2 Diabetes ◽

New Zealand ◽

Lived Experience ◽

Scoping Review ◽

Management Practices ◽

Self Management

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Linking Land Use Capability classes and APSIM to estimate pasture growth for regional land use planning

Soil Research ◽

10.1071/sr15018 ◽

2016 ◽

Vol 54 (1) ◽

pp. 94 ◽

Cited By ~ 5

Author(s):

Iris Vogeler ◽

Rogerio Cichota ◽

Josef Beautrais

Keyword(s):

Land Use ◽

New Zealand ◽

Land Use Planning ◽

Management Practices ◽

Growth Patterns ◽

Land Resource ◽

Pastoral Systems ◽

System Models ◽

Farm System ◽

The Impact

Investigation of land-use and management changes at regional scales require the linkage of farm-system models with land-resource information, which for pastoral systems includes forage supply. The New Zealand Land Resource Inventory (NZLRI) and associated Land Use Capability (LUC) database include estimates of the potential stock-carrying capacity across the country, which can be used to derive estimates of average annual pasture yields. Farm system models and decision support tools, however, require information on the seasonal patterns of pasture growth. To generate such pasture growth curves (PGCs), the Agricultural Production Systems Simulator (APSIM) was used, with generic soil profiles based on descriptions of LUC classes, to generate PGCs for three regions of New Zealand. Simulated annual pasture yields were similar to the estimates of annual potential pasture yield in the NZLRI spatial database, and they provided information on inter-annual variability. Simulated PGCs generally agreed well with measured long-term patterns of seasonal pasture growth. The approach can be used to obtain spatially discrete estimates of seasonal pasture growth patterns across New Zealand for use in farm system models and for assessing the impact of management practices and climate change on the regional sustainability.

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Devices for difficult airway management in academic emergency departments: Results of a national survery

Annals of Emergency Medicine ◽

10.1016/s0196-0644(99)80008-0 ◽

1999 ◽

Vol 33 (6) ◽

pp. 694-698 ◽

Cited By ~ 1

Author(s):

Richard M Levitan ◽

Scott Kush ◽

Judd E Hollander

Keyword(s):

Airway Management ◽

Difficult Airway ◽

Emergency Departments ◽

Difficult Airway Management

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Dairy cow welfare: the role of research and development in addressing increasing scrutiny

Animal Production Science ◽

10.1071/an12276 ◽

2013 ◽

Vol 53 (9) ◽

pp. 924 ◽

Cited By ~ 2

Author(s):

A. D. Fisher ◽

J. R. Webster

Keyword(s):

New Zealand ◽

Animal Welfare ◽

Body Condition ◽

Management Practices ◽

Good Practice ◽

Stocking Density ◽

Grazed Pasture ◽

Dairy Management ◽

Animal Management ◽

Cow Welfare

Pasture-based dairying in New Zealand and Australia has come under increasing animal welfare scrutiny as a result of changing public expectations for farm animal management. Concurrently, efficiency-driven changes in dairy management practices and a broadening of the feedbase beyond traditionally grazed pasture have resulted in increased intensification and stocking density within the dairy industries. This intensification has included a higher proportion of grain concentrates in the diet (particularly in Australia), and the greater management of cows off pasture and even in housing (particularly in New Zealand). Research to assess the animal welfare implications of these changes and to recommend good practice management has concentrated on issues of cow environments and cow feeding, including body condition. Research has shown that cows may be managed for a few hours per day on concrete surfaces without compromising their lying behaviour and other indicators of welfare, but that longer periods off pasture require the provision of a well drained and comfortable lying surface. Other research has defined the extremes of hot and cold/wet conditions beyond which cows benefit from provision of adequate shade and shelter. Research on cow body condition has indicated that welfare responses are aligned with measures of health and productivity in supporting the need to maintain a minimum body condition before calving and during the subsequent weight loss period of early lactation. Continued research, extension and industry adoption will enable dairy producers to address community expectations as they continue to change their farming practices.

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Etomidate and Airway Management Practices

Prehospital Emergency Care ◽

10.1016/j.prehos.2004.07.002 ◽

2004 ◽

Vol 8 (4) ◽

pp. 442-443

Author(s):

D KIM

Keyword(s):

Airway Management ◽

Management Practices

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“Measuring up”: a systematic literature review of performance measurement in Australia and New Zealand local government

Qualitative Research in Accounting & Management ◽

10.1108/qram-11-2020-0184 ◽

2021 ◽

Vol ahead-of-print (ahead-of-print) ◽

Author(s):

Mary C. Johnsson ◽

Matthew Pepper ◽

Oriana Milani Price ◽

Lauren P. Richardson

Keyword(s):

Systematic Review ◽

New Zealand ◽

Local Government ◽

Performance Measurement ◽

Local Governments ◽

Management Practices ◽

New Public Management ◽

Systematic Review Methodology ◽

Content Type ◽

Starting Point

Purpose Measurement practices have long been considered vital for informing the management of performance in organisations. Their application to local governments is a more recent, yet multi-decade phenomenon facilitated by New Public Management trends. This paper aims to review the landscape of publications that discuss performance measurement (PM) practices in Australian and New Zealand local government contexts and identify implications for future research. Design/methodology/approach A systematic review methodology was used to identify a shortlist of publications. Next, a rating-based researcher appraisal process was applied. Multiple iterations of search and appraisal were conducted to form the basis for inductive thematic analysis and synthesis. Findings Analysing 65 PM publications, two interrelated themes, namely, discourses of performance as efficiency, accountability or strategic growth and change were identified, which influence the adoption of local PM tools and frameworks. As demands for strategic growth and more complex service delivery increase, strategic and localised adaptation of PMs may be required to integrate learning and communicative competencies with technical and operational capabilities. Research limitations/implications The systematic review methodology has been applied to address some of the limitations of publication and reporting biases in literature. This research provides a starting point for future investigations and broadening of discourse in local government contexts. Originality/value This paper represents the first systematic review of 1995–2020 publications on performance management practices used by local governments in Australia and New Zealand.

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