Retrospective audit of airway management practices in children with craniocervical pathology

2019 ◽  
Vol 29 (4) ◽  
pp. 338-344
Author(s):  
Christa Morrison ◽  
Mary Claire Avanis ◽  
Susanna Ritchie‐McLean ◽  
Colleen Woo ◽  
Jane Herod ◽  
...  
Keyword(s):  
Airway Management ◽  
Management Practices ◽  
Retrospective Audit

scholarly journals Nutritional Care of Patients Admitted to Hospital for Alcohol Withdrawal: A 5-Year Retrospective Audit

2020 ◽  
Vol 55 (5) ◽  
pp. 489-496
Author(s):  
Cameron McLean ◽  
Linda Tapsell ◽  
Sara Grafenauer ◽  
Anne-Therese McMahon
Keyword(s):  
Alcohol Withdrawal ◽  
Medical Records ◽  
Management Practices ◽  
Nutritional Assessment ◽  
Average Length ◽  
Population Group ◽  
Future Research ◽  
Multivitamin Supplementation ◽  
Nutritional Care ◽  
Retrospective Audit

ABSTRACT Aim The aim of this study was to describe the characteristics and the nutritional approaches implemented with patients undergoing alcohol withdrawal. Methods A retrospective analysis of medical records for patients admitted to a tertiary hospital for alcohol withdrawal was completed over a 5-year period 2013–2017. Data on nutrition-related assessment and management were extracted and descriptively analysed. Results A total of 109 medical records were included (M = 73, F = 36), with the mean age of patients 47.3 years (SD ± 11.2, range 22–70). The average length of stay was 3.7 days (SD ± 3.9, range 0.70–27.8). Approaches towards nutritional care emerged from micronutrient assessment and supplementation and/or dietetic consultation. Nutrition-related biochemistry data was available for most patients, notably serum levels of sodium, urea and creatinine (102 patients; 93.5%) and magnesium and phosphate (66 patients, 60.5%). There was evidence of some electrolyte abnormalities on admission to hospital. Eight patients had serum micronutrient status assessed; no patients had serum thiamine levels assessed. Parenteral thiamine was provided to 96 patients (88.0%) for 1.9 days (SD ± 1.1, range 1.0–6.0) with a mean dose of 2458.7 mg (SD ± 1347.6, range 300–6700 mg). Multivitamin supplementation was provided to 24 patients (22.0%). Only 23 patients (21.2%) were seen by a dietician of whom 16 underwent a comprehensive nutritional assessment and 3 were screened using the malnutrition screening tool. Conclusion Inconsistent nutritional assessment and management practices were identified across a diverse population group, whilst nutritional professionals were underutilized. Future research should benchmark current guidelines and multidisciplinary approaches considering the role of nutritional specialists in the team.

scholarly journals Transforming airway management practices in a Level I trauma centre during COVID Crisis

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Nidhi Bhatia ◽  
Kajal Jain ◽  
Tanvir Samra ◽  
Ashish Singh Aditya ◽  
Mandeep Kumar ◽  
...  
Keyword(s):  
Airway Management ◽  
Management Practices ◽  
Trauma Centre ◽  
Level I

A Multisite Survey of Suctioning Techniques and Airway Management Practices

2003 ◽  
Vol 12 (3) ◽  
pp. 220-230 ◽  
Author(s):  
Mary Lou Sole ◽  
Jacqueline F. Byers ◽  
Jeffery E. Ludy ◽  
Ying Zhang ◽  
Christine M. Banta ◽  
...  
Keyword(s):  
Sodium Chloride ◽  
Airway Management ◽  
Closed System ◽  
Chloride Solution ◽  
Sodium Chloride Solution ◽  
Management Practices ◽  
Oral Care ◽  
The United States ◽  
Respiratory Therapists ◽  
Policies And Procedures

• Background Ventilator-associated pneumonia, common in critically ill patients, is associated with microaspiration of oropharyngeal secretions and may be related to suctioning and airway management practices.• Objectives To describe institutional policies and procedures related to closed-system suctioning and airway management of intubated patients, and to compare practices of registered nurses and respiratory therapists.• Methods A descriptive, comparative, multisite study of facilities that use closed-system suctioning devices on most intubated adults was conducted. Nurses and respiratory therapists who worked at the sites completed surveys related to their practices.• Results A total of 1665 nurses and respiratory therapists at 27 sites throughout the United States responded. The typical respondent had at least 6 years’ experience with patients receiving mechanical ventilation (61%) and a baccalaureate degree or higher (54%). Most sites had policies for management of endotracheal tube cuffs (93%), hyperoxygenation (89%) and use of gloves (70%) with closed-system suctioning, and instillation of isotonic sodium chloride solution for thick secretions (74%). Only 48% of policies addressed oral care and 37% addressed oral suctioning. Nurses did more oral suctioning and oral care than respiratory therapists did, and respiratory therapists instilled sodium chloride solution more and rinsed the suctioning device more often than nurses did.• Conclusions Policies vary widely and do not always reflect current research. Consistent performance of practices such as wearing gloves for airway management and maintaining endotracheal cuff pressures must be evaluated. Collaborative, research-based policies and procedures must be developed and implemented to ensure best practices for intubated patients.

Transtracheal jet ventilation in a general tertiary hospital: A 7-year audit

2021 ◽  
pp. 0310057X2110025
Author(s):  
Richard K Barnes ◽  
Jonathan Au
Keyword(s):  
Airway Management ◽  
Tertiary Hospital ◽  
High Rate ◽  
Low Flow ◽  
Jet Ventilation ◽  
Retrospective Audit ◽  
Tertiary Hospitals ◽  
Tertiary Healthcare ◽  
Alternative Means ◽  
Rate Of Success

Airway management in patients presenting with severe airway obstruction can present a challenge to the anaesthetist, as conventional difficult airway pathways are often inappropriate. The use of a transtracheal jet cannula is an alternative means of airway securement, but lack of familiarity has limited its use in general tertiary hospitals. We report a retrospective audit of the use of transtracheal jet ventilation in a general tertiary healthcare centre over the past seven years, with a total of 50 patients with severe airway compromise undergoing pharyngolaryngeal surgery. Transtracheal jet ventilation was successful in 98% of patients, and was the definitive means of airway management in 43 cases. In six cases, the technique was a useful temporising measure while the airway was secured by other means. Minor complications occurred in 12% of patients. No major morbidities or mortalities were recorded. We conclude that transtracheal jet ventilation for high-risk pharyngolaryngeal surgery can be performed using a high frequency jet ventilator, with a high rate of success and only minor complications. Cannulation of the trachea below the cricothyroid membrane is feasible but more challenging. Low-flow apnoeic oxygenation through the transtracheal jet ventilation cannula maintains oxygenation during initial surgical airway manipulation.

Current Practice in Airway Management: A Descriptive Evaluation

2010 ◽  
Vol 19 (2) ◽  
pp. 168-173 ◽  
Author(s):  
Rebecca Kjonegaard ◽  
Willa Fields ◽  
Major L. King
Keyword(s):  
Mechanical Ventilation ◽  
Airway Management ◽  
Registered Nurses ◽  
Management Practices ◽  
Current Practice ◽  
Ventilator Associated Pneumonia ◽  
Convenience Sample ◽  
Evidence Based Practices ◽  
Respiratory Therapists ◽  
Care Workers

Background Ventilator-associated pneumonia, a common complication of mechanical ventilation, could be reduced if health care workers implemented evidence-based practices that decrease the risk for this complication. Objectives To determine current practice and differences in practices between registered nurses and respiratory therapists in managing patients receiving mechanical ventilation. Methods A descriptive comparative design was used. A convenience sample of 41 registered nurses and 25 respiratory therapists who manage critical care patients treated with mechanical ventilation at Sharp Grossmont Hospital, La Mesa, California, completed a survey on suctioning techniques and airway management practices. Descriptive and inferential statistics were used to analyze the data. Results Significant differences existed between nurses and respiratory therapists for hyperoxygenation before suctioning (P =.03). In the 2 groups, nurses used the ventilator for hyper-oxygenation more often, and respiratory therapists used a bag-valve device more often (P =.03). Respiratory therapists instilled saline (P <.001) and rinsed the closed system with saline after suctioning (P =.003) more often than nurses did. Nurses suctioned oral secretions (P <.001) and the nose of orally intubated patients (P =.01), brushed patients’ teeth with a toothbrush (P<.001), and used oral swabs to clean the mouth (P <.001) more frequently than respiratory therapists did. Conclusion Nurses and respiratory therapists differed significantly in the management of patients receiving mechanical ventilation. To reduce the risk of ventilator-associated pneumonia, both nurses and respiratory therapists must be consistent in using best practices when managing patients treated with mechanical ventilation.

Airway Management Issues in the Intensive Care Unit: Revisiting Old Paradigms and Broadening Our Horizons

2011 ◽  
Vol 14 (2) ◽  
pp. 99 ◽  
Author(s):  
Jeffrey P. Keck ◽  
Thomas C. Mort
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Airway Management ◽  
Management Practices ◽  
Improve Patient Safety ◽  
Management Skills ◽  
First Responder ◽  
Skill Sets ◽  
Improve Patient ◽  
Management Issues

Airway management in the intensive care setting provides unique challenges that can be quite daunting, even for the most experienced practitioner. Airways are usually intubated for long periods, multiple comorbidities often interfere with "routine" airway management practices, and patients are often physiologically disadvantaged or hemodynamically unstable. Strapped with this calamity, the first responder to a patient with an acutely compromised airway is often someone less experienced with global airway management skills. As anesthesiologists, we are very familiar with the skill sets necessary to handle these predicaments, and as intensivists, we have the fortunate opportunity to share that wealth of information and experience. Airway care in the intensive care unit is a continuumfrom elective or emergent intubation, to airway preservation and hygiene, to elective or unintentional extubation. Thus, familiarization with the basics of airway management in routine and "first responder" settings should bolster confidence and greatly improve patient safety and outcomes.

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