scholarly journals Early intubation versus late intubation for COVID-19 patients: An in situ simulation identifying factors affecting performance and infection control in airway management

2021 ◽  
pp. 0310057X2110078
Author(s):  
Christopher P Lee ◽  
Yu-Yeung Yip ◽  
Albert KM Chan ◽  
Chun P Ko ◽  
Gavin M Joynt
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Infection Control ◽  
Airway Management ◽  
Mask Ventilation ◽  
Intubation Time ◽  
In Situ Simulation ◽  
Early Intubation ◽  
The Impact

COVID-19 poses an infectious risk to healthcare workers especially during airway management. We compared the impact of early versus late intubation on infection control and performance in a randomised in situ simulation, using fluorescent powder as a surrogate for contamination. Twenty anaesthetists and intensivists intubated a simulated patient with COVID-19. The primary outcome was the degree of contamination. The secondary outcomes included the use of bag-valve-mask ventilation, the incidence of manikin cough, intubation time, first attempt success and heart rate variability as a measure of stress. The contamination score was significantly increased in the late intubation group, mean (standard deviation, SD) 17.20 (6.17), 95% confidence intervals (CI) 12.80 to 21.62 versus the early intubation group, mean (SD) 9.90 (5.13), 95% CI 6.23 to 13.57, P = 0.005. The contamination score was increased after simulated cough occurrence (mean (SD) 18.0 (5.09) versus 5.50 (2.10) in those without cough; P<0.001), and when first attempt laryngoscopy failed (mean (SD) of 17.1 (6.41) versus 11.6 (6.20) P = 0.038). The incidence of bag-mask ventilation was higher in the late intubation group (80% versus 30%; P=0.035). There was no significant difference in intubation time, incidence of failed first attempt laryngoscopy or heart rate variability between the two groups. Late intubation in patients with COVID-19 may be associated with greater laryngoscopist contamination and potential aerosol-generating events compared with early intubation. There was no difference in performance measured by intubation time and incidence of first attempt success. Late intubation, especially when resources are limited, may be a valid approach. However, strict infection control and appropriate personal protective equipment usage is recommended in such cases.

THE IMPACT OF STRESS ON HEART RATE VARIABILITY OF ON-CALL PHYSICIANS

CHEST Journal ◽  
2005 ◽  
Vol 128 (4) ◽  
pp. 277S
Author(s):  
Stavros E. Mountantonakis ◽  
Dimitrios A. Moutzouris ◽  
Craig McPherson
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
The Impact

Abstract P315: Increase in Stress May Contribute to Lower Heart Rate Variability in Healthy Young Subjects

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Amanda C Costa ◽  
Ana Gabriela C Silva ◽  
Cibele T Ribeiro ◽  
Guilherme A Fregonezi ◽  
Fernando A Dias
Keyword(s):  
Cardiovascular Disease ◽  
Heart Rate ◽  
Heart Rate Variability ◽  
Healthy Volunteers ◽  
Perceived Stress ◽  
Low Frequency ◽  
Statistical Correlation ◽  
Total Power ◽  
The Impact ◽  
Nonparametric Correlation

Background: Stress is one of the risk factors for cardiovascular disease and decreased heart rate variability is associated to increased mortality in some cardiac diseases. The aim of the study was to assess the impact of perceived stress on cardiac autonomic regulation in young healthy volunteers. Methods: 35 young healthy volunteers (19 to 29 years old, 6 men) from a Brazilian population were assessed for perceived stress by the translated and validated Perceived Stress Scale (PSS, 14 questions) and had the R-R intervals recorded at rest on supine position (POLAR RS800CX) and analyzed (5 minutes, Kubius HRV software) by Fast-Fourier Transform for quantification of Heart Rate Variability (HRV). Results: Average data (±SD) for age, heart rate, BMI, waist circumference and percentage of body fat (%BF) were: 21.3±2.7 years; 65.5±7.9 bpm; 22.3±1.9 Kg/m 2 ; 76.0±6.1 cm and 32.1±6.6%; respectively. The mean score for the PSS-14 was 23.5±7.2 and for the HRV parameter as follow: SSDN=54.8±21.2ms; rMSSD=55.9±32.2ms; low-frequency (LF)= 794.8±579.7ms 2 ; High-frequency (HF)= 1508.0±1783.0 ms 2 ; LF(n.u.)= 41.1±16.2; HF(n.u.)= 58.9±16.2; LF/HF=0.89±0.80 and Total power (TP)= 3151±2570ms 2 . Spearman nonparametric correlation was calculated and there was a significant correlation of PSS-14 scores and LF (ms 2 ) (r=−0.343; p= 0.044). Other HRV variables did not shown significant correlation but also had negative values for Spearman r (TP r=−0.265, p=0.124; HF r=−0.158; SSDN r=−0.207; rMSSD r=−0.243, p=0.160). LF/HF and LF(n.u.) did not correlate to PSS-14 having Spearman r very close to zero (LF/HF r=−0.007, p=0.969; LF(n.u.) r=−0.005, p=0.976). No correlation was found for HRV parameters and BMI and there was a trend for statistical correlation of %BF and LF (ms 2 ) (r=−0.309, p=0.071). Conclusions: These data demonstrate a possible association of perceived stress level and HRV at rest. Changes in LF can be a consequence of both sympathetic and parasympathetic activity, however, analyzing the other variables HF, TP, SSDN and rMSSD (all negative Spearman r) and due to the lack of changes in LF/HF ratio and LF(n.u.) we interpret that increased stress may be associated to decrease in overall heart rate variability. These changes were seen in healthy individuals and may point out an important mechanism in cardiovascular disease development.

125 INTRODUCING AN IN SITU SIMULATION PROGRAMME IN AN INTENSIVE CARE UNIT

2021 ◽  
Author(s):  
Harry Bateman ◽  
Karen Johnston ◽  
Andrew Badacsonyi ◽  
Natalie Clarke ◽  
Kathleen Conneally ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Human Factors ◽  
Professional Training ◽  
In Situ Simulation ◽  
Airline Pilots ◽  
Staff Members ◽  
Emergency Scenarios ◽  
The Impact

This North London hospital has a 14-bed Intensive Care Unit (ICU). As a small District General ICU, staff exposure to emergency scenarios can be infrequent. Lack of practice can lead to a reduction in staff confidence and knowledge when these scenarios are encountered, especially during the COVID pandemic. The ICU had not previously undertaken in situ multi-disciplinary team (MDT) simulation sessions on the unit.The aim of the study was to introduce a novel programme of MDT simulation sessions in the ICU and provide feedback with the aim of increasing both staff confidence in managing emergency scenarios and staff understanding of the impact of human factors.A team of ICU Simulation Champions created emergency scenarios that could occur in the ICU. Pre-simulation and post-simulation questionnaires were produced to capture staff opinion on topics including benefits and barriers to simulation training and confidence in managing ICU emergencies. Members of the ICU MDT would be selected to participate in simulation scenarios. Afterwards, debrief sessions would be facilitated by Simulation Champions and Airline Pilots with a particular focus on competence in managing the emergency and human factors elements, such as communication and leadership. Participants would then be surveyed with the post-simulation questionnaire.Nine simulation sessions were conducted between October 2020 and June 2021. The sessions occurred within the ICU during the working day in a designated bay with the availability of all standard ICU resources and involved multiple MDT members to aid fidelity. Feedback by Simulation Champions mainly focussed on knowledge related to the ICU emergency, whilst the Airline Pilots provided expert feedback on human factors training. Fifty-five staff members completed the pre-simulation questionnaire and 37 simulation participants completed the post-simulation questionnaire. Prior to simulation participation, 28.3% of respondents agreed they felt confident managing emergency scenarios on ICU – this figure increased to 54.1% following simulation participation. 94.4% of simulation participants agreed that their knowledge of human factors had improved following the simulation and 100% of participants wanted further simulation teaching. Figure 1 shows a thematic analysis of the responses from 31 participants who were questioned about perceived benefits from simulation teaching. Following the success of the programme, the Hospital Trust will continue to support and develop inter-speciality and inter-professional training, and have funded the appointment of an ICU Simulation Fellow to continue to lead and enhance future in situ simulation teaching on the ICU.

scholarly journals SP10.1.7 The Important Role of In-Situ Simulation in Preparing Surgeons for the COVID-19 Pandemic

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Pierre Montauban ◽  
Charannya Balakumar ◽  
Jaideep Rait ◽  
Prizzi Zarsadias ◽  
Sara Iqbal ◽  
...  
Keyword(s):  
High Risk ◽  
In Situ Simulation ◽  
Level Of Confidence ◽  
Effective Training ◽  
Before And After ◽  
Quasi Experimental ◽  
Surgical Teams ◽  
Imminent Threat ◽  
The Impact

Abstract Background Effective training is vital when facing viral outbreaks such as the SARS Coronavirus 2 (SARS-CoV-2) outbreak of 2019. The objective of this study was to measure the impact of in-situ simulation on the confidence of the surgical teams of two hospitals in assessing and managing acutely unwell surgical patients who are high-risk or confirmed to have COVID-19. Methods This was a quasi-experimental study with a pretest-posttest design. The surgical teams at each hospital participated in multi-disciplinary simulation sessions to explore the assessment and management of a patient requiring emergency surgery who is high risk for COVID-19. The participants were surveyed before and after receiving simulation training to determine their level of confidence on a Visual Analog Scale (VAS) for the premise stated in each of the nine questions in the survey, which represented multiple aspects of the care of these patients. Results 27 participants responded the pre-simulation survey and 24 the one post-simulation. The level of confidence (VAS score) were statistically significantly higher for all nine questions after the simulation. Specific themes were identified for further training and changes in policy. Conclusion In-situ simulation is an effective training method. Its versatility allows it to be set up quickly as rapid-response training in the face of an imminent threat. In this study, it improved the preparedness of two surgical teams for the challenges of the COVID-19 pandemic.

scholarly journals The impact of sedentarism on heart rate variability (HRV) at rest and in response to mental stress in young women

2018 ◽  
Vol 6 (18) ◽  
pp. e13873 ◽  
Author(s):  
José Robertto Zaffalon Júnior ◽  
Ariane Oliveira Viana ◽  
Gileno Edu Lameira de Melo ◽  
Kátia De Angelis
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Young Women ◽  
Mental Stress ◽  
The Impact
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