If at First You Don't Succeed: Patient Characteristics Associated with First-Attempt Failure of Video Laryngoscopy in the Intensive Care Unit.
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ABSTRACT:
SUBMITTER: Semler MW
PROVIDER: S-EPMC5427726 | biostudies-literature | 2017 Mar
REPOSITORIES: biostudies-literature
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If at First You Don't Succeed: Patient Characteristics Associated with First-Attempt Failure of Video Laryngoscopy in the Intensive Care Unit.
Semler Matthew W MW Mikkelsen Mark E ME
Annals of the American Thoracic Society 20170301 3
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Project description:BackgroundRecent trials showed that video laryngoscopy (VL) did not yield higher first-attempt tracheal intubation success rate than direct laryngoscopy (DL) and was associated with higher rates of complications. Tracheal intubation can be more challenging in the general ward than in the intensive care unit. This study aimed to investigate which laryngoscopy mode is associated with higher first-attempt intubation success in a general ward.MethodsThis is a retrospective study of tracheal intubations conducted at a tertiary academic hospital. This analysis included all intubations performed by the medical emergency team in the general ward during a 48-month period.ResultsFor the 958 included patients, the initial laryngoscopy mode was video laryngoscopy in 493 (52%) and direct laryngoscopy in 465 patients (48%). The overall first-attempt success rate was 69% (664 patients). The first-attempt success rate was higher with VL (79%; 391/493) than with DL (59%; 273/465, p < 0.001). The first-attempt intubation success rate was higher among experienced operators (83%; 266/319) than among inexperienced operators (62%; 398/639, p < 0.001). In multivariate logistic regression analyses, VL, pre-intubation heart rate, pre-intubation SpO2 > 80%, a non-predicted difficult airway, experienced operator, and Cormack-Lehane grade were associated with first-attempt intubation success in the general ward. Over all intubation-related complications were not different between two groups (27% for VL vs. 25% for DL). However, incidence of a post-intubation SpO2 < 80% was higher with VL than with DL (4% vs. 1%, p = 0.005), and in-hospital mortality was also higher (53.8% vs. 43%, p = 0.001).ConclusionIn a general ward setting, the first-attempt intubation success rate was higher with video laryngoscopy than with direct laryngoscopy. However, video laryngoscopy did not reduce intubation-related complications. Furthers trials on best way to perform intubation in the emergency settings are required.
| S-EPMC6089856 | biostudies-literature
Project description:Adverse reactions, including severe cutaneous reactions, to cystic fibrosis transmembrane conductance regulator (CFTR) modulators have been described in the literature. Herein we present a drug eruption in response to elexacaftor/tezcaftor/ivacaftor (brand name, Trikafta) in a 7-year-old male with cystic fibrosis, followed by desensitization and successful continuation. A review of the literature outlining similar cases is provided. Attempting to mitigate and manage drug reactions to CFTR modulators is essential because they represent vital and irreplaceable therapies for individuals with cystic fibrosis (CF).
| S-EPMC9268110 | biostudies-literature
Project description:BackgroundThere are limited data on the use of video laryngoscopy for pediatric patients outside of the operating room.AimOur primary aim was to evaluate whether implementation of video laryngoscopy-guided coaching for tracheal intubation is feasible with a high level of compliance and associated with a reduction in adverse tracheal intubation-associated events.MethodsThis is a pre-post observational study of video laryngoscopy implementation with standardized coaching language for tracheal intubation in a single-center, pediatric intensive care unit. The use of video laryngoscopy as a coaching device with standardized coaching language was implemented as a part of practice improvement. All patients in the pediatric intensive care unit were included between January 2016 and December 2017 who underwent primary tracheal intubation with either video laryngoscopy or direct laryngoscopy. The uptake of the implementation, sustained compliance, tracheal intubation outcomes including all adverse tracheal intubation-associated events, oxygen desaturations (<80% SpO2), and first attempt success were measured.ResultsAmong 580 tracheal intubations, 284 (49%) were performed during the preimplementation phase, and 296 (51%) postimplementation. Compliance for the use of video laryngoscopy with standardized coaching language was high (74% postimplementation) and sustained. There were no statistically significant differences in adverse tracheal intubation-associated events between the two phases (pre- 9% vs. post- 5%, absolute difference -3%, CI95 : -8% to 1%, p = .11), oxygen desaturations <80% (pre- 13% vs. post- 13%, absolute difference 1%, CI95 : -6% to 5%, p = .75), or first attempt success (pre- 73% vs. post- 76%, absolute difference 4%, CI95 : -3% to 11%, p = .29). Supervisors were more likely to use the standardized coaching language when video laryngoscopy was used for tracheal intubation than with standard direct laryngoscopy (80% vs. 43%, absolute difference 37%, CI95 : 23% to 51%, p < .001).ConclusionsImplementation of video laryngoscopy as a supervising device with standardized coaching language was feasible with high level of adherence, yet not associated with an increased occurrence of any adverse tracheal intubation-associated events and oxygen desaturation.
| S-EPMC9357165 | biostudies-literature
Project description:Video 1.If at first you don't succeed… A complicated course of endoscopic reversal of a gastric bypass.
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Project description:Procedural memory is involved in the acquisition and control of skills and habits that underlie rule and procedural learning, including the acquisition of grammar and phonology. The serial reaction time task (SRTT), commonly used to assess procedural learning, has been shown to have poor stability (test-retest reliability). We investigated factors that may affect the stability of the SRTT in adults. Experiment 1 examined whether the similarity of sequences learned in two sessions would impact stability: test-retest correlations were low regardless of sequence similarity (r < .31). Experiment 2 added a third session to examine whether individual differences in learning would stabilise with further training. There was a small (but nonsignificant) improvement in stability for later sessions (Sessions 1 and 2: r = .42; Sessions 2 and 3: r = .60). Stability of procedural learning on the SRTT remained suboptimal in all conditions, posing a serious obstacle to the use of this task as a sensitive predictor of individual differences and ultimately theoretical advance.
| S-EPMC11529135 | biostudies-literature
Project description: Not available
| S-EPMC9843071 | biostudies-literature
Project description:Behavioral traits can be determined from the consistency in an animal's behaviors across time and situations. These behavioral traits may have been differentially selected in closely related species. Studying the structure of these traits across species within an order can inform a better understanding of the selection pressures under which behavior evolves. These adaptive traits are still expected to vary within individuals and might predict general cognitive capacities that facilitate survival, such as behavioral flexibility. We derived five facets (Flexible/Friendly, Fearful/Aggressive, Uninterested, Social/Playful, and Cautious) from behavioral trait assessments based on zookeeper surveys in 52 Felidae individuals representing thirteen species. We analyzed whether age, sex, species, and these facets predicted success in a multi access puzzle box-a measure of innovation. We found that Fearful/Aggressive and Cautious facets were negatively associated with success. This research provides the first test of the association between behavioral trait facets and innovation in a diverse group of captive felidae. Understanding the connection between behavioral traits and problem-solving can assist in ensuring the protection of diverse species in their natural habitats and ethical treatment in captivity.
| S-EPMC9703991 | biostudies-literature
Project description:ObjectiveTo assess the association between likelihood of success of smoking cessation attempts and time since most recent attempt.MethodsProspective study of 823 smokers who reported a failed quit attempt in the last 12 months at baseline and ≥1 quit attempt over 6-month follow-up. The input variable was time in months between the end (and in an exploratory analysis, the start) of the most recent failed quit attempt reported retrospectively at baseline and start of the first attempt made during the 6-month follow-up period. The outcome variable was success in the latter quit attempt.ResultsSuccess rates for failed quitters who waited <3, 3-6, and 6-12 months between their failed quit attempt ending and making a subsequent quit attempt were 13.8%, 17.5%, and 19.0% respectively. After adjustment for covariates, the odds of cessation relative to those who made a subsequent quit attempt within 3 months were 1.42 (95%CI 0.79-2.55) and 1.52 (95%CI 0.81-2.86) for those who waited 3-6 and 6-12 months respectively before trying again. Bayes factors indicated the data were insensitive. The exploratory analysis showed the odds of cessation were 1.55 (95%CI 0.78-3.08), 1.92 (95%CI 0.94-3.92), and 2.47 (95%CI 1.04-5.83) greater for those with an interval of 3-6, 6-12, and 12-18 months respectively than those who tried again within 3 months.ConclusionsWhile pre-planned analyses were inconclusive, exploratory analysis of retrospective reports of quit attempts and success suggested the likelihood of success of quit attempts may be positively associated with number of months since beginning a prior quit attempt. However, only the longest inter-quit interval examined (12-18 months) was associated with significantly greater odds of quit success relative to a <3 month interval in fully adjusted models; all other comparisons were inconclusive.
| S-EPMC7163297 | biostudies-literature
Project description:ObjectiveTo assess the efficacy and safety of visual rigid laryngoscopy and video laryngoscopy and to provide clinical information for developing a more suitable intubation tool for elderly patients.MethodsIn 75 consecutive elderly patients undergoing elective surgery in a single institution, tracheal intubation was randomly performed by 2 experienced anaesthesiologists using visual rigid laryngoscopy (Group I, n = 38) or video laryngoscopy (Group II, n = 37). The primary outcome was intubation time. Secondary outcomes were the first-attempt success rate of tracheal intubation, haemodynamic responses at 1, 3, and 5 min after intubation and the incidence of postoperative airway complications, including immediate complications and postoperative complaints.ResultsThe intubation times were 35.0 (30.0-41.5) s and 42.5 (38.0-51.3) s in Groups I and II, respectively (P < 0.001). The difference in direct complications between the two groups was statistically significant (P < 0.05). In contrast, there was no significant difference between the two groups regarding the follow-up of the main complaint 30 min and 24 h after tracheal extubation (P > 0.05). There was no difference in the intubation success rate between the 2 groups (P > 0.05). The haemodynamic responses at 1, 3, and 5 min after intubation were not significantly different (P > 0.05).ConclusionCompared with that of video laryngoscopy, the intubation time of visual rigid laryngoscopy in elderly patients was shorter. At the same time, visual rigid laryngoscopy reduced the incidence of immediate complications. However, during endotracheal intubation, there was no significant difference in haemodynamics between the two groups.Clinical trial registration numberChiCTR2100054174.
| S-EPMC11495622 | biostudies-literature