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Background Objectives Methods Results and Conclusions Comprehensive assessment of skills and performance are necessary to improve the quality of care in nursing education. Various factors pose challenges to accurate assessments, including high student–teacher ratio and observer bias.To establish an assessment system based on first‐person video of smart glasses and validate its usability and feasibility.We used two cameras (smart glasses for first‐person perspective and a web cam) to perform video analysis for skill and performance assessments. Usability tests were conducted using quantitative and qualitative questionnaires for the usefulness and acceptability of the current assessment system. Data from standardised checklists for three clinical nursing skills (intramuscular injection, endotracheal suction, and Levin tube feeding) were used to analyse the inter‐rater reliability in addition to Fleiss' Kappa coefficient analysis. A total of 22 participants (18 students and 4 reviewers) were recruited. They completed the study. Apart from physical discomfort component, the proposed smart glasses‐based first‐person video assessment system achieved good usability scores from both students and reviewers.Fleiss' Kappa values for individual items ranged from 0.450 to 0.808, with an overall average value of 0.592. Results of this study validated the potential of smart glasses‐based assessment system where a set of beneficial mechanisms may meaningfully support the formative learning process. However, issues regarding upgrading the device and need for guidelines for roles of raters and students still remain. [ABSTRACT FROM AUTHOR]

The given text provides summaries of multiple articles and research studies related to anesthesia and healthcare practices. The summaries cover a wide range of topics, including professional communication, trauma care, theater efficiency, dental sedation, mentoring networks, and more. These summaries offer valuable insights into various aspects of anesthesia and healthcare practices, making them useful for library patrons conducting research in these areas. It is suggested that addressing factors such as professional hierarchy, gender, and experience can improve communication and patient outcomes in peri-operative teams. [Extracted from the article]

Background: The retention of gastric contents at surgery presentation is a risk factor for perioperative aspiration. A preoperative fasting (nilper os; NPO) interval is widely used to reduce this risk, but this approach is based on assumptions about the prevalence of typical gastric emptying rates. We assessed NPO guidelines' reliability with ultrasound (US) imaging and suction in pediatric patients presenting for single long‐bone fracture repair after appropriate NPO intervals, when nearly all should have had empty stomachs. Aims and Methods: This prospective cross‐sectional observational study comprised 200 pediatric surgical patients. As their NPO times varied by food/drink type, we defined "weighted NPO units" as the lowest multiple of elapsed recommended NPO times between consumption and surgery for each type of food or drink. We used US to image the stomach and its contents before anesthesia induction, followed by gastric suction. We evaluated the relationships between weighted NPO units, US gastric contents grade, opioid analgesic dosage and timing, and suctioned volume. Results: Despite meeting typical NPO standards (median 14 h fasting), many patients retained nontrivial quantities of gastric contents at surgery. Weighted NPO units did not exhibit statistically‐significant relationships with either suctioned volume or US grade. However, suctioned volume did correspond well to US grade. Conclusion: NPO status may be a less reliable predictor of gastric contents at anesthesia induction in this patient population than has been assumed. Bedside US screening appears to provide more useful information for the planning of airway management. [ABSTRACT FROM AUTHOR]

Introduction: Neonates in intensive care units often require endotracheal intubation and mechanical ventilation. During this intubation procedure, a stylet is frequently used along with an endotracheal tube. Despite the widespread use of a stylet, it is still not known whether its use increases the intubation success rate. This study examined the association between stylet use and the intubation success rate in surgical neonates. Methodology: This single‐center study was conducted between December 2021 and December 2022 in the Neonatal surgical intensive care unit of a tertiary care center in Northern India. Infants were randomized to have the endotracheal intubation procedure performed using either an endotracheal tube alone or with a stylet. The primary outcome of the study was to assess the successful first‐attempt neonatal endotracheal intubation rate with and without using a stylet. Apart from the rate of successful intubation, the duration of the intubation and complications during the intubation procedures as measured by bradycardia, desaturation episodes, and local trauma were also recorded. Both groups were thus compared on above mentioned outcomes. Results: The total number of neonates enrolled were 200, and the overall success rate (81% in the stylet group vs. 73% in the non‐stylet group) was not statistically significant. Intubation time was however less, when stylet was used (16.2 ± 4.3 vs. 17.5 ± 5.0 s, p =.046). When the endotracheal tube size was 3 or less, the success rate was substantially higher in the stylet group (80%) than the non‐stylet group (63%), p =.03. No statistical difference was recorded for bleeding and local trauma, though the esophageal intubation rate was higher when intubation was attempted without the stylet. Conclusion: Endotracheal intubation using a stylet did not significantly improve the success rate of the procedure, however, intubation time significantly varied between groups and in different conditions. The rigidity and curvature provided by the stylet may facilitate the process of intubation when smaller caliber endotracheal tubes are used. [ABSTRACT FROM AUTHOR]

Aim: We developed an augmented reality technology‐based endotracheal aspiration simulation tool (the AR tool) consisting of three modes: a mode for nursing students to learn endotracheal aspiration by themselves (learning mode); a mode for repeated practice (practice mode); and a mode for confirmation testing (test mode). This study aimed to compare the learning outcomes of the AR tool with traditional training mannequins and identify potential uses and improvements of the AR tool. Methods: We invited students, and faculty members from the three universities who agreed to cooperate in conducting this study. Fifty‐four students and nine faculty members agreed to participate in this study. The students were divided into two groups. One group was to study with the AR tool and the other group was to study with the traditional half‐body training mannequin for suction. The students in both groups were asked to demonstrate endotracheal aspiration on another full‐body type training mannequin which could be used as a patient with a tracheostomy (Skill test). Group interviews with faculty members focused on the topic of the AR tool's potential use in nursing education and improvement needed. Results: There was little significant difference in the skill test results of endotracheal aspiration of students in both groups. The students and faculty members both expressed an interest in the AR tool. They said it was suitable for self‐study of endotracheal aspiration. Conclusions: This AR tool is an effective teaching tool for learning the sequence of endotracheal suctioning, although there are some areas that need improvement. [ABSTRACT FROM AUTHOR]

Background: Unhoused patients face significant barriers to receiving health care in both the inpatient and outpatient settings. For unhoused patients with heart failure who are in extremis, there is a lack of data regarding in‐hospital outcomes and resource utilization in the setting of cardiogenic shock (CS). Hypothesis: Unhoused patients hospitalized with CS have increased mortality and decreased use of invasive therapies as compared to housed patients. Methods: The National Inpatient Sample (NIS) database was queried from 2011 to 2019 for relevant ICD‐9 and ICD‐10 codes to identify unhoused patients with an admission diagnosis of CS. Baseline characteristics and in‐hospital outcomes between patients were compared. Binary logistic regression was used to adjust outcomes for prespecified and significantly different baseline characteristics (p <.05). Results: We identified a weighted sample of 1 202 583 adult CS hospitalizations, of whom 4510 were unhoused (0.38%). There was no significant difference in the comorbidity adjusted odds of mortality between groups. Unhoused patients had lower odds of receiving mechanical circulatory support, left heart catheterization, percutaneous coronary intervention, or pulmonary artery catheterization. Unhoused patients had higher adjusted odds of infectious complications, undergoing intubation, or requiring restraints. Conclusions: These data suggest that, despite having fewer traditional comorbidities, unhoused patients have similar mortality and less access to more aggressive care than housed patients. Unhoused patients may experience under‐diuresis, or more conservative care strategies, as evidenced by the higher intubation rate in this population. Further studies are needed to elucidate long‐term outcomes and investigate systemic methods to ameliorate barriers to care in unhoused populations. Key points: Unhoused patients hospitalized with cardiogenic shock (CS) have fewer traditional comorbidities however similar in‐hospital outcomes compared to housed patients.Unhoused patients with CS receive left and right heart catheterization and mechanical circulatory support less frequently than housed patients, however, undergo endotracheal intubation with greater frequency.A multidisciplinary approach along with strong community partnerships may result in improved access to care for this vulnerable population. [ABSTRACT FROM AUTHOR]

Background: This study aimed at figuring out the different effects of a neural integrity monitor electromyography endotracheal tube (NIM-EMG-ETT) and a standard endotracheal tube (ETT) on postoperative sore throat (POST). Methods: This prospective cohort study enrolled 143 patients scheduled to undergo general anesthesia with endotracheal intubation. Patients were allocated into three groups: Group A, non-thyroid surgery with a standard ETT; Group B, thyroid surgery with a standard ETT; Group C, thyroid surgery with a NIM-EMG-ETT. The incidence, the severity and visual analog scale (VAS) of POST were recorded. The incidence and the severity of POST were tested by χ2 test or Fisher's exact test. And VAS of POST was tested by Kruskal–Wallis test. Results: The incidences of POST in Group B and Group C were significantly higher than that of Group A at all the time points after extubation (P < 0.001). The incidences of POST in Group C was significantly higher than that in Group B at 8 h, 24 h and 48 h after extubation (89.4% vs. 68.8%, P = 0.014, relative risk (RR) 1.30, 95% confidence interval (CI) 1.05–1.61; 89.4% vs. 58.3%, P = 0.001, RR 1.53, 95% CI 1.18–1.98; 76.6% vs. 45.8%, P = 0.002, RR 1.67, 95% CI 1.18–2.36). Moreover, there was a significant higher VAS of POST and more serious POST with Group C than with Group B. Conclusions: A NIM-EMG-ETT may induce higher incidence of POST and more serious POST than a standard ETT. Trail Registration: Chinese Clinical Trail Registry (http://www.chictr.org.cn/index.aspx, ChiCTR2200058896, 2022-4-18). [ABSTRACT FROM AUTHOR]

This article discusses a randomized controlled trial conducted at St. Luke Catholic Hospital in Wolisso, Ethiopia, comparing the use of a bulb syringe or a suction catheter for oro-nasopharyngeal suctioning at birth. The study found that there was no statistically significant difference in outcomes between the two methods, suggesting that installing a suction system may not be a priority in settings where it is currently unavailable. The trial had some limitations, including a small sample size and lack of blinding. The authors suggest that suctioning with a bulb syringe may offer some benefits in terms of cost and waste. [Extracted from the article]

Aim: To review and analyse the evidence on the efficacy and safety of non‐pharmacological interventions for preterm infants to relieve endotracheal suctioning (ES) pain. Design: A systematic review per the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. Methods: Six databases were searched with a retrieval strategy. Parallel and crossover randomized controlled trials reporting non‐pharmacological interventions for relieving ES pain in preterm infants were identified from inception to 1 September 2021. The protocol was published in PROSPERO (CRD42021276058). Results: Ten studies were retrieved, including nine different non‐pharmacological interventions. Seven studies reported that non‐pharmacological interventions in relieving pain were more effective than conventional care during ES, and three trials reported its safety. Due to the heterogeneity of pain assessment tools, time of assessment and population, only Facilitated tucking had sufficient evidence that it is a safe and effective non‐pharmacological intervention. [ABSTRACT FROM AUTHOR]

Background: The respiratory consequences of daily nursing care interventions in patients with acute respiratory distress syndrome (ARDS) are not clearly established. Aims and objectives: The main objective of this study was to assess the feasibility of alveolar collapse analysis by the measurement of lung impedance distribution technique during nursing care in patients with ARDS. Design: Prospective observational pilot physiologic study in a surgical intensive care unit of a tertiary care hospital including adult intubated patients with moderate‐to‐severe ARDS. Methods: Each patient was monitored for 12 hours using a chest impedance device. Daily care interventions studied were as follows: endotracheal suctioning, mouth care, bed‐bathing, and blood sampling. The primary endpoint was the variation in end‐expiratory lung impedance (reflecting functional residual capacity) before and 1, 5, 15, and 30 minutes after nursing care interventions. Data are presented as median (interquartile‐range). Results: One hundred and eight events were collected in 18 patients. Endotracheal suctioning (n = 42), mouth care (n = 26), and bed‐bathing (n = 23) induced a significant decrease in lung impedance after care: endotracheal suctioning (−40.0 [−53.8; −28.6]% at 1 minute [P <.001], −10.4 [−27.9; 1.8]% at 30 minutes [P =.03]; mouth care −17.9 [−45.4; −14.6]% at 1 minute [P <.001], −10.4 [−21.3; 3.4]% at 30 minutes [P =.01]; bed‐bathing −40.2 [−53.5; −14.3]% at 1 minute [P <.001], −10.6 [−36.4; 1.6]% at 30 minutes [P =.01]). Blood sampling (n = 17) did not induce significant changes in lung impedance. Conclusions: The lung impedance distribution technique during nursing care appears feasible in the majority of patients with ARDS. Some daily nursing care in ARDS patients (including bed‐bathing and mouth care) resulted in a prolonged decrease in lung functional residual capacity and therefore could be associated with pulmonary de‐recruitment. Relevance to clinical practice: A caregiver who has to assess the functional residual capacity of these patients should probably be informed of the schedules of the nursing care interventions. [ABSTRACT FROM AUTHOR]

Background: COVID‐19 has been linked to over 40 million infections and 1.1 million deaths in 210 countries as of October 19, 2020. This highly contagious communicable disease has put not only infected individuals but other patients and frontline workers like nurses at risk in hospitals, especially in Intensive Care units (ICUs). There is a need for minimizing patient contact, improving hand hygiene practices, and optimizing healthcare provider time, especially nurses. Globally it is estimated that nearly a million health care providers have been infected with COVID‐19 as of the end of October 2020. Methods: This retrospective service evaluation documents the experience of health care providers in a COVID‐19 ICU in India that was used to implement new protocols for secretion management and oral hygiene. Patient chart information and staff feedback were utilized. Intervention: This pilot study captures the practical benefits of using VAPCare, an automated, closed‐loop system for oral secretion removal. Results: Six patients were included in this small‐scale study; three patients following the current standard of care for suctioning and oral hygiene and three receiving the new VAPCare and Lumen device protocol. With the new device protocol, the number of infected secretion interactions by a nurse was 50% lower, and nursing time spent on oral hygiene and secretion management 70% less than seen with the current standard of care. The number of disposable gloves used with VAPCare and Lumen was reduced by over 50%. All 10 nurses and six doctors gave positive feedback on device usage. The department recommended updating protocols to prioritize the use of the new secretion management system for patients with COVID19 and other highly contagious conditions. Conclusion: The findings are an early indication that using VAPCare for patients could help protect infected patients, other ICU patients, and health care workers. [ABSTRACT FROM AUTHOR]

The article discusses the importance of cerebral blood flow (CBF) in neonatology and the potential use of cerebral blood volume (CBV) as a surrogate measure of CBF. The authors explain that CBV can be measured easily and accurately using near-infrared spectroscopy (NIRS). They also discuss the limitations and challenges of using CBV as a measure of CBF, including the need for greater precision and the uncertainty of its relationship with other factors that affect CBF. The article concludes by suggesting that further research and clinical consideration are needed to determine the usefulness of CBV as a tool in neonatal care. [Extracted from the article]

Background and Purpose: The Physical Therapy Competence Assessment for Airway Suctioning (PT‐CAAS) is a recently developed measure to assess the clinical competence of physiotherapists who perform airway suctioning with adults. The purpose of this study was to assess the inter‐rater and intra‐rater reliability of the PT‐CAAS. Methods: Scoring rules were developed through expert consultation. Reliability was then assessed using nine videos of suctioning performed in a simulated learning environment. A repeated measures design was used, with two replicate sets of measurements made by each participant for all videos. Data were analyzed using a repeated measures model for the concurrent assessment of inter‐rater and intra‐rater reliability. Participants were physiotherapists with suctioning experience. Results: Twenty physiotherapists completed initial scoring and re‐scoring for all nine videos; their data were included in the analysis. Intraclass correlation coefficients (ICCs) for inter‐rater reliability ranged from 0.569 [lower one‐sided 95% confidence interval (CI): 0.395; standard error of measurement (SEM): 0.963] for infection control to 0.759 (lower one‐sided 95% CI: 0.612; SEM: 0.722) for post‐suctioning assessment and care. The inter‐rater ICC for overall performance was 0.752 (lower one‐sided 95% CI: 0.602; SEM: 0.660). ICCs for intra‐rater reliability ranged from 0.759 (lower one‐sided 95% CI: 0.197; SEM 0.721) for infection control to 0.860 (lower one‐sided 95% CI: 0.544; SEM: 0.550) for post‐suctioning assessment and care. The intra‐rater ICC for overall performance was 0.867 (lower one‐sided 95% CI: 0.559; SEM: 0.483). Discussion: Evidence of moderate to good inter‐rater and good intra‐rater reliability was found; however, the results should be interpreted with caution given the wide CIs and relatively large SEMs. Improved assessor training and assessments of reliability using a larger sample size are recommended. [ABSTRACT FROM AUTHOR]

An 18‐month‐old boy weighing 6 kilograms developed complete collapse of left lung following total correction of Tetralogy of Fallot on the next day of extubation. He received extensive chest physiotherapy, along with lung recruitment maneuver by using bubble CPAP, which failed to show any improvement in lung expansion in 2 days. He was then electively intubated on 3rd postoperative day (POD3) for the purpose of suctioning tracheobronchial secretions and maintaining positive airway pressure to open up the left lung. Good results were obtained immediately after intubation, and he was extubated 9 h later. His lung showed complete aeration afterward. He was transferred out of ICU on POD5 and discharged home on POD10. Lung collapse is common following pediatric cardiac surgery, and chest physiotherapy is the initial treatment. In extubated patients, if collapse does not improve with physiotherapy and provision of flexible bronchoscopy is not available, brief elective intubation for endotracheal suctioning and delivery of positive end expiratory pressure (PEEP) treats lung collapse. [ABSTRACT FROM AUTHOR]

Background: Laryngoscopy is a difficult skill to acquire and maintain and even more so by less frequent users. Numerous studies have compared limitations of direct laryngoscopic (DL) and video‐assisted laryngoscopic (VL) techniques for endotracheal intubation in different scenarios, but individual retention over time of intubation skills with either technique has, to our knowledge, never been reported. The primary aim of this study was to evaluate to what extent recently acquired basic skills of endotracheal intubation, based on DL or VL, are being maintained over time by inexperienced operators. Methods: This randomized crossover follow‐up study was designed to compare endotracheal intubation with direct (McIntosh blade) versus video‐assisted (hyperangulated blade) laryngoscopy by 20 undergraduate medical students in identical manikins three months after brief basic intubation training with no further intubation practice. Results: No significant differences in skills retention were found between DL and VL regarding the time for successful intubation or number of adverse events. However, the first intubation was significantly slower regardless of the technique compared with the last one three months earlier. Furthermore, DL was slower and associated with more incidents of esophageal intubation and dental manipulation than was VL. Conclusions: Although basic intubation skills seem to be similarly well maintained over time regardless of the laryngoscopic technique, endotracheal intubation with VL by inexperienced operators is faster and associated with fewer adverse events than is DL after a three‐month period with no further intubation training. [ABSTRACT FROM AUTHOR]

Objective(s): Our hypothesis was that our devised transesophageal echocardiography probe cover with the capacity for pinpoint suction would improve image quality. Design: Prospective cohort study. Setting: Single tertiary medical center. Participants: Patients undergoing surgery requiring intraoperative transesophageal echocardiography. Interventions: Suctioning with inserted orogastric tube. Measurements and main results: Changes in image quality with suctioning were assessed by 2 methods. In method #1, investigators categorized the quality of all acquired images on a numeric scale based on each investigator's impression (1: very poor, 2: poor, 3: acceptable, 4: good, and 5: very good). In method #2, the reproducibility of the left ventricular fraction area change (LV FAC) was assessed, assuming that improved transgastric midpapillary short‐axis view image quality would yield better LV FAC reproducibility. With method #1, for midesophageal views, 26.5%, 70.5%, and 3.0% of images showed improved, the same, and worsened image quality, respectively. For transgastric views, 55.3%, 43.3%, and 1.4% showed improved, the same, and worsened image quality, respectively. For deep transgastric views, 60.0%, 38.0%, and 2.0% showed improved, the same, and worsened image quality, respectively. With method #2, the presuction group had an ICC of 0.942 (95% CI: 0.91, 0.965). The postsuction group had an ICC of 0.988 (95% CI: 0.981, 0.993). Conclusions: Our investigation validates the potential image quality improvement withour devised TEE probe cover. However, its clinical validity needs to be confirmed by further studies. [ABSTRACT FROM AUTHOR]

Background: Endotracheal suction (ETS) is essential in intubated patients to prevent tube occlusion and is one of the most common nursing interventions performed in intensive care. Aims and objectives: To explore how paediatric ETS practices reflect evidence‐based practice (EBP) recommendations in paediatric intensive care units (PICU) worldwide. Study design and methods: A cross‐sectional electronic survey linked to a real patient suction episode. Nurses completed the survey following a recent ETS episode. Evidence‐based practice (EBP) was defined based on four of the American Association for Respiratory Care (AARC) best evidence recommendations: pre‐oxygenation before suction, use of a suction catheter no more than half the diameter of the tracheal tube, shallow depth of suction, and the continuous suction applied upon withdrawal of the catheter. Participants included PICU nurses who performed ETS in children (0‐17 years) excluding preterm neonates. Results: Four hundred forty‐six complete surveys were received from 20 countries. Most nurses (80%, 367/446) reported that their units had local guidelines for ETS. The most common reason for suctioning (44%) was audible/visible secretions. Over half of ETS episodes (57%) used closed suction. When exploring the individual components of suction, 63% (282/446) of nurses pre‐oxygenated their patient prior to suction, 71% (319/446) suctioned no further than 0.5 cm past end of the endotracheal tube (ETT), 59% (261/446) used a catheter no more than half the diameter of the ETT, and 78% (348/446) used continuous negative pressure. 24% of nurses gave patients an additional bolus of sedative, analgesic, and/or muscle‐relaxant medication prior to suction; this decision was not related to the child's history of instability with suction, as there was no significant difference in those who reported patients had a history of being unstable with suction (P =.80). 26% (117/446) of nurses complied with all four EBP components in the reported suctioning episode. Conclusions: Considerable variation in paediatric endotracheal suctioning practices exists internationally. Although most nurses applied single components of evidence‐based recommendations during ETT suctioning, just a quarter applied all four elements. Relevance to clinical practice: Nurses need to consider and strive to apply EBP principles to common nursing interventions such as ETS. [ABSTRACT FROM AUTHOR]

Aim: To compare the effects and safety of open and closed endotracheal suction in children with severe brain injury. Design: A single‐blinding, single‐centre randomized controlled trial (RCT). Methods: The children with severe brain injury admitted to the intensive care unit (ICU) from 1 September 2020–31 August 2022 will be included. And a total of 172 children with severe brain injury are expected to be included. The intracranial pressure, SpO2 and heart rate before suctioning, at the end of suction, and at 5 and 10 min after suction, the estimated sputum volume for each suction, the incidence of ventilator‐associated pneumonia, the duration of mechanical ventilation and the length of ICU stay will be analysed. Results: This present RCT has been prospectively registered in China Clinical Trial Registry (http://www.chictr.org.cn, ChiCTR2000030963). This present study is expected to provide reliable evidence to the airway management in children with severe brain injury. [ABSTRACT FROM AUTHOR]

Data about the diagnostic efficiency of bilateral bronchoalveolar lavage (BAL) samples and endotracheal aspirates (EA) testing for common viral respiratory infections are scarce. We analyzed data from 167 cases, where bilateral BAL samples were tested, and from 101 cases, where BAL samples and EA were tested. Multiplex polymerase chain reaction (PCR) was performed with the fast track diagnostics viral respiratory panel, producing data on the adenovirus, coronavirus, enterovirus, human metapneumovirus, bocavirus, influenza virus, parainfluenza virus, rhinovirus, and respiratory syncytial virus status of patients with respiratory disease symptoms. In the bilateral BAL cohort, 46 (27.5%) cases were positive for at least one of the viruses mentioned above in both samples. Discrepant results (virus not detected on one side) were seen in six (3.6%) cases. In the BAL versus EA cohort, 12 (11.9%) cases were positive in both materials, discrepant results (only one material being positive) were observed in 11 (10.9%) cases, with seven (63.6%) BAL samples, and four (36.4%) EA being positive. Bilateral sampling does not significantly improve the diagnostic efficiency of BAL for the detection of common respiratory viral pathogens via PCR. The diagnostic quality of EA and BAL samples for the detection of common viral respiratory pathogens is comparable. [ABSTRACT FROM AUTHOR]

A case study of a male infant born at 24-weeks' gestation by emergency cesarean section due to tocolysis failure, was intubated and admitted to the neonatal intensive care unit. Topics include bronchopulmonary dysplasia progressed that continued to require high oxygen concentration and high ventilator settings; and the patient suffered aspiration pneumonia caused by methicillin-sensitive Staphylococcus aureus (MSSA).

Objectives: Endotracheal intubation is an essential skill of every emergency department clinician. The current practice of emergency intubation in the emergency departments in China and its safety is largely unknown. This study aimed at evaluating the practice and the safety profile of emergency intubation in an emergency department in Shenzhen. Methods: This study was of retrospective design. It was conducted in the emergency department of a university affiliated hospital. All patients requiring emergency intubation from 1 January 2017 to 30 June 2018 were recruited. Data on demographic and clinical characteristics of patients and characteristics of intubations were collected and analyzed. Results: A total of 128 patients were analyzed. Patients with spontaneous intracerebral hemorrhage were most common. Airway protection for patency was the most common indication of intubation. Most intubations were performed by emergency department staff with direct laryngoscopy. The first attempt success rate was 93.8%. Serious adverse events were rare. Conclusion: The practice of endotracheal intubation in the emergency department is in line with international ones. The safety profile is good. A national registry of emergency airway management is recommended. [ABSTRACT FROM AUTHOR]

Introduction: Atelectasis is a common problem in intensive care units. It usually occurs due to airway obstruction caused by pulmonary secretions. As the left main bronchus angulates from carina more sharply, suctioning of the secretions from left side is less effective, causing failure in treatment of left lung atelectases. If chest physiotherapy and medical treatment fail, bronchoscopy should be considered; but it requires experience, time, effort and a higher cost. Objectives: To evaluate the success of a novel method "selective left bronchial aspiration (SeLBA)" in the treatment of left lung atelectases. Methods: The study consisted of 10 patients who suffered left lung atelectasis and treated with double catheter suctioning technique, SeLBA in Pediatric Intensive Care Unit of Hacettepe University Ihsan Dogramaci Children's Hospital between June 2017 and February 2019. The outcomes were evaluated by comparing the chest X‐rays before and after the procedure. Results: All of the patients' atelectases resolved successfully by SeLBA procedure. Conclusion: We introduce this novel technique of reopening the atelectased left lung as a rapid, safe and practical alternative for bronchoscopic clear away. [ABSTRACT FROM AUTHOR]

Introduction/Objectives: The aim of our study was to assess the safety, efficacy and feasibility of an Expiratory Flow Accelerator (EFA) device, Free Aspire, in reducing the need for daily suctions in tracheostomised (TCS) patients. Methods: Twenty‐five patients (13 males, 12 females, aged 69.88 ± 9.06 years) were investigated. The number of superficial/deep suctions, shallows, arterial blood gas (ABG) analysis, perception of mucus encumbrance (Visual Numeric Scale, VNS) and adverse event were recorded for five days. On the first two days (T1‐T2), suctioning was performed as usual, on the following three days (T3, T4, T5), patients were treated also with Free Aspire (20 min, 3 times a day). Results/Conclusion: The use of the non‐invasive device was associated with a decrease of total number of aspirations from T2 to T5 (8.48 ± 2.62 vs 4.48 ± 3.08, P = 0.0003). Total number of daily aspirations decreased over the five days (8.68 ± 3.64 vs 4.48 ± 3.08, P = 0.0009). Deep aspirations decreased from T1 to T5 (6.16 ± 3.53 vs 1.80 ± 1.50, P = 0.0001). ABG data confirmed that no significant side effects occurred. VNS score decreased from 7.03 ± 1.42 at T1 to 4.05 ± 1.80 at T5 (P < 0.0001). These data suggest that EFA may be useful for managing secretions in TCS patients, as it can reduce the number of daily suctions, particularly the deep ones, and may improve the perception of mucus encumbrance, without side effects. More studies are needed to confirm these data and to understand in which categories of TCS patients this device can be introduced. [ABSTRACT FROM AUTHOR]

Pain is a stressor for intensive care unit (ICU) patients, and inadequate pain assessment has been linked to increased morbidity and mortality. One hundred and twenty patients were evaluated during three periods: (T1) 1 min before, (T2) during, and (T3) 20 min after the nociceptive procedure. For each patient, data were obtained through at least two nociceptive procedures. Conscious patients' self‐reports of pain were assessed using the Numerical Rating Scale and Visual Analog Scale. For unconscious patients, the Behavioral Pain Scale was used instead. Descriptive statistical methods, Friedman's test, and Spearman's rank correlation coefficient were used for the data analysis. Significant changes were observed in heart rate (HR), respiratory rate (RR), and peripheral oxygen saturation (SpO2) during nociceptive procedures. The HR, RR, and pain scores increased, while the SpO2 decreased. Positive correlation coefficients were observed between the pain intensity and HR and RR levels. According to our study findings, vital signs are not strong indicators for pain assessment in neurosurgery ICU patients. However, HR and RR can be used as cues when behavioral indicators are not valid in these unconscious patients. [ABSTRACT FROM AUTHOR]

The article presents a case study of a female newborn with esophageal atresia (EA), tracheoesophageal fistula (TEF), communicating bronchopulmonary foregut malformation (CBPFM), and congenital tracheal stenosis (CTS). Topics discussed include the rationale for choosing the median sternotomy approach, the surgical procedure details, and considerations for managing risks such as mediastinitis.

The main purpose of this study was to evaluate bedside tUS, carried out by neonatologists to assess correct ETT placement, compared with XR. Secondary objectives were threefold: to determine tUS reproducibility between neonatologists, to compare time delays between tUS and XR, and to evaluate its tolerance. We analysed sensitivity of tUS to detect the same ETT position as XR and Kappa coefficient for the concordance between XR and tUS. [Extracted from the article]

Until the 1980s, it was thought that neonates could not perceive or localise pain like adults and painful procedures, including surgery, were regularly performed without analgesics.[1] The same applied to endotracheal intubation. However, premedication practices for neonatal endotracheal intubation differ widely and many infants are still being intubated without any analgesia or sedation.[[2]] The reasons why many neonatologists do not use appropriate premedication have been inadequately evaluated. [Extracted from the article]

ABSTRACT Background Maintaining endotracheal tube patency is critical for neonates receiving mechanical ventilation. Endotracheal tube suctioning removes accumulated secretions preventing potential adverse events, however is also potentially hazardous to the patient. Objective To compare respiratory rate, arterial blood oxygen saturation, heart rate and pain in newborns undergoing endotracheal tube suctioning with closed ( CS) and open ( OS) systems. Methods Randomized crossover trial with 13 newborns from two Brazilian hospitals. The respiratory rate, arterial blood oxygen saturation, heart rate and pain (Premature Infant Pain Profile) were analysed: immediately before ( T1), during ( T2), immediately after ( T3), 10 min after ( T4) and 30 min ( T5) after endotracheal suctioning. Results The majority (11/85·0%) of the newborns were premature and 45% weighed less than 1000 g. No statistically significant difference was identified according to the use of CS or OS to all the parameters investigated. The main results demonstrated that in T2 arterial blood oxygen saturation was higher with CS ( CS 93·0%; OS 89 · 0%; p = 0·561). In T3 there was an increase in respiratory rate average only with the use of OS ( T1 50·0; T3 56·0). The pain score in T2 and heart rate in T3 were higher with OS without significant differences ( p = 0·114; p = 0·479, respectively). Conclusion There was no significant difference in the studied clinical parameters or presence and intensity of pain according to the two investigated techniques of endotracheal tube suctioning. Relevance to clinical practice This research can provide support for clinical practice regarding endotracheal tube suctioning of newborns describing that the use of closed systems was similar to the open system regarding pain presence and intensity, as well as, in the clinical effects analysed, in accordance with other studies produced in this field. [ABSTRACT FROM AUTHOR]

New Australian and New Zealand Neonatal Resuscitation guidelines reflect recent advances in neonatal resuscitation science, as critically appraised by the International Liaison Committee on Resuscitation. Substantial changes since the 2010 guidelines include: (i) updates to the Newborn Resuscitation Flowchart to include a greater emphasis on maintaining normal body temperature, and to emphasise the importance of beginning assisted ventilation by 1 min in infants who have absent or ineffective spontaneous breathing; (ii) updates to the physiology of the normal perinatal transition that resuscitation is trying to restore; (iii) recommendations for more frequent reinforcement of training, and for structured feedback for resuscitation training instructors; (iv) new guidance in relation to the timing of cord clamping for preterm newborn infants; (v) recommendation to monitor body temperature on admission to newborn units as a resuscitation quality indicator; (vi) suggestion to consider electrocardiographic (ECG) monitoring (as an adjunct to oximetry) to obtain more rapid and accurate estimation of heart rate during resuscitation; (vii) removal of previous suggestions to intubate meconium-exposed, non-vigorous term infants to suction the trachea; and (viii) suggestion to establish vascular access to enable administration of intravenous adrenaline (epinephrine) as soon as chest compressions are deemed to be needed. [ABSTRACT FROM AUTHOR]

To date, morphine pharmacokinetics (PKs) are well quantified in neonates, but results about its efficacy are ambiguous. This work presents an analysis of a previously published study on pain measurements in mechanically ventilated preterm neonates who received either morphine or placebo to improve comfort during invasive ventilation. The research question was whether morphine reduces the pain associated with endotracheal or nasal suctioning before, during, and after suctioning. Because these neonates cannot verbalize their pain levels, pain was assessed on the basis of several validated pain measurement instruments (i.e., COMFORT-B, preterm infant pain profile [PIPP], Neonatal Infant Pain Scale (NIPS), and visual analogue scale (VAS)). The item response theory (IRT) was used to analyze the data in order for us to handle the data from multiple-item pain scores. The analysis showed an intra-individual relationship between morphine concentrations and pain reduction, as measured by COMFORT-B and VAS. However, the small magnitude of the morphine effect was not considered clinically relevant for this intervention in preterm neonates. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims The UK Department of Health (2012) recommends a ventilator care bundle in the form of a high impact intervention to reduce the incidence of ventilator-associated pneumonia. The aims of this project were to audit compliance with individual components of this care bundle in the UK. Design The first survey directly addressed compliance with each component of the recommended ventilator care bundle. The second survey was targeted towards the use of subglottic secretion drainage (SSD) and the logistics of implementing it. Methods The first survey was distributed electronically to the Nurse Leads of the Critical Care National Network Nurses Forum and then circulated more widely through local networks. This Forum covers England, Wales and Northern Ireland. The second survey was circulated electronically to the Intensive Care Society Linkmen and was UK-wide. Results The first survey received 112 responses following circulation via 40 Leads. Ninety-nine percent of responses were from nurses, the rest were from doctors. The second survey had 77 responses, 88% from doctors and was circulated via 155 Linkmen. The surveys showed that over 95% of respondents worked in intensive care units that use a ventilator care bundle. Compliance with each component of the bundle was greater than 85% in all units, except for SSD, which was performed in 47-53% of the units. Conclusions In this survey, most units comply with most of the nationally recommended ventilator care bundle components with the exception of SSD. Because of a lack of availability of suitable endotracheal tubes, a significant number of patients are being re-intubated to facilitate this therapy. Relevance to clinical practice Compliance with most components of the nationally recommended ventilator care bundle is good. SSD has not been as widely implemented as the other components and patients are undergoing re-intubation to facilitate it. [ABSTRACT FROM AUTHOR]

Background and Purpose Pain assessment in Intensive Care Units ( ICU) can be performed based on validated instruments as the Behavioral Pain Scale ( BPS). Despite the existence of this clinical score, there is no Brazilian version of it to assess critically ill patients. This study aimed to translate the BPS into Brazilian Portuguese, verify its psychometric properties (reliability, validity, and responsiveness) and the correlation between pain measured and heart rate ( HR), blood pressure ( BP), Ramsay, and RASS scores. Methods Pain intensity by using Brazilian BPS version, HR, and BP were observed by 2 investigators during 3 different moments: at rest; during eye cleaning ( EC); and tracheal suctioning ( TS) in 15 adult subjects sedated and mechanically ventilated. Sedation level, severity of disease, and use of sedatives and analgesic drugs were also recorded. Results There was a high responsiveness coefficient (coefficient = 1.72) and pain was significantly higher during tracheal suctioning ( P ≤ 0.003) and eye cleaning ( P ≤ 0.04) than at rest. It was evidenced a low reliability and no significant correlation between translated BPS scores and physiological parameters during tracheal suctioning, sedation scales, flow of the sedatives drugs, or with the general health status ( P > 0.07). Conclusion Brazilian BPS has high responsiveness and capacity to detect pain intensity in different situations in the ICU routine. This preliminary study proved the feasibility and importance of valid this scale in Brazil in order to improve critically ill patients care. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Endotracheal suctioning has been identified as a painful procedure for critically ill patients. Aim To determine the effect of music therapy on pain intensity, sedation level and physiological parameters during endotracheal suctioning of mechanically ventilated patients in cardiovascular surgery intensive care unit (ICU). Design Experimental survey. Methods The study was conducted between May 2010 and June 2013 in Ordu Medical Park Hospital Cardiovascular Surgery Intensive Care Unit. The study sample consisted of 66 patients (33 experimental and 33 control) who complied with the criteria of inclusion for the study. Data was collected using the 'Patient Information Form', 'Critical-Care Pain Observation Tool', 'Ramsay Sedation Scale' and 'Form of Physiological Parameters'. Results The mean scores of the Ramsay Sedation Scale during endotracheal aspiration were respectively 1·88 and 1·55 in the experimental and control group and the difference between the groups was statistically significant ( p = 0·003). The mean score of Critical-Care Pain Observation Tool during endotracheal suctioning in the experimental group was found to be lower statistically than those of the control group ( p < 0·001). There were no significant differences before, during and 20 min after suctioning between the two groups with regard to systolic blood pressure, diastolic blood pressure, heart rate and oxygen saturation ( p > 0·05). Conclusions The results of this study implies that music therapy can be effective practice for nurses attempting to reduce patients' pain and control sedation level in patients on mechanical ventilators during endotracheal suctioning. Relevance to clinical practice It is recommended that music therapy should be added to the routine nursing care for mechanically ventilated patients. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 6 year old girl with psychomotor retardation, cough, high fever and hemoptysis is presented. It is noted that she had already undergone a cardiac catheterization operation at the age of one. The article diagnoses vascular injury and the presence of blood clots and bloody mucus which was discovered during flexible bronchoscopy.

Suctioning at birth showed low adherence to official recommendations in a low-resource setting Education on neonatal resuscitation is most urgent in settings with poor access to intrapartum obstetric care, where immediate postnatal mortality can be reduced by 30% with basic training in neonatal resuscitation.1 Management of newborns at birth includes different interventions based on progressive steps (initial steps, ventilation, chest compressions and medications). The video review underlined late initiation and long duration of the procedure, with preference for deep suctioning and the use of a catheter. [Extracted from the article]

Sir, The COVID-19 pandemic has transformed care in operating rooms and healthcare centers. A nasopharyngeal swab was performed to test for COVID-19 (PCR-based test) as per our institution's standard practice but because of the emergent nature of his surgery the COVID-19 test result was not available before anesthesia induction. Screening with questions about cough, fever, and travel may not identify children with COVID-19, and centers should consider testing to determine children's COVID-19 status. [Extracted from the article]

Pulmonary alveolar proteinosis is a rare condition characterized by progressive accumulation of surfactant lipoproteins in the alveolar space, leading to poor gas exchange. Whole lung lavage therapy for pulmonary alveolar proteinosis: a global survey of current practices and procedures. [Extracted from the article]

Normal saline installation with endotracheal suctioning: primum non nocere (first do no harm) ¶ Normal saline instillation, in conjunction with endotracheal suctioning, is purported to be beneficial in removing thick and tenacious secretions for patients receiving mechanical ventilation. Guidelines for this routine procedure are inconsistent and its efficacy is unsupported by research-based evidence. This discussion paper highlights that the procedure produces no physiological benefits for the patient and, indeed, may have detrimental effects on the patient's psychological wellbeing. It is proposed that after 25 years of inconsistent practice in trying to remove thick and tenacious secretions, it is time to focus on techniques to prevent thick and tenacious secretions. [ABSTRACT FROM AUTHOR]

In issue 29 of Pediatric Anesthesia 2019, Goh and Colleagues, describe the results of a recent survey on the use of Total Intravenous Anesthesia (TIVA) for pediatric anesthesia.[1] Ten years on from a similar survey, Goh describes a doubling from 26% to 54% in the number of pediatric anesthetists comfortable using TIVA on a monthly basis in a variety of procedures. Lauder, in her review of the use of TIVA in children, suggested that total intravenous anesthesia, would soon replace traditional volatile based anesthesia in pediatrics,[2] however, Goh's survey tends to suggest the message is only slowly and partially getting through. HFNC oxygenation does, however, preclude the use of volatile anesthesia for maintenance of anesthesia during these examinations, necessitating all pediatric anesthetists to be TIVA competent. [Extracted from the article]

Pre-oxygenation for endotracheal suctioning for mechanically ventilated infants is routine practice in many neonatal intensive care units. In the present systematic review the evidence to support its use is discussed and the authors conclude that no confident recommendations can be made from the results of this review. [ABSTRACT FROM AUTHOR]