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2. Type I Kounis syndrome in a young woman without chest pain: a case report

Author

Miki Nanyoshi, Tomohiro Hayashi, Ryu Sugimoto, Hogara Nishisaki, and Tsuneaki Kenzaka

Subjects
Allergy, Anaphylaxis, Coronary syndrome, Chest pain, Atopic dermatitis, Wheals, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Abstract Background Kounis syndrome is defined as the concurrence of acute coronary syndromes in the setting of allergic or anaphylactic reactions. It primarily affects men aged 40–70 years and is often associated with chest pain. This syndrome is often unrecognized and undiagnosed in clinical practice due to a low level of awareness. Herein, we present a case of type I Kounis syndrome in a young woman without chest pain. Case presentation A 28-year-old Japanese woman with a history of atopic dermatitis received a glycyrrhizin, glutathione, and neurotropin preparation (a preparation of inflamed skin extract from rabbits inoculated with vaccinia virus) at a dermatology clinic to treat pruritus caused by atopic dermatitis. Immediately after the administration, the patient developed abdominal pain and generalized body wheals. The patient was diagnosed with anaphylaxis and was transported to our hospital. She had no chest pain on arrival at our hospital; however, a 12-lead electrocardiogram showed ST elevation in leads I, aVL, V2, and V3, and an echocardiogram showed decreased wall motion in the anterior and lateral walls of the left ventricle. Sublingual nitroglycerin administration improved ST-segment elevation and left ventricular wall motion abnormalities. The patient underwent emergency coronary angiography, which revealed no significant stenosis, and was diagnosed with type I Kounis syndrome. Conclusion Kounis syndrome without chest pain is rare in young women. Since it can be fatal in cases with severe allergic symptoms such as anaphylaxis, the possibility of concurrent acute coronary syndrome should be considered when treating systemic allergic reactions, regardless of age, sex, or the presence or absence of chest symptoms.

Published
2024
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3. Difficult or impossible facemask ventilation in children with difficult tracheal intubation: a retrospective analysis of the PeDI registry

Author

Garcia-Marcinkiewicz, Annery G, Lee, Lisa K, Haydar, Bishr, Fiadjoe, John E, Matava, Clyde T, Kovatsis, Pete G, Peyton, James, Stein, Mary L, Park, Raymond, Taicher, Brad M, Templeton, Thomas W, Collaborative, on behalf of the PeDI, Bruins, Benjamin B, Stricker, Paul, Laverriere, Elizabeth K, Lockman, Justin L, Struyk, Brian, Ward, Christopher, Nishisaki, Akira, Kodavatiganti, Ramesh, Guris, Rodrigo J Daly, Sequera-Ramos, Luis, Teen, Mark S, Oke, Ayodele, Hsu, Grace, Lingappan, Arul, Egbuta, Chinyere, Flynn, Stephen, Sarmiento, Lina, Goldfarb, Tally, Kiss, Edgar E, Olomu, Patrick N, Szmuk, Peter, Mireles, Sam, Murray, Andrea, Whyte, Simon, Jain, Ranu, Matuszczak, Maria, Hunyady, Agnes, Bosenberg, Adrian, Tham, See, Low, Daniel, Holmes, Christopher, Sabato, Stefan, Dalesio, Nicholas, Greenberg, Robert, Lucero, Angela, Reynolds, Paul, Lewis, Ian, Schrock, Charles, Nykiel-Bailey, Sydney, Starker, Elizabeth, Szolnoki, Judit, Brooks-Peterson, Melissa, Bhattacharya, Somaletha, Burjek, Nicholas E, Jagannathan, Narasimhan, Lardner, David, Watkins, Scott, Crockett, Christy, Moore, John, Robertson, Sara, Sathyamoorthy, Madhankumar, Chiao, Franklin, Patel, Jasmine, Sharma, Aarti, Marin, Piedad Echeverry, Pérez-Pradilla, Carolina, Singh, Neeta, von Ungern-Sternberg, Britta S, Sommerfield, David, Bilen-Rosas, Guelay, Lewkowitz-Shpuntoff, Hilana, Castro, Pilar, Perez, N Ricardo Riveros, de Graaff, Jurgen C, Vega, Eduardo, González, Alejandro, Ostermann, Paola, Rubin, Kasia, Lord, Charles, Lee, Angela, Heitmiller, Eugenie, Valairucha, Songyos, Dalal, Priti, Tran, Thanh, Ayad, Ihab, Rehman, Mohamed, Fernandez, Allison, Zamora, Lillian, Ravula, Niroop, and Shaik, Sadiq

Subjects
Rare Diseases, Lung, Assistive Technology, Bioengineering, Infant, Humans, Child, Masks, Intubation, Intratracheal, Retrospective Studies, Respiration, Laryngeal Masks, Airway Management, complications, difficult airway, difficult facemask ventilation, impossible facemask ventilation, paediatrics, supraglottic airway, PeDI Collaborative, Clinical Sciences, Anesthesiology
Abstract

BackgroundDifficult facemask ventilation is perilous in children whose tracheas are difficult to intubate. We hypothesised that certain physical characteristics and anaesthetic factors are associated with difficult mask ventilation in paediatric patients who also had difficult tracheal intubation.MethodsWe queried a multicentre registry for children who experienced "difficult" or "impossible" facemask ventilation. Patient and case factors known before mask ventilation attempt were included for consideration in this regularised multivariable regression analysis. Incidence of complications, and frequency and efficacy of rescue placement of a supraglottic airway device were also tabulated. Changes in quality of mask ventilation after injection of a neuromuscular blocking agent were assessed.ResultsThe incidence of difficult mask ventilation was 9% (483 of 5453 patients). Infants and patients having increased weight, being less than 5th percentile in weight for age, or having Treacher-Collins syndrome, glossoptosis, or limited mouth opening were more likely to have difficult mask ventilation. Anaesthetic induction using facemask and opioids was associated with decreased risk of difficult mask ventilation. The incidence of complications was significantly higher in patients with "difficult" mask ventilation than in patients without. Rescue placement of a supraglottic airway improved ventilation in 71% (96 of 135) of cases. Administration of neuromuscular blocking agents was more frequently associated with improvement or no change in quality of ventilation than with worsening.ConclusionsCertain abnormalities on physical examination should increase suspicion of possible difficult facemask ventilation. Rescue use of a supraglottic airway device in children with difficult or impossible mask ventilation should be strongly considered.

Published
2023

5. Brief report: incidence and outcomes of pediatric tracheal intubation-associated cardiac arrests in the ICU-RESUS clinical trial

Author

Nishisaki, Akira, Reeder, Ron W., McGovern, Elizabeth Laverriere, Ahmed, Tageldin, Bell, Michael J., Bishop, Robert, Bochkoris, Matthew, Burns, Candice, Carcillo, Joseph A., Carpenter, Todd C., Diddle, Wesley, Federman, Myke, Fink, Ericka L., Franzon, Deborah, Frazier, Aisha H., Friess, Stuart H., Graham, Kathryn, Hall, Mark, Hehir, David A., Horvat, Christopher M., Huard, Leanna L., Maa, Tensing, Manga, Arushi, McQuillen, Patrick, Meert, Kathleen L., Morgan, Ryan W., Mourani, Peter M., Nadkarni, Vinay M., Naim, Maryam Y., Notterman, Daniel, Palmer, Chella A., Sapru, Anil, Schneiter, Carleen, Sharron, Matthew P., Srivastava, Neeraj, Viteri, Shirley, Wessel, David, Wolfe, Heather A., Yates, Andrew R., Zuppa, Athena F., Sutton, Robert M., and Berg, Robert A.

Published
2024
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6. Safety of primary nasotracheal intubation in the pediatric intensive care unit (PICU)

Author

Ducharme-Crevier, Laurence, Furlong-Dillard, Jamie, Jung, Philipp, Chiusolo, Fabrizio, Malone, Matthew P., Ambati, Shashikanth, Parsons, Simon J., Krawiec, Conrad, Al-Subu, Awni, Polikoff, Lee A., Napolitano, Natalie, Tarquinio, Keiko M., Shenoi, Asha, Talukdar, Andrea, Mallory, Palen P., Giuliano, Jr., John S., Breuer, Ryan K., Kierys, Krista, Kelly, Serena P., Motomura, Makoto, Sanders, Jr., Ron C., Freeman, Ashley, Nagai, Yuki, Glater-Welt, Lily B., Wilson, Joseph, Loi, Mervin, Adu-Darko, Michelle, Shults, Justine, Nadkarni, Vinay, Emeriaud, Guillaume, and Nishisaki, Akira

Published
2024
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7. Ketamine Use in the Intubation of Critically Ill Children with Neurological Indications: A Multicenter Retrospective Analysis

Author

Loi, Mervin V., Lee, Jan Hau, Huh, Jimmy W., Mallory, Palen, Napolitano, Natalie, Shults, Justine, Krawiec, Conrad, Shenoi, Asha, Polikoff, Lee, Al-Subu, Awni, Sanders, Jr, Ronald, Toal, Megan, Branca, Aline, Glater-Welt, Lily, Ducharme-Crevier, Laurence, Breuer, Ryan, Parsons, Simon, Harwayne-Gidansky, Ilana, Kelly, Serena, Motomura, Makoto, Gladen, Kelsey, Pinto, Matthew, Giuliano, Jr, John, Bysani, Gokul, Berkenbosch, John, Biagas, Katherine, Rehder, Kyle, Kasagi, Mioko, Lee, Anthony, Jung, Philipp, Shetty, Rakshay, Nadkarni, Vinay, and Nishisaki, Akira

Published
2024
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8. Assessing the medium-term effects of a community-based medical education program with homestay practice: a cohort study in Tamba, Japan

Author

Tsuneaki Kenzaka, Shinsuke Yahata, Ken Goda, Ayako Kumabe, Nishisaki Hogara, and Masanobu Okayama

Subjects
Community medicine, community-based medical education, homestay, residency program, medium-term effect, attitude, Medicine
Abstract

Introduction This study intended to evaluate the medium-term effectiveness of a community-based medical education (CBME) program and to determine the program’s influence on the application rates of regional-quota students seeking to become residents in Tamba, Japan.Materials and Methods We conducted a cohort study of regional-quota students. Exposure factors included (1) experience compared to no experience of CBME in the Tamba area; (2) CBME experience compared to no experience in Tamba in the senior years (4–6 years of medical school) and experience in the junior years (1–3 years of medical school); and (3) experience in the senior years compared with those in the junior years. Outcome measures were applications to become a medical resident and actually becoming a medical resident at the Hyogo Prefectural Tamba Medical Center.Results Of 94 participants, 58 (61.7%) were male and 37 students (39.4%) had previous CBME experience in the Tamba area. In applying to become a resident at the Hyogo Prefectural Tamba Medical Center, students who had experienced CBME in the Tamba area in their senior years had significantly higher adjusted risk ratios compared to those who experienced it in their junior years. Regarding applications to become a resident, students who had experienced CBME in the Tamba area in their senior years had a significantly higher adjusted risk ratio than students who had not experienced CBME and students who had experienced CBME in their junior years.Conclusions There was a statistically significant application rate for residency programs among medical students who participated in the CBME program in their senior years compared with those who did not. This is the first study to confirm the medium-term effects of CBME after several years in short-term CBME programs of three days and two nights.

Published
2024
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10. Hyponatremia due to adrenal insufficiency after a Mamushi bite: a case report

Author

Ryu Sugimoto, Tsuneaki Kenzaka, and Hogara Nishisaki

Subjects
Hyponatremia, Sodium, Snake bites, Adrenal insufficiency, Empty sella, Snake venom, Diseases of the endocrine glands. Clinical endocrinology, RC648-665
Abstract

Abstract Background Mamushi bites are the most common venomous snake bites in Japan, with known complications including rhabdomyolysis and acute kidney injury; however, adrenal insufficiency as a result of snake bites has not been previously reported. We report a case of empty sella with transient adrenal insufficiency during hospitalization for a Mamushi bite. Case presentation An 84-year-old man was admitted to our hospital with a Mamushi bite on the right fifth finger. Serum sodium (Na) level remained in the normal range. On the ninth day of admission, he developed hyponatremia, with a serum Na level of 114 mEq/L and serum cortisol level of 4.0 μg/dL (reference value 4.5–21.1 μg/dL). His serum Na level was restored within the normal range after administration of corticosteroids with 3% NaCl solution. Both rapid adrenocorticotrophin and corticotropin-releasing hormone loading tests showed low cortisol response. Based on the results of the hormone loading tests, a diagnosis of pituitary adrenal insufficiency was made. Contrast-enhanced pituitary magnetic resonance imaging (MRI) showed primary empty sella. After discontinuation of corticosteroids, the hyponatremia did not recur, and the patient was discharged on the 24th day of hospitalization. After discharge, the patient visited an outpatient clinic, but hyponatremia recurrence was not observed. Conclusions This is the first report of hyponatremia due to pituitary adrenal insufficiency during hospitalization for a Mamushi bite in a patient with empty sella. When hyponatremia occurs during hospitalization for a Mamushi bite, cortisol measurement, hormone loading test, and head MRI should be performed to search for pituitary lesions because of the possibility of adrenal insufficiency caused by snake venom.

Published
2023
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16. Airway management in the paediatric difficult intubation registry: a propensity score matched analysis of outcomes over timeResearch in context

Author

Mary Lyn Stein, Lina Andrea Sarmiento Argüello, Steven J. Staffa, Julia Heunis, Chinyere Egbuta, Stephen G. Flynn, Sabina A. Khan, Stefano Sabato, Brad M. Taicher, Franklin Chiao, Adrian Bosenberg, Angela C. Lee, H. Daniel Adams, Britta S. von Ungern-Sternberg, Raymond S. Park, James M. Peyton, Patrick N. Olomu, Agnes I. Hunyady, Annery Garcia-Marcinkiewicz, John E. Fiadjoe, Pete G. Kovatsis, Benjamin Bruins, Paul Stricker, Elizabeth Laverriere, Justin L. Lockman, Brian Struyk, Christopher Ward, Akira Nishisaki, Ramesh Kodavatiganti, Rodrigo Daly Guris, Luis Sequera-Ramos, Mark Teen, Ayodele Oke, Grace Hsu, Arul Lingappan, Rhae Battles, Ashley Bocanegra, Tally Goldfarb, Edgar Kiss, Peter Szmuk, Sam Mireles, Andrea Murray, Simon Whyte, Ranu Jain, Maria Matuszczak, Christopher Holmes, Alexander McCann, Clyde Matava, Nicholas Dalesio, Robert Greenberg, Angela Lucero, Sapna Desai, Sondra Rosander, Sindhu Samba, Charles Schrock, Sydney Nykiel-Bailey, Jennifer Marsh, Melissa Brooks Peterson, Amy Lee, Somaletha Bhattacharya, Nicholas Burjek, Narasimhan Jagannathan, David Lardner, Christy Crockett, Sara Robetson, Jasmine Patel, Aarti Sharma, Thomas Templeton, Piedad Echeverry Marín, Carolina Pérez-Pradilla, Neeta Singh, David Sommerfield, Neil Hauser, Emily Hesselink, Hilana Lewkowitz-Shpuntoff, Pilar Castro, N. Ricardo Riveros Perez, Eduardo Vega, Alejandro González, Paola Ostermann, Kasia Rubin, Jonathan Meserve, Charles Lord, Angela Lee, Songyos Valairucha, Priti Dalal, Thanh Tran, Taylor Anspach, Lisa K. Lee, Ihab Ayad, Mohamed Rehman, Allison Fernandez, Lillian Zamora, Niroop Ravula, Sadiq Shaik, Judit Szolnoki, Preethy Mathew, Sandhya Yaddanapudi, Indu Sen, Aakriti Gupta, Kathryn Handlogten, J. Michael Sroka, Vinícius Caldeira Quintão, Ricardo Vieira Carlos, and Fernanda Leite

Subjects
Paediatric airway, Difficult airway, Intubation, Video laryngoscopy, Outcomes, Complications, Medicine (General), R5-920
Abstract

Summary: Background: The Paediatric Difficult Intubation Collaborative identified multiple attempts and persistence with direct laryngoscopy as risk factors for complications in children with difficult tracheal intubations and subsequently engaged in initiatives to reduce repeated attempts and persistence with direct laryngoscopy in children. We hypothesised these efforts would lead to fewer attempts, fewer direct laryngoscopy attempts and decrease complications. Methods: Paediatric patients less than 18 years of age with difficult direct laryngoscopy were enrolled in the Paediatric Difficult Intubation Registry. We define patients with difficult direct laryngoscopy as those in whom (1) an attending or consultant obtained a Cormack Lehane Grade 3 or 4 view on direct laryngoscopy, (2) limited mouth opening makes direct laryngoscopy impossible, (3) direct laryngoscopy failed in the preceding 6 months, and (4) direct laryngoscopy was deferred due to perceived risk of harm or poor chance of success. We used a 5:1 propensity score match to compare an early cohort from the initial Paediatric Difficult Intubation Registry analysis (August 6, 2012–January 31, 2015, 785 patients, 13 centres) and a current cohort from the Registry (March 4, 2017–March 31, 2023, 3925 patients, 43 centres). The primary outcome was first attempt success rate between cohorts. Success was defined as confirmed endotracheal intubation and assessed by the treating clinician. Secondary outcomes were eventual success rate, number of attempts at intubation, number of attempts with direct laryngoscopy, the incidence of persistence with direct laryngoscopy, use of supplemental oxygen, all complications, and severe complications. Findings: First-attempt success rate was higher in the current cohort (42% vs 32%, OR 1.5 95% CI 1.3–1.8, p

Published
2024
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20. Airway management in the paediatric difficult intubation registry: a propensity score matched analysis of outcomes over time

Author

Bruins, Benjamin, Stricker, Paul, Laverriere, Elizabeth, Lockman, Justin L., Struyk, Brian, Ward, Christopher, Nishisaki, Akira, Kodavatiganti, Ramesh, Guris, Rodrigo Daly, Sequera-Ramos, Luis, Teen, Mark, Oke, Ayodele, Hsu, Grace, Lingappan, Arul, Battles, Rhae, Bocanegra, Ashley, Goldfarb, Tally, Kiss, Edgar, Szmuk, Peter, Mireles, Sam, Murray, Andrea, Whyte, Simon, Jain, Ranu, Matuszczak, Maria, Holmes, Christopher, McCann, Alexander, Matava, Clyde, Dalesio, Nicholas, Greenberg, Robert, Lucero, Angela, Desai, Sapna, Rosander, Sondra, Samba, Sindhu, Schrock, Charles, Nykiel-Bailey, Sydney, Marsh, Jennifer, Peterson, Melissa Brooks, Lee, Amy, Bhattacharya, Somaletha, Burjek, Nicholas, Jagannathan, Narasimhan, Lardner, David, Crockett, Christy, Robetson, Sara, Patel, Jasmine, Sharma, Aarti, Templeton, Thomas, Marín, Piedad Echeverry, Pérez-Pradilla, Carolina, Singh, Neeta, Sommerfield, David, Hauser, Neil, Hesselink, Emily, Lewkowitz-Shpuntoff, Hilana, Castro, Pilar, Riveros Perez, N. Ricardo, Vega, Eduardo, González, Alejandro, Ostermann, Paola, Rubin, Kasia, Meserve, Jonathan, Lord, Charles, Lee, Angela, Valairucha, Songyos, Dalal, Priti, Tran, Thanh, Anspach, Taylor, Lee, Lisa K., Ayad, Ihab, Rehman, Mohamed, Fernandez, Allison, Zamora, Lillian, Ravula, Niroop, Shaik, Sadiq, Szolnoki, Judit, Mathew, Preethy, Yaddanapudi, Sandhya, Sen, Indu, Gupta, Aakriti, Handlogten, Kathryn, Sroka, J. Michael, Quintão, Vinícius Caldeira, Carlos, Ricardo Vieira, Leite, Fernanda, Stein, Mary Lyn, Sarmiento Argüello, Lina Andrea, Staffa, Steven J., Heunis, Julia, Egbuta, Chinyere, Flynn, Stephen G., Khan, Sabina A., Sabato, Stefano, Taicher, Brad M., Chiao, Franklin, Bosenberg, Adrian, Lee, Angela C., Adams, H. Daniel, von Ungern-Sternberg, Britta S., Park, Raymond S., Peyton, James M., Olomu, Patrick N., Hunyady, Agnes I., Garcia-Marcinkiewicz, Annery, Fiadjoe, John E., and Kovatsis, Pete G.

Published
2024
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35. Adverse Tracheal Intubation Events in Critically Ill Underweight and Obese Children: Retrospective Study of the National Emergency Airway for Children Registry (2013–2020)

Author

Gladen, Kelsey M., Tellez, David, Napolitano, Natalie, Edwards, Lauren R., Sanders, Ronald C., Jr, Kojima, Taiki, Malone, Matthew P., Shults, Justine, Krawiec, Conrad, Ambati, Shashikanth, McCarthy, Riley, Branca, Aline, Polikoff, Lee A., Jung, Philipp, Parsons, Simon J., Mallory, Palen, Komeswaran, Kavipriya, Page-Goertz, Christopher, Toal, Megan C., Bysani, G. Kris, Meyer, Keith, Chiusolo, Fabrizio, Glater-Welt, Lily B., Al-Subu, Awni, Biagas, Katherine, Hau Lee, Jan, Miksa, Michael, Giuliano, John S., Jr, Kierys, Krista L., Talukdar, Andrea M., DeRusso, Michelle, Cucharme-Crevier, Laurence, Adu-Arko, Michelle, Shenoi, Asha, Kimura, Dai, Flottman, Molly, Gangu, Shantaveer, Freeman, Ashley D., Piehl, Mark D., Nuthall, G. A., Tarquinio, Keiko M., Harwayne-Gidansky, Ilana, Hasegawa, Tatsuya, Rescoe, Erin S., Breuer, Ryan K., Kasagi, Mioko, Nadkarni, Vinay M., Nishisaki, Akira, Flori, Heidi, Thomas, Neal, Agus, Michael, Dahmer, Mary, Goertzen, Lexie, Khemani, Robinder, Pinto, Neethi, Faustino, Vincent, Brown, Ann-Marie, Prieto, Monica, Wing, Robyn, and Buffman, Hayley

Published
2023
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36. Tracheal Intubation by Advanced Practice Registered Nurses in Pediatric Critical Care: Retrospective Study From the National Emergency Airway for Children Registry (2015–2019)

Author

Van Damme, Danielle M., McRae, Emily M., Irving, Sharon Y., Kelly, Serena P., Tarquinio, Keiko M., Giuliano, John S., Jr, Ruppe, Michael D., Kierys, Krista L., Breuer, Ryan K., Parsons, Simon J., Mallory, Palen P., Shenoi, Asha N., Swain, Kelly A., Polikoff, Lee A., Lee, Anthony, Adu-Darko, Michelle A., Napolitano, Natalie, Shults, Justine, Nishisaki, Akira, and Berkenbosch, John W.

Published
2023
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37. Effect of apneic oxygenation with intubation to reduce severe desaturation and adverse tracheal intubation-associated events in critically ill children

Author

Natalie Napolitano, Lee Polikoff, Lauren Edwards, Keiko M. Tarquinio, Sholeen Nett, Conrad Krawiec, Aileen Kirby, Nina Salfity, David Tellez, Gordon Krahn, Ryan Breuer, Simon J. Parsons, Christopher Page-Goertz, Justine Shults, Vinay Nadkarni, Akira Nishisaki, and for National Emergency Airway Registry for Children (NEAR4KIDS) Investigators and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network

Subjects
Pediatrics, Tracheal intubation, Airway, Hypoxemia, Apneic oxygenation, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background Determine if apneic oxygenation (AO) delivered via nasal cannula during the apneic phase of tracheal intubation (TI), reduces adverse TI-associated events (TIAEs) in children. Methods AO was implemented across 14 pediatric intensive care units as a quality improvement intervention during 2016–2020. Implementation consisted of an intubation safety checklist, leadership endorsement, local champion, and data feedback to frontline clinicians. Standardized oxygen flow via nasal cannula for AO was as follows: 5 L/min for infants (

Published
2023
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38. Difficult or impossible facemask ventilation in children with difficult tracheal intubation: a retrospective analysis of the PeDI registry

Author

Bruins, Benjamin B., Stricker, Paul, Laverriere, Elizabeth K., Lockman, Justin L., Struyk, Brian, Ward, Christopher, Nishisaki, Akira, Kodavatiganti, Ramesh, Daly Guris, Rodrigo J., Sequera-Ramos, Luis, Teen, Mark S., Oke, Ayodele, Hsu, Grace, Lingappan, Arul, Egbuta, Chinyere, Flynn, Stephen, Sarmiento, Lina, Goldfarb, Tally, Kiss, Edgar E., Olomu, Patrick N., Szmuk, Peter, Mireles, Sam, Murray, Andrea, Whyte, Simon, Jain, Ranu, Matuszczak, Maria, Hunyady, Agnes, Bosenberg, Adrian, Tham, See, Low, Daniel, Holmes, Christopher, Sabato, Stefan, Dalesio, Nicholas, Greenberg, Robert, Lucero, Angela, Reynolds, Paul, Lewis, Ian, Schrock, Charles, Nykiel-Bailey, Sydney, Starker, Elizabeth, Szolnoki, Judit, Brooks-Peterson, Melissa, Bhattacharya, Somaletha, Burjek, Nicholas E., Jagannathan, Narasimhan, Lardner, David, Watkins, Scott, Crockett, Christy, Moore, John, Robertson, Sara, Sathyamoorthy, Madhankumar, Chiao, Franklin, Patel, Jasmine, Sharma, Aarti, Echeverry Marin, Piedad, Pérez-Pradilla, Carolina, Singh, Neeta, von Ungern-Sternberg, Britta S., Sommerfield, David, Bilen-Rosas, Guelay, Lewkowitz-Shpuntoff, Hilana, Castro, Pilar, Riveros Perez, N. Ricardo, de Graaff, Jurgen C., Vega, Eduardo, González, Alejandro, Ostermann, Paola, Rubin, Kasia, Lord, Charles (Ted), Lee, Angela, Heitmiller, Eugenie, Valairucha, Songyos, Dalal, Priti, Tran, Thanh, Ayad, Ihab, Rehman, Mohamed, Fernandez, Allison, Zamora, Lillian, Ravula, Niroop, Shaik, Sadiq, Garcia-Marcinkiewicz, Annery G., Lee, Lisa K., Haydar, Bishr, Fiadjoe, John E., Matava, Clyde T., Kovatsis, Pete G., Peyton, James, Stein, Mary L., Park, Raymond, Taicher, Brad M., and Templeton, Thomas W.

Published
2023
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41. Impact of multiple intubation attempts on adverse tracheal intubation associated events in neonates: a report from the NEAR4NEOS

Author

Singh, Neetu, Sawyer, Taylor, Johnston, Lindsay C., Herrick, Heidi M., Moussa, Ahmed, Zenge, Jeanne, Jung, Philipp, DeMeo, Stephen, Glass, Kristen, Howlett, Alexandra, Shults, Justine, Barry, James, Brei, Brianna K., Kim, Jae H., Quek, Bin Huey, Tingay, David, Mehrem, Ayman Abou, Napolitano, Natalie, Nishisaki, Akira, and Foglia, Elizabeth E.

Published
2022
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46. Implementation of Video Laryngoscope-Assisted Coaching Reduces Adverse Tracheal Intubation-Associated Events in the PICU*

Author

Giuliano, John, Jr, Krishna, Ashwin, Napolitano, Natalie, Panisello, Josep, Shenoi, Asha, Sanders, Ronald C., Jr, Rehder, Kyle, Al-Subu, Awni, Brown, Calvin, III, Edwards, Lauren, Wright, Lisa, Pinto, Matthew, Harwayne-Gidansky, Ilana, Parsons, Simon, Romer, Amy, Laverriere, Elizabeth, Shults, Justine, Yamada, Nicole K., Walsh, Catharine M., Nadkarni, Vinay, and Nishisaki, Akira

Published
2023
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47. Comparison of a dichotomous versus trichotomous checklist for neonatal intubation

Author

Lindsay Johnston, Taylor Sawyer, Akira Nishisaki, Travis Whitfill, Anne Ades, Heather French, Kristen Glass, Rita Dadiz, Christie Bruno, Orly Levit, and Marc Auerbach

Subjects
Neonatal intubation, Dichotomous checklist, Trichotomous checklist, Global skills assessment, Entrustable professional activities assessment, Special aspects of education, LC8-6691, Medicine
Abstract

Abstract Background To compare validity evidence for dichotomous and trichotomous versions of a neonatal intubation (NI) procedural skills checklist. Methods NI skills checklists were developed utilizing an existing framework. Experts were trained on scoring using dichotomous and trichotomous checklists, and rated recordings of 23 providers performing simulated NI. Videolaryngoscope recordings of glottic exposure were evaluated using Cormack-Lehane (CL) and Percent of Glottic Opening scales. Internal consistency and reliability of both checklists were analyzed, and correlations between checklist scores, airway visualization, entrustable professional activities (EPA), and global skills assessment (GSA) were calculated. Results During rater training, raters gave significantly higher scores on better provider performance in standardized videos (both p

Published
2022
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48. International consensus conference recommendations on ultrasound education for undergraduate medical students

Author

Richard A. Hoppmann, Jeanette Mladenovic, Lawrence Melniker, Radu Badea, Michael Blaivas, Miguel Montorfano, Alfred Abuhamad, Vicki Noble, Arif Hussain, Gregor Prosen, Tomás Villen, Gabriele Via, Ramon Nogue, Craig Goodmurphy, Marcus Bastos, G. Stephen Nace, Giovanni Volpicelli, Richard J. Wakefield, Steve Wilson, Anjali Bhagra, Jongyeol Kim, David Bahner, Chris Fox, Ruth Riley, Peter Steinmetz, Bret P. Nelson, John Pellerito, Levon N. Nazarian, L. Britt Wilson, Irene W. Y. Ma, David Amponsah, Keith R. Barron, Renee K. Dversdal, Mike Wagner, Anthony J. Dean, David Tierney, James W. Tsung, Paula Nocera, José Pazeli, Rachel Liu, Susanna Price, Luca Neri, Barbara Piccirillo, Adi Osman, Vaughan Lee, Nitha Naqvi, Tomislav Petrovic, Paul Bornemann, Maxime Valois, Jean-Francoise Lanctot, Robert Haddad, Deepak Govil, Laura A. Hurtado, Vi Am Dinh, Robert M. DePhilip, Beatrice Hoffmann, Resa E. Lewiss, Nayana A. Parange, Akira Nishisaki, Stephanie J. Doniger, Paul Dallas, Kevin Bergman, J. Oscar Barahona, Ximena Wortsman, R. Stephen Smith, Craig A. Sisson, James Palma, Mike Mallin, Liju Ahmed, and Hassan Mustafa

Subjects
Ultrasound, Medical student, Education, Undergraduate, International consensus conference, Curriculum recommendations, Medical physics. Medical radiology. Nuclear medicine, R895-920
Abstract

Abstract Objectives The purpose of this study is to provide expert consensus recommendations to establish a global ultrasound curriculum for undergraduate medical students. Methods 64 multi-disciplinary ultrasound experts from 16 countries, 50 multi-disciplinary ultrasound consultants, and 21 medical students and residents contributed to these recommendations. A modified Delphi consensus method was used that included a systematic literature search, evaluation of the quality of literature by the GRADE system, and the RAND appropriateness method for panel judgment and consensus decisions. The process included four in-person international discussion sessions and two rounds of online voting. Results A total of 332 consensus conference statements in four curricular domains were considered: (1) curricular scope (4 statements), (2) curricular rationale (10 statements), (3) curricular characteristics (14 statements), and (4) curricular content (304 statements). Of these 332 statements, 145 were recommended, 126 were strongly recommended, and 61 were not recommended. Important aspects of an undergraduate ultrasound curriculum identified include curricular integration across the basic and clinical sciences and a competency and entrustable professional activity-based model. The curriculum should form the foundation of a life-long continuum of ultrasound education that prepares students for advanced training and patient care. In addition, the curriculum should complement and support the medical school curriculum as a whole with enhanced understanding of anatomy, physiology, pathophysiological processes and clinical practice without displacing other important undergraduate learning. The content of the curriculum should be appropriate for the medical student level of training, evidence and expert opinion based, and include ongoing collaborative research and development to ensure optimum educational value and patient care. Conclusions The international consensus conference has provided the first comprehensive document of recommendations for a basic ultrasound curriculum. The document reflects the opinion of a diverse and representative group of international expert ultrasound practitioners, educators, and learners. These recommendations can standardize undergraduate medical student ultrasound education while serving as a basis for additional research in medical education and the application of ultrasound in clinical practice.

Published
2022
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50. Providing Oxygen during Intubation in the NICU Trial (POINT): study protocol for a randomised controlled trial in the neonatal intensive care unit in the USA

Author

Elizabeth E Foglia, Natalie Napolitano, Akira Nishisaki, Justine Shults, Heidi M Herrick, Mackenzie O'Reilly, Sura Lee, and Paul Wildenhain

Subjects
Medicine
Abstract

Introduction Nearly half of neonatal intubations are complicated by severe desaturation (≥20% decline in pulse oximetry saturation (SpO2)). Apnoeic oxygenation prevents or delays desaturation during intubation in adults and older children. Emerging data show mixed results for apnoeic oxygenation using high-flow nasal cannula (NC) during neonatal intubation. The study objective is to determine among infants ≥28 weeks’ corrected gestational age (cGA) who undergo intubation in the neonatal intensive care unit (NICU) whether apnoeic oxygenation with a regular low-flow NC, compared with standard of care (no additional respiratory support), reduces the magnitude of SpO2 decline during intubation.Methods and analysis This is a multicentre, prospective, unblinded, pilot randomised controlled trial in infants ≥28 weeks’ cGA who undergo premedicated (including paralytic) intubation in the NICU. The trial will recruit 120 infants, 10 in the run-in phase and 110 in the randomisation phase, at two tertiary care hospitals. Parental consent will be obtained for eligible patients prior to intubation. Patients will be randomised to 6 L NC 100% oxygen versus standard of care (no respiratory support) at time of intubation. The primary outcome is magnitude of oxygen desaturation during intubation. Secondary outcomes include additional efficacy, safety and feasibility outcomes. Ascertainment of the primary outcome is performed blinded to intervention arm. Intention-to-treat analyses will be conducted to compare outcomes between treatment arms. Two planned subgroup analyses will explore the influence of first provider intubation competence and patients’ baseline lung disease using pre-intubation respiratory support as a proxy.Ethics and dissemination The Institutional Review Boards at the Children’s Hospital of Philadelphia and the University of Pennsylvania have approved the study. Upon completion of the trial, we intend to submit our primary results to a peer review forum after which we plan to publish our results in a peer-reviewed paediatric journal.Trial registration number ClinicalTrials.gov Registry (NCT05451953).

Published
2023
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