Anaesthesia and intensive care
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Anaesth Intensive Care · May 2021
Staff perceptions of military chemical-biological-radiological-nuclear (CBRN) air-purifying masks during a simulated clinical task in the context of SARS-CoV-2.
Air-purifying full-face masks, such as military chemical-biological-radiological-nuclear masks, might offer superior protection against severe acute respiratory syndrome coronavirus 2 compared to disposable polypropylene P2 or N95 masks. In addition, disposable masks are in short supply, while military chemical-biological-radiological-nuclear masks can be disinfected then reused. It is unknown whether such masks might be appropriate for civilians with minimal training in their use. ⋯ We conclude that this air-purifying full-face mask is acceptable to clinicians in a civilian intensive care unit. It enhances staff confidence, reduces waste, and is likely to be a lower logistical burden during a prolonged pandemic. Formal testing of effectiveness is warranted.
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Anaesth Intensive Care · May 2021
Case ReportsIatrogenic pneumomediastinum followed by bilateral pneumothoraces: A case report.
Major respiratory catastrophe associated with iatrogenic airway injury during the Sistrunk operation is a rare event. A three-year-old patient underwent thyroglossal duct cyst removal under general anaesthesia. ⋯ The patient was managed with bilateral chest drains and endotracheal intubation, and he required mechanical ventilation for three days. So, even after repair of a recognised iatrogenic airway injury associated with the Sistrunk operation, it may be necessary to continue positive pressure ventilation in the postoperative period to avoid serious respiratory complications.
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Anaesth Intensive Care · May 2021
Observational StudyVentilatory parameters measured during a physiological study of simulated powered air-purifying respirator failure in healthy volunteers.
Powered air-purifying respirators (PAPR) are a high level of respiratory personal protective equipment. Like all mechanical devices, they are vulnerable to failure. The precise physiological consequences of failure in live subjects have not previously been reported. ⋯ Median collateral entrainment of room air into the hood was 17.6 l/min (interquartile range 12.3-27.0 l/min). All subjects reported thermal discomfort, with two (22.2%) requesting early termination of the experiment. Whilst the degree of rebreathing in this experiment was not sufficient to cause dangerous physiological derangement, the degree of reported thermal discomfort combined with the consequences of entrainment of possibly contaminated air into the hood, pose a risk to wearers in the event of failure.
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Anaesth Intensive Care · May 2021
Letter Randomized Controlled TrialSurvey of attitudes towards a randomised trial about sugammadex, neostigmine and pulmonary complications.
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Anaesth Intensive Care · May 2021
Massive transfusion experience, current practice and decision support: A survey of Australian and New Zealand anaesthetists.
Massive transfusions guided by massive transfusion protocols are commonly used to manage critical bleeding, when the patient is at significant risk of morbidity and mortality, and multiple timely decisions must be made by clinicians. Clinical decision support systems are increasingly used to provide patient-specific recommendations by comparing patient information to a knowledge base, and have been shown to improve patient outcomes. To investigate current massive transfusion practice and the experiences and attitudes of anaesthetists towards massive transfusion and clinical decision support systems, we anonymously surveyed 1000 anaesthetists and anaesthesia trainees across Australia and New Zealand. ⋯ The majority of respondents reported that they were likely, or very likely, both to use (73.1%) and to trust (85%) a clinical decision support system for massive transfusions, with no significant difference between anaesthesia trainees and specialists (P = 0.375 and P = 0.73, respectively). While the response rate to our survey was poor, there was still a wide range of massive transfusion experience among respondents, with multiple subjective factors identified limiting massive transfusion practice. We identified several potential design features and barriers to implementation to assist with the future development of a clinical decision support system for massive transfusion, and overall wide support for a clinical decision support system for massive transfusion among respondents.