Anaesthesia and intensive care
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Anaesth Intensive Care · May 2022
Incidence and determinants of malpositioning tracheostomy tubes in critically ill adult patients.
Tracheostomy tubes are chosen primarily based on their internal diameter; however, the length of the tube may also be important. We performed a prospective clinical audit of 30 critically ill patients following tracheostomy to identify the type of tracheostomy tube inserted, the incidence of malpositioning and the factors associated with the need to change the tracheostomy tube subsequently. Anthropometric neck measurements, distance between the skin and tracheal rings and the position of the tracheostomy cuff relative to the tracheal stoma were recorded and analysed. ⋯ Portex (Smiths Medical Australasia, Macquarie Park, NSW) ≤8.0 mm internal diameter with length <7.5 cm) was used, with risk further increased when the patient's skin to trachea depth was greater than 0.8 cm. Identifying a high riding cuff relative to the tracheal stoma confirmed by a translaryngeal bronchoscopy strongly predicted the risk of air leak and the need to change the tracheostomy tube subsequently. Our study suggests that when a small (and short) tracheostomy tube is planned for use, intraoperative translaryngeal bronchoscopy is warranted to exclude malpositioning of the tracheostomy tube with a high riding cuff.
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Anaesth Intensive Care · May 2022
Predicting recovery and disability after surgery in patients with severe obesity: The role of the six-minute walk test.
The most appropriate method to predict postoperative outcomes in patients with severe obesity undergoing elective non-bariatric surgery is not known. We conducted a single-centre prospective cohort study in patients with a body mass index of at least 35 kg/m2 undergoing non-bariatric, non-cardiac surgery. Patients completed the six-minute walk test prior to surgery. ⋯ The six-minute walk test was most discriminatory at shorter distances. This population of patients with severe obesity appeared to recover well and had few adverse outcomes. The degree of functional capacity was more important than the degree of obesity in predicting postoperative outcomes.
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Anaesth Intensive Care · May 2022
Case ReportsUnexpected survival after deliberate phosphine gas poisoning: An Australian experience of extracorporeal membrane oxygenation rescue in this setting.
Phosphine poisoning is responsible for hundreds of thousands of deaths per year in countries where access to this pesticide is unrestricted. Metal phosphides release phosphine gas on contact with moisture, and ingestion of these tablets most often results in death despite intensive support. ⋯ In this case, serendipitous access to an untested Extracorporeal Membrane Oxygenation (ECMO) service of a regional hospital effected a successful rescue and prevented the predicted death. We discuss the toxicology, management and the evidence for and against using ECMO in this acute poisoning.
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Anaesth Intensive Care · May 2022
Analysis of medication errors during anaesthesia in the first 4000 incidents reported to webAIRS.
Medication error is a well-recognised cause of harm to patients undergoing anaesthesia. From the first 4000 reports in the webAIRS anaesthetic incident reporting system, we identified 462 reports of medication errors. These reports were reviewed iteratively by several reviewers paying particular attention to their narratives. ⋯ These data add to current evidence suggesting a persistent and concerning failure effectively to address medication safety in anaesthesia. The wide variation in the nature of the errors and contributing factors underline the need for increased systematic and multifaceted efforts underpinned by a strengthening of the current focus on safety culture to improve medication safety in anaesthesia. This will require the concerted and committed engagement of all concerned, from practitioners at the clinical workface, to those who fund and manage healthcare.