Anaesthesia
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We reviewed all patient safety incidents reported to the UK National Patient Safety Agency between August 2006 and February 2007 from intensive care or high dependency units. Incidents involving equipment were then categorised. A total of 12 084 incidents were submitted from 151 organisations (median (range) 40 (1-634) per organisation). ⋯ Twenty-nine incidents were associated with more than temporary harm to patients. Failure or faulty equipment was described in 537 incidents (26% with some harm) and incorrect setting or use was described in 358 incidents; these were more likely to be associated with harm (39%; p = 0.001). We suggest changes to improve the reporting of incidents and to improve equipment safety.
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Bag-valve-mask ventilation is a key component of life support, but only one handheld resuscitator is designed to operate in contaminated or toxic atmospheres. Following Institutional Review Board approval we determined the efficacy of this device. Twenty anaesthetists ventilated a modified manikin, either with or without a combination filter attached to the resuscitator inlet. ⋯ The achieved maximum minute volumes ranged from 13.4 to 4 l x min(-1) in the controls and from 9.5 to 3 l x min(-1) in the filter group. The delay in refilling of the self-inflatable bag may have resulted in reduced achievable minute volumes. The range of the maximum minute volumes in both groups highlights the need for continuous bag-valve-mask ventilator training.
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Review Meta Analysis
A meta-analysis of the utility of pre-operative brain natriuretic peptide in predicting early and intermediate-term mortality and major adverse cardiac events in vascular surgical patients.
We conducted a meta-analysis of the utility of pre-operative B-type natriuretic peptide (BNP) and N-terminal-pro B-type natriuretic peptide in predicting early (< 30 days) and intermediate (< 180 days) term mortality and major adverse cardiac events (cardiac death and nonfatal myocardial infarction) in patients following vascular surgery. A Pubmed Central and EMBASE search was conducted up to January 2008. ⋯ A B-type natriuretic peptide or N-terminal-pro B-type natriuretic peptide above the optimal discriminatory threshold determined by receiver operating characteristic curve analysis was associated with 30-day cardiac death (OR 7.6, 95% CI 1.33-43.4, p = 0.02), nonfatal myocardial infarction (OR 6.24, 95% CI 1.82-21.4, p = 0.004) and major adverse cardiac events (OR 17.37, 95% CI 3.31-91.15, p = 0.0007), and intermediate-term, all-cause mortality (OR 3.1, 95% CI 1.85-5.2, p < 0.0001), nonfatal myocardial infarction (OR 2.95, 95% CI 1.17-7.46, p = 0.02) and major adverse cardiac events (OR 3.31, 95% CI 2.1-5.24, p < 0.00001). B-type natriuretic peptide and N-terminal-pro B-type natriuretic peptide are potentially useful pre-operative prognostic tests in vascular surgical patients.
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Randomized Controlled Trial Multicenter Study
Emergency cricothyroidotomy: a randomised crossover study of four methods.
Emergency physicians and registrars performed emergency cricothyroidotomy on an artificial airway model using a standard surgical approach and three common commercial products, participants had received no refresher training. The order in which the methods were used was randomised to minimise any learning effect. ⋯ Despite success in using the surgical method, the Quicktrach and Minitrach II were rated as first or second preference by the majority of operators (78% and 70% respectively). Without refresher training emergency physicians and registrars successfully performed emergency cricothyroidotomy using the standard surgical method, Quicktrach and Minitrach II kits however the use of the Melker kit under these conditions resulted in significant delays or failure to establish an airway.