British journal of anaesthesia
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Multicenter Study
Factors associated with failed epidural blood patch after accidental dural puncture in obstetrics: a prospective, multicentre, international cohort study.
Unsuccessful epidural blood patch is associated with higher lumbar levels, shorter time between puncture & patch, and with patients with migraine history.
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Other than acute kidney injury, there appears no outcome difference between spinal and general anaesthesia in hip fracture surgery.
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Review Meta Analysis
Tracheostomy outcomes in critically ill patients with COVID-19: a systematic review, meta-analysis, and meta-regression.
We performed a systematic review of mechanically ventilated patients with COVID-19, which analysed the effect of tracheostomy timing and technique (surgical vs percutaneous) on mortality. Secondary outcomes included intensive care unit (ICU) and hospital length of stay (LOS), decannulation from tracheostomy, duration of mechanical ventilation, and complications. ⋯ PROSPERO CRD42021272220.
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Randomized Controlled Trial
Exposure to incivility does not hinder speaking up: a randomised controlled high-fidelity simulation-based study.
Speaking up with concerns is critical for patient safety. We studied whether witnessing a civil (i.e. polite, respectful) response to speaking up would increase the occurrence of further speaking up by hospital staff members as compared with witnessing a pseudo-civil (i.e. vague and slightly dismissive) or rude response. ⋯ Our study challenges current assumptions about the interplay of civility and speaking up behaviour in healthcare.
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Review Meta Analysis
Bayesian analysis of a systematic review of early versus late tracheostomy in ICU patients.
A recent systematic review and meta-analysis of RCTs of early vs late tracheostomy in mechanically ventilated patients suggest that early tracheostomy reduces the duration of ICU stay and mechanical ventilation, but does not reduce short-term mortality or ventilator-associated pneumonia (VAP). Meta-analysis of randomised trials is typically performed using a frequentist approach, and although reporting confidence intervals, interpretation is usually based on statistical significance. To provide a robust basis for clinical decision-making, we completed the search used from the previous review and analysed the data using Bayesian methods to estimate posterior probabilities of the effect of early tracheostomy on clinical outcomes. ⋯ Bayesian meta-analysis suggests a high probability that early tracheostomy compared with delayed tracheostomy has at least some benefit across all clinical outcomes considered.