Analysis of Difficult Tracheal Intubation Based on Video Records Using a Macintosh Type Video Intubating Laryngoscope in Adult

To assess the incidence of the difficult intubation and evaluate its clinical characteristics, we analyzed 964 cases of video records of tracheal intubation by Macintosh type video laryngoscope (MVL; X-Lite video^[○!R]: Rusch, Germany). The views during the laryngoscopy were recorded on a video system, and the number of intubation attempts and total attempt times were measured afterwards. The video laryngoscope grade (V-grade) was determined based on the Cormack & Lehane grade (C-grade), and its correlation with the Mallampati classes (MP), the number of intubation attempts, and total attempt time were analyzed. V-grade 3 was defined as a difficult intubation, and morphological measurement of the head and neck regions was performed postoperatively. Of the 964 patients, 522, 416, and 26 patients were classified into V-grade 1, 2 and 3, respectively, and the number and time of attempts significantly increased with the grade (p<0.05). The V-grades were significantly correlated with the MP classes and the number and time of attempts (p<0.0001). At least 1 of the 3 morphological measurement items was abnormal in the 26 patients with difficult intubation in visual assistance and recognition. The use of MVL might facilitate difficult intubation. Its video records were useful for analysis. The postoperative morphological feature was consistent with previous reports where MVL was not used

Teaching paediatric critical care medicine to paediatric residents

Critical care training during paediatric residency provides an ideal opportunity to learn and refine the skills needed in the early recognition and prompt treatment of the acutely ill paediatric patients. Paediatric critical care medicine is a relatively young sub-specialty in Pakistan. The aim of this study is to describe our experience of teaching paediatric residents in paediatric critical care medicine during paediatric intensive care unit rotation. Our paediatric critical care teaching curriculum for residents is based on the spectrum of our common critical care problems along with basic principal of critical care. The clinical rotation in our paediatric intensive care unit is very dynamic, thrilling, enjoyable and provides a lot of learning opportunities. During the rotation, the residents were exposed to all major critical care illnesses in infants and children. We use four traditional models of learning in our Paediatric Intensive Care Unit (PICU): bedside rounds, direct patient care, didactic learning and self-study. Our curriculum enhances the resident\u27s educational and clinical experience of paediatric intensive care medicine

The practice of glycaemic control in intensive care units: A multicentre survey of nursing and medical professionals.

AIMS AND OBJECTIVES: To determine the views of nurses and physicians working in intensive care units (ICU) about the aims of glycaemic control and use of their protocols. BACKGROUND: Evidence about the optimal aims and methods for glycaemic control in ICU is controversial, and current local protocols guiding practice differ between ICUs, both nationally and internationally. The views of professionals on glycaemic control can influence their practice. DESIGN: Cross-sectional, multicentre, survey-based study. METHODS: An online short survey was sent to all physicians and nurses of seven ICUs, including questions on effective glycaemic control, treatment of hypoglycaemia and deviations from protocols' instructions. STROBE reporting guidelines were followed. RESULTS: Over half of the 40 respondents opined that a patient spending <75% admission time within the target glycaemic levels constituted poor glycaemic control. Professionals with more than 5 years of experience were more likely to rate a patient spending 50%-74% admission time within target glycaemic levels as poor than less experienced colleagues. Physicians were more likely to rate a patient spending <50% admission time within target as poor than nurses. There was general agreement on how professionals would rate most deviations from their protocols. Nurses were more likely to rate insulin infusions restarted late and incorrect dosage of rescue glucose as major deviations than physicians. Most professionals agreed on when they would treat hypoglycaemia. CONCLUSIONS: When surveyed on various aspects of glycaemic control, ICU nurses and physicians often agreed, although there were certain areas of disagreement, in which their profession and level of experience seemed to play a role. RELEVANCE TO CLINICAL PRACTICE: Differing views on glycaemic control amongst professionals may affect their practice and, thus, could lead to health inequalities. Clinical leads and the multidisciplinary ICU team should assess and, if necessary, address these differing opinions.Nottingham University Hospitals (NUH) Charity and the NUH Department of Research and Innovation University of Nottingham School of Health Sciences director of research small grant

Involvement of K^+ Channels and Na^+, K^+-ATPase in Relaxant Actions of Selective Phosphodiesterase 3 Inhibitors on Airway and Vascular Smooth Muscles Isolated from Guinea-pigs

Milrinone or olprinone, a selective phosphodiesterase (PDE) 3 inhibitor, has relaxant actions on smooth muscles in addition to positive inotropic actions. The exact mechanism on vasodilating and bronchodilating actions of milrinone or olprinone has not been elucidated. In the present experiments, relaxant responses to PDE3 inhibitors were examined on the precontracted airway or pulmonary artery smooth muscle preparations to clarify their mechanism. Both milrinone and olprinone relaxed the airway smooth muscle preparation or the pulmonary artery preparation isolated from guinea-pigs in a concentration-dependent manner. In the airway smooth muscle, these relaxations were markedly blocked by iberiotoxin (a blocker of large conductance Ca^-activated K^+ channels). On the other hand, in the main pulmonary artery, the milrinone- and olprinone-induced relaxations were significantly blocked by iberiotoxin, and were more strongly blocked by ouabain (an inhibitor of Na^+, K^+-ATPase). In the right/left (R/L) pulmonary artery, ouabain also strongly blocked relaxant responses to milrinone and olprinone, but iberiotoxin did not modify these relaxations. Similar observations were seen on the bucladesine (a cyclic AMP mimic agent)-induced relaxation. In conclusion, milrinone and olprinone cause concentration-dependent relaxations of the isolated airway and pulmonary artery smooth muscles via an increase in intracellular cyclic AMP (cAMP). In the airway smooth muscle, large conductance Ca^-activated K^+ (BK_) channels seem to play a crucial role for these relaxations. Relaxations of the main pulmonary artery induced by milrinone and olprinone are mediated predominantly by activation of Na^+, K^+-ATPase, and partly through BK_ channels. In the R/L pulmonary artery, vasorelaxant effects of milrinone and olprinone are more likely mediated by activation of Na^+, K^+-ATPase, but not BK_ channels

Cerebral perfusion in sepsis

This article is one of ten reviews selected from the Yearbook of Intensive Care and Emergency Medicine 2010 (Springer Verlag) and co-published as a series in Critical Care. Other articles in the series can be found online at http://ccforum.com/series/yearbook. Further information about the Yearbook of Intensive Care and Emergency Medicine is available from http://www.springer.com/series/2855

The microcirculation of the critically ill pediatric patient

textabstractNote: This article is one of eleven reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2011 (Springer Verlag) and co-published as a series in Critical Care. Other articles in the series can be found online at http://ccforum.com/series/annual. Further information about the Annual Update in Intensive Care and Emergency Medicine is available from http://www.springer.com/series/890

Increasing Early Mobility of Patients in the Intensive Care Unit

Abstract This project occurred in a 35-bed intensive care unit at a level II trauma center in central California. The purpose of this project was to strengthen the implementation of evidence-based initiatives promoted by the Society of Critical Care Medicine. The Society of Critical Care Medicine has a set of initiatives for the intensive care units nationwide to improve the outcomes for patients. One of the initiatives is the ICU Liberation, which includes six different bundles labeled: A, B, C, D, E, & F (Society of Critical Care Medicine ,2013). Their studies showed a significant improvement in the outcomes for the ICU patient according the Society of Critical Care Medicine. Post intensive care syndrome and intensive care delirium has been decreased through mobilizing the ICU patients early upon admission (Hopkins, Mitchell, Thomsen, Schafer, Link, & Brown, 2016). Increased early mobility of both ventilated and non-ventilated patients has shown to increase muscle strength, improve quality of life and physical function. This led a reduction of length of ventilator days and the entire length of stay, therefore saving thousands of dollars (Lord, Mayhew, Korupolu, Mantheiy, Friedman, Palmer, & Needham, 2013) The implementation of early mobility into the ICU workflow and consistently applying early mobility to every patient, every day, would be the goal for this project. It will require the assistance of all stakeholders: nurses, intensivists, respiratory therapists, and physical therapists. Providing continuous education and identifying barriers is an important part of implementing early mobility. This will assist in removing barriers and allowing this project to be successful (Castro, Turncinovic, Platz, & Law, 2015). Pre-project surveys, post-project survey, and weekly audits will be valuable tools to identify barriers, implement changes or provide further education if needed

Thirty years of critical care medicine

Critical care medicine is a relatively young but rapidly evolving specialty. On the occasion of the 30th International Symposium on Intensive Care and Emergency Medicine, we put together some thoughts from a few of the leaders in critical care who have been actively involved in this field over the years. Looking back over the last 30 years, we reflect on areas in which, despite large amounts of research and technological and scientific advances, no major therapeutic breakthroughs have been made. We then look at the process of care and realize that, here, huge progress has been made. Lastly, we suggest how critical care medicine will continue to evolve for the better over the next 30 years

Recommendations for core critical care ultrasound competencies as a part of specialist training in multidisciplinary intensive care: a framework proposed by the European Society of Intensive Care Medicine (ESICM)

© 2020 The Author(s). Critical care ultrasound (CCUS) is an essential component of intensive care practice. Although existing international guidelines have focused on training principles and determining competency in CCUS, few countries have managed to operationalize this guidance into an accessible, well-structured programme for clinicians training in multidisciplinary intensive care. We seek to update and reaffirm appropriate CCUS scope so that it may be integrated into the international Competency-based Training in Intensive Care Medicine. The resulting recommendations offer the most contemporary and evolved set of core CCUS competencies for an intensive care clinician yet described. Importantly, we discuss the rationale for inclusion but also exclusion of competencies listed. Background/aim: Critical care ultrasound (CCUS) is an essential component of intensive care practice. The purpose of this consensus document is to determine those CCUS competencies that should be a mandatory part of training in multidisciplinary intensive care. Methods: A three-round Delphi method followed by face-to-face meeting among 32 CCUS experts nominated by the European Society of Intensive Care Medicine. Agreement of at least 90% of experts was needed in order to enlist a competency as mandatory. Results: The final list of competencies includes 15 echocardiographic, 5 thoracic, 4 abdominal, deep vein thrombosis diagnosis and central venous access aid. Conclusion: The resulting recommendations offer the most contemporary and evolved set of core CCUS competencies for an intensive care clinician yet described