Airway management in anesthesia for thoracic surgery: A “real life” observational study

Background: One-lung ventilation (OLV) in thoracic anesthesia is required to provide good surgical exposure. OLV is commonly achieved through a double lumen tube (DLT) or a bronchial blocker (BB). Malposition is a relevant issue related to these devices use. No prospective studies with adequately large sample size have been performed to evaluate the malposition rate of DLTs and BBs. Methods: A total of 2,127 patients requiring OLV during thoracic surgery were enrolled. The aim of this multicenter prospective observational study performed across 26 academic and community hospitals is to evaluate intraoperative malposition rate of DLTs and BBs. We also aim to assess: which device is the most used to achieve OLV, the frequency of bronchoscope (BRO) use, the incidence rate of desaturation during OLV and the role of other factors that can correlate to this event, and incidence of difficult airway. Results: Malposition rate for DLTs was 14%, for BBs 33%. DLTs were used in 95% of patients and BBs in 5%. Mean positioning time was shorter for DLT than BB (156±230 vs. 321±290 s). BRO was used in 54% of patients to check the correct positioning of the DLT. Desaturation occurred in 20% of all cases during OLV achieved through a DLT. Predicting factors of desaturation were dislocation (OR 2.03) and big size of DLT (OR 1.15). BRO use (OR 0.69) and left surgical side (OR 0.41) proved to be protective factors. Difficult airway prevalence was 16%; 10.8% predicted and 5.2% unpredicted. Conclusions: DLT has a low malpositioning rate and is the preferred device to achieve OLV. BRO use recorded was unexpectedly low. The possibility of encountering a difficult airway is frequent, with an overall prevalence of 16%. Risk factors of desaturation are malposition and increased size of DLT. Left procedures and BRO use could lead to fewer episodes of desaturation

A systematic review characterizing and clarifying intrinsic teaching challenges linked to inquiry‐based practical work

Since scientific literacy has become a key goal in science education, many people have argued in favor of the incorporation of inquiry in science education. However, scattered in the literature are extrinsic and intrinsic teaching challenges linked to the design and implementation of inquiry‐based practical work (IBPW) in secondary school science classrooms. The purpose of this systematic literature review was to characterize and clarify the intrinsic challenges. From an instructional design perspective, the characterization of the challenges yielded four primary categories. The categories consist of initiation‐phase challenges (such as unfavorable views regarding science and practical work), planning‐phase challenges (including difficulties involved in designing IBPW), implementation‐phase challenges (e.g., persuading learners to reflect on their experiences and findings), and summative evaluation‐phase challenges which include concerns linked to the grading of practical inquiry. In the different categories, the challenges are linked to gaps in various aspects of teacher competencies especially in the context of the TPACK framework. The aspects include content knowledge (CK) (such as science content and scientific inquiry); in addition to technological knowledge (TK) linked to standard technologies. Also included is pedagogic CK (including orientation toward science teaching). Moreover, some of the intrinsic challenges are linked to gaps in skills (including pervasive classroom management and practical skills); in addition to values (such as commitment). These results have theory‐, practice‐, and research‐based implications.http://wileyonlinelibrary.com/journal/tea2020-05-01hj2019Science, Mathematics and Technology Educatio