Pre-hospital advanced airway management by anaesthetist and nurse anaesthetist critical care teams: a prospective observational study of 2028 pre-hospital tracheal intubations

Background: Pre-hospital tracheal intubation success and complication rates vary considerably among provider categories. The purpose of this study was to estimate the success and complication rates of pre-hospital tracheal intubation performed by physician anaesthetist or nurse anaesthetist pre-hospital critical care teams. Methods: Data were prospectively collected from critical care teams staffed with a physician anaesthetist or a nurse anaesthetist according to the Utstein template for pre-hospital advanced airway management. The patients served by six ambulance helicopters and six rapid response vehicles in Denmark, Finland, Norway, and Sweden from May 2015 to November 2016 were included. Results: The critical care teams attended to 32 007 patients; 2028 (6.3%) required pre-hospital tracheal intubation. The overall success rate of pre-hospital tracheal intubation was 98.7% with a median intubation time of 25 s and an on-scene time of 25 min. The majority (67.0%) of the patients' tracheas were intubated by providers who had performed >2500 tracheal intubations. The success rate of tracheal intubation on the first attempt was 84.5%, and 95.9% of intubations were completed after two attempts. Complications related to pre-hospital tracheal intubation were recorded in 10.9% of the patients. Intubations after rapid sequence induction had a higher success rate compared with intubations without rapid sequence induction (99.4% vs 98.1%; P=0.02). Physicians had a higher tracheal intubation success rate than nurses (99.0% vs 97.6%; P=0.03). Conclusions: When performed by experienced physician anaesthetists and nurse anaesthetists, pre-hospital tracheal intubation was completed rapidly with high success rates and a low incidence of complications.Peer reviewe

Uso de microbiota cecal congelada com crioprotetores em pintos infectados experimentalmente com Salmonella enterica sorovar Enteritidis Use of frozen cecal microbiota with cryoprotectors in chicks experimentally infected with Salmonella enterica serotype Enteritidis

Pintos de corte com um dia de idade foram tratados com microbiota cecal cultivada em condição de aerobiose, nos tempos de congelamento de 90, 200, 290 e 360 dias, e associada aos crioprotetores sacarose, trealose, dimetilsulfóxido (DMSO) e glicerol. Posteriormente as aves foram desafiadas com Salmonella Enteritidis, visando determinar a eficácia dos tratamentos em relação à quantidade de bactérias viáveis da microbiota que foi maior aos 90 dias (10,58 Log10 UFC/ml), quando as aves foram tratadas com sacarose, e menor aos 290 dias, quando tratadas com glicerol (7,73 Log10 UFC/ml). No tempo zero, todas as aves apresentaram Salmonella (100%) quando tratadas com DMSO e glicerol, com colonização cecal de 4,9 e 5,2 Log10 UFC/g do conteúdo cecal, respectivamente; aos 360 dias nenhuma ave foi infectada, independente do tratamento. A microbiota cecal, independente de tratamento, sempre determinou menor quantidade de S. Enteritidis em qualquer um dos parâmetros pesquisados, quando comparada com a das aves não tratadas. O congelamento em nitrogênio líquido foi eficaz na manutenção da viabilidade da microbiota cecal até 360 dias.<br>One-day-old broiler chicks were treated with cecal microbiota cultivated under aerobiose conditions, frozen during 90, 200, 290 and 360 days and associated with different cryoprotectors such as sucrose, trehalose, DMSO and glycerol. Subsequently, the birds were challenged with Salmonella Enteritidis in order to determine the efficacy of the different treatments in relation to the quantity of viable bacteria, which was higher at 90 days when treated with sucrose (10.58 log10 CFU/ml) and lower at 290 days when treated with glycerol (7.73 log10 CFU/ml). The quantity of infected birds was 100% in 0 time, when the cecal colonization by S. Enteritidis was 4.9 and 5.2 log10 CFU/g of cecal content, respectively treated with DMSO and glycerol. No bird was infected at 360 days, irrespectively of the treatment. In all treatments, the cecal microbiota always determined a lesser quantity of S. Enteritidis for all the studied parameters compared to non-treated birds. Frozen in liquid nitrogen was effective in maintaining the viability of cecal microbiota during the experimental period of 360 days