Point-of-care arterial blood gas (ABG) is a blood measurement test and a useful diagnostic tool that assists with treatment and therefore improves clinical outcomes. However, numerically reported ...test results make rapid interpretation difficult or open to interpretation. The arterial blood gas algorithm (ABG-a) is a new digital diagnostics solution that can provide clinicians with real-time interpretation of preliminary data on safety features, oxygenation, acid-base disturbances and renal profile. The main aim of this study was to clinically validate the algorithm against senior experienced clinicians, for acid-base interpretation, in a clinical context.
We conducted a prospective international multicentre observational cross-sectional study. 346 sample sets and 64 inpatients eligible for ABG met strict sampling criteria. Agreement was evaluated using Cohen's kappa index, diagnostic accuracy was evaluated with sensitivity, specificity, efficiency or global accuracy and positive predictive values (PPV) and negative predictive values (NPV) for the prevalence in the study population.
The concordance rates between the interpretations of the clinicians and the ABG-a for acid-base disorders were an observed global agreement of 84,3% with a Cohen's kappa coefficient 0.81; 95% CI 0.77 to 0.86; p < 0.001. For detecting accuracy normal acid-base status the algorithm has a sensitivity of 90.0% (95% CI 79.9 to 95.3), a specificity 97.2% (95% CI 94.5 to 98.6) and a global accuracy of 95.9% (95% CI 93.3 to 97.6). For the four simple acid-base disorders, respiratory alkalosis: sensitivity of 91.2 (77.0 to 97.0), a specificity 100.0 (98.8 to 100.0) and global accuracy of 99.1 (97.5 to 99.7); respiratory acidosis: sensitivity of 61.1 (38.6 to 79.7), a specificity of 100.0 (98.8 to 100.0) and global accuracy of 98.0 (95.9 to 99.0); metabolic acidosis: sensitivity of 75.8 (59.0 to 87.2), a specificity of 99.7 (98.2 to 99.9) and a global accuracy of 97.4 (95.1 to 98.6); metabolic alkalosis sensitivity of 72.2 (56.0 to 84.2), a specificity of 95.5 (92.5 to 97.3) and a global accuracy of 93.0 (88.8 to 95.3); the four complex acid-base disorders, respiratory and metabolic alkalosis, respiratory and metabolic acidosis, respiratory alkalosis and metabolic acidosis, respiratory acidosis and metabolic alkalosis, the sensitivity, specificity and global accuracy was also high. For normal acid-base status the algorithm has PPV 87.1 (95% CI 76.6 to 93.3) %, and NPV 97.9 (95% CI 95.4 to 99.0) for a prevalence of 17.4 (95% CI 13.8 to 21.8). For the four-simple acid-base disorders and the four complex acid-base disorders the PPV and NPV were also statistically significant.
The ABG-a showed very high agreement and diagnostic accuracy with experienced senior clinicians in the acid-base disorders in a clinical context. The method also provides refinement and deep complex analysis at the point-of-care that a clinician could have at the bedside on a day-to-day basis. The ABG-a method could also have the potential to reduce human errors by checking for imminent life-threatening situations, analysing the internal consistency of the results, the oxygenation and renal status of the patient.
Despite the benefits of abdominal normothermic regional perfusion (A‐NRP) for abdominal grafts in controlled donation after circulatory death (cDCD), there is limited information on the effect of ...A‐NRP on the quality of the cDCD lungs. We aimed to study the effect of A‐NRP in lungs obtained from cDCD and its impact on recipients´ outcomes. This is a study comparing outcomes of lung transplants (LT) from cDCD donors (September 2014 to December 2021) obtained using A‐NRP as the abdominal preservation method. As controls, all lung recipients transplanted from donors after brain death (DBD) were considered. The primary outcomes were lung recipient 3‐month, 1‐year, and 5‐year survival. A total of 269 LT were performed (60 cDCD and 209 DBD). There was no difference in survival at 3 months (98.3% cDCD vs. 93.7% DBD), 1 year (90.9% vs. 87.2%), and 5 years (68.7% vs. 69%). LT from the cDCD group had a higher rate of primary graft dysfunction grade 3 at 72 h (10% vs. 3.4%; p < .001). This is the largest experience ever reported with the use of A‐NRP combined with lung retrieval in cDCD donors. This combined method is safe for lung grafts presenting short‐term survival outcomes equivalent to those transplanted through DBD.
Transplantation of lungs procured in controlled donation after circulatory death with use of normothermic regional perfusion shows equivalent outcomes to transplantation of lungs procured in donation after brain death.
It is uncertain whether individualisation of the perioperative open-lung approach (OLA) to ventilation reduces postoperative pulmonary complications in patients undergoing lung resection. We compared ...a perioperative individualised OLA (iOLA) ventilation strategy with standard lung-protective ventilation in patients undergoing thoracic surgery with one-lung ventilation.
This multicentre, randomised controlled trial enrolled patients scheduled for open or video-assisted thoracic surgery using one-lung ventilation in 25 participating hospitals in Spain, Italy, Turkey, Egypt, and Ecuador. Eligible adult patients (age ≥18 years) were randomly assigned to receive iOLA or standard lung-protective ventilation. Eligible patients (stratified by centre) were randomly assigned online by local principal investigators, with an allocation ratio of 1:1. Treatment with iOLA included an alveolar recruitment manoeuvre to 40 cm H
O of end-inspiratory pressure followed by individualised positive end-expiratory pressure (PEEP) titrated to best respiratory system compliance, and individualised postoperative respiratory support with high-flow oxygen therapy. Participants allocated to standard lung-protective ventilation received combined intraoperative 4 cm H
O of PEEP and postoperative conventional oxygen therapy. The primary outcome was a composite of severe postoperative pulmonary complications within the first 7 postoperative days, including atelectasis requiring bronchoscopy, severe respiratory failure, contralateral pneumothorax, early extubation failure (rescue with continuous positive airway pressure, non-invasive ventilation, invasive mechanical ventilation, or reintubation), acute respiratory distress syndrome, pulmonary infection, bronchopleural fistula, and pleural empyema. Due to trial setting, data obtained in the operating and postoperative rooms for routine monitoring were not blinded. At 24 h, data were acquired by an investigator blinded to group allocation. All analyses were performed on an intention-to-treat basis. This trial is registered with ClinicalTrials.gov, NCT03182062, and is complete.
Between Sept 11, 2018, and June 14, 2022, we enrolled 1380 patients, of whom 1308 eligible patients (670 434 male, 233 female, and three with missing data assigned to iOLA and 638 395 male, 237 female, and six with missing data to standard lung-protective ventilation) were included in the final analysis. The proportion of patients with the composite outcome of severe postoperative pulmonary complications within the first 7 postoperative days was lower in the iOLA group compared with the standard lung-protective ventilation group (40 6% vs 97 15%, relative risk 0·39 95% CI 0·28 to 0·56), with an absolute risk difference of -9·23 (95% CI -12·55 to -5·92). Recruitment manoeuvre-related adverse events were reported in five patients.
Among patients subjected to lung resection under one-lung ventilation, iOLA was associated with a reduced risk of severe postoperative pulmonary complications when compared with conventional lung-protective ventilation.
Instituto de Salud Carlos III and the European Regional Development Funds.
Resumen: Introducción: Durante la pandemia de la COVID-19 es necesario que los profesionales actualicen conocimientos, actitudes y habilidades para tratar la infección, y se protejan frente al ...contagio con suministros sanitarios limitados. Se describe el empleo estratégico de un centro de simulación para facilitar la adaptación de un servicio de salud a la pandemia. Métodos: Se analiza la experiencia de un centro de simulación en Cantabria, España. Un grupo de trabajo identifica y clasifica las necesidades en 3 áreas: 1) aprendizaje (categorizadas con un sistema de zonas para adaptar el diseño e implementación del entrenamiento a las necesidades específicas); 2) innovación (relacionadas con la práctica asistencial y el equipamiento sanitario); y 3) suministros sanitarios (que pueden fabricarse con las impresoras 3D disponibles en el centro de simulación para material docente). Resultados: Se implementan 3 tipos de actividades de entrenamiento: talleres de formación de formadores para protección frente a trasmisión por gota-contacto, simulaciones para la protección frente a contagio por aerosoles y un marco de trabajo para el análisis de las situaciones con pacientes reales.Se analizan máscaras de buceo para la asistencia ventilatoria, prototipos de ventiladores y técnicas para ventilar 2 pacientes con un ventilador.Se fabrican máscaras de protección facial, hisopos para la toma de muestras y horquillas para mascarillas. Conclusión: La participación estratégica de un centro de simulación puede promover y facilitar la adaptación de un sistema de salud a una epidemia por la COVID-19. Abstract: Introduction: During the COVID-19 pandemic professionals need to update the knowledge, attitudes and skills necessary to treat infected patients, and protect themselves against the transmission of the disease with limited medical supplies. The strategic use of a simulation center to facilitate the adaptation of a health service to the pandemic is described. Methods: The experience of a simulation center in Cantabria, Spain is analyzed. A working group identifies and classifies organizational needs into three areas: 1) learning (categorized with a zone system to tailor the design and implementation of training to specific needs); 2) innovation (related to healthcare practice and healthcare equipment); and 3) sanitary supplies (which can be manufactured with the 3D printers available in the simulation center for teaching materials). Results: Three types of simulation training activities are implemented: train the trainer workshops for protection against drop-contact transmission, simulations for protection against aerosol transmission and a framework for the analysis of real situations with patients.Diving masks for ventilatory assistance, techniques for ventilating two patients with one ventilator and prototype ventilators are analyzed.Facial protection masks, swabs and mask forks are printed. Conclusion: The strategic participation of a simulation center can promote and facilitate the adaptation of a health system to a COVID-19 pandemic.
Durante la pandemia de la COVID-19 es necesario que los profesionales actualicen conocimientos, actitudes y habilidades para tratar la infección, y se protejan frente al contagio con suministros ...sanitarios limitados. Se describe el empleo estratégico de un centro de simulación para facilitar la adaptación de un servicio de salud a la pandemia.
Se analiza la experiencia de un centro de simulación en Cantabria, España. Un grupo de trabajo identifica y clasifica las necesidades en 3 áreas: 1) aprendizaje (categorizadas con un sistema de zonas para adaptar el diseño e implementación del entrenamiento a las necesidades específicas); 2) innovación (relacionadas con la práctica asistencial y el equipamiento sanitario); y 3) suministros sanitarios (que pueden fabricarse con las impresoras 3D disponibles en el centro de simulación para material docente).
Se implementan 3 tipos de actividades de entrenamiento: talleres de formación de formadores para protección frente a trasmisión por gota-contacto, simulaciones para la protección frente a contagio por aerosoles y un marco de trabajo para el análisis de las situaciones con pacientes reales.
Se analizan máscaras de buceo para la asistencia ventilatoria, prototipos de ventiladores y técnicas para ventilar 2 pacientes con un ventilador.
Se fabrican máscaras de protección facial, hisopos para la toma de muestras y horquillas para mascarillas.
La participación estratégica de un centro de simulación puede promover y facilitar la adaptación de un sistema de salud a una epidemia por la COVID-19.
During the COVID-19 pandemic professionals need to update the knowledge, attitudes and skills necessary to treat infected patients, and protect themselves against the transmission of the disease with limited medical supplies. The strategic use of a simulation center to facilitate the adaptation of a health service to the pandemic is described.
The experience of a simulation center in Cantabria, Spain is analyzed. A working group identifies and classifies organizational needs into three areas: 1) learning (categorized with a zone system to tailor the design and implementation of training to specific needs); 2) innovation (related to healthcare practice and healthcare equipment); and 3) sanitary supplies (which can be manufactured with the 3D printers available in the simulation center for teaching materials).
Three types of simulation training activities are implemented: train the trainer workshops for protection against drop-contact transmission, simulations for protection against aerosol transmission and a framework for the analysis of real situations with patients.
Diving masks for ventilatory assistance, techniques for ventilating two patients with one ventilator and prototype ventilators are analyzed.
Facial protection masks, swabs and mask forks are printed.
The strategic participation of a simulation center can promote and facilitate the adaptation of a health system to a COVID-19 pandemic.
El abordaje de la vía aérea es un reto para el equipo de salud, más aún el manejo de la vía aérea difícil en el paciente crítico. La toma de decisiones, la interacción con el equipo, el uso de los ...recursos y las destrezas motoras en momentos de estrés pueden verse afectadas e ir en contra del resultado en la seguridad del paciente.
Hacer una revisión del estado del arte en el manejo de la vía aérea difícil en el paciente críticamente enfermo, desde el saber disciplinar hasta las habilidades no técnicas.
Se realizó una revisión de la literatura en bases de datos (OvidSP, PubMed, ScienceDirect, EMBASE y en las bases de datos de los autores) con las palabras clave; se seleccionaron los artículos en los que se encontrara relación entre como mínimo 2 de las 6 palabras clave.
Se generaron recomendaciones de manejo y se diseñó una ayuda cognitiva para ser usada en situaciones de crisis.
Entrenar y desarrollar habilidades no técnicas como el liderazgo, el trabajo en equipo, la toma de decisiones, la conciencia de la situación y el uso de ayudas cognitivas puede ayudar al manejo eficiente y seguro de la vía aérea difícil en enfermos graves, donde se requiere más que la habilidad mecánica y la movilización de recursos tecnológicos.
Although the approach of the airway is a challenge for the health team, airway management is even more difficult in critically ill patients. Decision making, interaction within the team, the use of resources, as well as motor skills may be affected under stress, and go against the outcome as regards patient safety.
To review the state of the art in the management of the difficult airway in the critically ill patient, from the knowledge of this discipline to the non-technical skills.
A literature review was made in the literature databases (OvidSP, PubMed, ScienceDirect, EMBASE and databases of authors) with the keywords; Articles were selected in which there was a relationship between at least 2 of the 6 keywords.
Management recommendations were produced and a cognitive aid for use in crisis situations was designed.
Training and developing non-technical skills, such as leadership, teamwork, decision-making, situational awareness, as well as the use of cognitive aids can help in the efficient and safe management of the difficult airway in severely ill patients, in which something more than mechanical skills and technological resources are required.
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