ABSTRACT
INTRODUCTION: As an infection control measure for COVID-19, our PICU transitioned to near universal video laryngoscopy (VL). In 2019, 24% of intubations used VL;this increased to 96% in 2021. Comparing these two cohorts elucidates the effect of transitioning from direct laryngoscopy (DL) to VL on first time success rate (FTSR), Cormack-Lehane (C-L) grade view and successful trainee intubation. First time intubation success is associated with fewer complications and is therefore an important marker of intubation safety. METHOD(S): Single Center retrospective case control. Data for 2019 were identified via chart review. Data from 2021 were obtained through a dedicated form introduced in the Fall of 2020. Each comparison group was limited to a full calendar year (Jan-Dec) to account for progression in trainee skill. A comparison was made between all patients in cohort groups with additional stratification of patients above and below the age of one. Included intubations were those in the PICU as well as those in the pediatric floor or ED performed by PICU staff. Statistics via Fischer Exact test. RESULT(S): 75 patients met criteria for 2019 and 73 in 2021. The age range in both groups was 2 days to 23 years. C-L view was documented in 72 of 75 patients in 2019 and all patients in 2021. 2019 had a 69.4% grade 1 C-L view rate, while 2021 had a 79.5% grade 1 C-L view rate (p=0.19). The overall FTSR in 2019 was 57.3% vs 65.7% in 2021 (p=0.31). 26 children under the age of one were intubated in both years, with a FTSR of 53.8% and 50% respectively. The FTSR in children above one year was 59.2% and 74.5% respectively (p=0.13). Additionally, an airway provider was documented in all but two cases in 2019. Of these, 75.3% were managed successfully by pediatric subspecialty fellows (PICU or rotating PEM). In 2021 this number increased to 84.9% (p=0.21). CONCLUSION(S): FTSR did not improve with transition to VL. In the 2021 cohort, children above age one had a 15.3% increased FTSR and trainees had a 9.6% increase in completed intubations. While not significant, these findings would benefit from reanalysis with a larger sample. First time success is an important marker for safe intubation practice, however there may be other benefits to either approach such as set up time and assistance from a second viewer.
ABSTRACT
INTRODUCTION: Public health measures to reduce the transmission of COVID-19 have required various changes in life-style, including loss or risk to employment and social isolation. We wished to assess how these measured effected 30-45 year old smokers at risk of COPD participating in the BLF Early COPD cohort study METHODS: At enrolment, participants were aged 30-45 years, tobacco smokers with >10 pack-year smoking history, FEV1=>80% predicted and a BMI < 35kg/m2. Participants were seen face-to-face in clinic pre-COVID. During lock-down, they were posted questionnaires and contacted by telephone. The last clinic visit took place on the 12 March 2020, remote visits took place between 16 April and 28 Sep. 260 individuals at six sites (25 Belfast, 38 Birmingham, 25 Edinburgh, 101 London, 27 Manchester and 44 Nottingham) were asked about smoking habits. The MRC chronic bronchitis questionnaire, COPD Assessment test (CAT), Leicester cough questionnaire, Hospital Anxiety and Depression questionnaire were completed in writing by the participant and returned by post or photographed and returned by email. At enrolment, the post-BD FEV1 was 3.81 (SD 0.8) litres, 101% (11) of GLI predicted. Comparisons were made by paired t-tests and chi-squared tests. RESULTS: Level of anxiety increased from 6.74 (SD 4.4) to 7.37 (SD 4.7, n=233;p=0.010) during lock-down;depression scores increased from 4.30 (3.9) to 5.14 (SD 4.1;n=233;p<0.001). Anxiety increased in 78/233 and depression in 89/233 participants by 2 or more units, 2 units is considered the minimally important (MCID) in bronchiectasis, COPD and ILD (Wynne, 2020) Figure 1 shows that during lock-down, the proportion of participants not smoking increased from 31/259 (12.0%) to 62/259 (23.9%;p<0.001). In those who continued to smoke, cigarettes per day (p=0.59) and rolling tobacco consumption (g/week) (p=0.92) were unchanged. Participants reported less chronic bronchitis defined as “do you bring up phlegm like this on most days (or nights) as much as three months each year”, fell from 83/260 (31.9%) participants to 74/259 (28.6%;p<0.001). CAT scores fell from 10.5 (SD 6.4) to 9.6 (SD 6.3;n=233;p=0.007) and total cough score improved from 18.7 (SD 2.7) to 19.1 (2.6;n=204;p=0.007). CONCLUSIONS: Despite increased anxiety and depression, participants quit smoking and those that continued to smoke, did not smoke more. Respiratory symptoms of chronic bronchitis, cough and CAT scores improved. REFERENCES:Wynne SC, et al. Chron Respir Dis. 2020 Jan-Dec;17:1479973120933292. doi: 10.1177/1479973120933292. .