Social Media Use by Hand Surgery Fellowship Programs.

INTRODUCTION: Social media has emerged as a useful tool in the fellowship recruitment process. We aimed to assess the prevalence of social media use among hand surgery fellowships, to analyze social media posts according to content, and to evaluate the level of engagement generated by specific content. METHODS: We used a list of accredited hand surgery fellowships from the American Society for Surgery of the Hand Fellowship Directory to identify all hand surgery fellowship profiles on Facebook, Twitter, and Instagram. Instagram was the most commonly used platform and thus the focus of this study. Two reviewers independently assessed all Instagram posts from each program and assigned content labels. We assessed the variability in content published by each program using a Monte Carlo estimation of an exact chi-square test. We calculated the level of engagement generated by each content label using the number of likes per post per number of account followers. We analyzed the variability in engagement using a Kruskal-Wallis test. RESULTS: We identified 21 Instagram accounts from 89 fellowship programs (24%). Seventeen of 21 (81%) were created after the onset of the coronavirus disease 2019 pandemic. There was significant variability in the scope of content published by each program ( P < 0.0001) and in the level of engagement generated by each content label ( P < 0.0001). Skills, conferences, fellow, case example(s), faculty, and team dynamics generated some of the most engagement. Logistics, miscellaneous, and facilities generated the least. DISCUSSION: There is wide variability in the content produced by hand fellowship programs. Specific types of content generate more engagement from followers than others. This information may guide fellowship programs to produce the type of content potential applicants find most useful when making application and rank list decisions.

Coronavirus Disease 2019: Anesthesia Machine Circuit Pressure During Use as an Improvised Intensive Care Unit Ventilator.

BACKGROUND: Use of anesthesia machines as improvised intensive care unit (ICU) ventilators may occur in locations where waste anesthesia gas suction (WAGS) is unavailable. Anecdotal reports suggest as much as 18 cm H2O positive end-expiratory pressure (PEEP) being inadvertently applied under these circumstances, accompanied by inaccurate pressure readings by the anesthesia machine. We hypothesized that resistance within closed anesthesia gas scavenging systems (AGSS) disconnected from WAGS may inadvertently increase circuit pressures. METHODS: An anesthesia machine was connected to an anesthesia breathing circuit, a reference manometer, and a standard bag reservoir to simulate a lung. Ventilation was initiated as follows: volume control, tidal volume (TV) 500 mL, respiratory rate 12, ratio of inspiration to expiration times (I:E) 1:1.9, fraction of inspired oxygen (Fio2) 1.0, fresh gas flow (FGF) rate 2.0 liters per minute (LPM), and PEEP 0 cm H2O. After engaging the ventilator, PEEP and peak inspiratory pressure (PIP) were measured by the reference manometer and the anesthesia machine display simultaneously. The process was repeated using prescribed PEEP levels of 5, 10, 15, and 20 cm H2O. Measurements were repeated with the WAGS disconnected and then were performed again at FGF of 4, 6, 8, 10, and 15 LPM. This process was completed on 3 anesthesia machines: Dräger Perseus A500, Dräger Apollo, and the GE Avance CS2. Simple linear regression was used to assess differences. RESULTS: Utilizing nonparametric Bland-Altman analysis, the reference and machine manometer measurements of PIP demonstrated median differences of -0.40 cm H2O (95% limits of agreement [LOA], -1.00 to 0.55) for the Dräger Apollo, -0.40 cm H2O (95% LOA, -1.10 to 0.41) for the Dräger Perseus, and 1.70 cm H2O (95% LOA, 0.80-3.00) for the GE Avance CS2. At FGF 2 LPM and PEEP 0 cm H2O with the WAGS disconnected, the Dräger Apollo had a difference in PEEP of 0.02 cm H2O (95% confidence interval [CI], -0.04 to 0.08; P = .53); the Dräger Perseus A500, <0.0001 cm H2O (95% CI, -0.11 to 0.11; P = 1.00); and the GE Avance CS2, 8.62 cm H2O (95% CI, 8.55-8.69; P < .0001). After removing the hose connected to the AGSS and the visual indicator bag on the GE Avance CS2, the PEEP difference was 0.12 cm H2O (95% CI, 0.059-0.181; P = .0002). CONCLUSIONS: Displayed airway pressure measurements are clinically accurate in the setting of disconnected WAGS. The Dräger Perseus A500 and Apollo with open scavenging systems do not deliver inadvertent continuous positive airway pressure (CPAP) with WAGS disconnected, but the GE Avance CS2 with a closed AGSS does. This increase in airway pressure can be mitigated by the manufacturer's recommended alterations. Anesthesiologists should be aware of the potential clinically important increases in pressure that may be inadvertently delivered on some anesthesia machines, should the WAGS not be properly connected.