Subject(s)
Brain Injuries, Traumatic/physiopathology , Neuromuscular Nondepolarizing Agents/therapeutic use , Rocuronium/therapeutic use , Subarachnoid Hemorrhage, Traumatic/physiopathology , Sugammadex/therapeutic use , Accidents, Traffic , Brain Contusion/complications , Brain Contusion/diagnosis , Brain Contusion/physiopathology , Brain Contusion/therapy , Brain Injuries, Traumatic/complications , Brain Injuries, Traumatic/diagnosis , Brain Injuries, Traumatic/therapy , Disease Management , Humans , Intubation, Intratracheal/methods , Kidney Failure, Chronic/complications , Male , Middle Aged , Neurologic Examination , Subarachnoid Hemorrhage, Traumatic/complications , Subarachnoid Hemorrhage, Traumatic/diagnosis , Subarachnoid Hemorrhage, Traumatic/therapyABSTRACT
BACKGROUND: The transfer of critically ill patients from the operating room (OR) to the surgical intensive care unit (SICU) involves handoffs between multiple providers. Incomplete handoffs lead to poor communication, a major contributor to sentinel events. Our aim was to determine whether handoff standardization led to improvements in caregiver involvement and communication. METHODS: A prospective intervention study was designed to observe thirty one patient handoffs from OR to SICU for 49 critical parameters including caregiver presence, peri-operative details, and time required to complete key steps. Following a six month implementation period, thirty one handoffs were observed to determine improvement. RESULTS: A significant improvement in presence of physician providers including intensivists and surgeons was observed (p = 0.0004 and p < 0.0001, respectively). Critical details were communicated more consistently, including procedure performed (p = 0.0048), complications (p < 0.0001), difficult airways (p < 0.0001), ventilator settings (p < 0.0001) and pressor requirements (p = 0.0134). Conversely, handoff duration did not increase significantly (p = 0.22). CONCLUSIONS: Implementation of a standardized protocol for handoffs between OR and SICU significantly improved caregiver involvement and reduced information omission without affecting provider time commitment.
Subject(s)
Critical Care/standards , Intensive Care Units/standards , Patient Admission/standards , Patient Care Team/standards , Patient Handoff/standards , Postoperative Care/standards , Quality Improvement/organization & administration , Communication , Critical Care/organization & administration , Critical Care/statistics & numerical data , Humans , Intensive Care Units/organization & administration , Intensive Care Units/statistics & numerical data , Interprofessional Relations , Patient Admission/statistics & numerical data , Patient Care Team/organization & administration , Patient Care Team/statistics & numerical data , Patient Handoff/organization & administration , Patient Handoff/statistics & numerical data , Patient Safety/standards , Patient Safety/statistics & numerical data , Postoperative Care/methods , Postoperative Care/statistics & numerical data , Practice Guidelines as Topic , Prospective Studies , Quality Improvement/statistics & numerical data , Time FactorsSubject(s)
Intubation, Intratracheal/adverse effects , Risk Assessment/methods , Female , Humans , MaleABSTRACT
OBJECTIVES: To compare cardiac output (CO) measurements from a novel endotracheal bioimpedance cardiac output monitor device (ECOM; ConMed, Irvine, CA) to simultaneous pulmonary artery thermodilution (TD) CO. DESIGN: Prospective study. SETTING: One academic hospital. PARTICIPANTS: Forty volunteer patients undergoing cardiac surgery. INTERVENTIONS: Intraoperative CO measurements. MEASUREMENTS AND MAIN RESULTS: Simultaneous comparative data points were collected from ECOM and TD at 4 periods: post-induction, post-sternotomy, post-cardiopulmonary bypass, and post-chest closure. The mean CO(TD) was compared with CO(ECOM) for each operative period then assessed for agreement by linear regression, Bland-Altman analysis, and percent error methods. There were 35 men (87.5%) with a mean age of 66 ± 10.7 years in the present study population. R values (p value) for the 4 time periods were 0.50 (0.002), 0.33 (0.035), 0.42 (0.007), and 0.48 (0.002). Bias and 95% limits of agreement in L/min were -0.11 (-2.40 to 2.18), 0.04 (-2.57 to 2.65), -0.06 (-2.86 to 2.74), and 0.02 (-2.42 to 2.45). Percent errors of the 4 time periods were 51%, 53%, 50%, and 48%. CONCLUSIONS: ECOM did not adequately agree with TD in patients undergoing cardiac surgery.
Subject(s)
Cardiac Output/physiology , Cardiac Surgical Procedures/methods , Intubation, Intratracheal/methods , Monitoring, Intraoperative/methods , Aged , Female , Humans , Male , Middle Aged , Prospective Studies , Thermodilution/methodsABSTRACT
BACKGROUND: We report a case of severe upper airway obstruction due to a retropharyngeal hematoma that presented nearly one day after a precipitating traumatic injury. Retropharyngeal hematomas are rare, but may cause life-threatening airway compromise. CASE PRESENTATION: A 50 year-old man developed severe dyspnea with oropharyngeal airway compression due to retropharyngeal hematoma 20 hours after presenting to the emergency department. The patient also had a fractured first cervical vertebra and was diagnosed with a left brachial plexopathy. The patient underwent emergent awake fiberoptic endotracheal intubation to provide a definitive airway. CONCLUSION: Retropharyngeal hematoma with life-threatening airway compromise can develop hours or days after a precipitating injury. Clinicians should be alert to the potential for this delayed airway collapse, and should also be prepared to rapidly secure the airway in this patient population likely to have concomitant cervical spinal or head injuries.