Effect of mechanical insufflation-exsufflation for ineffective cough on weaning duration in diseases of the peripheral or central nervous system (MEDINE): study protocol for a randomised controlled trial in a neurological weaning centre.

INTRODUCTION: Patients with neurological or neurosurgical disease can suffer from impaired cough, which may result in life-threatening retention of tracheobronchial secretions, atelectasis, pneumonia and finally death. Due to a lack of alternatives and pathophysiological plausibility, the application of mechanical insufflation-exsufflation (MI-E) has already become international standard care in neuromuscular disease and spinal cord injury although a lack of evidence for efficacy. High-quality studies to support the use of MI-E in neurological and neurosurgical patients during weaning from mechanical ventilation are missing. The goal of this exploratory study is to display the effect size of MI-E intervention on the duration of mechanical ventilation and additional outcomes. METHODS AND ANALYSIS: One hundred adult patients with a cough deficiency or retention of secretion admitted to a neurological intensive care unit (ICU) are planned to be recruited for this randomised controlled trial. Patients are randomised 1:1 to receive either MI-E or best standard care. Observation will take place until discharge from the hospital, death or end of the study period. The primary endpoint of this trial is the duration of mechanical ventilation from randomisation until successful weaning. The outcome will be analysed with Kaplan-Meier estimation and competing risks analyses. Secondary endpoint is the proportion of patients with successful weaning. Further outcomes will include the incidence of hospital-acquired pneumonia, mortality, decannulation rate, length of stay on the ICU and the total score of the Glasgow Coma Scale. ETHICS AND DISSEMINATION: The study was approved by the Medical Ethics Committee of the University of Oldenburg. The findings of this study will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER: DRKS00020981.

Improving Emergency Service Quality and Patient Safety Through the Use of Cross-Sectoral Digital Feedback Systems - An Overview.

BACKGROUND: Feedback is essential for personal and professional development, also in emergency services. However, EMS usually ends at the interface with the emergency department, thus, the long-term effect of initiated emergency measures often remains unclear for emergency personnel. Digital, data-driven tools providing systematic feedback on patients' outcome may be valuable to improve emergency service quality and patient safety. OBJECTIVES: To provide an overview about current approaches for cross-sectoral digital feedback systems in EMS. METHODS: Literature review in PubMed/MEDLINE and Google Scholar in accordance with the PRISMA statement. RESULTS: The search resulted in 567 articles out of which only three were identified as eligible. In only one study cross-sectoral feedback was used to improve quality. CONCLUSION: Although feedback is described as a method for improving the quality of the rescue service and feedback is also considered in the description of the requirements for digitization, there seems to be no technical implementation of a cross-sectoral feedback system so far.

Feasibility of Three Head Mounted Eye-Tracker in Anesthesia: A Feasibility Study.

Many studies use eye-tracker to analyse the socio-technical system, also in medical research. Only a few articles describe the use of eye-tracker to examine human-computer interaction in a critical care environment, especially in the field of anaesthesia or surgery. Therefore, we have tested in a feasibility study head-mounted eye-tracker of three different manufactures in a simulated anesthesia surrounding with mankind patient simulators. The research question was to analyse whether the field scene camera of the eye-tracker can be used in the light conditions and changes in brightness of the operating room. In addition, it was tested whether the eye-tracker was still calibrated and held on the subject's head during the resuscitation movement. All eye-trackers tested had a good adaptation on changing light or changing distances.

Alarm Fatigue: Causes and Effects.

The term "Alarm fatigue" is commonly used to describe the effect which a high number of alarms can have on caregivers: Frequent alarms, many of which are avoidable, can lead to inadequate responses, severely impacting patient safety. In the first step of a long-term effort to address this problem, both the direct and indirect impact of alarms, as well as possible causes of unnecessary alarms were focused. Models of these causes and impacts were developed using a scoping review which included guided interviews with experts from medical informatics, clinicians and medical device manufacturers. These models can provide the methodical grounds for the definition of targeted interventions and the assessment of their effects.

Retrospective Evaluation of Percutaneous Access for TEVAR and EVAR: Time to Make it the Standard Approach?

Introduction To evaluate the safety of percutaneous endovascular aortic repair and the relationship of access site characteristics to complications Materials and Methods All patients undergoing percutaneous TEVAR, EVAR and FEVAR procedures from January 2010 to May 2016 were retrospectively analysed for incidence of complications and their relationship to various access site characteristics like access artery size, degree of vessel calcification, skin to artery distance and sheath to artery ratio. Hemostasis occurring within 15 min after suture closure with or without manual compression was defined as primary hemostasis. Results 92 patients with 142 femoral access sites were included in the study. Median follow-up was 28.13 months (range 2.5 - 76.7 months, Mean 32.39, SD - 21.66 months). Introducer system size ranged from 12F to 25F. Primary haemostasis was achieved in 97.1 % (138/142) of the total femoral access sites. Four access sites (2.8 %) had to be closed surgically; in all 4 cases the introducer systems was ≥ 18F. Two of these access sites had been operated upon previously. Late complications including inguinal hematoma (n = 7), wound infection (n = 1), scrotal hematoma (n = 1), pseudoaneurysm (n = 4) and late bleeding (n = 4) occurred in 17 access sites (11.9 %), of which 13 were managed conservatively. On account of the low complication rate, no correlation between the evaluated variables and observed complications could be established. Conclusion Percutaneous endovascular aortic repair is feasible and safe irrespective of the size of the introducer sheath and the nature of aorto-iliac pathology. The technical success rate is high and the incidence of complications is low. Early complications are most often associated with sheath sizes ≥ 18 F. The majority of the late complications can be treated conservatively. Key points: · Percutaneous endovascular aortic repair is feasible and safe.. · Technical success rate is high and complication rate is low.. · Vascular closure device failure in the occasional patient may necessitate surgical intervention.. Citation Format · Thomas RP, Kowald T, Schmuck B et al. Retrospective Evaluation of Percutaneous Access for TEVAR and EVAR: Time to Make it the Standard Approach?. Fortschr Röntgenstr 2017; 189: 347 - 355.

Feasibility of Eyetracking in Critical Care Environments - A Systematic Review.

Achieving a good understanding of the socio-technical system in critical or emergency situations is important for patient safety. Research in human-computer interaction in the field of anesthesia or surgery has the potential to improve usability of the user interfaces and enhance patient safety. Therefore eye-tracking is a technology for analyzing gaze patterns. It can also measure what is being perceived by the physician during medical procedures. The aim of this review is the applicability of eye-tracker in the domain of simulated or real environments of anesthesia, surgery or intensive care. We carried out a literature research in PubMed. Two independent researchers screened the titles and abstracts. The remaining 8 full-papers were analyzed based on the applicability of eye-trackers. The articles contain topics like training of surgeons, novice vs. experts or the cognitive workload. None of the publications address our goal. The applicability or limitations of the eye-tracker technology were stated incidentally.