Identifying Relevant Topics for Inclusion in an Ethics Curriculum for Anesthesiology Trainees: A Survey of Practitioners in the Field.

Anesthesiology training programs are tasked with equipping trainees with the skills to become medically and ethically competent in the practice of anesthesia and to be prepared to obtain board certification, yet there is currently no standardized ethics curriculum within anesthesia training programs in the United States. To bridge this gap, and to provide a validated ethics curriculum to meet the aforementioned needs, in July 2021, a survey was sent to anesthesia scholars in the field of biomedical ethics to identify key areas that should be included in such an ethics curriculum. The responses were rated on a Likert scale and ranked. This paper identifies the top ten topics identified as high priority for inclusion in an anesthesiology training program and consequently deemed most relevant to meet the educational needs of graduates of an anesthesiology residency: (1) capacity to consent; (2) capacity to refuse elective versus lifesaving treatment; (3) application of surrogate decisionmaking; (4) approach to do not resuscitate (DNR) status in the operating room; (5) patient autonomy and advance directives; (6) navigating patient beliefs that may impair care; (7) "futility" in end-of-life care: when to withdraw life support; (8) disclosure of medical errors; (9) clinical criteria for "brain death" and consequences of this definition; and (10) the impaired anesthesiologist.

Preoperative Pressure Ulcers, Mortality, and Complications in Older Hip Fracture Surgery Patients.

INTRODUCTION: The effect of a preoperative pressure ulcer (PPU) in hip fracture patients on postoperative outcomes has not been well studied. We hypothesized that the presence of a PPU would be associated with increased mortality and serious complications in hip fracture surgery patients. METHODS: We conducted a cohort study of 19,520 hip fracture patients from 2016 to 2019 with data from the National Surgical Quality Improvement Program. The study exposure was the presence of a PPU. This study's primary outcome was 30-day mortality. Secondary outcomes included deep vein thrombosis (DVT), pulmonary embolism, surgical site infection, pneumonia, and unplanned hospital readmission. Propensity score analysis and inverse probability of treatment weighting were used to control for confounding and reduce bias. RESULTS: The presence of a PPU was independently associated with a 21% increase in odds of 30-day mortality (odds ratio (OR) = 1.2, P = 0.004). The presence of a PPU was also independently associated with increased odds of DVT (OR = 1.59, P < 0.001), pneumonia (OR = 1.39, P < 0.001), and unplanned hospital readmission (OR = 1.43, P < 0.001) and a significant increase in the mean length of hospital stay of 0.4 days (P = 0.007). DISCUSSION: We found that PPUs were independently associated with increased 30-day mortality, DVT, pneumonia, hospital length of stay, and unplanned hospital readmission.

Usefulness of preoperative point-of-care ultrasound measurement of the lateral parapharyngeal wall to predict difficulty in mask ventilation.

Measurement of the lateral parapharyngeal wall has been shown to correlate with severity of obstructive sleep apnea, which is believed to increase risk of difficulty in mask ventilation (MV). This study aimed to assess the efficacy of using ultrasound to measure the lateral parapharyngeal wall thickness (LPWT) to predict the difficulty of MV. The LPWT was measured as the distance between the inferior border of the carotid artery and the lateral wall of the pharynx. Difficulty of MV was assessed according to an MV scale. A total of 92 patients were enrolled. Measurements of the LPWT ranged from 1.52 to 4.43 cm. There was a significant correlation between LPWT and difficulty of MV (P = 0.004). Every increase in 1 cm of LPWT was associated with an odds of increase in MV score of 3.17 (P < 0.05). With a cutoff of 3.5 cm, the area under the curve for LPWT was 0.67. The negative predictive value was 0.89, and the positive predictive value was 0.57. Use of point-of-care ultrasound to measure the LPWT shows promise in its ability to aid in airway management planning. Ultrasonic measurements of the LPWT have reasonable accuracy for predicting difficulty of MV.

Utilization of submandibular ultrasound to measure oral cavity changes with interventions in routine airway management.

Ultrasound is a quick, noninvasive, inexpensive tool that can provide an accurate airway assessment. Tongue thickness, oral cavity height, and their relationship were measured using submandibular ultrasonography with and without oral airway interventions during intubation in 26 patients. The mean tongue thickness to oral cavity height ratio was 0.83 ± 0.03. The percent change of tongue thickness to oral cavity height decreased significantly by 36.47% with an oral airway and by 43.49% with laryngoscope interventions (P < 0.01). This study demonstrates how ultrasound-measured oral cavity ratios change with the placement of airway equipment, and application of these findings may advance our understanding of advanced airway management among diverse patient populations.

Racial disparities in catheter related urinary tract infections among elderly trauma patients in the US.

BACKGROUND: Catheter associated urinary tract infections (CAUTIs) have become a focus for reducing healthcare costs. Reimbursement may be reduced to hospitals with higher rates. The implementation of bundles or other efforts to reduce infection numbers may not be as robust at hospitals caring for more diverse patient populations. This may lead to a disparity in hospital-associated infections rates that may lead to lower reimbursement and a downward spiral of quality of care and racial disparities. METHODS: We analyzed patients in the National Trauma Data Bank from 2016 to 2017. The final analysis included patients 65 years or older with one or more day of mechanical ventilation. This was the population had the highest rate of CAUTI. We compared white patients to non-whites using students t test, Mann Whitney U test, or chi-square as appropriate. Logistic regression with odds ratios (ORs) and 95% confidence intervals (CI) was computed to identify risk factors for of CAUTI. RESULTS: Risk factors for developing a CAUTI were race (OR 1.44, 95% confidence interval (95%CI) 1.23-1.71), injury severity score (OR 1.10 per increase of one, 95% CI 1.01-1.02), care at a teaching hospital (OR 1.17, 95%CI 1.02-1.35), private insurance (OR 1.28, 95%CI 1.09-1.51), hypertension (OR 1.18, 95%CI 1.02-1.37), female gender (OR 1.54, 95%CI 1.33-1.77). Non-white patients received care at teaching hospitals more often and had a higher rate of government insurance or no insurance. DISCUSSION: The Center for Medicare and Medicaid Services (CMS) has put in place a reimbursement modification 87 plan based on the rates of hospital-associated infections including CAUTIs. We have demonstrated non-white 88 patients have higher odds for developing a CAUTI. CONCLUSION: CMS may potentially worsen the racial disparity by further cutting reimbursement to hospitals who care for higher proportions of non-whites.

Intubation of a Patient with a Large Goiter: The Advantageous Role of Videolaryngoscopy.

Fiberoptic bronchoscopy has long been considered the gold standard for patients who present with a difficult airway. In the case presented, a patient has a large palpable goiter and requires intubation. After the unsuccessful attempt to intubate with the use of fiberoptic bronchoscopy, the decision to switch to videolaryngoscopy afforded a positive result. We present this case to suggest that the utilization of videolaryngoscopy may be an alternative option for intubation when other methods have failed. It is imperative for anesthesiologists to understand the benefits that this modality may provide.