Comprehensive maternal hemorrhage protocols improve patient safety and reduce utilization of blood products.

OBJECTIVE: The purpose of this study was to assess the effectiveness of instituting a comprehensive protocol for the treatment of maternal hemorrhage. STUDY DESIGN: The protocol was separated into 4 stages, designated 0-3, based on the degree of blood loss and the patient response to interventions. Key components included admission risk assessment, measurement of blood loss, early but limited use of uterotonic agents, early presence of obstetrical and anesthesia staff, and transfusion with fixed ratios of blood products. Data were collected retrospectively and prospectively relative to the start of the protocol. RESULTS: We noted a significant shift toward resolution of maternal bleeding at an earlier stage (P < .01), use of fewer blood products (P < .01), and a 64% reduction in the rate of disseminated intravascular coagulation. In addition, there were significant improvements in staff and physician perceptions of patient safety (P < .01). CONCLUSION: Comprehensive maternal hemorrhage treatment protocols improve patient safety and reduce utilization of blood products.

Acute endotracheal tube occlusion caused by use of an esophageal detector device: report of a case and a discussion of its utility.

An experienced intensivist performed an emergency endotracheal intubation on a 72-year-old woman without difficulty. The vocal cords were visualized during the intubation. An esophageal detector device was used to confirm correct airway placement. After aspiration of the device, it was impossible to easily ventilate the patient. The endotracheal tube was removed and found to be occluded by a mucus plug. It is postulated that aspiration of the syringe on the esophageal detector device suctioned the mucus plug from the bronchial tree into the endotracheal tube and precluded ventilation of the airway. This complication has not been previously reported. The utility and possible hazards of the esophageal detector device are discussed.

Factitious oxygen desaturation after isosulfan blue injection.

Profound pulse oximetery desaturations are observed following isosulfan blue dye injection during breast sentinel node biopsy. The objective of this study was to examine the effect isosulfan dye has on oxygenation status and the reliability of pulse oximetery in evaluating this parameter. After study design, institutional review board approval was obtained. A prospective 5-month study was performed between January and April 2002. Twenty-one women with invasive breast cancer were monitored during breast sentinel node biopsies. Twenty-two operative cases were analyzed by pulse oximetry and arterial catheterization to record oxygen saturation. Time intervals of analysis were 0, 5, 10, 20, 30, and 40 minutes following injection of isosulfan blue dye. Simultaneous pulse oximetry and arterial blood gas analysis allowed comparison of indirect oximetry oxygen saturation (SpO2) to actual arterial oxygen saturation (SaO2). SpO2 values were decreased from baseline values at 10, 20, and 30 minutes without decrease in SaO2 saturation (P < 0.001). The mean oximetry SpO2 desaturation was 5.6 per cent, with a range to 9 per cent. After injection with isosulfan blue dye, a significant SpO2 desaturation occurs. Clinicians must be aware of the factitious effect isosulfan blue dye has on SpO2 monitoring, to assess accurately the oxygenation status of the anesthetized patient.