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Measuring the Impact of Time Pressure on Team Task Performance
Published in Rhona Flin, Lucy Mitchell, Safer Surgery, 2009
Colin F. Mackenzie, Shelly A. Jeffcott, Yan Xiao
This chapter examines the impact of time pressure on trauma resuscitation team performance, by using tracheal intubation as a model to contrast task performance at two levels of task urgency, emergency and elective interventions, depending on the clinical circumstances. The task of tracheal intubation is very relevant to understanding anaesthesia activities during surgery, as it is a task carried out after induction of anaesthesia in the operating room. Tracheal intubation includes rendering unconsciousness (using anaesthetic and paralysing drugs if the patient is awake or semi-conscious) to stop breathing efforts or patient resistance and allow placement of an endo-tracheal tube through the mouth and between the vocal cords. The ‘airway management’ achieved by tracheal intubation is a lifesaving intervention when executed correctly in an emergency. However, it requires significant technical skill and has risks (vomiting and aspiration, detrimental changes in vital signs including cardiac arrest) that may even significantly outweigh the potential benefits of improved oxygenation and ventilation. The complications associated with task accomplishment may, themselves, become more life threatening than the problem that the intervention was intended to remedy. Several methods were considered to collect data to examine the impact of time pressure on tracheal intubation.
The impact of aerosol box on tracheal intubation during the COVID‐19 pandemic: a systematic review
Published in Expert Review of Medical Devices, 2022
Trias Mahmudiono, Saurabh Singhal, Anas Amer Mohammad, Virgilio E Failoc-Rojas, Maria Jade Catalan Opulencia, Angel Santillán Haro, Yasir Salam Karim, Nizom Qurbonov, Walid Kamal Abdelbasset, Ahmed B. Mahdi, Yasser Fakri Mustafa
There are sparse data regarding the impact of the aerosol box on intubation time. Some studies have shown that the use of aerosol box leads to an increase in intubation time, and this is statistically significant [24,25,30,31,35,36,39,42]. However, there were a number of studies reporting no significant differences in the time to intubation with and without the aerosol box [32,38,40]. The findings of other systematic reviews dedicated to the intubation box showed that intubation time was significantly longer when using the aerosol box [20,55,60]. Moreover, it was reported that intubation time was relatively shorter when intubation was carried out by more experienced proceduralists using the video laryngoscopy [60]. Of note, the video laryngoscopy is a helpful tool in difficult airway management that facilitates the tracheal intubation maneuver by visualizing the patient’s larynx through a fiber-optic camera integral to a laryngoscope blade to indirectly display it on a monitor [61]. Several studies have widely reported the superiority of video laryngoscopy compared to direct laryngoscopy for glottic visualization, particularly in cases of difficult tracheal intubation [62–64]; as the video laryngoscopes are the recommended devices to perform tracheal intubation according to the different guidelines [65–68].
Video laryngoscopy-assisted tracheal intubation in airway management
Published in Expert Review of Medical Devices, 2018
Chia-Chih Liao, Fu-Chao Liu, Allen H. Li, Huang-Ping Yu
Successful airway management require a wide range of knowledge from the acute care providers, such as the ability to predict a difficult airway and to formulate a plan for airway management and the skills for using various kinds of airway devices [1]. Securing and maintaining a patent airway remains a fundamental issue in clinical practice. Failure to establish airway in patients can cause severe hypoxic brain injury and even death in a few minutes. According to the American Society of Anesthesiologists (ASAs), development of an airway emergency increased the odds ratio of brain damage or death to 15-folds [2]. Although the incidence of airway-related complications has declined in recent decades, they are still a leading cause of major adverse events in anesthesia and emergency departments [3–5]. Therefore, one of the essential responsibilities for every healthcare practitioner is to ensure adequate ventilation with oxygen, and a patent airway for patients when indicated. Endotracheal intubation is regarded as one of the most common methods in airway management. Several devices, including the supraglottic airway as an intubating conduit, laryngoscope blades, intubating stylet, flexible fiberoptic bronchoscope, light wand, and video laryngoscopes, have been introduced for tracheal intubation in the clinical arena. However, these techniques may have issues related to complexity, reliability, availability, and cost and may only be advantageous in certain conditions [6]. Familiarity of medical personnel with all these devices may help reduce the incidence of airway-related complications in patients.