Effectiveness of high-flow nasal cannula oxygen in apneic oxygenation during intubation in high-risk surgical patients: a systematic review protocol.

OBJECTIVE: This review will investigate the effectiveness of high-flow nasal oxygen in apneic oxygenation through safe apnea time and other ventilation parameters in patients at high risk of oxygen desaturation during induction and tracheal intubation for anesthesia management. INTRODUCTION: High-risk surgical patient groups include obese patients, those with suspected or known obstructive sleep apnea, and critically ill patients, who are at risk of rapid oxygen desaturation during intubation. Conventional oxygen administration in induction and intubation of patients undergoing general anesthesia include nasal cannulas, simple face masks, Venturi, buccal oxygenation, bag-valve mask ventilation, and non-invasive ventilation. High-flow nasal oxygen has emerged as a novel technique, and is advantageous because it increases positive end-expiratory pressure and oxygen delivered. INCLUSION CRITERIA: Eligible studies will include high-risk surgical patients aged 18 or above requiring endotracheal intubation in both emergency and elective anesthetic settings. High-risk patients are defined as those with suspected or known obstructive sleep apnea, obesity (BMI > 35), or critically ill patients (scored the American Society of Anesthesiologists classification as 3 or above). METHODS: The review will follow the JBI methodology for systematic reviews of effectiveness. Databases to be searched include MEDLINE, Embase, and Scopus. Reference lists of selected studies will then be hand-searched for additional eligible studies. The primary outcome will be safe apnea time, with secondary outcomes including oxygen and carbon dioxide parameters, and adverse events (eg, gastric distension). Studies will, where possible, be pooled in statistical meta-analyses with data heterogeneity assessed using the standard χ2 and I2 tests. REVIEW REGISTRATION: PROSPERO CRD42022312145.

Incidence and factors impacting PTSD following the 2005 Eyre Peninsula bushfires in South Australia - A 7 year follow up study.

OBJECTIVES: To identify the incidence and factors impacting post-traumatic stress disorder (PTSD) at 6 months, 2 and 7 years following the 2005 Eyre Peninsula bushfires in South Australia. METHODS: A questionnaire was used to assess symptoms. DESIGN AND SETTING: A longitudinal follow-up study with responses collected from a self-report booklet. PARTICIPANTS: 179 respondents were present at 6 months post bushfires, with 103 and 87 participants at 2 and 7 years, respectively. MAIN OUTCOME MEASURES: PTSD rates and its precipitating factors. RESULTS: The proportion of PTSD cases at times 1, 2 and 3 were 13.4% (24/179), 10.7% (11/103), and 4.8% (4/87), respectively. At 6 months, terrifying experience of fire reduced odds of developing PTSD (Odds Ratio [OR]: 0.45; 95% CI 0.21-0.96) while relocation increased odds (OR: 2.93; 95% CI 1.06-8.08). At 2 years, relocation (OR: 6.81; 95% CI 1.07-43.41) was a positive predictor. At 7 years, personal loss from the fires (OR: 2.82; 95% CI 1.17-6.77) positively predicted PTSD. CONCLUSION: PTSD rates declined over time. Relocation may be a proxy measure of high levels of emotional trauma. Those most traumatised probably decided to relocate, and hence, relocation should be considered a trigger for PTSD in the aftermath of bushfire.

Airway Management in the Operating Room and Interventional Suites in Known or Suspected COVID-19 Adult Patients: A Practical Review.

Current evidence suggests that coronavirus disease 2019 (COVID-19) spread occurs via respiratory droplets (particles >5 µm) and possibly through aerosol. The rate of transmission remains high during airway management. This was evident during the 2003 severe acute respiratory syndrome epidemic where those who were involved in tracheal intubation had a higher risk of infection than those who were not involved (odds ratio 6.6). We describe specific airway management principles for patients with known or suspected COVID-19 disease for an array of critical care and procedural settings. We conducted a thorough search of the available literature of airway management of COVID-19 across a variety of international settings. In addition, we have analyzed various medical professional body recommendations for common procedural practices such as interventional cardiology, gastroenterology, and pulmonology. A systematic process that aims to protect the operators involved via appropriate personal protective equipment, avoidance of unnecessary patient contact and minimalization of periprocedural aerosol generation are key components to successful airway management. For operating room cases requiring general anesthesia or complex interventional procedures, tracheal intubation should be the preferred option. For interventional procedures, when tracheal intubation is not indicated, cautious conscious sedation appears to be a reasonable approach. Awake intubation should be avoided unless it is absolutely necessary. Extubation is a high-risk procedure for aerosol and droplet spread and needs thorough planning and preparation. As updates and modifications in the management of COVID-19 are still evolving, local guidelines, appraised at regular intervals, are vital in optimizing clinical management.

Effectiveness of endoscopic versus external surgical approaches in the treatment of orbital complications of rhinosinusitis: a systematic review protocol.

OBJECTIVE: This review aims to investigate and compare the effectiveness of endoscopic drainage techniques against external drainage techniques for the treatment of orbital and subperiosteal abscesses as a complication of rhinosinusitis. INTRODUCTION: Transnasal endoscopic drainage and external drainage techniques have been used in the management of subperiosteal orbital abscesses secondary to rhinosinusitis. Each of these approaches has its own advantages and disadvantages, with extensive literature describing each technique separately. However, there is a lack of guidance in the studies on assessing and comparing the safety, effectiveness and suitability of these techniques. This review aims to compare the effectiveness of these techniques based on measuring outcomes in the literature such as: length of postoperative hospital stay, rate of revision surgery and complication rates. INCLUSION CRITERIA: Eligible studies will include people of all ages diagnosed with subperiosteal abscess, orbital abscess or cavernous sinus thrombosis (Chandler stages III-V) secondary to rhinosinusitis disease, who have also undergone drainage via either an endoscopic approach, external approach or combined surgical approach. METHODS: A comprehensive search of both published and unpublished literature will be performed to uncover studies meeting the inclusion criteria. Reference lists of studies included in final analyses will also be manually searched and subject matter experts contacted to investigate other sources of literature. Two reviewers will screen studies and a third reviewer will resolve disagreements. Studies will, where possible, be pooled in statistical meta-analysis with heterogeneity of data being assessed using the standard Chi-squared and I tests.