The Effects of Endotracheal Tube Size During Bronchoscopy in Simulated Models of Intubated Patients.

OBJECTIVE: The aim is to use a simulation lung model to assess the possibility of performing bronchoscopy through endotracheal tubes (ETT) less than 8.0-mm while appropriately ventilating patients with normal and ARDS lungs in the setting of SARS-CoV-2. METHODS: Five SHERIDAN® ETTs were used to ventilate SimMan® 3G under respiratory compliance levels representing normal and severe ARDS lungs. Baseline measurements of peak pressure, plateau pressure, and auto-positive end expiratory pressure (auto-PEEP) were recorded at four different inspiratory times (Ti). Three different-sized disposable bronchoscopes were inserted, and all measurements were repeated. RESULTS: Normal lung model: Slim bronchoscopes in 6.0-mm ETTs resulted in plateau pressures <30 cm H2 O, and increasing Ti to minimize peak pressure resulted in low auto-PEEP. Regular bronchoscopes in 7.0-mm ETTs had similar results. Large bronchoscopes in 7.5-mm ETTs generated plateau pressures ranging from 28 to 35 cm H2 O with modest auto-PEEP. Severe ARDS lung model: Slim bronchoscopes in 6.0-mm ETTs resulted in plateau pressures of 46 and an auto-PEEP of 5 cm H2 O. Regular bronchoscopes in 7.0-mm ETTs generated similar results. Large bronchoscopes in 8.0-mm ETTs displayed plateau pressures of 44 and an auto-PEEP of 2 cm H2 O. CONCLUSION: To mitigate risk of laryngeal injury, larger ETTs during bronchoscopy should be avoided. Our data show bronchoscopy with any ETT causes auto-PEEP and high plateau pressures, especially in lungs with poor compliance; however, ETT less than 7.5 mm can be used when considering several factors. Our data also suggest similar studies in patients with varying degrees of ARDS would be informative. LEVEL OF EVIDENCE: NA Laryngoscope, 133:147-153, 2023.

Reporting of Unsafe Conditions at an Academic Women and Children's Hospital.

BACKGROUND: Unsafe conditions (UCs) are circumstances that increase the probability of a patient safety event occurring. Each UC identified presents an opportunity to prevent a near miss or adverse patient event through proactive mitigation. The aim of this study was to describe the frequency, characteristics, contributing factors, and potential for harm of reported UCs. METHODS: This is a retrospective descriptive analysis of UC incident reports voluntarily entered into an electronic medical event reporting system at a single tertiary care women and children's hospital. Reports were reviewed and categorized using a previously published classification scheme and a modified Healthcare Failure Mode and Effects Analysis (HFMEA). Reporter role, hospital location, and time to incident resolution were also described. RESULTS: Between July 1, 2016, and June 30, 2019, 348 UCs were entered, representing 3.4% of all reports. Predominant categories of UCs were equipment (43.7%), medication (20.7%), and environmental safety (14.4%). A contributing factor was identified for >99.4% of all UCs, with 77.6% having more than one. Nurses (70.1%) submitted the highest numbers of UCs. The majority of UCs were of mild severity (79.9%) but had the potential to recur frequently (73.3%). CONCLUSION: UCs represented a small proportion of all reported events across the hospital. Equipment and medication issues were important causes of UCs, and most UCs had one or more contributing factors. Though most UCs were of mild severity, they had a predicted potential to recur frequently, representing significant opportunities for improvement.