Speech intelligibility in respiratory protective equipment - Implications for verbal communication in critical care.

Respiratory protective equipment (RPE) such as filtering facepiece respirators, elastomeric respirators and powered air-purifying respirators are routinely worn in the critical care unit as a component of personal protective equipment (PPE) when caring for patients with coronavirus disease 2019 (COVID-19). It is the authors' anecdotal experience that RPE may, however, inadvertently interfere with verbal communication between critical care staff. The literature pertaining to the effects of RPE wear on verbal communication was therefore reviewed. A literature search returned 98 articles, and 4 records were identified from other sources; after screening for content relevancy, 15 experimental studies were included in the narrative synthesis. Previous studies in both healthcare and other occupational settings suggest a detrimental impact on speech intelligibility, varying according to RPE type and test conditions. The effects of background noise and potential for increased cognitive load through compensatory behaviours are also identified. The clinical significance of these effects remains uncertain though, as evidence measuring clinical outcomes or errors is lacking. Mitigating strategies include increasing speech intelligibility through environmental changes and technology; modifying verbal communication strategies; and decreasing reliance on verbal communication where possible.

Assembly Line ICU: what the Long Shops taught us about managing surge capacity for COVID-19.

OBJECTIVES: To safely expand and adapt the normal workings of a large critical care unit in response to the COVID-19 pandemic. METHODS: In April 2020, UK health systems were challenged to expand critical care capacity rapidly during the first wave of the COVID-19 pandemic so that they could accommodate patients with respiratory and multiple organ failure. Here, we describe the preparation and adaptive responses of a large critical care unit to the oncoming burden of disease. Our changes were similar to the revolution in manufacturing brought about by 'Long Shops' of 1853 when Richard Garrett and Sons of Leiston started mass manufacture of traction engines. This innovation broke the whole process into smaller parts and increased productivity. When applied to COVID-19 preparations, an assembly line approach had the advantage that our ICU became easily scalable to manage an influx of additional staff as well as the increase in admissions. Healthcare professionals could be replaced in case of absence and training focused on a smaller number of tasks. RESULTS: Compared with the equivalent period in 2019, the ICU provided 30.9% more patient days (2599 to 3402), 1845 of which were ventilated days (compared with 694 in 2019, 165.8% increase) while time from first referral to ICU admission reduced from 193.8±123.8 min (±SD) to 110.7±76.75 min (±SD). Throughout, ICU maintained adequate capacity and also accepted patients from neighbouring hospitals. This was done by managing an additional 205 doctors (70% increase), 168 nurses who had previously worked in ICU and another 261 nurses deployed from other parts of the hospital (82% increase).Our large tertiary hospital ensured a dedicated non-COVID ICU was staffed and equipped to take regional emergency referrals so that those patients requiring specialist surgery and treatment were treated throughout the COVID-19 pandemic. CONCLUSIONS: We report how the challenge of managing a huge influx of patients and redeployed staff was met by deconstructing ICU care into its constituent parts. Although reported from the largest colocated ICU in the UK, we believe that this offers solutions to ICUs of all sizes and may provide a generalisable model for critical care pandemic surge planning.

Up- and down-regulation of longissimus tenderness parallels changes in the myofibril-bound calpain 3 protein.

The objective of this study was to utilize Ca(2+) and Zn(2+) treatments of meat to critically explore the possible role of calpain 3 in meat tenderisation. Calpains 1 and 2 were also examined for comparative purpose. Control animals plus animals infused with CaCl(2), ZnCl(2) or H(2)O were used (six lambs per treatment) to determine the temporal changes in muscle calpain 3 protein in the Longissimus thoracis et lumborum (LTL) during post-mortem storage. Concurrently, the temporal changes of; (1) shear force, (2) sarcomere length, (3) proteolysis of titin and nebulin and (4) calpains 1 and 2 proteins were also determined. Infusing LTL with Ca(2+) or Zn(2+) caused significant up- and down-regulation of LTL tenderisation, respectively, compared to water infusion and the control animals. Furthermore, the rate of breakdown of calpain 3, the rate of proteolysis of titin and nebulin and the rate of meat tenderisation during post-mortem storage of LTL in the various treatments were highly correlated. These studies suggest that calpain 3, like calpain 1, may be involved in the tenderisation of meat through limited proteolysis of specific muscle structural proteins such as titin and nebulin.