The Impact of Implementing the Vortex Approach on Airway Management Performance in Stressed Medical Students: A Randomized Controlled Simulation Study.

BACKGROUND The ability to manage airways in emergencies is paramount, especially for less experienced medical students. Although the Vortex Approach, a useful scheme to support decision-making during airway management, promises structured guidance, there's limited research on its benefits among students. Our study aimed to evaluate student proficiency in a simulated difficult airway scenario and assess the advantages of the Vortex Approach. MATERIAL AND METHODS Medical students initially practiced on low-fidelity mannequins. Subsequently, they were divided into Vortex (n=48) and control groups (n=48). The Vortex group received specialized training. Both groups encountered a simulated scenario focusing on proper ventilation and supraglottic device insertion when traditional intubation failed. Performance was assessed using the airway management outcome score (AMOS). RESULTS The Vortex-trained group demonstrated superior capabilities. Fewer participants exceeded 3 lifeline interventions (4.2% vs 16.7%, P=0.046). The Vortex group consistently optimized subsequent attempts (31.3% vs 10.4%, P=0.01) and reduced prolonged apnea episodes (47.9% vs 81.3%, P=0.0009). Their AMOS scores were notably higher (56.3% vs 27.1%, AMOS=2, P=0.002), reflecting better patient outcomes (41.7% vs 10.4%, P=0.0005). CONCLUSIONS There is a marked need to enhance airway management skills among senior medical students. The Vortex Approach, even after brief exposure, yields significant skill improvements, underscoring its potential as a pivotal component in medical training. Integrating it into the curriculum could bridge the evident skill gap, optimizing future patient care.

A Simulation Study Using a Quality Cardiopulmonary Resuscitation Medical Manikin to Evaluate the Effects of Using Personal Protective Equipment on Performance of Emergency Resuscitation by Medical Students from the University of Silesia, Katowice, Poland and Non-Medical Personnel.

BACKGROUND During the Coronavirus disease 2019 (COVID-19) pandemic, personal protective equipment (PPE) is used during medical resuscitation aerosol-generating procedures (AGP). This simulation study aimed to evaluate the effects of PPE on the performance of emergency resuscitation by medical students from the University of Silesia, Katowice, Poland and non-medical personnel, and used a quality cardiopulmonary resuscitation (Q-CPR) medical manikin. MATERIAL AND METHODS A simulation study was conducted using the Resusci Anne quality cardiopulmonary resuscitation (Q-CPR) medical manikin (Laerdal Medical AS, Norway). Participants were divided into 2 groups: a medical group of 50 and a non-medical group of 52, matched in pairs. Each pair performed 10 min of manual CPR with a compression-ventilation ratio of 30: 2 wearing PPE for AGP. The reference method was manual CPR wearing casual clothes along with surgical masks and latex gloves. Data about compression and ventilation were gathered using the QCPR Training application from Laerdal Medical. RESULTS Data analyses indicated statistically significant differences between medical students using PPE for AGP and basic protection: average rate of chest compressions (123 vs 114 per min; P=0.004), chest recoil (69 vs 93; P=0.0050, correct depth of chest compressions (86.5 vs 97; P=0.0081), quality of ventilation (85 vs 89; P=0.0041). Among non-medical personnel however, a statistically significant difference was in the quality of ventilation (69-85.5; P=0.0032). CONCLUSIONS The findings from this study showed that the use of PPE for AGP during CPR was associated with slower average speed of chest compressions, less chest recoil, incorrect depth of chest compressions, and lower quality of ventilation.

Effect of Treatment and Nutrition on Glycemic Variability in Critically Ill Patients.

Nondiabetic hyperglycemia is a dangerous metabolic phenomenon in the intensive care unit. Inattentive treatment of glycemic disorders is a serious health hazard promoting negative outcomes. The aim of our study was to assess glycemic variability and its basic determinants, and to verify its relationship with mortality in patients hospitalized in a mixed ICU (intensive care unit). The medical records of 37 patients hospitalized 13 January−29 February 2020 were analyzed prospectively. The BG (blood glucose) variability during the stay was assessed using two definitions, i.e., the value of standard deviation (SD) from all the measurements performed and the coefficient of variation (CV). A correlation between the BG variability and insulin dose was observed (SD: R = 0.559; p < 0.01; CV: R = 0.621; p < 0.01). There was also a correlation between the BG variability and the total energy daily dose (SD: R = 0.373; p = 0.02; CV: R = 0.364; p = 0.03). Glycemic variability was higher among patients to whom treatment with adrenalin (p = 0.0218) or steroid (p = 0.0292) was applied. The BG variability, expressed using SD, was associated with ICU mortality (ROC = 0.806; 95% CI: 0.643−0.917; p = 0.0014). The BG variability in the ICU setting arises from the loss of balance between the supplied energy and the applied insulin dose and may be associated with a worse prognosis.

Usefulness of Selected Peripheral Blood Counts in Predicting Death in Patients with Severe and Critical COVID-19.

BACKGROUND: Immune dysregulation and hypoxemia are two important pathophysiological problems in patients with COVID-19 that affect peripheral blood count parameters. We hypothesized that assessment of the neutrophil-lymphocyte ratio (NLR) and red blood cell distribution width index (RDW-SD) could predict death in patients with severe and critical COVID-19. METHODS: Seventy patients admitted to the intensive care unit (ICU) for COVID-19 acute respiratory failure were included in the study. RDW-SD and NLR on the day of ICU admission and peak values during the entire hospitalization were assessed. The primary endpoint was death before ICU discharge. RESULTS: Patients who died had higher NLR on admission (20.3, IQR 15.3-30.2 vs. 11.0, IQR 6.8-16.9; p = 0.003) and higher RDW-SD (48.1 fL; IQR 43.1-50.5 vs. 43.9 fL; IQR 40.9-47.3, p = 0.01) than patients discharged from the ICU. NLR and RDW-SD values on ICU admission accurately predicted death in 76% (AUC = 0.76; 95%CI 0.65-0.86; p = 0.001; cut-off > 14.38) and 72% of cases (AUC = 0.72; 95%CI 0.60-0.82; p = 0.003; cut-off > 44.7 fL), respectively. Multivariable analysis confirmed that NLR > 14.38 on the day of ICU admission was associated with a 12-fold increased risk of death (logOR 12.43; 95%CI 1.61-96.29, p = 0.02), independent of other blood counts, clinical and demographic parameters. CONCLUSIONS: Neutrophil-lymphocyte ratio determined on the day of ICU admission may be a useful biomarker predicting death in patients with severe and critical COVID-19.