Clinical leadership in reducing risk: Managing patient airways.

Niagara Health, a multi-site hospital organization, has developed a multimodal, comprehensive strategy to manage patients with a Difficult Airway (DA) in a non-operative setting. The Difficult Airway Pathway (DAP) is an evidence-based strategy aimed to train staff to reduce critical events. The DAP initiative aligns with the LEADS framework for change management and includes an annual review of reported critical incidents and an Enterprise Risk Management (ERM) Assessment Summary, with the goal to "create a regional systematic approach to support personnel, equipment and education." The guiding vision is: "Right people, Right equipment, Right timing: No failed airway." Preliminary evaluation suggests the strategy reduces morbidity and mortality of difficulty airway incidents outside the operating room.

α-Tocopheryl phosphate: uptake, hydrolysis, and antioxidant action in cultured cells and mouse.

α-Tocopheryl phosphate (α-TP), a water-soluble analogue of α-tocopherol, is found in humans, animals, and plants. α-TP is resistant to both acid and alkaline hydrolysis and may exert its own function in this form in vivo. In this study, the uptake, hydrolysis, and antioxidant action of α-TP were measured using α-TP with a deuterated methyl group, CD(3), at position 5 of the chroman ring (α-TP(CD3)). The hydrolysis of α-TP(CD3) was followed by measuring α-tocopherol containing the CD(3) group, α-T(CD3), in comparison to unlabeled α-tocopherol, α-T(CH3). α-TP(CD3) was incubated with cultured cells, and the intracellular α-T(CD3) formed was measured with HPLC-ECD and GC-MS. α-TP(CD3) was also administered to mice for 4 weeks by mixing in the diet, and α-T(CD3) was measured in plasma, liver, brain, heart, and testis to compare with endogenous unlabeled α-T(CH3). It was found that α-TP(CD3) was taken in and hydrolyzed readily to α-T(CD3) in cultured cells and in mice. The hydrolysis of α-TP(CD3) in cell culture medium was not observed. α-TP protected primary cortical neuronal cells from glutamate-induced cytotoxicity, and α-TP given to mice reduced the levels of lipid peroxidation products in plasma and liver. These results suggest that α-TP is readily hydrolyzed in vivo to α-T, which acts as an antioxidant, and that α-TP may be used as a water-soluble α-T precursor in intravenous fluids, in eye drops, or as a dietary supplement.