A comparison of three techniques for cricothyrotomy on a manikin.

BACKGROUND: Cricothyrotomy can either be performed by an "open" cricothyrotomy technique, or by a needle (Seldinger) technique. Clinical uncertainty exists regarding which technique is more effective. We compared three different techniques for cricothyrotomy, performed by anesthesiologists on a manikin. METHODS: The techniques studied include an open surgical technique, the Melker Cricothyrotomy kit (Cook), and the Portex Cricothyroidotomy Kit (Smiths Medical). Participants were randomized to the order they performed each technique. Each procedure was videotaped and the time to first ventilation recorded. The participants completed a 10-point scale following the performance of all techniques to assess the subjective level of difficulty of each technique and to indicate which technique they would prefer in a real clinical CICO scenario. RESULTS: Mean time to ventilation was significantly faster with the surgical cricothyrotomy technique, when compared with both the Portex and Melker techniques (Mean difference: Portex-surgical = 18 s, 95% CI (1, 36) and Melker-surgical = 42 s, 95% CI (31, 54)). The Portex technique was significantly faster than the Melker technique (Melker-Portex = 24 s, 95% CI (11, 37)). Six of the 11 (55%) participants preferred the Melker procedure, four (36%) preferred the surgical procedure, and only one anesthesiologist (9%) preferred the Portex procedure. DISCUSSION: The surgical technique was faster than both the Portex and Melker techniques. The surgical technique was also more successful than the Melker technique. The preferred technique among the participants was the Melker technique, despite being the slowest, least successful, and rated most difficult by participants and observers. This suggests that although the surgical technique may not be preferred by many airway practitioners, it has been shown to be the most likely technique to achieve the primary goal of the procedure: establishing oxygenation and preventing death. IMPLICATION STATEMENT: This research examines three techniques for cricothyrotomy in the "Can't Intubate, Can't Oxygenate" scenario. Our data, as well as data from other studies, suggest that a practice shift towards a surgical technique, and away from needle based techniques, may be warranted.

The genome sequence of a hoverfly, Cheilosia impressa (Loew, 1840).

We present a genome assembly from an individual male Cheilosia impressa (hoverfly; Arthropoda; Insecta; Diptera; Syrphidae). The genome sequence is 395.0 megabases in span. Most of the assembly is scaffolded into 6 chromosomal pseudomolecules, including the X sex chromosome. The mitochondrial genome has also been assembled and is 16.87 kilobases in length.

The genome sequence of a conopid fly, Myopa testacea (Linnaeus, 1767).

We present a genome assembly from an individual male Myopa testacea (conopid fly; Arthropoda; Insecta; Diptera; Conopidae). The genome sequence is 243.3 megabases in span. Most of the assembly is scaffolded into 5 chromosomal pseudomolecules, including the X and Y sex chromosomes. The mitochondrial genome has also been assembled and is 17.61 kilobases in length. Gene annotation of this assembly on Ensembl identified 25,472 protein coding genes.

The genome sequence of the parsley Cheilosia, Cheilosia pagana (Meigen, 1822).

We present a genome assembly from an individual female Cheilosia pagana (the parsley Cheilosia; Arthropoda; Insecta; Diptera; Syrphidae). The genome sequence is 354.1 megabases in span. Most of the assembly is scaffolded into 6 chromosomal pseudomolecules, including the X sex chromosome. The mitochondrial genome has also been assembled and is 16.76 kilobases in length.

Recruitment manoeuvres in acute respiratory distress syndrome: Little evidence for routine use.

The use of alveolar recruitment manoeuvres for the treatment of acute respiratory distress syndrome is a topic of uncertainty in current critical care practice. Acute respiratory distress syndrome leads to inflammatory atelectasis, which challenges the gas exchange properties of the lung. Recruitment of atelectatic lung tissue requires elevation of transpulmonary pressure. Transpulmonary pressure can be suppressed at a given airway pressure when pleural pressures are elevated. The present review discusses recruitment of lung tissue in detail, highlighting the key research in the field. Differing techniques for recruiting lung tissue, as well as various outcome measures to determine efficacy, are analyzed and critiqued. The commonly used sustained inflation manoeuvre is perhaps regarded as the only strategy to recruit the lung, explaining its prevalence. Staircase recruitment with positive end-expiratory pressure titration is shown to be an equally - if not more - effective therapy that devotes attention to the maintenance of lung recruitment.

L'utilité des manœuvres de recrutement alvéolaire pour traiter le syndrome de détresse respiratoire aiguë demeure incertaine en soins aigus. Le syndrome de détresse respiratoire aiguë entraîne une atélectasie inflammatoire qui nuit aux propriétés d'échange gazeux des poumons. Pour recruter les tissus pulmonaires atélectasiques, il faut élever la pression transpulmonaire. On peut supprimer la pression transpulmonaire à une pression donnée des voies aériennes lorsque les pressions pleurales sont élevées. La présente analyse traite en détail du recrutement des tissus pulmonaires et fait ressortir les recherches clés dans le domaine. Les chercheurs analysent et critiquent diverses techniques de recrutement des tissus pulmonaires, de même que diverses mesures d'issue pour en déterminer l'efficacité. La manœuvre d'inflation courante est peut-être considérée comme la seule stratégie de recrutement des poumons, ce qui en expliquerait la prévalence. Les chercheurs démontrent que le recrutement par paliers à l'aide du titrage de la pression positive en fin d'expiration est un traitement tout aussi efficace, sinon plus, qui est entièrement axé sur le maintien du recrutement pulmonaire.

The genome sequence of the Figwort Cheilosia, Cheilosia variabilis (Panzer, 1798).

We present a genome assembly from an individual male Cheilosia variabilis (the Figwort Cheilosia; Arthropoda; Insecta; Diptera; Syrphidae). The genome sequence is 414.7 megabases in span. Most of the assembly is scaffolded into 7 chromosomal pseudomolecules, including the X and Y sex chromosomes. The mitochondrial genome has also been assembled and is 16.77 kilobases in length.