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10.1053/j.jvca.2020.09.080 http://scihub22266oqcxt.onion/10.1053/j.jvca.2020.09.080 C7598358!7598358!C7598358     free     free     free Deprecated: Implicit conversion from float 209.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 209.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 209.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 209.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 209.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 209.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 243.2 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 243.2 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 243.2 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534       J+Cardiothorac+Vasc+Anesth 2020 ; 34 (ä): S56-7 Nephropedia Template TP {{tp|p=C7598358|t=2020. Reducing patient harm following inadvertent endobronchial placecement of nasogastric tubes in patients with SARS-COV-2 |pdf=|usr=}}{{C7598358}} gab.com Text Reducing patient harm following inadvertent endobronchial placecement of nasogastric tubes in patients with SARS-COV-2 JO: J Cardiothorac Vasc Anesth http://www.kidney.de/pget.php?&tw=1&pmid=C7598358 #FOAvip Introduction: Nasogastric tube (NGT) insertion is essential for enteral feeding but can potentially cause significant injury to the lungs (1). Following a critical incident, we audited our practice of NGT insertion and the consequences of injury in patients with Severe Acute Respiratory Syndrome COVID-19 caused by the (SARS-CoV-2) virus. Methods: NGT insertion followed a local standard safety protocol and were inserted by consultants or senior registrars in anaesthesia and critical care medicine, or advanced critical care practitioners. Individual practitioners were able to choose their technique of insertion. All patients had their post-NGT insertion chest x-ray reviewed and those with misplaced NGTs had their case notes reviewed. Early in the outbreak, blind insertion was recommended in our institution to reduce aerosolisation, this was rapidly changed to direct visualisation with laryngoscopy as our experience managing SARS-CoV-2 patients increased. Results: During the SARS-CoV-2 pandemic, a total of 135 NGTs were inserted into ventilated and/or extracorporeal membrane oxygenation (ECMO) patients. All of NGTs positioned were confirmed by a chest radiograph. Eleven (8.1%) were inadvertently endobronchial, of which four developed pneumothoraces (figure 1). Three patients (including both who had received ECMO) died and a fourth is currently undergoing a prolonged respiratory wean. No patients were fed or received drugs via a misplaced NGT.Chest radiograph of patient with inadvertent NGT placement in right lower lobe. Note the path of the tube suggests breech of the bronchial tree and direct injury to the lung parenchyma (arrowhead). A CT the following day showed a large pneumothorax (arrowhead), some haemothorax (black arrow) and severe ground glass changes consistent with SARS-CoV-2 (white arrow). Discussion: Our inadvertent endobronchial NGT rate is relatively high, compared to our previous clinical experience, which we believe may be related to the challenges of working with cumbersome personal protective equipment and/or changed practice to attempt to reduce transmission of SARS-CoV-2 (2). We suspect the lung parenchyma is particularly fragile in acute respiratory distress syndrome caused by SARS-CoV-2, which contributes to the high rate of pleural breech and subsequent poor outcome (3). We recommend experienced operators place NGTs and do so using direct or videolaryngoscopy to minimise the risk of incorrect placement.We would like to thank the families of our patients for their permission to share the images in this work. Twit Text FOAVip Reducing patient harm following inadvertent endobronchial placecement of nasogastric tubes in patients with SARS-COV-2 ????J Cardiothorac Vasc Anesth http://www.kidney.de/pget.php?&tw=1&pmid=C7598358 #FOAvip Twit Text # Free Paper on # # # # # LINK http://www.kidney.de/pget.php?&tw=1&pmid=C7598358 #FOAvip English Wikipedia <ref>{{Cite pmid|C7598358}}</ref> Reducing patient harm following inadvertent endobronchial placecement of nasogastric tubes in patients with SARS-COV-2 #MMPMIDC7598358 Mandalia R; Poimenidi E; Edwards J; Charlton M; Hanna-Jumma S; Howells P J Cardiothorac Vasc Anesth 2020[Oct]; 34 (ä): S56-7 PMIDC7598358show ga Introduction: Nasogastric tube (NGT) insertion is essential for enteral feeding but can potentially cause significant injury to the lungs (1). Following a critical incident, we audited our practice of NGT insertion and the consequences of injury in patients with Severe Acute Respiratory Syndrome COVID-19 caused by the (SARS-CoV-2) virus. Methods: NGT insertion followed a local standard safety protocol and were inserted by consultants or senior registrars in anaesthesia and critical care medicine, or advanced critical care practitioners. Individual practitioners were able to choose their technique of insertion. All patients had their post-NGT insertion chest x-ray reviewed and those with misplaced NGTs had their case notes reviewed. Early in the outbreak, blind insertion was recommended in our institution to reduce aerosolisation, this was rapidly changed to direct visualisation with laryngoscopy as our experience managing SARS-CoV-2 patients increased. Results: During the SARS-CoV-2 pandemic, a total of 135 NGTs were inserted into ventilated and/or extracorporeal membrane oxygenation (ECMO) patients. All of NGTs positioned were confirmed by a chest radiograph. Eleven (8.1%) were inadvertently endobronchial, of which four developed pneumothoraces (figure 1). Three patients (including both who had received ECMO) died and a fourth is currently undergoing a prolonged respiratory wean. No patients were fed or received drugs via a misplaced NGT.Chest radiograph of patient with inadvertent NGT placement in right lower lobe. Note the path of the tube suggests breech of the bronchial tree and direct injury to the lung parenchyma (arrowhead). A CT the following day showed a large pneumothorax (arrowhead), some haemothorax (black arrow) and severe ground glass changes consistent with SARS-CoV-2 (white arrow). Discussion: Our inadvertent endobronchial NGT rate is relatively high, compared to our previous clinical experience, which we believe may be related to the challenges of working with cumbersome personal protective equipment and/or changed practice to attempt to reduce transmission of SARS-CoV-2 (2). We suspect the lung parenchyma is particularly fragile in acute respiratory distress syndrome caused by SARS-CoV-2, which contributes to the high rate of pleural breech and subsequent poor outcome (3). We recommend experienced operators place NGTs and do so using direct or videolaryngoscopy to minimise the risk of incorrect placement.We would like to thank the families of our patients for their permission to share the images in this work. äReducing patient harm following inadvertent endobronchial placecement (epmc).pdf DeepDyve Pubget Overpricing