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Utilizing Anesthesiologists, Emergency and Critical Care Physicians with Telemedicine Monitoring to Develop Intubation and Ventilation Services in an Intensive Care Unit in the Austere Medical Environment: A Case Series. Expansion of the EP/CC GAS Project

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Open Journal of Anesthesiology 2018年第6期8卷 183-197页

作者： Richard Skupski Arthur Toth Michael T. McCurdy Shane Kappler James Lantry Gerson Pyran Donald Zimmer Joseph Dynako Anne Grisoli David Zimmer John Wilson Bhavesh M. Patel Hannelisa Callisen Alyssa Chapital lovely nathalie colas Marc Edson Augustin nathalie Edema Enzo Del Brocco Richard Frechette Mark Thompson James Corcoran Michael Mazowiecki Mark Walsh Memorial Hospital Trauma Center South Bend IN USA University of Maryland School of Medicine Baltimore MD USA Indiana University School of Medicine South Bend Campus South Bend IN USA Mayo Clinic Rochester MN USA Mayo Clinic Phoenix AZ USA Hô spital Saint Luc Port-Au-Prince Haiti Excela Health Westmoreland Hospital Greensburg PA USA Saint Joseph Regional Medical Center Mishawaka IN USA

Background: Significant resource constraints and critical care training gaps are responsible for the limited development of intensive care units (ICUs) in resource limited settings. We describe the implementation of an ICU in Haiti and report the successes and difficulties encountered throughout the process. We present a consecutive case series investigating an anesthesiologist, emergency, and critical care physician implemented endotracheal intubation and mechanical ventilation protocol in an austere environment with the assistance of telemedicine. Methods: A consecutive case series of fifteen patients admitted to an ICU at St. Luc Hospital located in Portau-Prince, Haiti, between the months of February 2012 to April 2014 is reported. Causes of respiratory failure and the clinical course are presented. Patients were followed to either death or discharge. Results: Fifteen patients (eight women and seven men) were included in the study with an average age of 37.7 years. The mean duration of ventilation was three days. Of the fifteen patients intubated, five patients (33.3%) survived and were discharged from the ICU. Of the five surviving patients, two were intubated for status epilepticus, one for status asthmaticus and one for hyperosmolar coma associated with intracerebral hemorrhage. Of the patients dying on the ventilator, four patients died from pneumonia, two from renal failure, and one from tetanus. The remaining three died from strokes and cardiac arrests. Conclusions: Mortality of mechanically ventilated patients in a resource-limited country is significant. Focused training in core critical care skills aimed at increasing the endotracheal intubation and ventilatory management capacity of local medical staff should be a priority in order to continue to develop ICUs in these austere environments. Collaborative educational and training efforts directed by anesthesiologists, emergency, and critical care physicians, and aided by telemedicine can facilitate reali

关键词： Intensive Care Unit (ICU) Critical Care Mechanical Ventilation Endotracheal Ventilation Anesthesiologist Low and Moderate-Income Country Austere Environment Telemedicine

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Evaluation of Google Glass^(■) with Camera Adaptor and GoPro^(■) as Teaching Tools for Endotracheal Intubation in the Austere Medical Environment

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Open Journal of Anesthesiology 2018年第8期8卷 229-239页

作者： Michael Son David Zimmer Ross McCauley Donald Zimmer Joseph Dynako Richard Skupski Bhavesh Patel Nuha Zackariya Faadil Shariff lovely nathalie colas Gerson Pyram Marc Edson Augustin Carmeline Mathurin Stanley Louis Patricia Saint Louis Stanley Loriston Dan Herbstman Lucio Cervantes Shane Kappler Michael TMcCurdy Jecko Thachil Sarah Greve Mark Walsh University of Notre Dame Notre DameINUSA Memorial Hospital South BendINUSA Indiana University School of Medicine South BendINUSA Mayo Clinic PhoenixAZUSA Indiana University Bloomington BloomingtonINUSA Hospital Saint Luc Port-Au-PrinceHaiti Department of Anesthesiology Hopital Universitaire JustinienCap HaitienHaiti Third Eye Health ChicagoILUSA Adisat Colonia:Condessa Mexico CityMexico 1 University of Maryland School of Medicine BaltimoreMDUSA 1 Department of Haematology Manchester Royal InfirmaryManchesterUK 1 St Joseph Regional Medical Center MishawakaINUSA

Objective: Endotracheal intubation (ETI) is a life-saving emergency procedure, but it is a complex skill that is difficult to teach. Recent studies have shown that video laryngoscopy is effective in teaching ETI to learners at various levels of medical expertise;however, it has proven to be costly and provides images of inconsistent quality. In this educational proof of concept feasibility convenience sample pilot study, we aim to explore and compare the effectiveness of using modified Google Glass? (GG) and GoPro? (GP) technologies to visualize and teach ETI to critical care physicians in the austere medical environment of a low-income country. We propose, based on our findings, that this inexpensive technology could teach lifesaving ETI to pre-hospital providers in the austere medical environment, medical students, rural emergency physicians, critical care physicians in low-income countries, far forward military medical providers, and other learners. Methods: A case series of twenty-five patients, five in the United States (US) at Memorial Hospital in South Bend, IN and twenty at Saint Luc’s Hospital in Port Au Prince, Haiti, is presented. These patients were collected from November 1st 2015 through February 1st of 2016. The anesthesiologist and the emergency physicians in the United States utilized GG to intubate five patients in the US prior to the twenty patients intubated during two separate trips to Haiti. On the two separate trips to Haiti, the GG was trialed and modified to obtain better exposure. These adaptations resulted in the final collection of twenty patients studied with the adapted GG system and GP. Physicians graded airway visualization based on LEMON and Cormack-Lehane scores. Previously published parameters for the assessment of failed intubation risk and passage of the cords were used as data points for analysis using a Likert-Scale analysis for each parameter. The data were analyzed by averages of Likert-Scale scoring with their respective sta

关键词： Endotracheal Intubation Google Glass^(■) GoPro^(■) Cord Visualization Military Medicine Austere Medical Environment Low Income Country Rural Prehospital

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