دورية أكاديمية
Clinical triggers and vital signs influencing crisis acknowledgment and calls for help by anesthesiologists: A simulation-based observational study.
| العنوان: | Clinical triggers and vital signs influencing crisis acknowledgment and calls for help by anesthesiologists: A simulation-based observational study. |
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| المؤلفون: | Matern LH; Clinical Fellow in Critical Care Medicine, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA., Gardner R; Assistant Professor, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Boston, MA, USA; Interim Executive Director, Center for Medical Simulation, Boston, MA, USA., Rudolph JW; Lecturer in Surgery, Harvard Medical School, Boston, MA, USA; Senior Director of Innovation, Center for Medical Simulation, Boston, MA, USA; Professor, Health Professions Education, Massachusetts General Hospital Institute for the Health Professions, Boston, MA, USA., Nadelberg RL; Instructor Emeritus in Anesthesia, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA; Assistant Director of Anesthesia Clinical Courses, Center for Medical Simulation, Boston, MA, USA., Buléon C; Staff Anesthesiologist and Intensivist, Polyclinique du Parc, Caen, France; Adjunct Faculty, Center for Medical Simulation, Boston, MA, USA; Faculty, Medical Simulation Center, University Hospital of Liege, Liege, Belgium., Minehart RD; Assistant Professor, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA; Principal Faculty, Center for Medical Simulation, Boston, MA, USA. Electronic address: rminehart@mgh.harvard.edu. |
| المصدر: | Journal of clinical anesthesia [J Clin Anesth] 2023 Nov; Vol. 90, pp. 111235. Date of Electronic Publication: 2023 Aug 24. |
| نوع المنشور: | Observational Study; Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Elsevier Country of Publication: United States NLM ID: 8812166 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1873-4529 (Electronic) Linking ISSN: 09528180 NLM ISO Abbreviation: J Clin Anesth Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: <2008->: New York : Elsevier Original Publication: [Stoneham, MA] : Butterworths, [c1988- |
| مواضيع طبية MeSH: | Anesthesiology* , Anaphylaxis*/diagnosis , Anaphylaxis*/etiology, Humans ; Anesthesiologists ; Prospective Studies ; Respiratory Rate |
| مستخلص: | Study Objective: In a perioperative emergency, anesthesiologists must acknowledge the unfolding crisis promptly, call for timely assistance, and avert patient harm. We aimed to identify vital signs and qualitative factors prompting crisis acknowledgment and to compare responses between observers and participants in simulation. Design: Prospective, simulation-based, observational study. Setting: An anesthesia crisis resource management course at a freestanding simulation center. Subjects: Sixty attending anesthesiologists from a variety of practice settings. Interventions: In each case, a primary anesthesiologist in charge (PAIC) managed a simulated patient undergoing a uniformly scripted sequence of perioperative anaphylaxis and called for help from another anesthesiologist when a crisis began. Anesthesiologist observers (AOs) viewed the case separately and recorded times of crisis onset. Measurements: Simulation footage was reviewed by investigators for patient vital signs and participant behaviors at times of crisis acknowledgment, with the call for help as an explicit proxy for PAIC crisis acknowledgment. These factors were categorized, and group-level data were compared. Results: Nineteen PAICs and 41 AOs were included. Clinicians acknowledged crises around a mean arterial pressure (MAP) of 65 mmHg and oxygen saturation of 94% as anaphylactic shock progressed. PAICs acknowledged crises at a higher respiratory rate than AOs (20 vs. 18 breaths/min, p = 0.038). Other vitals and timing of crisis acknowledgment did not differ between PAICs and AOs. Nearly half of all participants (45%) identified crises at MAP <65 mmHg. Timing of crisis acknowledgment varied widely (range: 421 s). Conclusions: Despite overall heterogeneity in clinical performance, anesthesiologists acknowledged crises per standard definitions of hypotension. Thresholds for crisis acknowledgment did not significantly differ between PAICs and AOs, suggesting minimal effect from active care responsibility. Many indicated crises at MAP <65 mmHg or after significant deterioration, risking failure-to-rescue events. We suggest that crisis management instruction should address triggers for requesting help. Competing Interests: Declaration of Competing Interest This research did not receive specific grant funding from any public, commercial, or not-for-profit agencies. As the authors of this manuscript, we individually and collectively report no personal or financial conflicts of interest regarding the submission of our work. (Copyright © 2023. Published by Elsevier Inc.) |
| فهرسة مساهمة: | Keywords: Anesthesiology; Crisis resource management; Medical education; Perioperative medicine; Simulation |
| تواريخ الأحداث: | Date Created: 20230826 Date Completed: 20230912 Latest Revision: 20230913 |
| رمز التحديث: | 20230913 |
| DOI: | 10.1016/j.jclinane.2023.111235 |
| PMID: | 37633044 |
| قاعدة البيانات: | MEDLINE |
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Full Text Finder | تدمد: | 1873-4529 |
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| DOI: | 10.1016/j.jclinane.2023.111235 |