Łukasz Czyżewski

Assessment of Health-Related Quality of Life of Patients after Kidney Transplantation in Comparison with Hemodialysis and Peritoneal Dialysis

BACKGROUND The quality of life may determine the efficacy of renal replacement therapy (RRT). The purpose of the study was to compare the health-related quality of life (HRQOL) of end-stage renal disease (ESRD) patients depending on RRT method. MATERIAL/METHODS The studies were conducted on 120 patients divided into 3 groups depending on RRT method: 30 peritoneal dialysis (PD) patients, 40 hemodialysis (HD) patients, and 47 post-kidney transplantation (KTx) patients. The following research tools were used: (1) Medical Outcomes Study 36 - the Short Form (SF-36 v.1); (2) Kidney Disease Quality of Life Short Form (KDQOL-SF™ v.1.3); and (3) disease history. The relevance level was p<0.05. RESULTS The evaluation of PCS by HD and PD patients is poorer compared to patients in the 3rd and 12th month after KTx (34.7 ± 7.4 vs. 37.51 ± 10.63 vs. 45.01 ± 9.43 vs. 45.55 ± 8.62; p<0.05; respectively). PCS statistically significantly correlated with the following: SBP (r=-0.54; p<0.05), DBP (r=-0.58; p<0.05), and creatinine concentration (r=0.46; p<0.05) in the 12(th) month after KTx. CONCLUSIONS HRQOL of ESRD patients differed depending on the RRT method: top values were shown by post-KTx patients, lower by PD patients, and the bottom ones by HD patients. Along with patient age, increased BP, and BMI, a drop in value of HRQOL in post-Tx or PD patients was observed. When choosing RTT method, patients may use the results of the evaluation of quality of life. A preferred lifestyle, and predominantly the work status and quality of social interaction, should decide the choice of treatment.

Simulated endotracheal intubation of a patient with cervical spine immobilization during resuscitation: a randomized comparison of the Pentax AWS, the Airtraq, and the McCoy Laryngoscopes

BACKGROUND Tracheal intubation during cardiopulmonary resuscitation is a high-risk procedure. The aim of this study was to compare efficacy of intubation with the Pentax AWS, Airtraq, and McCoy laryngoscopes in patients with cervical spine immobilization during resuscitation in a randomized, controlled simulation trial. METHODS We compared times to intubation, success rate, Cormack and Lehane grading, and ease of intubation when using Pentax AWS, Airtraq, and McCoy in randomized order. RESULTS Sixty-seven paramedics were trained in the use of the Pentax AWS, Airtraq, and McCoy laryngoscopes with a METIman Prehospital manikin. Participants performed tracheal intubation in patients with cervical spine immobilization during resuscitation scenario. We measured success rates, times for tracheal intubation, the glottic view, and ease of intubation. RESULTS The primary study end point, overall success rate, was highest when using Pentax AWS (94.0%) and was lower in Airtraq (86.6%; P = .017) and in McCoy (85.1%; P = .019). Time to first effective ventilation was achieved significantly shorter when using Pentax AWS (25.4 ± 6.7 seconds) than Airtraq (35.6 ± 5.1 seconds; P < .001) or McCoy (38.5 ± 10.3 seconds; P < .001). The quality of glottic view and ease of use were best with Pentax AWS. CONCLUSIONS The Pentax AWS videolaryngoscope provided a better view of the vocal cords, less insertion time, and higher success rate of the endotracheal intubation compared with the Airtraq or McCoy laryngoscopes in adults with simulated cervical spine immobilization during resuscitation.

Tracheal intubation with a VivaSight-SL endotracheal tube by paramedics in a cervical-immobilized manikin.

Our results indicate that our technique enables one to identify and rule out parotid duct injuries in patients with deep penetrating facial soft tissue trauma using commonly available materials in the ED. The technique was performed for the first time by two of the authors with very little technical difficulty. Both patients also had no complications of parotid duct injury such as salivary fistula, sialocele, abscess formation, wound dehiscence, or parotitis at follow-up. The advantages of this technique include the ability to avoid surgical exploration and resultant potential additional trauma. If the fluorescein dye test is negative, sparing a trip to the operating room could help contain costs. The lacrimal probe could cause ductal injury, however only a small length of probe needs to be inserted. Injury is likely a greater risk using a lacrimal probe alone because it must be advanced much farther into the wound bed. A less rigid material such as prolene suture may not cannulate the papilla as easily and is difficult to visualize. Injection of another dye such as methylene blue could be attempted, but is not recommended due to tissue staining and difficulty identifying structures [3]. Other methods to identify parotid duct injury like sialography and sialoendoscopy are not as readily available and require more experience [4,5]. Fluorescein has been safely applied in several othermedical applications [6–9].

Comparison of 3 video laryngoscopes against the Miller laryngoscope for tracheal intubation during infant resuscitation

Overcrowding (crowding, boarding, high volumes) 636 23% 21.5%-24.6% Financial, reimbursement, insurance, ACA, health care reform, EMR, charting, hospital policies 509 19% 17.0%-19.9% Clinical challenges, diagnosis, knowledge, fast pace, elderly and pediatric patients, community hospital 438 16% 14.5%-17.3% Nonacute use of ED, primary care, EMTALA abuse, chronic pain, psych patients, violent patients 393 14% 13.0%-15.6% Balance, shift work, odd hours, burnout 346 13% 11.3%-13.8% Legal, risk management, malpractice, defensive medicine 298 11% 9.7%-12.0% Define EM, specialty, consultants, midlevel providers, corporate groups 130 5% 3.9%-5.5% Patient safety (handoffs) 6 0.2% 0%-0.4%

Pentax Airway Scope AWS-S200 video laryngoscope for child tracheal intubation in a manikin study with 3 airway scenarios ☆,☆☆,★

BACKGROUND Endotracheal intubation is considered a criterion standard for securing the airway during cardiopulmonary resuscitation, yet it requires a very skillful operator. The aim of the study was to investigate whether paramedic staff can successfully use the Pentax Airway Scope AWS-S200 video laryngoscope (AWS) for intubating with 3 simulated airway scenarios. METHODS It was a randomized nonblinded crossover simulation trial. Fifty-four paramedics performed intubation using an AWS in a manikin, with 3 airway scenarios: scenario A, normal airway; scenario B, normal airway with chest compression (CC); and scenario C, difficult airway with CC. RESULTS Median intubation times for the AWS during scenarios A, B, and C were 20 seconds (interquartile range [IQR], 19-23 seconds), 22 seconds (IQR, 20-25 seconds), and 26 seconds (IQR, 23-29 seconds), respectively, and the respective overall success rates of intubation were 100%, 100%, and 94.4%. CONCLUSION In this manikin study, paramedics could successfully intubate using the AWS, regardless of CCs being interrupted or not, even when a patients airway was difficult.

Contribution of volume overload to the arterial stiffness of hemodialysis patients

Abstract Arterial stiffness is evaluated with the measurement of pulse wave velocity (PWV), while overhydration (OH) and nutritional status are evaluated with bioimpedance spectroscopy (BIS). In this study, we investigated the effect of a single dialysis session on arterial stiffness, hydration status, and laboratory parameters. The observational, cross-sectional, cohort study included 71 HD patients with mean age 64 ± 16 yrs. A Complior device was used to perform PWV measurements. The patients were examined immediately before and 15 min after a mid-week hemodialysis session. Body fluids and nutritional status were studied using a Body Composition Monitor (BCM), Fresenius Medical Care. Clinical and laboratory data were also analyzed. Multivariate regression analysis of PWV before HD showed that an OH increase of 1 L relate to a PWV parameter rise before HD of 0.523 m/s. Multivariate regression analysis of PWV after HD showed that a rise of central SBP after HD of 10 mmHg relate to a PWV increase after HD of 0.707 m/s. Our data indicate that hydration status and blood pressure may be major determinants of PWV in HD patients.

Are paramedics able to perform endotracheal intubation with access to the patient through the back seat of the car? Randomized crossover manikin study

Patients with trauma present unique airway management concerns. Conventional oral intubation with manual in-line stabilization (MILS) is still the most effective approach for early control of the airway in trauma [1]. However, there are situations inwhich access to the patient is difficult and direct viewing of the airways is impossible [2,3]. Such a situation might be encountered when a patient requires intubation when trapped in a vehicle [4]. In such cases, alternativemethods of endotracheal intubation can be used, including videolaryngoscopy or video tubes, ie, the ETView VivaSight-SL (ETView Ltd., Misgav, Israel). The aim of the study was to evaluate the VivaSight single lumen endotracheal tube (ETView) and the Macintosh laryngoscope (MAC) for intubation of a patient trapped in a motor vehicle. The trial is a continuation of studies undertaken by Truszewski et al [5]. The Institutional Review Board at International Institute of Rescue Research and Education approved this study. IRB number was 12.2015.08.32. Forty-five paramedics were asked to perform advanced airway management in a manikin entrapped in a cars left front seat, with access to the patient from the back seat. First, each participant received a 30-min standardized demonstration of the Macintosh laryngoscope (HEINE Optotechnik, Munich, Germany) and ETViewbyoneof the investigators, including ademonstrationof the correct use of the devices (5 min/device). Subsequently, each participant was allowed to practice intubations and placements, respectively, in a classically positioned a SimMan manikin (Laerdal, Stavanger, Norway; 10 min/device). After the practice session, the subjects were divided into two groups using Research Randomizer software. The first group attempted ETI using the MAC, the second using the ETView (Figure). After completing the ETI procedure, participants had a 10-min break before performing intubation using another technique. Participants had a maximum of 3 attempts for ETI with each intubation method. To simulate patient entrapped in vehicle manikin was placed on the drivers seat. The seat belt was fastened around themanikins torso and the seatwasmoved as far forward as possible to reduce space and to simulate entrapment. Access to the patient was possibility from the back seat of the car (with the drivers seat back reclined to 75°). A cuffed ETT with an inner diameter of 7.0 mmwas used for endotracheal intubation (with a semi-rigid stylet inserted into the ETT). All participants were unassisted during the airway procedures. The Statistica statistical package (ver.12.0 for Windows; StatSoft, Tulsa, OK) was used for statistical analysis. Data were presented as median and interquartile range (IQR) or mean ± standard deviation (SD). We used Shapiro–Wilk test for verifying normal distribution and

Comparison of infant intubation through the TruView EVO2, TruView PCD, and Miller laryngoscope by paramedics during simulated infant cardiopulmonary resuscitation: A randomized crossover manikin study

INTRODUCTION The aim of the study was to compare the efficacy of the TruView EVO2, TruView PCD, and Miller laryngoscopes for tracheal intubation during cardiopulmonary resuscitation with and without chest compressions (CCs) by paramedics in an infant manikin model. METHODS This was an open, prospective, randomized, simulated trial. After a brief didactic session, 78 volunteer paramedics attempted to intubate a manikin using TruView EVO2, TruView PCD, and Miller laryngoscopes during resuscitation with and without CC scenarios. Primary end point was intubation success rate and secondary was time to intubation with each device. Glottic view using a Cormack-Lehane grade in using each device was also assessed. RESULTS In scenario with uninterrupted CCs, the median time to intubation using the TruView EVO2, TruView PCD, and Miller varied with the times being 25.3 seconds (interquartile range [IQR], 23-30.5 seconds) vs 20.2 seconds (IQR, 18-23 seconds) vs 24.4 seconds (IQR, 21-28 seconds), respectively. The overall success rate of intubation during CC for the devices were 94.9% vs 100% vs 92.1%. During intubation without CC, median time to intubation varied and amounted to 24.9 seconds (IQR, 21-29.6 seconds) for TruView EVO2, 18.3 seconds (IQR, 16-21.3 seconds) for TruView PCD, and 19.4 seconds (IQR, 17-23.3 seconds) for Miller laryngoscope. The overall success rate of intubation without CC for all devices was 100%. CONCLUSIONS For infant tracheal intubation with TruView PCD, when used by paramedics, the malleable TruView PCD showed shorter intubation time and higher overall success rate in a simulated CC scenario than TruView EVO2 or Miller laryngoscopes. Further clinical studies are necessary to confirm these initial positive findings.

The effect of the sequential therapy in end-stage heart failure (ESHF)--from ECMO, through the use of implantable pump for a pneumatic heart assist system, Religa Heart EXT, as a bridge for orthotopic heart transplant (OHT). Case study.

BACKGROUND Modern Polish medicine offers patients various treatments for end-stage treatment-resistant heart failure. Methods applied at the right time before the occurrence of irreversible changes in organs give a chance for survival and prolong life. CASE REPORT Here, we report on the safety and efficacy of the sequential use of the above treatments in a 58-year old patient with heart failure in dilatative cardiomyopathy (DCM). A 7-day mechanical blood circulatory support and extracorporeal membrane oxygenation of blood (ECMO), followed by a 13-day implantation of a left ventricular assist device, Religa Heart EXT, was used as a bridge to a successful orthotopic heart transplant (OHT). On Day 40 after OHT, the patient was discharged home with stable function of the circulatory system. We describe our experiences with the qualification, preparation, and procedure of sequential ECMO, Religa Heart EXT, and OHT. CONCLUSIONS Application of short-term ECMO as a bridge-to-bridge helped save the patient from severe cardiogenic shock caused by increased left ventricular afterload. The experimental implantation of an innovative Religa Heart EXT prosthesis was a safe and efficacious bridge to transplantation. Too short time of Religa Heart EXT implantation in the discussed patient prevented the possibility to evaluate the occurrence of thromboembolic complications and infections compared to the documented complications of POLVAD implanted until now. OHT is a safe and efficacious method of treatment of patients previously supported by ECMO and Religa Heart EXT.

Airtraq Laryngoscope Versus the Conventional Macintosh Laryngoscope During Pediatric Intubation Performed by Nurses: A Randomized Crossover Manikin Study With Three Airway Scenarios

ObjectivesWe hypothesized that the Airtraq laryngoscope (Airtraq LLC, Bonita Springs, Fla) is beneficial for intubation of pediatric manikins while performing cardiopulmonary resuscitation (CPR). In the present study, we evaluated the effectiveness of the Macintosh (MAC) laryngoscope (HEINE Optotechnik, Munich, Germany) and Airtraq in 3 simulated CPR scenarios. MethodsA randomized crossover simulation trial was designed. Eighty-three nurses intubated the trachea of a PediaSIM CPR training manikin (FCAE HealthCare, Sarasota, Fla) using the MAC and Airtraq in a normal airway scenario, normal airway with chest compression scenario, and difficult airway with chest compression scenario. The participants were directed to perform a maximum of 3 attempts in each scenario. The success rate, time to intubation, Cormack & Lehane grade, dental compression, and the ease of intubation were measured. ResultsAll participants performed successful intubation with the Airtraq in all 3 scenarios. In all scenarios, the success rate was significantly higher and the time to intubation was significantly shorter with the Airtraq than with the MAC. Glottic visualization using the Cormack-Lehane scale was also better when using Airtraq in all scenarios. ConclusionsIn this manikin study, we found that the Airtraq can be used successfully for the intubation of pediatric manikins with normal and difficult airways by medical staff without previous experience in pediatric intubation. Moreover, intubation can be achieved without interrupting chest compression. The use of the Airtraq compared with the MAC led to faster time to intubation. Nevertheless, we recommend that the performance of the Airtraq and the MAC during CPR should be further evaluated in a clinical setting.