Prospective Clinical Evaluation of the Singularity™ Air Laryngeal Mask in Adult Patients.

A laryngeal mask is one of the most widely used airway management devices. The Singularity Air is a second-generation laryngeal mask whose shaft angle can be adjusted after insertion. Since the device's performance has been assessed on mannequins only, this study aimed to evaluate Singularity Air's effectiveness in the clinical setting.

Spinal cord injury and prescribed opioids for pain: a scoping review.

Objective: Spinal cord injury (SCI) is a life-altering neurological condition affecting physical and psycho-social functioning and associated high rates of pain. Thus, individuals with SCI may be more likely to be exposed to prescription opioids. A scoping review was conducted to synthesize published research findings on post-acute SCI and prescription opioid use for pain, identify literature gaps, and propose recommendations for future research.

Dynamics of disease characteristics and clinical management of critically ill COVID-19 patients over the time course of the pandemic: an analysis of the prospective, international, multicentre RISC-19-ICU registry.

Background: It remains elusive how the characteristics, the course of disease, the clinical management and the outcomes of critically ill COVID-19 patients admitted to intensive care units (ICU) worldwide have changed over the course of the pandemic.

Methods: Prospective, observational registry constituted by 90 ICUs across 22 countries worldwide including patients with a laboratory-confirmed, critical presentation of COVID-19 requiring advanced organ support. Hierarchical, generalized linear mixed-effect models accounting for hospital and country variability were employed to analyse the continuous evolution of the studied variables over the pandemic.

Critical care staffing ratio and outcome of COVID-19 patients requiring intensive care unit admission during the first pandemic wave: a retrospective analysis across Switzerland from the RISC-19-ICU observational cohort.

Study Aim: The surge of admissions due to severe COVID-19 increased the patients-to-critical care staffing ratio within the ICUs. We investigated whether the daily level of staffing was associated with an increased risk of ICU mortality (primary endpoint), length of stay (LOS), mechanical ventilation and the evolution of disease (secondary endpoints).

Methods: We employed a retrospective multicentre analysis of the international Risk Stratification in COVID-19 patients in the ICU (RISC-19-ICU) registry, limited to the period between March 1 and May 31, 2020, and to Switzerland.

Compatibility of left-sided double-lumen endobronchial tubes with tracheal and bronchial dimensions: a retrospective comparative study.

Background: Double-lumen endobronchial tubes (DLT) continue to be the most widely used method for obtaining lung isolation during anesthesia. We compared recommendations for DLT size selection with radiologically assessed lower airway dimensions gathered from a large patient population.

Methods: For this retrospective comparative study, we assessed computed tomography (CT) scans of 150 adults with no known airway pathologies.

Implications of early respiratory support strategies on disease progression in critical COVID-19: a matched subanalysis of the prospective RISC-19-ICU cohort.

Background: Uncertainty about the optimal respiratory support strategies in critically ill COVID-19 patients is widespread. While the risks and benefits of noninvasive techniques versus early invasive mechanical ventilation (IMV) are intensely debated, actual evidence is lacking. We sought to assess the risks and benefits of different respiratory support strategies, employed in intensive care units during the first months of the COVID-19 pandemic on intubation and intensive care unit (ICU) mortality rates.

Perioperative blood transfusions in hip and knee arthroplasty: a retrospective assessment of combined risk factors.

Introduction: Accurate identification of patients at risk of blood transfusion can reduce complications and improve institutional resource allocation. Probabilistic models are used to detect risk factors and formulate patient blood management strategies. Whether these predictors vary among institutions is unclear.

Simulated dimensional compatibility of uncuffed and cuffed tracheal tubes for selective endobronchial intubation in children.

Background: Cuffed tracheal tubes have recently been recommended for selective endobronchial intubation to establish single-lung ventilation even in smaller children. This implies that, compared with uncuffed tracheal tubes, the cuffed tracheal tubes selected will be smaller and therefore have a shorter length. We hypothesized that cuffed tracheal tubes might be of insufficient length for selective endobronchial intubation if the tube cuff were fully immersed in the left or right mainstem bronchus.

Non-invasive continuous blood pressure monitoring (ClearSight™ system) during shoulder surgery in the beach chair position: a prospective self-controlled study.

Background: The beach chair position that is commonly used in shoulder surgery is associated with relative hypovolemia, which leads to a reduction in arterial blood pressure. The effects of patient positioning on the accuracy of non-invasive continuous blood pressure monitoring with the ClearSight™ system (CS-BP; Edwards Lifesciences, Irvine CA, USA) have not been studied extensively. Our research aim was to assess agreement levels between CS-BP measurements with traditional blood pressure monitoring techniques.

An observational study comparing the performance of TOF-Cuff with TOF-Scan monitoring during anaesthetic induction in clinical routine.

Introduction: Neuromuscular monitoring by acceleromyography assesses the effects of non-depolarising neuromuscular blocking agents used during anaesthesia induction to optimise intubation conditions. A new type of neuromuscular monitor, TOF-Cuff, integrates electrode stimulation into a blood pressure monitoring cuff. Comparisons of this device with TOF-Scan, considered a clinical standard acceleromyography device, have not been published.

A retrospective analysis of surgical outcomes following direct anterior hip arthroplasty with or without a surgical extension table.

Purpose: Using a surgical extension table during total hip arthroplasty (THA) is widely considered state-of-the-art. However, intra-operative leg positioning requires additional time and leg length determination can be challenging. Our study's aim was to compare patient outcomes, particularly leg length precision, following surgery with or without an extension table.

Neuromuscular monitoring during modified rapid sequence induction: A comparison of TOF-Cuff® and TOF-Scan®.

Background: Acceleromyometry is the clinical standard for quantitative neuromuscular monitoring, mostly using the stimulation pattern train-of-four (TOF). TOF-Cuff®, a recently introduced neuromuscular monitor with stimulating electrodes integrated within a blood pressure cuff, assesses the muscular response in the upper arm.

Methods: The time from administration of a neuromuscular blocking agent to TOF-ratio 0% during modified rapid sequence induction was compared between TOF-Cuff® and acceleromyometry (TOF-Scan®).

Neuromuscular monitoring using TOF-Cuff® versus TOF-Scan®: an observational study under clinical anesthesia conditions.

Background: Anesthesia guidelines advise objective neuromuscular monitoring. Acceleromyography, the standard technique used in clinical practice, is commonly used with the train-of-four (TOF) nerve stimulation pattern. Objective of this study was to compare the performance of two devices, TOF-Scan® and TOF-Cuff®.

Dimensional Variations of Left-Sided Double-Lumen Endobronchial Tubes.

Background: Tube size selection is critical in ventilating patients' lungs using double-lumen endobronchial tubes (DLTs). Little information about relevant parameters is readily available from manufacturers. The aim of this study is to provide reference data for relevant dimensions of conventionally available DLTs.

Placement of TOF-Cuff® on the lower leg for neuromuscular and blood pressure monitoring during anesthetic induction for shoulder surgeries.

The aim of this study was to compare two devices for neuromuscular monitoring during anesthetic induction. TOF-Cuff was installed on the lower leg stimulating the tibial nerve, while the more conventional TOF-Scan was installed over the ulnar nerve at the wrist. Methods Twenty adult patients were enrolled in this prospective, controlled study.

Measuring the accuracy of propofol target-controlled infusion (TCI) before and after surgery with major blood loss.

Target-controlled infusion (TCI) is based on pharmacokinetic models designed to achieve a desired drug level in the blood. TCI's predictive accuracy of plasma propofol levels at the end of surgery with major blood loss has not been well established. This prospective observational study included adult patients (BMI 20-35 kg/m) undergoing surgery with expected blood loss ≥ 1500 mL.

Endotracheal tube cuff pressure changes during manual cuff pressure control manoeuvres: An in-vitro assessment.

Background: Endotracheal tube (ETT) cuffs are designed to seal the lower airway for precise ventilation and to protect against ingress of pathogens from the pharyngeal space. Therefore, a minimal continuous cuff pressure must be maintained. Aim of this study was to analyse the course of cuff pressure in an in-vitro model during manual cuff pressure control manoeuvres.

Postoperative delirium assessed by post anesthesia care unit staff utilizing the Nursing Delirium Screening Scale: a prospective observational study of 1000 patients in a single Swiss institution.

Background: Delirium has become better studied, but is still only partially understood and significantly underestimated. There are some well-known risk factors, but little is known about the incidence of delirium in the diverse patient population of a post anesthesia care unit (PACU). The aim of this study was to investigate the presence of delirium using the Nursing Delirium Screening Scale (NU-DESC).

Anesthetic management of patients undergoing bariatric surgery: two year experience in a single institution in Switzerland.

Background: In the field of anesthesia for bariatric surgery, a wide variety of recommendations exist, but a general consensus on the perioperative management of such patients is missing. We outline the perioperative experiences that we gained in the first two years after introducing a bariatric program.

Methods: The perioperative approach was established together with all relevant disciplines.

What patients and relatives expect from an intensivist--the Swiss side of a European survey.

Background: Until recently, patients' and families' expectations of specialists in intensive care medicine were largely unknown. This paper reports the results from the Swiss subgroup of a recently performed European multicentre study addressing this question.

Methods: Purposeful sample of adult ICUs in Switzerland.

Accuracy of continuous central venous oxygen saturation monitoring in patients undergoing cardiac surgery.

Objective: Continuous assessment of central venous oxygen saturation (S(cevox)O(2)) with the CeVOX device (Pulsion Medical Systems, Munich, Germany) was evaluated against central venous oxygen saturation (S(cv)O(2)) determined by co-oximetry.

Methods: In 20 cardiac surgical patients, a CeVOX fiberoptic probe was introduced into a standard central venous catheter placed in the right internal jugular vein and advanced 2-3 cm beyond the catheter tip. After in vivo calibration of the probe, S(cevox)O(2), S(cv)O(2), mixed venous oxygen saturation (S(mv)O(2)) haemoglobin (Hb), body temperature, heart rate, central venous and mean arterial pressure, and cardiac index were assessed simultaneously at 30 min intervals during surgery and at 60 min intervals during recovery in the intensive care unit.

Cerebral near-infrared spectroscopy in adult patients after cardiac surgery is not useful for monitoring absolute values but may reflect trends in venous oxygenation under clinical conditions.

Objective: Cerebral near-infrared spectroscopy (NIRS) was evaluated for use in monitoring global oxygenation in adult patients after cardiac surgery.

Design: Prospective, randomized clinical monitoring study.

Setting: Intensive care unit for cardiac surgery; university hospital.

Cuffed tracheal tubes in children: past, present and future.

This article reviews recent developments and core topics in the use and design of pediatric cuffed tracheal tubes. A concept for an appropriate pediatric cuffed tracheal tube is introduced. The main points in this concept are evidence-based tracheal tube size recommendation, continuous cuff pressure monitoring and a pediatric tracheal tube with an anatomically-based intubation depth mark and a short distally placed high-volume-low pressure cuff made from an ultra-thin polyurethane membrane with markedly improved tracheal sealing performance.