BACKGROUND: We sought to describe adverse events associated with unplanned extubation (UE) and to explore risk factors for serious adverse events post-UE among infants who experienced UE. METHODS: Data were prospectively collected on all infants who had a UE event at a single institution over a 4-y period. Demographic information and information on outcomes were obtained retrospectively. We described the frequency of post-UE adverse events: success or failure of extubation trial if offered, rate of re-intubation, post-UE changes in ventilator settings, and serious adverse events post-UE (eg, need for cardiopulmonary resuscitation, clinical sepsis, and death or tracheostomy prior to discharge). We used a multivariate logistic regression model to identify the risk factors associated with serious adverse events. RESULTS: There were 134 documented UE events. Agitation was the most common known cause. After UE, 49% of the subjects were given a trial of extubation, and 65% of the trials were successful at 48 h. Cardiopulmonary resuscitation (CPR) was performed in 13% of cases. In subjects requiring immediate re-intubation, mean airway pressure (P aw) and oxygen requirement increased in 33% and 55% of the subjects, respectively. Post-UE clinical sepsis occurred in 17% of subjects. Higher pre-UE P aw and difficult re-intubation were associated with a need for CPR. Subjects who received CPR had increased odds (3.7؋) of developing clinical sepsis. CONCLUSION: UE can result in serious adverse events, including hemodynamic instability and possibly an increased risk for clinical sepsis. Difficult re-intubation was associated with a higher risk of needing CPR and, later, tracheostomy and death.

ObjectiveTo find out the type of bacteria colonising the tracheostomy tube and to determine the antibiotic sensitivity pattern and resistance in patients who have had tracheostomy in intensive care unit (ICU) set up and to initiate proper empirical treatment in such patients.MethodsThe study was a retrospective review of patients who underwent tracheostomy at Ministry of Health, Sur Hospital, Oman January 2005 and December 2015. The Hospital has 4 bedded pediatric intensive care unit (PICU) and 10 bedded adult ICU which is headed by consultant anaesthetists, consultant physicians, ICU trained nurses and respiratory therapists. All patients who required mechanical ventilation and were therefore subject to an orotracheal intubation and those who underwent a conventional tracheostomy were considered for inclusion. Patients who had been intubated in other hospitals or ICUs, other airways infection issues were excluded from this study. Data's were collected from computer based hospital management system, operation theatre and registers in Medical records department and entered in a preformed questionnaire before thorough analysis. The specimens for swab was obtained from the cut tracheostomy tube tips and the samples were sent to microbiology laboratory for isolation of the organism and obtain an antibiogram to know the susceptibility and resistance to antibiotics. Data were analyzed by Statistical Package for Social Sciences (SPSS, version 16, Chicago, Inc) and the values are reported as number (%). The commonest isolated organism was Pseudomonas followed by Acinetobacter.ResultsDuring the ten year retrospective study, there were 108 patients included in our study with 56 males and 51 females. Fourteen different microorganisms were isolated during our study which included Pseudomonas aeruginosa (n = 39), Acinetobacter baumanii (n = 28), Klebsiella (n = 10) and coagulase negative staphylococcus (n = 6). The most commonest organisms in both genders was Pseudomonas aeruginosa closely followed by Acinetobacter baumanii. In children under age of 12, it was Pseudomonas aeruginosa and in adults the impending organism was Acinetobacter baumanii. In terms of antiobiograms, 89% of Acinetobacter, 38% of Staphylococcus aureus, 37% of Klebsiella and 54% of Proteus mirabilis were resistant to ciprofloxacin. These organisms were resistant to ceftazidime in 97%, 83%, 89% and 57% of the cases, respectively and resistant to imipenem in 7.4%, 18.2%, 1.8% and 8.1%.ConclusionsIn summary, this study presents the most common microorganisms colonized from tracheostomy of hospitalized patients and their pattern of antibiotic resistance. As our study showed, Pseudomonas is the most common microorganism isolated from tracheostomy tube. Ciprofloxacin was also the most prevalent antibiotic revealing resistant pattern. Moreover, most of the microorganisms were sensitive to imipenem and pipracillin‐tazobactam.

BackgroundNeonatal endotracheal intubation is a life-saving procedural skill where best practices have been developed from expert opinion. Few empirical studies have examined how this skill should be taught.ObjectiveTo determine whether a video laryngoscope (VL) assisted intubation training curriculum compared to a traditional direct laryngoscope (DL) assisted curriculum improves neonatal intubation performance of novice intubators in a simulated setting.MethodsA randomized trial of novice intubators was conducted at the University of Texas-Houston from 6/2013–8/2013. Eligible candidates were randomly assigned to control group (DL curriculum) or intervention group (VL curriculum). Those in the intervention group received instruction with VL videos and practice with Storz C-MAC® VL (Karl Storz, Tuttlingen, Germany) in addition to a traditional curriculum. Intubation performance was evaluated in a simulated setting using a SimNewB® (Laerdal, NY, USA) manikin and traditional intubation equipment. The number of intubation attempts, outcome of each attempt, and time to successful intubation were recorded. The data was analyzed using Fisher's exact test and logistic regression where appropriate.ResultsOne hundred twenty-three trainees were enrolled, 62 (50%) in DL group and 61 (50%) in the VL group. Intubation success on first attempt was achieved by 69% (43/62) of the DL group vs. 61% (37/61) of the VL group, P=0.35. Time to successful intubation was 25 sec (interquartile range (IQR) 18, 32) in the DL group and 26.5 sec (IQR 20, 43) in the VL group, P=0.27. Those in the VL group were more likely to need more than two attempts to achieve intubation success, OR=3.09 (95% CI 1.03–9.28).ConclusionsIn a simulated setting, teaching with a VL curriculum did not improve intubation performance compared to teaching with DL. Further studies are needed to determine if VL-based teaching has an impact on clinical intubation performance.

Pulmonary hypoplasia is the incomplete development of lung tissue. A reduced number of lung cells, airways, and alveoli is the hallmark and can be seen unilaterally or in both lungs. The diagnosis, however, is usually made upon pathologic examination. Here we have presented a case of a term infant presenting with severe hypoxemic respiratory failure. Despite optimizing medical and respiratory management, the infant passed away at 22 hours of life. On autopsy, she was discovered to have bilateral diaphragmatic eventrations, which is a rare cause of secondary pulmonary hypoplasia. She also was found to have some other minor abnormalities on autopsy but no unifying cause for the eventrations and other abnormalities was elucidated.