No abstract

BACKGROUND The role of magnesium in patients with acute chronic obstructive pulmonary disease (COPD) exacerbation remains to be determined. AIM We aim to explore the effect of magnesium on COPD exacerbation, as well as its impact on pulmonary function tests and on hospital admissions for acute exacerbation in the emergency department. METHODS This is a systematic review and meta-analysis that included a search of the keywords "magnesium" and "COPD" on PubMed, Google Scholar, Cochrane databases, and Gray literature (ClinicalTrials.gov and World Health Organization International Clinical Trials Registry Platform) from 1963 to May 2021. RESULTS The use of IV magnesium reduced the risk ratio for admission RR= 0.85 (95% CI 0.62 to 1.17). The combined risk ratio for admission increased to 0.95 when we added nebulised magnesium sulphate (95% CI 0.85 to 1.07), p>0.05. The mean score for improvement after IV magnesium was higher (M=16.75, SD=5.11) than the mean score before its administration (M=8.74, SD=8.85), t(4)=-2.57, p=0.031. Thus, the use of IV magnesium sulphate results in a 91.64% improvement in the pulmonary function test. CONCLUSION IV magnesium sulphate improves the pulmonary function test of patients with acute COPD exacerbation in the ED, and possibly reduces the admission rate.

Background: Healthcare providers performing aerosol-generating procedures like airway management are at the highest risk for contamination with coronavirus disease 2019 . We developed an in-situ simulation (ISS) airway management training in confirmed or suspected COVID-19 patients for emergency and anesthesiology staff, evaluated participants' reactions, and identified perceived challenges. Methods:We used a cross-sectional study design incorporating a quantitative questionnaire to describe participants' reaction to the ISS and a qualitative group interview using the plus-delta debriefing modality to explore participants' challenges in acquiring the knowledge and skills required for each learning objective. Data were analyzed using descriptive statistics and deductive content analysis.Results: Two hundred and ninety-nine healthcare providers participated in 62 ISS training sessions. Over 90% of our study participants agreed or strongly agreed that: they understood the learning objectives; the training material appropriately challenged them; the course content was relevant, easy to navigate, and essential; the facilitators' knowledge, teaching, and style were appropriate; the simulation facilities were suitable; and they had ample opportunities to practice the learned skills. The main challenges identified were anticipating difficult airways, preparing intubation equipment, minimizing the number of personnel inside the room, adhering to the proper doffing sequence, preparing needed equipment outside the intubation room, speaking up, and ensuring closed-loop communication. Conclusion:The newly developed ISS training was feasible for busy healthcare practitioners to safely perform airway management procedures for suspected or confirmed COVID-19 patients without affecting bedside care. Anticipation of difficult airways and speaking up were the most frequent challenges identified across all specialties in this study.