Purpose Because of the anticipated surge in cases requiring intensive care unit admission, the high aerosolgenerating risk of tracheal intubation, and the specific requirements in coronavirus disease (COVID-19) patients, a dedicated Mobile Endotracheal Rapid Intubation Team (MERIT) was formed to ensure that a highly skilled team would be deployed to manage the airways of this cohort of patients. Here, we report our intubation team experience and activity as well as patient outcomes during the COVID-19 pandemic. Methods The MERIT members followed a protocolized early tracheal intubation model. Over a seven-week period during the peak of the pandemic, prospective data were collected on MERIT activity, COVID-19 symptoms or diagnosis in the team members, and demographic, procedural, and clinical outcomes of patients. Results We analyzed data from 150 primary tracheal intubation episodes, with 101 (67.3%) of those occurring in men, and with a mean (standard deviation) age of 55.7 (13.8) yr. Black, Asian, and minority ethnic groups accounted for 55.7% of patients. 91.3% of tracheal intubations were performed with videolaryngoscopy, and the first pass success rate was 88.0%. The 30-day survival was 69.2%, and the median [interquartile range] length of critical care stay was 11 [6-20] days and of hospital stay was 12 [7-22] days. Seven (11.1%) MERIT healthcare professionals self-isolated because of COVID-19 symptoms, with a total 41 days of clinical work lost. There was one reported incident of a breach of personal protective equipment and multiple anecdotal reports of doffing breaches. Conclusion We have shown that a highly skilled designated intubation team, following a protocolized, early tracheal intubation model may be beneficial in improving patient and staff safety, and could be considered by other institutions in future pandemic surges.
Gynae-oncology patients are increasingly older and living with frailty and multimorbidity, resulting in higher rates of perioperative or treatment-associated adverse outcomes. Collaborative shared decision making (SDM), where healthcare professionals and patients work in partnership to reach a treatment decision, can be used to engage patients in treatment decisions. Comprehensive geriatric assessment (CGA), a multidimensional, interdisciplinary process assessing medical, psychological and functional capabilities, can inform individualised management and SDM in older gynae-oncology patients with complex conditions. Evidence is emerging for the use of CGA to inform individualised management and underpin integrated care pathways and SDM for older people. This methodology is advocated in NHS England's Cancer Strategy through integrated pathways for older cancer patients with geriatrician involvement. Using clinical case studies, this review contextualises the application of SDM through CGA in older patients with gynaecological malignancy.
Learning objectivesKnow that SDM takes proposed risks and benefits into account, together with projected disease progression with and without treatment and patient preferences. Understand that limitations to SDM in older people include the effects of multimorbidity, cognitive impairment and frailty, limited data on long-term clinician and patient-reported outcomes and frequent exclusion of older people from research trials.
Minimally invasive surgical techniques have gained increasing interest in recent years for their conferred recovery and postoperative advantages. Robot-assisted surgery requires special consideration for anaesthetic and perioperative management. The introduction of robot- assisted intra-oral surgery has important implications on anaesthesia provision, airway management and patient safety. Due to its relatively novel use we explore these considerations alongside our own experience in this field.
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