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Above-Cuff Vocalization (ACV) can be performed using any tracheostomy tube with a subglottic suction channel and is the only method to facilitate speech in patients with tracheostomies who require mechanical ventilation with cuff inflation. Current ACV literature is largely comprised of case series, with no studies assessing widespread implementation of ACV in the ICU setting. Our goal was to assess the feasibility of hospital-wide implementation of an ACV protocol using ACV-capable tracheostomy tubes and its impact on patient speech. METHODS:We performed an observational before-and-after study in four ICUs at an academic tertiary care hospital. An ACV implementation protocol was developed by intensivists and speech-language pathologists. This protocol was introduced after hospital-wide transition to a tracheostomy tube with a subglottic channel as the default cuffed tube placed in ICU patients. All patients who underwent routine tracheostomy while in the Medical ICU, Heart and Vascular ICU, Neurologic ICU, or Trauma/Surgical ICU during the study period were included. In addition to data collection on ACV efficacy and safety, time-to-speech after tracheostomy was compared between the pre-transition and post-transition groups using the Wilcoxon Rank-Sum test. RESULTS:Of 255 subjects who received tracheostomy while in an ICU during the study period, 167 underwent the procedure before the transition and 88 after. 101 of 167 (60%) patients achieved speech within 60 days before the transition compared to 52 of 88 (59%) after. Amongst patients who achieved speech, a significant decrease in median time-to-speech was observed after the transition, from 13 days (IQR 8-20) to 10 days (IQR 6-14) (p = 0.01). 18 of 52 (35%) patients who achieved speech post-transition did so using ACV, with the remainder using speaking valve. Of the 18 patients who spoke with ACV, 6 of 18 (33%) did not progress to speaking valve within the follow-up period. Of those who did, the median speech-days gained using ACV was 5 (IQR 4-9 days). ACV was successful in facilitating speech in 18 of 21 (86%) patients trialed, with no major complications.CONCLUSIONS: Routine implementation of ACV after tracheostomy is feasible, safe, and associated with earlier speech post-tracheostomy in a diverse cohort of critically ill patients.

Zavod za hitnu medicinsku pomoć Kragujevac 4 Služba hitne pomoći Novi Pazar Prehospitalno zbrinjavanje hipoglikemije Sažetak Uvod: Hipoglikemija je kliničko stanje koje karakteriše vrednost glukoze u krvi manja od 3,5mmol/l. Teška hipoglikemija ukoliko se na vreme ne prepozna i terapijski ne reaguje može uzrokovati oštećenje mozga, a koja traje više od jednog sata moždanu smrt. Cilj rada: je analiza učestalosti hipoglikemijske krize kod pacijenata obolelih od diabetes mellitus-a pregledanih u ambulanti i na terenu Službe hitne medicinske pomoći (SHMP) u Novom Pazaru. Metod rada: Sprovedena je retrospektivna analiza 52593 pacijenta koji su pregledani u SHMP u periodu od 01.01.2019. do 31.12.2019.god. Analizirani su podaci iz protokola pacijenata obolelih od diabetes mellitus-a kod kojih je potvrđena hipoglikemija. Analizirana je demografska struktura, distribucija poziva po mesecima kao i dnevni vremenski intervali kad su ekipe hitne medicinske službe reagovale. Poseban osvrt smo imali na pacijente mlađe i starije životne dobi koji su pored hipoglikemijske krize imali i epileptični napad. Rezultati: U periodu od 01.01.2019. do 31.12.2019. godine u SHMP pregledano je 52593 pacijenta. Od ovog broja 7201 su oboleli od diabetes mellitusa tip 1 i tip 2, što predstavlja 13,69% od ukupnog broja pregledanih. Žene su bile zastupljenije 3728 (51,77%), dok je muškaraca bilo 3473. Glikemija je izmerena 2794 puta, od toga je kod 752 pacijenta potvrđena hipoglikemija (10,44%). Najviše hipoglikemija bilo je na terenu 701 (93,21%), dok je u ambulanti bilo 51 (6,78%). Vrednosti glikemije od 3,5 do 3,2 mmol/l imalo je 323 (42,95%) pacijenta. Između 3,1 i 2,2 mmol/l imalo je 207 (27,52%) pacijenata. Vrednosti 2,1 mmol/l i niže imalo je 222 (29,52%) pacijenata. U ovoj grupi od 222 pacijenta epileptični napad je zabeležen kod 151 pacijenta (68,01%). Zaključak: Hipoglikemija je dijagnostikovana kod 10% pacijenata obolelih od dijabetes melitusa. Tešku hipoglikemiju smo dijagnostikovali kod 222 pacijenta. Više intervencija je bilo na terenu, najviše u toku avgusta meseca i u ranim jutarnjim satima.

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