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Found 109 results
  1. News Article
    A teenager died after a breathing tube was possibly squashed by a wheel of her hospital trolley during emergency surgery, an inquest has heard. Jasmine Hill, 19, had a cardiac arrest shortly after undergoing a procedure on her neck at Gloucestershire royal hospital in Gloucester. The inquest heard that a report commissioned by lawyers acting for Hill’s family referred to the tube being “squashed by the wheel of a trolley”. Hill, from Cirencester, had been readmitted to the hospital after her neck became swollen five days after a thyroidectomy – the removal of all or part of the thyroid gland – in September 2020. Doctors thought the site of the surgery in Hill’s neck, which was red and swollen, may have become infected and it was decided the wound should be cleaned under general anaesthetic. The procedure took less than an hour and the teenager went into cardiac arrest shortly after she was moved by staff from the operating table to a bed. Gloucestershire coroner’s court heard an endotracheal tube, which supports breathing, was positioned behind Hill’s head and away from her neck, fixed to a holder and connected to the ventilator. The assistant Gloucestershire coroner Roland Wooderson asked Dr Hiro Ishii, who carried out the procedure, whether he was aware that the anaesthetist had checked the position of the endotracheal tube. Ishii replied: “I didn’t make a formal inquiry at that stage.” Read full story Source: The Guardian, 7 November 2022
  2. News Article
    The lungs and hearts of patients damaged by the coronavirus improve over time, a study has shown. Researchers in Austria recruited coronavirus patients who had been admitted to hospital. The patients were scheduled to return for evaluation 6, 12 and 24 weeks after being discharged, in what is said to be the first prospective follow-up of people infected with COVID-19, which will be presented at today's European Respiratory Society International Congress. Clinical examinations, laboratory tests, analysis of the amounts of oxygen and carbon dioxide in arterial blood, and lung function tests were carried out during these visits. At the time of their first visit, more than half of the patients had at least one persistent symptom, predominantly breathlessness and coughing, and CT scans still showed lung damage in 88% of patients. But by the time of their next visit, 12 weeks after discharge, the symptoms had improved, and lung damage was reduced to 56%. Dr Sabina Sahanic, a clinical PhD student at the University Clinic in Innsbruck and part of the team that carried out the study, said: "The bad news is that people show lung impairment from COVID-19 weeks after discharge; the good news is that the impairment tends to ameliorate over time, which suggests the lungs have a mechanism for repairing themselves." A separate presentation to the congress said that the sooner COVID-19 patients started a pulmonary rehabilitation programme after coming off ventilators, the better and faster their recovery. Yara Al Chikhanie, a PhD student at the Dieulefit Sante clinic for pulmonary rehabilitation and the Hp2 Lab at the Grenoble Alps University in France, used a walking test to evaluate the weekly progress of 19 patients who had spent an average of three weeks in intensive care and two weeks in a pulmonary ward before being transferred to a clinic for pulmonary rehabilitation. She said: "The most important finding was that patients who were admitted to pulmonary rehabilitation shortly after leaving intensive care progressed faster than those who spent a longer period in the pulmonary ward where they remained inactive. The sooner rehabilitation started and the longer it lasted, the faster and better was the improvement in patients' walking and breathing capacities and muscle gain." Read full story Source: The Independent, 7 September 2020
  3. News Article
    Inpatient mortality among people receiving non-invasive ventilation (NIV) has decreased for the first time since 2010, falling from 34% in 2013 to 26% in 2019, figures released by the British Thoracic Society show. The annual National Adult Non-Invasive Ventilation audit, which began in 2010, reported “substantial improvements in processes of care and patient outcomes” in 2019 when compared with previous years. “Some improvement in overall mortality may be attributed to improved patient selection,” it said. “Mortality outcomes were lower for each diagnostic category, and most notably for patients with COPD [chronic obstructive pulmonary disease] and obesity-related respiratory failure.” Read full story (paywalled) Source: BMJ, 10 July 2020
  4. News Article
    Patients with respiratory disease have been overlooked during the COVID-19 pandemic, with the NHS storing up problems for the winter months, a group of experts including the Royal College of General Practitioners (RCGP) has warned. Analysis by the 34-member Taskforce for Lung Health showed that referrals for lung conditions fell by 70% in April, with two-in-five (39%) of CCGs seeing no appointment bookings for respiratory conditions for the whole of May. On average, the group calculated a weekly average of 3,399 lung patients missing out on urgent and routine referrals during the COVID-19 lockdown, amounting to a total of at least 34,780 people, based on NHS England data. This was blamed in part on a general reduction in routine procedures during the pandemic, which will have affected all disease areas, but also the limitations on clinicians including GPs to carry out spirometry due to the risk of COVID-19 infection spread. But the taskforce - which includes the RCGP and the Primary Care Respiratory Society, as well as the Royal College of Physicians and Asthma UK - is now calling on NHS England to urgently restore services to pre-pandemic levels to tackle the backlog of lung patients requiring support. It said that failure to do so risked causing the premature death of patients who require urgent diagnosis as well as overwhelming the NHS during the winter season, when respiratory symptoms worsen. Read full story Source: Pulse, 9 July 2020
  5. News Article
    Tens of thousands of people will need to be recalled to hospital after a serious OVID-19 infection to check if they have been left with permanent lung damage, doctors have told the BBC. Experts are concerned a significant proportion could be left with lung scarring, known as pulmonary fibrosis. The condition is irreversible and symptoms can include severe shortness of breath, coughing and fatigue. Research into the prevalence of lung damage caused by COVID-19 is still at a very early stage. It's thought those with a mild form of the disease are unlikely to suffer permanent damage. But those in hospital, and particularly those in intensive care or with a severe infection, are more vulnerable to complications. In a study from China, published in March, 66 of 70 patients still had some level of lung damage after being discharged from hospital. Radiologists in the UK say, based on the early results of follow-up scans, they are concerned about the long term-effects of a serious infection. Prof Gisli Jenkins, of the National Institute for Health Research, is running assessment clinics for those discharged from hospital with COVID-19. He said: "My real concern is that never before in our lifetime have so many people been subject to the same lung injury at the same time." NHS England has said it is planning to open a number of specialist COVID-19 rehabilitation centres to help patients recover from long-term effects, including possible lung damage. Read full story Source: BBC News, 24 June 2020
  6. News Article
    Demand for oxygen from COVID-19 patients recovering at home is set to place the NHS under strain, the health service has warned. NHS England has issued guidance to out-of-hospital health providers on the extra demands likely to be placed on them given the number of people recovering after a hospital stay with the coronavirus. It warns that the provision from its home oxygen services and community respiratory teams across the NHS is expected to be an issue as the scale of demand increases. Andrew Whittamore, a practising GP and clinical lead for the Asthma UK and British Lung Foundation partnership, said concerns about the potential for hospitals to be overwhelmed in the early part of the pandemic had led to community oxygen teams being primed to take on more patients – but he described that ramping up as “a short-term fix”. “We don’t know how long people are going to need oxygen or other services for,” he said. “There are definitely going to be extra patients added on to our community teams’ workloads.” The Taskforce for Lung Health – of which the British Lung Foundation is a member – has raised particular concerns about access to pulmonary rehabilitation. An education- and exercise-based treatment, which is proven to be more effective for lung patients than many drug-based treatments, and face-to-face classes have been suspended during the pandemic. It may be that such treatment would also be helpful for some patients recovering from COVID-19. Jackie Eagleton, policy officer at the British Lung Foundation, said there had been issues with access to pulmonary rehabilitation for a long time, but the need to offer this form of support to people with lung conditions “has never been more pressing than it is now”. Read full story Source: The Independent, 16 June 2020
  7. News Article
    Doctors, nurses and paramedics have been given conflicting advice about when to start resuscitation for coronavirus patients, amid fears the procedure could put them at risk of infection. While Public Health England has said it does not believe CPR creates a risk, the UK’s Resuscitation Council – which is responsible for setting standards for resuscitation in the NHS – has said it believes there is a risk and staff should wear full equipment. The Independent has seen several examples of different messages being sent out to hospital staff and ambulance workers, and some NHS trusts were forced to change their guidance within a matter of days after PHE changed its stance. One set of guidance could mean a delay in starting CPR for patients while staff put on protective equipment, while the other means staff could be at risk of being infected with coronavirus. Ken Spearpoint, a former consultant nurse and resuscitation officer at Imperial College Healthcare Trust, said the situation had led to confusion and created an “ethical dilemma” for some staff who were being forced to choose between the Resus UK’s position and their trust’s guidance. Read full story Source: The Independent, 6 April 2020
  8. News Article
    The number of heart and lung transplants could quadruple thanks to a "reanimation" machine used in a pioneering operation, a hospital says. The device, developed at Royal Papworth Hospital in Cambridge, managed to pump oxygenated blood into both organs in a world-first procedure. The machine can revitalise deteriorating organs allowing "donation after circulatory death" (DCD). Hospital surgeon Pedro Catarino said it was like "recharging the batteries". "It is reanimation and then it replenishes the energy stores of the heart, what we call reconditioning, which allows it be transplanted," he said. "We think it could at least double and perhaps quadruple the number of [heart and lungs] available for transplant." He said it was desperately needed, adding: "Patients die on the waiting list every day." Read full story Source: BBC News, 23 March 2020
  9. News Article
    A “critical” shortage of lung specialists may leave the NHS struggling to cope with a spike in hospital admissions related to complications of pneumonia and flu this winter, the British Thoracic Society (BTS) has warned. At its winter meeting this week (taking place 4-6 December), the society presented results from a survey it conducted of almost 250 UK NHS respiratory specialists. Some 83% of respondents (199) thought respiratory healthcare staff shortages would impair the ability of the NHS to cope with the increase in lung disease hospital admissions this winter. Read full story (paywalled) Source: BMJ, 4 December 2019
  10. Content Article
    There is great disparity in the way we think about and address different sources of environmental infection. Governments have for decades promulgated a large amount of legislation and invested heavily in food safety, sanitation, and drinking water for public health purposes. By contrast, airborne pathogens and respiratory infections, whether seasonal influenza or COVID-19, are addressed fairly weakly, if at all, in terms of regulations, standards, and building design and operation, pertaining to the air we breathe. We suggest that the rapid growth in our understanding of the mechanisms behind respiratory infection transmission should drive a paradigm shift in how we view and address the transmission of respiratory infections to protect against unnecessary suffering and economic losses. It starts with a recognition that preventing respiratory infection, like reducing waterborne or foodborne disease, is a tractable problem.
  11. Content Article
    The Pre-Hospital Care Podcast is designed to have engaging and inspirational conversations with some of the World’s leading experts relating to pre-hospital care. This session interviews flight paramedic Paul Swinton, to talk about how to optimise the rapid sequence intubation (RSI) in the pre-hospital environment. It unpacks some of the nuances, challenges, and approaches that Paul has found from being both a pre-hospital practitioner and in innovating the layout and design for an RSI in creating the SCRAM bag. SCRAM™ (Structured CRitical Airway Management) is an innovative solution for enhancing the performance of emergency airway management. It involves the systemisation, standardisation, cognitive offloading, human factors and good governance are core principles to the design and philosophy of SCRAM.
  12. Content Article
    The purpose of this investigation by the Healthcare Safety Investigation Branch (HSIB) is to help improve patient safety in relation to the management of patients with COVID-19 being treated with non-invasive respiratory support, for example continuous positive airway pressure (CPAP), in non-critical care settings. The HSIB investigation reviewed the experience of Terry, who was admitted to hospital with symptoms of COVID-19 and required support with is breathing using CPAP. On the second day after his admission to hospital, Terry was found on the floor next to his bed, having called for assistance. Terry’s CPAP tubing had become disconnected from his mask, meaning that Terry’s breathing was not supported. Staff attempted to resuscitate Terry, however they were unsuccessful, and he died.
  13. Content Article
    Getting It Right First Time (GIRFT) is designed to improve the quality of care within the NHS by reducing unwarranted variations. By tackling variations in the way services are delivered across the NHS, and by sharing best practice between trusts, GIRFT identifies changes that will help improve care and patient outcomes, as well as delivering efficiencies such as the reduction of unnecessary procedures and cost savings.
  14. Content Article
    This pre-print study looks at the impact of using FFP3 Personal Protective Equipment on a Covid-19 ward. Authors estimated a 37% reduction in staff sick days when immunity (infection and vaccination) were factored in.
  15. Content Article
    Ventilator-associated pneumonia is an important healthcare-associated infection. Interventions for the prevention of ventilator-associated pneumonia are often used within bundles of care. Recent evidence has challenged widespread practices mandating a review of subject. This article outlines guidance for ventilator-associated pneumonia prevention.
  16. Content Article
    Healthcare workers (HCWs) are exposed to a range of high and low molecular weight agents that are allergic sensitisers or irritants, including cleaners and disinfectants, natural rubber latex, and various medications. Studies have shown that exposed HCWs are at risk for work-related rhinitis and asthma (WRA). Work-related rhinitis may precede development of WRA and should be considered as an early marker of WRA. Avoidance of causative exposures through control strategies such as elimination, substitution, engineering controls, and process modification is the preferred primary prevention strategy for preventing development of work-related allergic diseases. There is limited evidence for the effectiveness of respirators in preventing occupational asthma. If sensitizer-induced WRA is diagnosed, it is important to avoid further exposure to the causative agent, preferably by more rigorous application of exposure control strategies to the workplace. This review from Mazurek and Weissman focuses on allergic occupational respiratory diseases in HCWs.
  17. Content Article
    In this article Wang et al. review recent advances in understanding airborne transmission gained from studying the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections and other respiratory pathogens. 
  18. Content Article
    When a patient can’t breathe by themselves, healthcare staff may decide to intubate them to make it easier to get air into and out of the lungs. A tube goes down the throat and into the windpipe, and a machine called a ventilator pumps in air with extra oxygen. It can be life-saving, but life-threatening complications can also occur during a significant number of these procedures.  Sam Goodhand is a registrar in the Sussex region, specialising in anaesthetics and intensive care medicine. In this interview for Patient Safety Learning he tells us how and why he developed an accessible checklist for staff involved in intubation processes. 
  19. Content Article
    Healthier Together and The Royal College of Paediatrics and Child Health have developed a set of resources to help you know what to do if a child is experiencing breathing difficulties or wheezing. These resources include information on: When to worry What to do How long symptoms should last Where to go for help.
  20. Content Article
    This article describes the application of colour coding for cognitive aids to facilitate the management of an unanticipated difficult airway and its further local implementation in the form of a colour-coded difficult airway trolley. The authors conclude that the use of colour coding as a cognitive aid can enhance the management of an unanticipated difficult airway and make it simpler to obtain help from other operating room personnel who are not regularly involved in airway management. However, they note that frequent training and simulation with the material and equipment in the difficult airway trolley remains crucial.
  21. Content Article
    The Healthcare Safety Investigation Branch (HSIB) held a webinar on 12 May to discuss asthma management in children, to support the launch of their recent publication: Management of chronic asthma in children aged 16 years and under. For those of you who missed the event, HSIB have made available the webinar recording, presentation slides and Q&As.
  22. Content Article
    This investigation from the Healthcare Safety Investigation Branch, focuses on the design and implementation of patient safety alerts. It follows a reference event where an 85-year old woman was connected to the piped medical air supply, instead of the oxygen supply, whilst she was receiving hospital treatment after a fall at home.
  23. Content Article
    When Addenbrooke’s Hospital in Cambridge upgraded its face masks for staff working on COVID-19 wards to filtering face piece 3 (FFP3) respirators, it saw a dramatic fall – up to 100% – in hospital-acquired SARS-CoV-2 infections among these staff. Healthcare workers – particularly those working on COVID-19 wards – are much more likely to be exposed to coronavirus, so it’s important we understand the best ways of keeping them safe The findings are reported by a team at the University of Cambridge and Cambridge University Hospitals (CUH) NHS Foundation Trust. The research has not yet been peer-reviewed, but is being released early because of the urgent need to share information relating to the pandemic.
  24. Content Article
    The Royal College of Anaesthetists recently received a coroners report where an oesophageal intubation took place and was not recognised in time to save the life of the patient. Unrecognised oesophageal intubation is preventable through adherence to published recommendations on the monitoring of exhaled carbon dioxide (capnography) and its correct interpretation. All clinicians involved in airway management should watch the College and DAS video on capnography. Always remember 'No Trace = Wrong Place' and actively seek to exclude oesophageal intubation when a flat capnograph trace is encountered.
  25. Event
    until
    Join respiratory specialists, Dr Daryl Freeman and Dr Vincent Mak, for this interactive webinar. This 1-hour, interactive webinar will cover: Community ‘hublets’. The outpatient transformation workstream. Community Diagnostic Centres (CDCs) and Primary Care Networks (PCNs). Quality assurance and interpretation of spirometry. Register
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