An Audit of the Emergency Airway Service in a Regional Hospital in Singapore

Background: Emergency endotracheal intubations (EEI) performed outside of operating theatre (OT) tend to be more challenging and associated with higher risk of complications. In 2011, with the objective of improving patient outcomes, we set up an Emergency Airway Service (EAS) at our 1000-bed regional hospital, with the aim of providing specialized assistance for outside of OT difficult airway management. Method: A retrospective audit of EAS activation from 12/9/2016 and 27/10/2020 was conducted. EAS forms and electronic medical records were reviewed. We collected information on patient characteristics, EAS activation characteristics and its outcomes. Descriptive analysis method was used to present the collected data. Results: There were a total of 275 activations, of which 268 were analysed. Reasons for activation were anticipated difficult intubation (42.2% n = 113), failed intubation attempt (52.6%, n = 141) and advanced intubation equipment required (5.2% n = 14). Intubation was attempted in 261/268 (97.4%) cases by the EAS team. Of these, 255 (97.7%) cases were successful while 6 (2.3%) cases failed intubation. Of the successful intubations by the EAS team, 208/255 (81.5%) were successful on the first attempt. Out of the 6 unsuccessful intubation cases, 1 case required a rescue cricothyroidotomy and 4 cases required an open tracheostomy. Intubation was deemed easy by the EAS team in 170/261 (65.1%) cases. 64/170 (37.6%) cases were intubated with a video laryngoscope (VL). There were 85 cases (32.3%) classified as difficult intubation by the EAS specialist, 13/85 (15.3%) were intubated using only VL, 54/85 (63.5%) cases were intubated using VL with style/bougie. Conclusion: Audit results showed that providing an experienced and well-equipped team of airway specialists round-the-clock to assist in difficult and potentially difficult endotracheal intubations is justifiable and may reduce complications associated with EEI.

SURVEY OF AIRBORNE POLLEN IN HUBEI PROVINCE OF CHINA

Objective To study the genera and seasonal distribution of airborne pollen in Hubei province of China, and its relationship with pollinosis. Methods From November 2003 to October 2004, an airborne pollen investigation was performed in 16 chosen areas in 12 cities of Hubei province using gravity sedimentation technique. Meanwhile, univalent skin prick tests of pollens were performed and the invasion season was studied on 2 300 patients with pollinosis. Among them, 352 cases underwent the airway responsiveness measurements, and the correlation between airway responsiveness and results of pollen count was analyzed. Results A total of 61 pollen genera were observed and 257 520 pollens were collected. The peak of airborne pollen distribution occurred in two seasons each year: spring (March and April) and autumn (from August to October). The attack of pollinosis corresponded to the peak of pollen distribution. There was a significantly negative relationship between the provocation dose causing a 20% decrease of forced expiratory volume in one second (FEV1) from baseline and airborne pollen concentration (r = -0.6829, P < 0.05). Conclusion This study provides useful information for airborne pollen epidemiology of Hubei province, and it provides important insights to clinical prevention, diagnosis, and treatment of pollen-related allergic diseases.