ObjectivesOne major goal of the emergency department (ED) is to decide, whether patients need to ... more ObjectivesOne major goal of the emergency department (ED) is to decide, whether patients need to be hospitalised or can be sent home safely. We aim at providing criteria for these decisions without knowing the SARS-CoV-2 test result in suspected cases.SettingTertiary emergency medicine.ParticipantsAll patients were treated at the ED of the Charité during the pandemic peak and underwent SARS-CoV-2 testing. Patients with positive test results were characterised in detail and underwent a 14-day-follow-up.Primary and secondary outcome measuresLogistic regression and classification and regression tree (CART) analyses were performed to identify predictors (primary endpoint), which confirm safe discharge. The clinical endpoint was all-cause mortality or need for mechanical ventilation during index stay or after readmission.ResultsThe primary test population of suspected COVID-19 consisted of n=1255 cases, 45.2% were women (n=567). Of these, n=110 tested positive for SARS-CoV-2 (8.8%). The ...
Background:We investigated the impact of videolaryngoscopy for double-lumen tube (DLT) intubation... more Background:We investigated the impact of videolaryngoscopy for double-lumen tube (DLT) intubation in thoracic anaesthesia with videolaryngoscopy (GVL) using a thin GlideScope®-Titanium single use blade.Methods:A clinical, prospective, randomised, controlled trial was conducted with a total of 70 patients undergoing elective thoracic surgery and need for a DLT intubation. Finally, 65 patients were analysed (DL group [n = 31] vs. GVL group [n = 34]). Endpoints were time to intubate, subjective symptoms and objective trauma of the oropharynx and supraglottic space. Results:Mean intubation time in GVL group was 178 seconds ± 279 versus 84 seconds ± 62 in DL group [p = 0.044]. Videolaryngoscopy resulted in significantly improved visualisation of the larynx compared with Direct Laryngoscopy (DL). Cormack and Lehane (CL) grade of 1 was more frequent in GVL group (97%) than in DL Group (74%) [p = 0.008]. In analysis of the postoperatively completed questionnaires, no significant differences...
Unconscious patients with severe trauma often require urgent endotracheal intubation. In trauma v... more Unconscious patients with severe trauma often require urgent endotracheal intubation. In trauma victims with possible cervical spine injury, any movement of the head and neck should be avoided. We investigated the effect of GlideScope videolaryngoscopy on cervical spine movement compared with conventional laryngoscopy in anesthetized patients with unsecured cervical spines. Sixty patients scheduled for elective surgery with general anesthesia and without anticipated airway problems were enrolled in the study after ethics committee approval and written informed consent. Intubation was performed with videolaryngoscopy (GlideScope(®), Verathon Inc., Bothell, WA) or conventional laryngoscopy (MacIntosh). Using video motion analysis with a lateral view, the maximum extension angle α was measured with reference to anatomical points (baseline and line drawn from processus mastoideus to os frontale [glabella]). Values were analyzed using Mann Whitney U-tests. The deviation of α was a median 11.8° in the videolaryngoscope group and 14.3° in the conventional group (p = 0.045), with a maximum of 19.2° (videolaryngoscopy) vs. 29.3° (conventional). Intubation by physicians with some experience in videolaryngoscopy was associated with a reduced angle deviation (α = 10.3°) compared to inexperienced physicians (12.8°, p = 0.019). Intubation time was a median 24 s (min/max 12/75 s) in the MacIntosh group and 53 s (min/max 28/210 s) in the GlideScope group. In 3 patients randomized to the conventional group in whom conventional intubation failed, intubation could be successfully performed using videolaryngoscopy. GlideScope videolaryngoscopy reduces movements of the cervical spine in patients with unsecured cervical spines and therefore might reduce the risk of secondary damage during emergency intubation of patients with cervical spine trauma.
Background: Unconscious patients with severe trauma often require urgent endotracheal intubation.... more Background: Unconscious patients with severe trauma often require urgent endotracheal intubation. In trauma victims with possible cervical spine injury, any movement of the head and neck should be avoided. Study Objectives: We investigated the effect of GlideScope videolaryngoscopy on cervical spine movement compared with conventional laryngoscopy in anesthetized patients with unsecured cervical spines. Methods: Sixty patients scheduled for elective surgery with general anesthesia and without anticipated airway problems were enrolled in the study after ethics committee approval and written informed consent. Intubation was performed with videolaryngoscopy (GlideScope Ò , Verathon Inc., Bothell, WA) or conventional laryngoscopy (MacIntosh). Using video motion analysis with a lateral view, the maximum extension angle a was measured with reference to anatomical points (baseline and line drawn from processus mastoideus to os frontale [glabella]). Values were analyzed using Mann Whitney U-tests. Results: The deviation of a was a median 11.8 in the videolaryngoscope group and 14.3 in the conventional group (p = 0.045), with a maximum of 19.2 (videolaryngoscopy) vs. 29.3 (conventional). Intubation by physicians with some experience in videolaryngoscopy was associated with a reduced angle deviation (a = 10.3 ) compared to inexperienced physicians (12.8 , p = 0.019). Intubation time was a median 24 s (min/max 12/75 s) in the MacIntosh group and 53 s (min/max 28/210 s) in the GlideScope group. In 3 patients randomized to the conventional group in whom conventional intubation failed, intubation could be successfully performed using videolaryngoscopy. Conclusion: Gli-deScope videolaryngoscopy reduces movements of the cervical spine in patients with unsecured cervical spines and therefore might reduce the risk of secondary damage during emergency intubation of patients with cervical spine trauma. Ó 2013 Elsevier Inc.
ObjectivesOne major goal of the emergency department (ED) is to decide, whether patients need to ... more ObjectivesOne major goal of the emergency department (ED) is to decide, whether patients need to be hospitalised or can be sent home safely. We aim at providing criteria for these decisions without knowing the SARS-CoV-2 test result in suspected cases.SettingTertiary emergency medicine.ParticipantsAll patients were treated at the ED of the Charité during the pandemic peak and underwent SARS-CoV-2 testing. Patients with positive test results were characterised in detail and underwent a 14-day-follow-up.Primary and secondary outcome measuresLogistic regression and classification and regression tree (CART) analyses were performed to identify predictors (primary endpoint), which confirm safe discharge. The clinical endpoint was all-cause mortality or need for mechanical ventilation during index stay or after readmission.ResultsThe primary test population of suspected COVID-19 consisted of n=1255 cases, 45.2% were women (n=567). Of these, n=110 tested positive for SARS-CoV-2 (8.8%). The ...
Background:We investigated the impact of videolaryngoscopy for double-lumen tube (DLT) intubation... more Background:We investigated the impact of videolaryngoscopy for double-lumen tube (DLT) intubation in thoracic anaesthesia with videolaryngoscopy (GVL) using a thin GlideScope®-Titanium single use blade.Methods:A clinical, prospective, randomised, controlled trial was conducted with a total of 70 patients undergoing elective thoracic surgery and need for a DLT intubation. Finally, 65 patients were analysed (DL group [n = 31] vs. GVL group [n = 34]). Endpoints were time to intubate, subjective symptoms and objective trauma of the oropharynx and supraglottic space. Results:Mean intubation time in GVL group was 178 seconds ± 279 versus 84 seconds ± 62 in DL group [p = 0.044]. Videolaryngoscopy resulted in significantly improved visualisation of the larynx compared with Direct Laryngoscopy (DL). Cormack and Lehane (CL) grade of 1 was more frequent in GVL group (97%) than in DL Group (74%) [p = 0.008]. In analysis of the postoperatively completed questionnaires, no significant differences...
Unconscious patients with severe trauma often require urgent endotracheal intubation. In trauma v... more Unconscious patients with severe trauma often require urgent endotracheal intubation. In trauma victims with possible cervical spine injury, any movement of the head and neck should be avoided. We investigated the effect of GlideScope videolaryngoscopy on cervical spine movement compared with conventional laryngoscopy in anesthetized patients with unsecured cervical spines. Sixty patients scheduled for elective surgery with general anesthesia and without anticipated airway problems were enrolled in the study after ethics committee approval and written informed consent. Intubation was performed with videolaryngoscopy (GlideScope(®), Verathon Inc., Bothell, WA) or conventional laryngoscopy (MacIntosh). Using video motion analysis with a lateral view, the maximum extension angle α was measured with reference to anatomical points (baseline and line drawn from processus mastoideus to os frontale [glabella]). Values were analyzed using Mann Whitney U-tests. The deviation of α was a median 11.8° in the videolaryngoscope group and 14.3° in the conventional group (p = 0.045), with a maximum of 19.2° (videolaryngoscopy) vs. 29.3° (conventional). Intubation by physicians with some experience in videolaryngoscopy was associated with a reduced angle deviation (α = 10.3°) compared to inexperienced physicians (12.8°, p = 0.019). Intubation time was a median 24 s (min/max 12/75 s) in the MacIntosh group and 53 s (min/max 28/210 s) in the GlideScope group. In 3 patients randomized to the conventional group in whom conventional intubation failed, intubation could be successfully performed using videolaryngoscopy. GlideScope videolaryngoscopy reduces movements of the cervical spine in patients with unsecured cervical spines and therefore might reduce the risk of secondary damage during emergency intubation of patients with cervical spine trauma.
Background: Unconscious patients with severe trauma often require urgent endotracheal intubation.... more Background: Unconscious patients with severe trauma often require urgent endotracheal intubation. In trauma victims with possible cervical spine injury, any movement of the head and neck should be avoided. Study Objectives: We investigated the effect of GlideScope videolaryngoscopy on cervical spine movement compared with conventional laryngoscopy in anesthetized patients with unsecured cervical spines. Methods: Sixty patients scheduled for elective surgery with general anesthesia and without anticipated airway problems were enrolled in the study after ethics committee approval and written informed consent. Intubation was performed with videolaryngoscopy (GlideScope Ò , Verathon Inc., Bothell, WA) or conventional laryngoscopy (MacIntosh). Using video motion analysis with a lateral view, the maximum extension angle a was measured with reference to anatomical points (baseline and line drawn from processus mastoideus to os frontale [glabella]). Values were analyzed using Mann Whitney U-tests. Results: The deviation of a was a median 11.8 in the videolaryngoscope group and 14.3 in the conventional group (p = 0.045), with a maximum of 19.2 (videolaryngoscopy) vs. 29.3 (conventional). Intubation by physicians with some experience in videolaryngoscopy was associated with a reduced angle deviation (a = 10.3 ) compared to inexperienced physicians (12.8 , p = 0.019). Intubation time was a median 24 s (min/max 12/75 s) in the MacIntosh group and 53 s (min/max 28/210 s) in the GlideScope group. In 3 patients randomized to the conventional group in whom conventional intubation failed, intubation could be successfully performed using videolaryngoscopy. Conclusion: Gli-deScope videolaryngoscopy reduces movements of the cervical spine in patients with unsecured cervical spines and therefore might reduce the risk of secondary damage during emergency intubation of patients with cervical spine trauma. Ó 2013 Elsevier Inc.
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Papers by Joachim Risse