ORCID Profile
0000-0002-6896-5568
Current Organisations
University of Queensland
,
Royal Brisbane and Women's Hospital
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Publisher: SAGE Publications
Date: 07-2019
Abstract: Correct intracuff pressure of endotracheal tubes and supraglottic airway devices is required to avoid complications such as sore throat, dysphagia and dysphonia, while maintaining an adequate airway seal. However, intracuff pressure monitoring of airway devices during general anaesthesia may not receive the attention it deserves. The aim of this survey was to investigate the current practice regarding intraoperative cuff pressure monitoring in hospitals across Australia and New Zealand. An online ten-question survey was disseminated by the Australian and New Zealand College of Anaesthetists Clinical Trials Network to a randomised selection of 1000 Australian and New Zealand College of Anaesthetists Fellows working in private and public hospitals of varying sizes. There were 305 respondents in total, but not all respondents answered all questions. In total, 67 of 304 respondents (22.0%) did not have access to a cuff pressure manometer at their main site of work, and of these, 30 (9.9%) expressed that they would like access to one in their daily practice. Of 288 respondents, 122 (40.0%) reported that they used cuff pressure monitoring as part of their routine practice, but 95 (33.0%) measured the cuff pressure at induction only. For supraglottic airway devices, only 44 of 250 respondents (17.6%) aimed for a cuff pressure of 40–60 cmH 2 O. Of 255 respondents, 101 (39.6%) aimed for a cuff pressure of 20–30 cmH 2 O for endotracheal tubes. These findings indicate that educational programmes are required to increase the availability and use of cuff pressure monitoring devices for both endotracheal tubes and supraglottic airway devices across Australia and New Zealand.
Publisher: SAGE Publications
Date: 27-02-2023
DOI: 10.1177/14604086231159687
Abstract: The ‘Red Blanket’ protocol fast tracks trauma patients with severe blood loss to the designated trauma operating theatre directly from the hospital helipad or Emergency Department. This study aimed to assess the impact of patient blood management (PBM) strategies on severely injured trauma patients treated under the ‘Red Blanket’ protocol at a quaternary referral hospital. This retrospective review was conducted on all urgent trauma cases that were treated under the ‘Red Blanket’ protocol in a ten-year period between January 2007 and December 2017. The use of blood products and patient outcomes was compared between the 3.5-year periods pre- and post-ROTEM ® implementation on 30th June 2014 (Jan 2011-June 2014 versus July 2014-Dec 2017). During the study period, 120 trauma patients were treated under the ‘Red Blanket’ protocol at our institution. Intention to treat analysis showed a reduction in fresh frozen plasma usage following the introduction of ROTEM ® -guided transfusion. Furthermore, subgroup analysis suggested reduced blood product usage in patients who survived. Patient blood management is a coordinated package of systems and tools, including education, patient logistics, anaemia management, intraoperative cell salvage, rotational thromboelastometry and massive transfusion protocols that together conserve blood products and improve outcomes. The implementation of ROTEM ® -guided transfusion demonstrated a reduction in fresh frozen plasma usage.
Publisher: Wiley
Date: 05-03-2020
DOI: 10.1111/AJO.13141
Publisher: Wiley
Date: 11-02-2020
Abstract: The aim of this study was to establish rotational thromboelastometry (ROTEM A prospective, observational study. Tertiary referral hospital. Healthy women in labour. Ethics approval was granted for an opt-out recruitment approach. ROTEM ROTEM One hundred and twenty-one women met the inclusion criteria, with a mean (± SD) age of 29.6 ± 5.4 years and median (interquartile range) gestation of 39.4 weeks (37.4-40.4 weeks). Seventy-five (62.0%) women were nulliparous and 71 (58.7%) delivered vaginally. The median and interquartile ranges for selected ROTEM The FIBTEM/EXTEM/INTEM litudes were higher than the manufacturer's reference ranges for non-obstetric patients. The FIBTEM MCF upper and lower limits were higher and the EXTEM/INTEM CT was shorter and narrower in range. This study provides reference ranges for ROTEM This is the first study to report on ROTEM
Publisher: Wiley
Date: 07-01-2022
DOI: 10.1111/AJO.13474
Abstract: Rotational thromboelastometry (ROTEM ® ) is a point‐of‐care test of coagulation. ROTEM ® ‐defined hypercoagulability has been identified in pregnant women and in non‐pregnant patients with diabetes mellitus. Pregnancy is known to be a hypercoagulable state, but the influence of gestational diabetes mellitus (GDM) on coagulation is unknown. The aim of this study was to assess the combined effect of pregnancy and GDM on coagulation using ROTEM ® and to compare this to healthy pregnant women presenting for elective caesarean delivery. Ethics approval was granted for recruitment of women presenting for elective caesarean delivery. Women with pre‐existing conditions affecting coagulation were excluded. Group N included health pregnant women at term and Group G included pregnant women at term with GDM. Data regarding GDM management and glycaemic control were collected. Poor glycaemic control was defined by markers of accelerated fetal growth and elevated fasting or postprandial blood glucose levels. The ROTEM ® parameters (extrinsically activated thromboelastometric test (EXTEM) / fibrin polymerisation test (FIBTEM) litude at five minutes, coagulation time, maximum clot firmness and clot formation time) were compared between the two groups using Student’s t ‐test. There were 75 women in Group N and 21 women in Group G. Mean age and median body mass index values were comparable for both groups. There were no statistical differences found between the EXTEM and FIBTEM parameters analysed for the two groups. There was no association between GDM and increased hypercoagulability as demonstrated by ROTEM ® parameters in healthy pregnant women presenting for elective caesarean delivery at term.
Publisher: Elsevier BV
Date: 02-2020
DOI: 10.1016/J.IJOA.2019.10.003
Abstract: Rotational thromboelastometry (ROTEM®) is a point-of-care coagulation test. Reference ranges in non-labouring women have recently been established from a cohort of women presenting for elective caesarean delivery using the recommended minimum s le size of 120. This study aimed to present baseline parameters for labouring and non-labouring women and to compare the mean values of these ROTEM® parameters. Ethical approval was granted for an opt-out recruitment approach for labouring women and written consent was obtained from non-labouring women (data published previously). ROTEM® testing was performed in these two cohorts at term gestation. Women with any condition affecting coagulation were excluded. ROTEM® Delta reference ranges were derived by calculating the 2.5 and 97.5 percentiles for INTEM/EXTEM/FIBTEM litude at 5 min (A5), coagulation time (CT), maximum clot firmness (MCF) and clot formation time (CFT). One hundred and twenty-one labouring and 132 non-labouring women met inclusion criteria. The mean values for selected ROTEM® parameters for labouring and non-labouring women respectively were: FIBTEM A5, 21.05 and 19.7 mm (P=0.008) EXTEM A5, 54.8 and 53.2 mm (P=0.025) and EXTEM CT, 52.2 and 53.7 s (P=0.049). Significant differences between the groups were observed in measures of clotting onset and clot firmness. We demonstrated a significant decrease in the mean time-to-clotting onset in labouring women compared with non-labouring women. Mean values for measures of clot firmness were greater in labouring women. In comparison to previously established ROTEM® baseline parameters for non-labouring women, this study provides evidence that there is greater hyper-coagulability in labouring women.
Publisher: Elsevier BV
Date: 05-2019
DOI: 10.1016/J.IJOA.2019.01.008
Abstract: Formal reference ranges for rotational thromboelastometry (ROTEM®) in pregnancy have not been obtained in the recommended minimum s le size of 120. This prospective observational study aimed to establish baseline parameters in an Australian population of women undergoing elective caesarean delivery. The secondary aim was to compare these reference ranges with those from prior studies and the manufacturer. Women undergoing elective caesarean delivery at term were included if they were at term, of normal body mass index and had no conditions affecting coagulation. ROTEM® reference ranges were derived by calculating the 2.5 and 97.5 percentiles for INTEM/EXTEM/FIBTEM litude at 5 minutes (A5), litude at 15 minutes (A15), coagulation time (CT), maximum clot firmness (MCF), and clot formation time (CFT). Of 202 women screened, 132 met the inclusion criteria, having a mean age of 32.7 ± 5.0 years and median body mass index of 23.8 kg/m ROTEM® reference ranges for women with uncomplicated term pregnancies were reported as per the International Federation of Clinical Chemistry. The FIBTEM MCF and FIBTEM/EXTEM/INTEM litudes were higher in comparison to the manufacturer's reference ranges for the non-obstetric population. The EXTEM CT was shorter than the non-obstetric reference ranges. These ranges show an increase in coagulability during normal pregnancy compared to the non-pregnant reference ranges.
Publisher: SAGE Publications
Date: 11-2020
Abstract: A review of the first 4000 reports to the webAIRS anaesthesia incident reporting database was performed to analyse cases reported as difficult or failed intubation. Patient, task, caregiver and system factors were evaluated. Among the 4000 reports, there were 170 incidents of difficult or failed intubation. Difficult or failed intubation incidents were most common in the 40–59 years age group. More than half of cases were not predicted. A total of 40% involved patients with a body mass index kg/m 2 and 41% involved emergency cases. A third of the reports described multiple intubation attempts. Of the reports, 18% mentioned equipment problems including endotracheal tube cuff rupture, laryngoscope light failure, dysfunctional capnography and delays with availability of additional equipment to assist with intubation. Immediate outcomes included 40 cases of oxygen desaturation below 85% of these cases, four required cardiopulmonary resuscitation. The majority of the incidents resulted in no harm or minor harm (45%). However, 12% suffered moderate harm, 3.5% severe harm and there were three deaths (although only one related to the airway incident). Despite advances and significant developments in airway management strategies, difficult and failed intubation still occurs. Although not all incidents are predictable, nor are all preventable, the information provided by this analysis might assist with future planning, preparation and management of difficult intubation.
Publisher: Wiley
Date: 03-12-2020
DOI: 10.1111/PAN.14088
Location: Australia
No related grants have been discovered for Julie Lee.