ORCID Profile
0000-0001-6925-4277
Current Organisations
Royal Adelaide Hospital
,
University of Adelaide
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Publisher: Wiley
Date: 03-2021
DOI: 10.1111/ANS.16571
Publisher: BMJ
Date: 09-2022
DOI: 10.1136/BMJOPEN-2021-057614
Abstract: Most patients admitted to hospital recover with treatments that can be administered on the general ward. A small but important group deteriorate however and require augmented organ support in areas with increased nursing to patient ratios. In observational studies evaluating this cohort, proxy outcomes such as unplanned intensive care unit admission, cardiac arrest and death are used. These outcome measures introduce subjectivity and variability, which in turn hinders the development and accuracy of the increasing numbers of electronic medical record (EMR) linked digital tools designed to predict clinical deterioration. Here, we describe a protocol for developing a new outcome measure using mixed methods to address these limitations. We will undertake firstly, a systematic literature review to identify existing generic, syndrome-specific and organ-specific definitions for clinically deteriorated, hospitalised adult patients. Secondly, an international modified Delphi study to generate a short list of candidate definitions. Thirdly, a nominal group technique (NGT) (using a trained facilitator) will take a erse group of stakeholders through a structured process to generate a consensus definition. The NGT process will be informed by the data generated from the first two stages. The definition(s) for the deteriorated ward patient will be readily extractable from the EMR. This study has ethics approval (reference 16399) from the Central Adelaide Local Health Network Human Research Ethics Committee. Results generated from this study will be disseminated through publication and presentation at national and international scientific meetings.
Publisher: Springer Science and Business Media LLC
Date: 11-2022
Publisher: BMJ
Date: 03-2020
DOI: 10.1136/BMJOPEN-2018-027262
Abstract: Postoperative recovery rooms have existed since 1847, however, there is sparse literature investigating interventions undertaken in recovery, and their impact on patients after recovery room discharge. This review aimed to investigate the organisation of care delivery in postoperative recovery rooms and its effect on patient outcomes including mortality, morbidity, unplanned intensive care unit (ICU) admission and length of hospital stay. NCBI PubMed, EMBASE and Cumulative Index to Nursing and Allied Health Literature. Studies published since 1990, investigating health system initiatives undertaken in postoperative recovery rooms. One author screened titles and abstracts, with two authors completing full-text reviews to determine inclusion based on predetermined criteria. A total of 3288 unique studies were identified, with 14 selected for full-text reviews, and 8 included in the review. EndNote V.8 (Clarivate Analytics) was used to manage references. One author extracted data from each study using a data extraction form adapted from the Cochrane Data Extraction Template, with all data checked by a second author. Narrative synthesis of data was the primary outcome measure, with all data of in idual studies also presented in the summary results table. Four studies investigated the use of the postanaesthesia care unit (PACU) as a non-ICU pathway for postoperative patients. Two investigated the implementation of physiotherapy in PACU, one evaluated the use of a new nursing scoring tool for detecting patient deterioration, and one evaluated the implementation of a two-track clinical pathway in PACU. Managing selected postoperative patients in a PACU, instead of ICU, does not appear to be associated with worse patient outcomes, however, due to the high risk of bias within studies, the strength of evidence is only moderate. Four of eight studies also examined hospital length of stay two found the intervention was associated with decreased length of stay and two found no association. This protocol is registered on the International Prospective Register of Systematic Reviews (PROSPERO) database, registration number NCT42018106093 .
Publisher: SAGE Publications
Date: 09-2019
Publisher: Wiley
Date: 31-08-2023
DOI: 10.1111/ANAE.15845
Abstract: We conducted a systematic review to evaluate the effect of high‐flow nasal oxygen and conventional oxygen therapy during procedural sedation amongst adults and children. We searched MEDLINE, EMBASE and CINAHL for randomised controlled trials that reported the effects of high‐flow nasal oxygen during procedural sedation. The primary outcome measure was hypoxaemia and the secondary outcomes were minimum oxygen saturation hypercarbia requirement for airway manoeuvres and procedure interruptions. The quality of evidence was assessed using the revised Cochrane risk‐of bias tool and grading of recommendations, assessment, development and evaluation (GRADE). Nineteen randomised controlled trials (4121 patients) including three in children were included. Administration of high‐flow nasal oxygen reduced hypoxaemia, risk ratio (95%CI) 0.37 (0.24–0.56), p 0.001 minor airway manoeuvre requirements, risk ratio (95%CI) 0.26 (0.11–0.59), p 0.001 procedural interruptions, risk ratio (95%CI) 0.17 (0.05–0.53), p = 0.002 and increased minimum oxygen saturation, mean difference (95%CI) 4.1 (2.70–5.50), p 0.001 as compared with the control group. High‐flow nasal oxygen had no impact on hypercarbia, risk ratio (95%CI) 1.24 (0.97–1.58), p = 0.09, I 2 = 0%. High‐flow nasal oxygen reduced the incidence of hypoxaemia regardless of the procedure involved, degree of fractional inspired oxygen, risk‐profile of patients and mode of propofol administration. The evidence was ascertained as moderate for all outcomes except for procedure interruptions. In summary, high‐flow nasal oxygen compared with conventional oxygenation techniques reduced the risk of hypoxaemia, increased minimum oxygen saturation and reduced the requirement for airway manoeuvres. High‐flow nasal oxygen should be considered in patients at risk of hypoxaemia during procedural sedation.
Publisher: Springer Science and Business Media LLC
Date: 13-05-2020
DOI: 10.1186/S12871-020-01019-5
Abstract: Various airway techniques have been employed for endoscopic procedures, with an aim to optimise patient outcomes by improving airway control and preventing hypoxia whilst avoiding the need for intubation. The LMA® Gastro™ Airway, a novel dual channel supraglottic airway technique, has been described as such a device. Its utility alongside sedation with low flow nasal cannula and general anaesthesia (GA) with intubation for endoscopic retrograde cholangiopancreatography (ERCP) procedures was evaluated. Details of all the ERCPs performed in our institution from March 2017 to June 2018 were carefully recorded in the patients’ electronic case records. Data on the successful completion of ERCP through LMA® Gastro™ Airway any difficulty encountered by the gastroenterologists and adverse events were recorded. Episodes of hypoxia (SpO 2 92%) and haemodynamic parameters were compared across the three groups: LMA® Gastro™ vs. sedation with low flow nasal cannula vs. GA with an endotracheal tube (ETT). One hundred seventy-seven ERCP procedures were performed during the study period. The LMA® Gastro™ Airway was employed in 64 procedures (36%) on 59 patients. Of these 64 procedures, ERCP was successfully completed with LMA® Gastro™ Airway in 63 (98%) instances, with only one case requiring conversion to an endotracheal tube. This instance followed difficulty in negotiating the endoscope through LMA® Gastro™ Airway. No episodes of hypoxia or hypercapnia were documented in both LMA® Gastro™ and GA with ETT groups. One sedation case with nasal cannula was noted to have hypoxia. Adverse intraoperative events were recognised in 2 cases of LMA® Gastro™: one had minimal blood stained secretions from the oral cavity that resolved with suctioning the other developed mild laryngospasm which resolved spontaneously within a few minutes. In patients undergoing ERCP, the LMA® Gastro™ airway demonstrated a high success rate for ERCP completion. Ventilation was well maintained with minimal intraoperative and postoperative adverse events. This technique may have a role in higher risk groups such as high ASA (American Society of Anesthesiologists) status, or those with potential airway difficulties such as high body mass index and those with known or suspected sleep apnoea.
Publisher: Wiley
Date: 07-10-2021
DOI: 10.1111/ANAE.15260
Abstract: Postoperative complications are common and may be under‐recognised. It has been suggested that enhanced postoperative care in the recovery room may reduce in‐hospital complications in moderate‐ and high‐risk surgical patients. We investigated the feasibility of providing advanced recovery room care for 12–18 h postoperatively in the post‐anaesthesia care unit. The primary hypothesis was that a clinical trial of advanced recovery room care was feasible. The secondary hypothesis was that this model may have a sustained impact on postoperative in‐hospital and post‐discharge events. This was a multicentre, prospective, feasibility before‐and‐after trial of moderate‐risk patients (predicted 30‐day mortality of 1–4%) undergoing non‐cardiac surgery and who were scheduled for postoperative ward care. Patients were managed using defined assessment checklists and goals of care in an advanced recovery room care setting in the immediate postoperative period. This utilised existing post‐anaesthesia care unit infrastructure and staffing, but extended care until the morning of the first postoperative day. The advanced recovery room care trial was deemed feasible, as defined by the recruitment and per protocol management of 120 patients. However, in a specialised cancer centre, recruitment was slow due to low rates of eligibility according to narrow inclusion criteria. At a rural site, advanced recovery room care could not be commenced due to logistical issues in establishing a new model of care. A definitive randomised controlled trial of advanced recovery room care appears feasible and, based on the indicative data on outcomes, we believe this is warranted.
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Guy Ludbrook.