Background: Wide geographical variations in depression and anxiety rates related to the ethical climate have been reported during the COVID-19 pandemic in intensive care units (ICUs). The objective was to investigate whether moral distress is associated and has predictive values for depression, anxiety, and intention to resign. Methods: 79 consenting ICU nurses completed MMD-HP and PHQ-4 scales in this cross-sectional study between October 2020–February 2021, after ethical approval. The association between MMD-HP and PHQ-4, and the predictive value of MMD-HP for anxiety, depression, and an intention to leave were analyzed (linear regression and receiver operating characteristics curve analysis). Results: From MMD-HP items, system related factors had highest scores (Kruskal–Wallis test, p < 0.0001). MMD-HP and PHQ-4 were weakly correlated (r = 0.41 [0.21–0.58]). MMD-HP and its system-related factors discriminate between nurses with and without depression or anxiety, while system-related factors differentiate those intending to resign (p < 0.05). The MMD-HP score had 50 [37.54–62.46] sensitivity with 80.95 [60–92.33] specificity to predict the intention to leave, and 76.12 [64.67–84.73] sensitivity with 58.33 [31.95–80.67] specificity to detect anxiety or depression symptoms. Conclusions: During the COVID-19 pandemic, system-associated factors seem to be the most important root factors inducing moral distress. Moral distress is associated with negative psychological outcomes.

Background: Ultrasonography-assessed hyomental distance (HMD) ratio has been found to discriminate between obese patients with Cormack-Lehane grades 1 or 2 vs. those with grades 3 or 4. The aim of our study is to evaluate the performance of the HMD evaluated ultrasonographically in neutral, ramped, and maximum hyperextended positions, as well as for the ratios obtained by dividing the HMD in the ramped position to that in the neutral position (HMDR1) and by dividing the HMD in maximum hyperextension to that in the neutral position (HMDR2), in order to predict the occurrence of Cormack-Lehane grades 3 or 4 during direct laryngoscopy. Methods: Ultrasound measurements were performed preoperatively in 25 patients with morbid obesity, measuring the HMD in the neutral, ramped, and maximum hyperextended positions. Pre-epyglotic soft tissue thickness, Mallampati and upper lip bite test scores were recorded. Cormack-Lehane grading was considered as an outcome variable in the Receiver Operating Characteristics curve analysis. Results: HMD in the neutral, ramped and maximum hyperextended positions presented similar sensitivities, 100% [39.8–100.0]. For HMD, specificity was 42.86% [21.8–66.0] in the neutral position, 61.9% [38.4–81.9] in the ramped postion, and 71.4% [47.8–88.7] in the maximum hyperextended position. For HMDR1, the cut-off value was 1.12. This threshold provides 75% [19.4–99.4] sensitivity and 76.2% [52.8–91.8] specificity. For HMDR2, a cut-off value of 1.23 provides 100% [39.8–100.0] sensitivity and 90.5% [69.6–98.8] specificity. Conclusion: HMDR2 seems to have superior diagnostic accuracy in predicting difficult laryngoscopy in the obese population compared to HMDR1, as well as compared to the HMD in the neutral, ramped, and maximum hyperextended positions. Background: Ultrasonography-assessed hyomental distance (HMD) ratio has been found to discriminate between obese patients with Cormack-Lehane grades 1 or 2 vs. those with grades 3 or 4. The aim of our study is to evaluate the performance of the HMD evaluated ultrasonographically in neutral, ramped, and maximum hyperextended positions, as well as for the ratios obtained by dividing the HMD in the ramped position to that in the neutral position (HMDR1) and by dividing the HMD in maximum hyperextension to that in the neutral position (HMDR2), in order to predict the occurrence of Cormack-Lehane grades 3 or 4 during direct laryngoscopy. Methods: Ultrasound measurements were performed preoperatively in 25 patients with morbid obesity, measuring the HMD in the neutral, ramped, and maximum hyperextended positions. Pre-epyglotic soft tissue thickness, Mallampati and upper lip bite test scores were recorded. Cormack-Lehane grading was considered as an outcome variable in the Receiver Operating Characteristics curve analysis. Results: HMD in the neutral, ramped and maximum hyperextended positions presented similar sensitivities, 100% [39.8–100.0]. For HMD, specificity was 42.86% [21.8–66.0] in the neutral position, 61.9% [38.4–81.9] in the ramped postion, and 71.4% [47.8–88.7] in the maximum hyperextended position. For HMDR1, the cut-off value was 1.12. This threshold provides 75% [19.4–99.4] sensitivity and 76.2% [52.8–91.8] specificity. For HMDR2, a cut-off value of 1.23 provides 100% [39.8–100.0] sensitivity and 90.5% [69.6–98.8] specificity. Conclusion: HMDR2 seems to have superior diagnostic accuracy in predicting difficult laryngoscopy in the obese population compared to HMDR1, as well as compared to the HMD in the neutral, ramped, and maximum hyperextended positions.

Several different criteria for the positivity of the flow-assisted Basophil Activation Test (BAT) for the diagnosis of Neuromuscular Blocking Agents (NMBA) hypersensitivity reactions have been used in past studies. Our aims were to determine the threshold for BAT positivity expressed as the stimulation index (SI, calculated as the percentage of activated basophils after stimulation with NMBA divided by the number of basophils with no NMBA stimulation) and as the percentage of activated basophils, and to determine the sensitivity and specificity of BAT for NMBAs.

Airway management is one of the most important skills in everyday practice of anesthesia. Improper airway management might contribute to significant morbidity and mortality. In some patients, clinical parameters do not anticipate all difficulties related to airway management. Ultrasonography (US) might confer a potential screening tool for difficult airway. Suprahyoid and infrahyoid US measurements have been investigated for difficult airway prediction in anesthesiology. The most extensively investigated parameter was the anterior neck soft tissue thickness measured at different levels: anterior to the hyoid bone, epiglottis and vocal cords commissure. Hyomental distances measured with the head placed in neutral, sniffing or maximal hyperextended position and the derived hyomental distance ratios have also been evaluated for difficult airway prediction. For the evaluation of the tongue, measurements such as thickness, cross-sectional area, width, volume and tongue-to-oral cavityratio can be used. Thus, anesthesiologists have many available potential US measurements, which could provide information regarding airway anatomy during the preoperative airway assessment and could serve as potential screening parameters for difficult airway. Still, we do not yet know which of these provides optimal predictive accuracy and larger sample size studiesare required to validate their use in the preoperative evaluation of the airway.

Hagau N, et al. Allergy Asthma Immunol Res. 2013 Nov;5(6):383-388. https://doi.org/10.4168/aair.2013.5.6.383

Background: Physiological composite scores are used to predict mortality in multiple trauma patients. Sepsis is the leading cause of late mortality in trauma victims brought about by immune suppression due to homeostasis dysregulation. Objective: To determine whether APACHE II, SOFA, ISS and RTS scores can predict the occurrence of sepsis in multiple trauma patients. Methods: APACHE II, SOFA, ISS, and RTS scores were calculated during the first twenty-four hours after the injury for sixty-four adult poly-traumatic patients. The occurrence of infectious complications was investigated over a fourteenday period. The infection-free rates for the multiple trauma patients were considered as end-points in the Kaplan- Meier plot analysis. Results: For SOFA, a cutoff score of 4 points was identified as a predictor of the occurrence of sepsis, with 89% of the patients with SOFA4 were infection-free (p<0.01). None of the patients with APACHE II≤5 points developed infections. Eighty-four percent of patients with APACHE II scores of 5-10 did not develop sepsis, while 49% with APACHE II≥11 were infection-free (p<0.01). A cutoff of 7 points was found to be most discriminative for RTS. Eighty-eight percent of the patients with RTS≥7 and 43% of those with RTS<7 were infection-free (p<0.01). Eighty-eight percent of patients with ISS<22 did not develop sepsis and 56% with ISS≥22 did not develop sepsis (p<0.01). Conclusion: APACHE II, SOFA, ISS, and RTS functional severity scores can predict mortality as well as the occurrence of sepsis in multiple trauma patients.