Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Multicenter Study
Tolerability and safety of awake prone positioning COVID-19 patients with severe hypoxemic respiratory failure.
Prone positioning of non-intubated patients with coronavirus disease (COVID-19) and hypoxemic respiratory failure may prevent intubation and improve outcomes. Nevertheless, there are limited data on its feasibility, safety, and physiologic effects. The objective of our study was to assess the tolerability and safety of awake prone positioning in COVID-19 patients with hypoxemic respiratory failure. ⋯ In a small sample, prone positioning non-intubated COVID-19 patients with severe hypoxemia was safe; however, many patients did not tolerate prolonged durations. Although patients had improved oxygenation and respiratory rate in the prone position, many still required intubation. Future studies are required to determine methods to improve the tolerability of awake prone positioning and whether there is an impact on clinical outcomes.
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The Guidelines to the Practice of Anesthesia Revised Edition 2021 (the Guidelines) were prepared by the Canadian Anesthesiologists' Society (CAS), which reserves the right to determine their publication and distribution. The Guidelines are subject to revision and updated versions are published annually. ⋯ Anesthesiologists should exercise their own professional judgement in determining the proper course of action for any patient's circumstances. The CAS assumes no responsibility or liability for any error or omission arising from the use of any information contained in its Guidelines to the Practice of Anesthesia.
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Competency-based medical education requires robust assessment in authentic clinical environments. Using work-based assessments, entrustment scales have emerged as a means of describing a trainee's ability to perform competently. Nevertheless, psychometric properties of entrustment-based assessment are relatively unknown, particularly in anesthesiology. This study assessed the generalizability and extrapolation evidence for entrustment scales within a program of assessment during anesthesiology training. ⋯ As part of an assessment program, entrustment scales used early during anesthesiology training showed evidence of validity. Intraoperative entrustment scores had good reliability and showed acceptable internal consistency. Interpreting entrustment scores in this setting may constitute a valuable adjunct complementing traditional summative evaluations.