S4A-07 SESSION 4A: GENERALITIES IN CRANIOSYNOSTOSIS – PART I CATASTROPHIC AND CRITICAL INTRA-OPERATIVE EVENTS DURING PEDIATRIC CRANIOFACIAL SURGERY: A NURSING PERSPECTIVE.
Notice bibliographique
Résumé
Introduction: Pediatric craniofacial surgery carried out in tertiary care centres by dedicated teams of surgeons, anaesthetists and nursing staff is associated with a high level of safety with exceptionally low (< 1%) rates of mortality. However, the majority of life-threatening events occurring in patients undergoing major craniomaxillofacial procedures occur in the operating room. The aim of this study was to review the incidence and outcomes following catastrophic and critical events during surgery and review the role of the nursing team. Methods: Over a 10-year period at a tertiary care pediatric centre specializing in pediatric craniofacial surgery with 2 senior surgeons, catastrophic and critical intra-operative events as defined by alerting the alarm button eliciting a code event and team approach to patient management were reviewed. Details of these cases and outcomes were tabulated. The importance of the nursing role was assessed. Results: From January 2009 to January 2019, 4055 procedures were carried out by the 2 senior pediatric craniofacial surgeons with 1109 cases considered to be major craniofacial (intracranial, intra-extracranial or major facial osteotomies). In this time period, 12 events (0.01% of major craniofacial procedures) were recorded: 5 venous air embolisms, 2 profound cardiovagal reflex responses with cardiac standstill, 1 anaphylaxis and 4 major bleeding episodes that required aggressive resuscitation. All patients survived. Surgery was curtailed in 3 cases. Nursing response to intra-operative codes was critical to the outcomes. Awareness and experience of the procedure, communication strategies, initiation of massive transfusion protocols, documentation, protection of sterile resources and tissue, post-event debriefing and discussion at M&M rounds are all crucial roles for nursing involvement in these events. Further case details and a protocol will be presented. Conclusion: The importance of experience and dedicated teams in the management of catastrophic and critical intra-operative events during major pediatric craniofacial procedures cannot be over-stated. Despite operating in a tertiary care pediatric centre with senior experienced surgeons, these events can occur and successful outcomes are dependent on experience, communication and team approach to maintain an excellent safety record. The importance of the nursing team will be emphasized.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».