Jason Brainard - Academia.edu (original) (raw)

Papers by Jason Brainard

Critical Care Medicine, Dec 13, 2023

American Journal of Respiratory and Critical Care Medicine, 2017

Anesthesiology Clinics of North America, 1997

BMC Anesthesiology, Jan 10, 2023

Seminars in Cardiothoracic and Vascular Anesthesia, Dec 1, 2015

Postoperative pulmonary complications following cardiac and thoracic surgery are common and assoc... more Postoperative pulmonary complications following cardiac and thoracic surgery are common and associated with significant morbidity and mortality. Noninvasive ventilation has emerged as a successful and well-validated strategy to treat various acute medical conditions. More recently, noninvasive ventilation has been studied in selective surgical patient populations with the goal of preventing postoperative complications and treating acute respiratory failure. In this clinical review, we will briefly examine the incidence of pulmonary complications following cardiothoracic surgery and the physiology and mechanics of acute respiratory failure and noninvasive ventilation. We then present a systematic review of the indications, patient selection, and current literature investigating the specific use of noninvasive ventilation in this population.

Critical Care Medicine, 2018

Critical Care Medicine • Volume 46 • Number 1 (Supplement) www.ccmjournal.org Learning Objectives... more Critical Care Medicine • Volume 46 • Number 1 (Supplement) www.ccmjournal.org Learning Objectives: The AAMC states that physicians entering residency should be competent in recognizing and initiating the management of a deteriorating patient who requires emergent care. One opportunity to learn such knowledge is by caring for critically-ill patients. There is currently no consensus on what medical students should learn regarding critical care. This lack of consensus is in contrast to other specialties. Other specialties have utilized the Delphi method to develop consensus content outlines. The aim of this research is to develop a national critical care content outline through a multidisciplinary expert consensus process. Methods: We used a modified Delphi process to reach consensus on the core skills and knowledge that should be learned during a UME critical care experience. The Delphi panel included 3 expert groups: 1) UME critical care educators identified through SCCM; 2) residency program directors of multiple specialties nominated by their national organizations; 3) residents nominated by program directors to represent their specialties. Over three, iterative rounds, the Delphi panel reached consensus on the critical care skills and knowledge expected of graduating medical students. Results: The Delphi panel included 28 experts, including 17 experts with sub-specialty training in critical care. Experts represented anesthesia, emergency medicine, internal medicine, OB/ GYN, pediatrics and surgery. Consensus content recommendations were grouped into five subjects: 1) circulatory failure 2) respiratory failure 3) electrolyte derangement 4) altered mental status 5) arrhythmias. Bag-mask ventilation was the only consensus procedure recommended. Conclusions: This Delphi provides a national, consensus UME content outline for critical care. By including experts from multiple specialties, our content outline is meaningful for graduating students, independent of their intended specialty. The content outline represents a first step in the development of local and national UME critical care curriculums.

BMC Medical Research Methodology, Jul 5, 2018

Background: Limited translational success in critical care medicine is thought to be in part due ... more Background: Limited translational success in critical care medicine is thought to be in part due to inadequate methodology, study design, and reporting in preclinical studies. The purpose of this study was to compare reporting of core features of experimental rigor: blinding, randomization, and power calculations in critical care medicine animal experimental research. We hypothesized that these study design characteristics were more frequently reported in 2015 versus 2005. Methods: We performed an observational bibliometric study to grade manuscripts on blinding, randomization, and power calculations. Chi-square tests and logistic regression were used for analysis. Inter-rater agreement was assessed using kappa and Gwet's AC1. Results: A total of 825 articles from seven journals were included. In 2005, power estimations were reported in 2%, randomization in 35%, and blinding in 20% (n = 482). In 2015, these metrics were included in 9, 47, and 36% of articles (n = 343). The increase in proportion for the metrics tested was statistically significant (p < 0.001, p = 0.002, and p < 0.001). Conclusions: Only a minority of published manuscripts in critical care medicine journals reported on recommended study design steps to increase rigor. Routine justification for the presence or absence of blinding, randomization, and power calculations should be considered to better enable readers to assess potential sources of bias.

Anesthesiology, May 1, 2015

For many thousands of years, the sun was our only source of light, and human behavior followed a ... more For many thousands of years, the sun was our only source of light, and human behavior followed a natural day-night cycle. This milieu began to change approximately 150 years ago with the invention of incandescent lighting. Electric lighting disrupted our behavioral dependence on the day-night cycles of the sun, and facilitated alterations in our circadian sleep-wake cycles. Recent research has begun to identify the physiologic consequences of unnatural light exposure and subsequently altered circadian rhythms. 1 In this paper, we review the molecular basis of circadian rhythms and discuss the established connection between disrupted circadian rhythms and clinical disease. We also explore the concept of daylight as therapy to restore disrupted circadian rhythms and improve clinical outcomes. Molecular mechanisms: daylight as an essential regulator of circadian rhythms For nearly four billion years, life on Earth, outside of the poles and deep oceans, has evolved under a consistent pattern of alternating bright days and dark nights. As a result, most organisms on our planet synchronize "daily life" to a 24-hour cycle. This is called a circadian (from Latin circa, meaning "around", and dies, meaning "day") rhythm. It is in this same environment that modern humans evolved over the past 200,000 years. Today we know that the circadian rhythm does not simply regulate sleep-wake cycles, but also influences the molecular biology of individual cells and organ systems. The molecular mechanism of the circadian rhythm itself was discovered around 1970 in the common fruit fly, Drosophila melanogaster, and shortly thereafter described in humans. Genes including Clock and Period were identified as important regulators of the circadian rhythm, through

Critical Care Medicine, 2020

Introduction/Hypothesis: Fear of physical or verbal violence against healthcare providers present... more Introduction/Hypothesis: Fear of physical or verbal violence against healthcare providers presents a significant barrier to the ability of providers to efficiently and effectively care for patients. Recent nationally publicized events have heightened these concerns increasing dialog about the importance of ensuring healthcare provider safety. According to the Sentinel Event Alert published by the Joint Commission, health care organizations are encouraged to address this growing problem by looking beyond solutions that simply increase security. Improved safety for staff can be achieved through both modifications to hospital policies and changes to physical barriers. Examples include securing barrier doors and changes to policies on patient anonymity. These modifications can improve perceptions of personal safety in the workplace. Methods: A descriptive quantitative survey was conducted to obtain nursing staff perceptions of safety in the Surgical Trauma Intensive Care Unit (STICU). The Workplace Violence Against Nurses Survey was selected as a validated tool to quantify staff perception. Based on results of this survey, two interventions were implemented. Video monitoring for visitor entry with strict badge access at STICU entrances compared to open doors and policy changes to improve patient anonymity during their inpatient stay. Following this intervention, the survey was readministered to the nursing staff. Results: Pre-intervention survey results, based on a Likert scale, found 12% of staff felt the organization was “not safe at all” and 10% felt the organization was “not at all effective” at managing workplace violence. After the interventions, survey data found 0% of staff felt they were “not safe at all” and only 2% felt the organization was “not effective at managing” workplace violence. Conclusions: By modifying existing measures, improvements to security can be made that benefit patients and providers. Any defense from outside threats will benefit the ability of staff to effectively care for their patients in a controlled and secure environment. Patients will also be allowed to convalesce without fear of further injury or violence. Future studies on APP and Physician safety perceptions and ongoing RN evaluations are warranted.

Critical Care Medicine, 2020

Objectives: No consensus exists on a standardized critical care content outline for medical stude... more Objectives: No consensus exists on a standardized critical care content outline for medical student education. The aim of this research is to develop a national undergraduate medical education critical care content outline. Design: The authors used a Delphi process to reach expert consensus on a content outline that identified the core critical care knowledge topics and procedural skills that medical students should learn prior to entering residency. Over three iterative rounds, the expert panel reached consensus on a critical care content outline. Setting: An electronic survey of critical care medical educators, residency program directors, and residents in the United States. Subjects: The expert panel included three groups as follows: 1) undergraduate medical education critical care educators, 2) residency program directors representing all core specialties, and 3) residents representing their core specialties. Interventions: None. Measurements and Main Results: The expert panel included 28 members. Experts represented the following medical specialties: anesthesiology, emergency medicine, internal medicine, obstetrics and gynecology, pediatrics, and surgery. Seventeen experts had subspecialty training in critical care. The expert panel identified 19 highly recommended critical care knowledge topics and procedural skills. These topics and procedural skills were grouped into five broad categories as follows: 1) neurologic, 2) respiratory, 3) cardiovascular, 4) renal and electrolytes, and 5) supplemental ICU topics. Bag-mask ventilation was the only procedural skill identified as highly recommended. Conclusions: This study provides a national consensus undergraduate medical education critical care content outline. By including experts from multiple specialties, this content outline is meaningful for medical student education, independent of medical specialty. The content outline represents a first step in the development of a national undergraduate medical education critical care curriculum.

Research Square (Research Square), Aug 17, 2022

Background Reusable laryngoscopes have been reported to be superior to disposable laryngoscopes w... more Background Reusable laryngoscopes have been reported to be superior to disposable laryngoscopes with plastic blades during emergent intubations. Surprisingly, at our institution a quality reporting system revealed a high number of equipment failures with reusable laryngoscopes in an emergency out-of-OR (operating room) setting. As recent studies indicated an improved quality of disposable laryngoscopes, we hypothesized that a thoroughly evaluated disposable laryngoscope would result in less equipment failure in an emergency out-of-OR setting. Methods To perform a more standardized and time e cient analysis, four distinct disposable laryngoscope blade/handle con gurations were trialed during standard intubations (n = 4x30) in the OR by experienced

Critical Care Medicine, 2018

Journal of Critical Care, Aug 1, 2017

Background-Thoracic surgery patients are at high-risk for adverse pulmonary outcomes. Heated humi... more Background-Thoracic surgery patients are at high-risk for adverse pulmonary outcomes. Heated humidified high-flow nasal cannula oxygen (HHFNC O 2) may decrease such events. We hypothesized that patients randomized to prophylactic HHFNC O 2 would develop fewer pulmonary complications compared to conventional O 2 therapy. Methods and Patients-Fifty-one patients were randomized to HHFNC O 2 vs. conventional O 2. The primary outcome was a composite of postoperative pulmonary complications. Secondary outcomes included oxygenation and length of stay. Continuous variables were compared with ttest or Mann-Whitney-U test, categorical variables with Fisher's Exact test. Results-There were no differences in postoperative pulmonary complications based on intention to treat [two in HHFNC O 2 (n=25), two in control (n=26), p=0.680], and after exclusion of patients who discontinued HHFNC O 2 early [one in HHFNC O 2 (n=18), two in control (n=26), p=0.638]. Discomfort from HHFNC O 2 occurred in 11/25 (44%); 7/25 (28%) discontinued treatment. Conclusions-Pulmonary complications were rare after thoracic surgery. Although HHFNC O 2 did not convey significant benefits, these results need to be interpreted with caution, as our study was likely underpowered to detect a reduction in pulmonary complications. High rates of patientreported discomfort with HHFNC O 2 need to be considered in clinical practice and future trials.

Seminars in Cardiothoracic and Vascular Anesthesia, Oct 7, 2014

The rotation of the earth and associated alternating cycles of light and dark-the basis of our ci... more The rotation of the earth and associated alternating cycles of light and dark-the basis of our circadian rhythms-are fundamental to human biology and culture. However, it was not until 1971 that researchers first began to describe the molecular mechanisms for the circadian system. During the past few years, groundbreaking research has revealed a multitude of circadian genes affecting a variety of clinical diseases, including diabetes, obesity, sepsis, cardiac ischemia, and sudden cardiac death. Anesthesiologists, in the operating room and intensive care units, manage these diseases on a daily basis as they significantly affect patient outcomes. Intriguingly, sedatives, anesthetics, and the intensive care unit environment have all been shown to disrupt the circadian system in patients. In the current review, we will discuss how newly acquired knowledge of circadian rhythms could lead to changes in clinical practice and new therapeutic concepts.

Background Reusable laryngoscopes have been reported to be superior to disposable laryngoscopes w... more Background Reusable laryngoscopes have been reported to be superior to disposable laryngoscopes with plastic blades during emergent intubations. Surprisingly, at our institution a quality reporting system revealed a high number of equipment failures with reusable laryngoscopes in an emergency out-of-OR (operating room) setting. As recent studies indicated an improved quality of disposable laryngoscopes, we hypothesized that a thoroughly evaluated disposable laryngoscope would result in less equipment failure in an emergency out-of-OR setting. Methods To perform a more standardized and time efficient analysis, four distinct disposable laryngoscope blade/handle configurations were trialed during standard intubations (n = 4x30) in the OR by experienced anesthesia providers who completed a 6-question, Likert-scale/open-ended survey for product evaluation. The ‘best’ disposable blade was implemented in an emergency out-of-OR setting and equipment failure rates were monitored over a 3-yea...

Critical Care Medicine, Dec 13, 2023

American Journal of Respiratory and Critical Care Medicine, 2017

Anesthesiology Clinics of North America, 1997

BMC Anesthesiology, Jan 10, 2023

Seminars in Cardiothoracic and Vascular Anesthesia, Dec 1, 2015

Postoperative pulmonary complications following cardiac and thoracic surgery are common and assoc... more Postoperative pulmonary complications following cardiac and thoracic surgery are common and associated with significant morbidity and mortality. Noninvasive ventilation has emerged as a successful and well-validated strategy to treat various acute medical conditions. More recently, noninvasive ventilation has been studied in selective surgical patient populations with the goal of preventing postoperative complications and treating acute respiratory failure. In this clinical review, we will briefly examine the incidence of pulmonary complications following cardiothoracic surgery and the physiology and mechanics of acute respiratory failure and noninvasive ventilation. We then present a systematic review of the indications, patient selection, and current literature investigating the specific use of noninvasive ventilation in this population.

Critical Care Medicine, 2018

Critical Care Medicine • Volume 46 • Number 1 (Supplement) www.ccmjournal.org Learning Objectives... more Critical Care Medicine • Volume 46 • Number 1 (Supplement) www.ccmjournal.org Learning Objectives: The AAMC states that physicians entering residency should be competent in recognizing and initiating the management of a deteriorating patient who requires emergent care. One opportunity to learn such knowledge is by caring for critically-ill patients. There is currently no consensus on what medical students should learn regarding critical care. This lack of consensus is in contrast to other specialties. Other specialties have utilized the Delphi method to develop consensus content outlines. The aim of this research is to develop a national critical care content outline through a multidisciplinary expert consensus process. Methods: We used a modified Delphi process to reach consensus on the core skills and knowledge that should be learned during a UME critical care experience. The Delphi panel included 3 expert groups: 1) UME critical care educators identified through SCCM; 2) residency program directors of multiple specialties nominated by their national organizations; 3) residents nominated by program directors to represent their specialties. Over three, iterative rounds, the Delphi panel reached consensus on the critical care skills and knowledge expected of graduating medical students. Results: The Delphi panel included 28 experts, including 17 experts with sub-specialty training in critical care. Experts represented anesthesia, emergency medicine, internal medicine, OB/ GYN, pediatrics and surgery. Consensus content recommendations were grouped into five subjects: 1) circulatory failure 2) respiratory failure 3) electrolyte derangement 4) altered mental status 5) arrhythmias. Bag-mask ventilation was the only consensus procedure recommended. Conclusions: This Delphi provides a national, consensus UME content outline for critical care. By including experts from multiple specialties, our content outline is meaningful for graduating students, independent of their intended specialty. The content outline represents a first step in the development of local and national UME critical care curriculums.

BMC Medical Research Methodology, Jul 5, 2018

Background: Limited translational success in critical care medicine is thought to be in part due ... more Background: Limited translational success in critical care medicine is thought to be in part due to inadequate methodology, study design, and reporting in preclinical studies. The purpose of this study was to compare reporting of core features of experimental rigor: blinding, randomization, and power calculations in critical care medicine animal experimental research. We hypothesized that these study design characteristics were more frequently reported in 2015 versus 2005. Methods: We performed an observational bibliometric study to grade manuscripts on blinding, randomization, and power calculations. Chi-square tests and logistic regression were used for analysis. Inter-rater agreement was assessed using kappa and Gwet's AC1. Results: A total of 825 articles from seven journals were included. In 2005, power estimations were reported in 2%, randomization in 35%, and blinding in 20% (n = 482). In 2015, these metrics were included in 9, 47, and 36% of articles (n = 343). The increase in proportion for the metrics tested was statistically significant (p < 0.001, p = 0.002, and p < 0.001). Conclusions: Only a minority of published manuscripts in critical care medicine journals reported on recommended study design steps to increase rigor. Routine justification for the presence or absence of blinding, randomization, and power calculations should be considered to better enable readers to assess potential sources of bias.

Anesthesiology, May 1, 2015

For many thousands of years, the sun was our only source of light, and human behavior followed a ... more For many thousands of years, the sun was our only source of light, and human behavior followed a natural day-night cycle. This milieu began to change approximately 150 years ago with the invention of incandescent lighting. Electric lighting disrupted our behavioral dependence on the day-night cycles of the sun, and facilitated alterations in our circadian sleep-wake cycles. Recent research has begun to identify the physiologic consequences of unnatural light exposure and subsequently altered circadian rhythms. 1 In this paper, we review the molecular basis of circadian rhythms and discuss the established connection between disrupted circadian rhythms and clinical disease. We also explore the concept of daylight as therapy to restore disrupted circadian rhythms and improve clinical outcomes. Molecular mechanisms: daylight as an essential regulator of circadian rhythms For nearly four billion years, life on Earth, outside of the poles and deep oceans, has evolved under a consistent pattern of alternating bright days and dark nights. As a result, most organisms on our planet synchronize "daily life" to a 24-hour cycle. This is called a circadian (from Latin circa, meaning "around", and dies, meaning "day") rhythm. It is in this same environment that modern humans evolved over the past 200,000 years. Today we know that the circadian rhythm does not simply regulate sleep-wake cycles, but also influences the molecular biology of individual cells and organ systems. The molecular mechanism of the circadian rhythm itself was discovered around 1970 in the common fruit fly, Drosophila melanogaster, and shortly thereafter described in humans. Genes including Clock and Period were identified as important regulators of the circadian rhythm, through

Critical Care Medicine, 2020

Introduction/Hypothesis: Fear of physical or verbal violence against healthcare providers present... more Introduction/Hypothesis: Fear of physical or verbal violence against healthcare providers presents a significant barrier to the ability of providers to efficiently and effectively care for patients. Recent nationally publicized events have heightened these concerns increasing dialog about the importance of ensuring healthcare provider safety. According to the Sentinel Event Alert published by the Joint Commission, health care organizations are encouraged to address this growing problem by looking beyond solutions that simply increase security. Improved safety for staff can be achieved through both modifications to hospital policies and changes to physical barriers. Examples include securing barrier doors and changes to policies on patient anonymity. These modifications can improve perceptions of personal safety in the workplace. Methods: A descriptive quantitative survey was conducted to obtain nursing staff perceptions of safety in the Surgical Trauma Intensive Care Unit (STICU). The Workplace Violence Against Nurses Survey was selected as a validated tool to quantify staff perception. Based on results of this survey, two interventions were implemented. Video monitoring for visitor entry with strict badge access at STICU entrances compared to open doors and policy changes to improve patient anonymity during their inpatient stay. Following this intervention, the survey was readministered to the nursing staff. Results: Pre-intervention survey results, based on a Likert scale, found 12% of staff felt the organization was “not safe at all” and 10% felt the organization was “not at all effective” at managing workplace violence. After the interventions, survey data found 0% of staff felt they were “not safe at all” and only 2% felt the organization was “not effective at managing” workplace violence. Conclusions: By modifying existing measures, improvements to security can be made that benefit patients and providers. Any defense from outside threats will benefit the ability of staff to effectively care for their patients in a controlled and secure environment. Patients will also be allowed to convalesce without fear of further injury or violence. Future studies on APP and Physician safety perceptions and ongoing RN evaluations are warranted.

Critical Care Medicine, 2020

Objectives: No consensus exists on a standardized critical care content outline for medical stude... more Objectives: No consensus exists on a standardized critical care content outline for medical student education. The aim of this research is to develop a national undergraduate medical education critical care content outline. Design: The authors used a Delphi process to reach expert consensus on a content outline that identified the core critical care knowledge topics and procedural skills that medical students should learn prior to entering residency. Over three iterative rounds, the expert panel reached consensus on a critical care content outline. Setting: An electronic survey of critical care medical educators, residency program directors, and residents in the United States. Subjects: The expert panel included three groups as follows: 1) undergraduate medical education critical care educators, 2) residency program directors representing all core specialties, and 3) residents representing their core specialties. Interventions: None. Measurements and Main Results: The expert panel included 28 members. Experts represented the following medical specialties: anesthesiology, emergency medicine, internal medicine, obstetrics and gynecology, pediatrics, and surgery. Seventeen experts had subspecialty training in critical care. The expert panel identified 19 highly recommended critical care knowledge topics and procedural skills. These topics and procedural skills were grouped into five broad categories as follows: 1) neurologic, 2) respiratory, 3) cardiovascular, 4) renal and electrolytes, and 5) supplemental ICU topics. Bag-mask ventilation was the only procedural skill identified as highly recommended. Conclusions: This study provides a national consensus undergraduate medical education critical care content outline. By including experts from multiple specialties, this content outline is meaningful for medical student education, independent of medical specialty. The content outline represents a first step in the development of a national undergraduate medical education critical care curriculum.

Research Square (Research Square), Aug 17, 2022

Background Reusable laryngoscopes have been reported to be superior to disposable laryngoscopes w... more Background Reusable laryngoscopes have been reported to be superior to disposable laryngoscopes with plastic blades during emergent intubations. Surprisingly, at our institution a quality reporting system revealed a high number of equipment failures with reusable laryngoscopes in an emergency out-of-OR (operating room) setting. As recent studies indicated an improved quality of disposable laryngoscopes, we hypothesized that a thoroughly evaluated disposable laryngoscope would result in less equipment failure in an emergency out-of-OR setting. Methods To perform a more standardized and time e cient analysis, four distinct disposable laryngoscope blade/handle con gurations were trialed during standard intubations (n = 4x30) in the OR by experienced

Critical Care Medicine, 2018

Journal of Critical Care, Aug 1, 2017

Background-Thoracic surgery patients are at high-risk for adverse pulmonary outcomes. Heated humi... more Background-Thoracic surgery patients are at high-risk for adverse pulmonary outcomes. Heated humidified high-flow nasal cannula oxygen (HHFNC O 2) may decrease such events. We hypothesized that patients randomized to prophylactic HHFNC O 2 would develop fewer pulmonary complications compared to conventional O 2 therapy. Methods and Patients-Fifty-one patients were randomized to HHFNC O 2 vs. conventional O 2. The primary outcome was a composite of postoperative pulmonary complications. Secondary outcomes included oxygenation and length of stay. Continuous variables were compared with ttest or Mann-Whitney-U test, categorical variables with Fisher's Exact test. Results-There were no differences in postoperative pulmonary complications based on intention to treat [two in HHFNC O 2 (n=25), two in control (n=26), p=0.680], and after exclusion of patients who discontinued HHFNC O 2 early [one in HHFNC O 2 (n=18), two in control (n=26), p=0.638]. Discomfort from HHFNC O 2 occurred in 11/25 (44%); 7/25 (28%) discontinued treatment. Conclusions-Pulmonary complications were rare after thoracic surgery. Although HHFNC O 2 did not convey significant benefits, these results need to be interpreted with caution, as our study was likely underpowered to detect a reduction in pulmonary complications. High rates of patientreported discomfort with HHFNC O 2 need to be considered in clinical practice and future trials.

Seminars in Cardiothoracic and Vascular Anesthesia, Oct 7, 2014

The rotation of the earth and associated alternating cycles of light and dark-the basis of our ci... more The rotation of the earth and associated alternating cycles of light and dark-the basis of our circadian rhythms-are fundamental to human biology and culture. However, it was not until 1971 that researchers first began to describe the molecular mechanisms for the circadian system. During the past few years, groundbreaking research has revealed a multitude of circadian genes affecting a variety of clinical diseases, including diabetes, obesity, sepsis, cardiac ischemia, and sudden cardiac death. Anesthesiologists, in the operating room and intensive care units, manage these diseases on a daily basis as they significantly affect patient outcomes. Intriguingly, sedatives, anesthetics, and the intensive care unit environment have all been shown to disrupt the circadian system in patients. In the current review, we will discuss how newly acquired knowledge of circadian rhythms could lead to changes in clinical practice and new therapeutic concepts.

Background Reusable laryngoscopes have been reported to be superior to disposable laryngoscopes w... more Background Reusable laryngoscopes have been reported to be superior to disposable laryngoscopes with plastic blades during emergent intubations. Surprisingly, at our institution a quality reporting system revealed a high number of equipment failures with reusable laryngoscopes in an emergency out-of-OR (operating room) setting. As recent studies indicated an improved quality of disposable laryngoscopes, we hypothesized that a thoroughly evaluated disposable laryngoscope would result in less equipment failure in an emergency out-of-OR setting. Methods To perform a more standardized and time efficient analysis, four distinct disposable laryngoscope blade/handle configurations were trialed during standard intubations (n = 4x30) in the OR by experienced anesthesia providers who completed a 6-question, Likert-scale/open-ended survey for product evaluation. The ‘best’ disposable blade was implemented in an emergency out-of-OR setting and equipment failure rates were monitored over a 3-yea...