key: cord-0012671-ylkpkz6l
authors: Peyton, James; Matava, Clyde T.; von Ungern‐Sternberg, Britta S.
title: The plural of anecdote is not data, please mind the gap between virtual and real life
date: 2020-08-28
journal: Paediatr Anaesth
DOI: 10.1111/pan.13908
sha: f10adfaa38b5bb753248ca2b487c6bb487ccf4cf
doc_id: 12671
cord_uid: ylkpkz6l

nan

The COVID-19 pandemic introduced challenges to everyone in society but particularly so to every aspect of medical practice. It is bewildering how quickly the profession has had to respond to a rapidly changing clinical landscape. Our well-established methods involve collecting and analyzing data to generate an evidence base which is then disseminated and implemented into routine clinical practice.

This approach, which champions a careful and considered assessment of novel clinical concepts, is unable to respond quickly enough in this chaotic environment. It is therefore clear that adaptations have to be made for sharing our rapidly gained individual experiences and thoughts in a timely manner.

The Chinese word for "crisis" (simplified Chinese: 危机) is frequently invoked as being composed of two Chinese characters signifying "danger" and "opportunity" respectively. This indeed reflects our conundrum-we have to embrace change, be quick in adapting to new challenges, and grasp the opportunity, but there are many dangers along this path. In 1928, John A Shed warned us that, "A ship in harbor is safe, but that is not what ships are built for." While something might seem very protective in the nonclinical environment, it does not mean it will be in the real world. In the time of crisis, we should be adaptive but always put our own safety and the safety of our patients first-the need to be innovative needs to be balanced with safety and efficacy in the real world.

Given the nature of the pandemic, with a virus spread by droplets and aerosols, a key aspect of clinical practice to come under the microscope was airway management and intubation. Guidelines were rapidly produced by expert groups 1,2 that are professionally researched and used the best evidence available, combined with expert opinion to formulate clear, actionable advice in a similar way to prepandemic projects. At the same time, the fear (and in some institutions harsh reality) of inadequate (or even close to absent) personal protective equipment (PPE) provision saw a rapid proliferation of suggested mechanisms to prevent provider contamination. The urge to assist and make a difference during this pandemic has also led to numerous instances of "faux" innovation that are akin to scavenging or intellectual piracy. The touting of jerry-rigged ventilators, ventilator splitters, and 3D-printed ventilators has led to a flurry of "first to market" and false invention claims. In the most perplexing instance, STL files for an open-source 3D-printed ventilator available online were accessed by many "innovators" and hospitals across the globe. These were 3D-printed and paraded as innovation from these local entities and at times branded as startups 4 . Many of these entities have claimed the life-saving utility of such devices without formal testing, approvals, and licensing. In most instances,

Pediatric Airway Management in COVID-19 patients -Consensus Guidelines from the Society for Pediatric Anesthesia's Pediatric Difficult Intubation Collaborative and the Canadian Pediatric Anesthesia Society

Consensus guidelines for managing the airway in patients with COVID-19: Guidelines from the Difficult Airway Society, the Association of Anaesthetists the Intensive Care Society, the Faculty of Intensive Care Medicine and the Royal College of Anaesthetists

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Medically approved emergency 3D printed ventilator goes into production

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