Tag: intubation

Upvote Story 6
Oxygen desaturation was more commonly observed during tracheal intubation in children with cyanotic versus noncyanotic heart disease. However, hemodynamic tracheal intubation associated event rates were similar. In both groups, oxygen desaturation greater than or equal to 30% was significantly associated with increased occurrence of hemodynamic tracheal intubation associated events. Our exposure of interest was oxygen desaturation measured by a fall in pulse oximetry from baseline... Read More | Comment
Upvote Story 6
Lower respiratory tract infections (LRTIs) are the leading cause of infectious disease-related deaths worldwide yet remain challenging to diagnose because of limitations in existing microbiologic tests. In critically ill patients, noninfectious respiratory syndromes that resemble LRTIs further complicate diagnosis and confound targeted treatment. This prospective observational study evaluated adults with acute respiratory failure requiring mechanical ventilation who were admitted to the University of California, San... Read More | Comment
Upvote Story 10
This book discusses mechanical ventilation in emergency settings, covering the management of patients from the time of intubation until transfer to the ICU. It provides an introduction to key concepts of physiology pertinent to mechanical ventilation as well as a review of the core evidence-based principles of ventilation. The text highlights the management of mechanical ventilation for critically ill patients with several conditions commonly encountered... Read More | Comment
Upvote Story 5
This large randomized clinical trial performed in patients undergoing anesthesia with RSI failed to demonstrate the non-inferiority of the sham procedure in preventing pulmonary aspiration. Further studies are required in pregnant women and outside the operating room. Although this study failed to demonstrate non-inferiority of sham cricoid pressure to cricoid pressure the data does not show any hint that cricoid pressure is the better approach.... Read More | Comment
Upvote Story 5
Intubation and mechanical ventilation are commonly performed ED interventions and although patients optimally go to an ICU level of care afterwards, many of them remain in the ED for prolonged periods of time. It is widely accepted that the utilization of lung-protective ventilation reduces ventilator-associated complications including acute respiratory distress syndrome (ARDS). Additionally, it is believed that ventilatory-associated lung injury can occur early after the... Read More | Comment
Upvote Story 9
Not many aspects of Emergency Medicine define our specialty better than resuscitation, and few concepts exemplify resuscitation better than shock and intubation. Yet few words together strike greater fear in the minds of savvy resuscitationists. Not because we cannot deftly manage shock, or because we are anything but hardy intubators, but because the swiftest way to transform a living patient into a dying patient or... Read More | Comment
Upvote Story 5
Emergency Department exposure to hyperoxia is common and associated with increased mortality in mechanically ventilated patients achieving normoxia after admission. This suggests that hyperoxia in the immediate post-intubation period could be particularly injurious, and targeting normoxia from initiation of mechanical ventilation may improve outcome. A total of 688 patients were included. ED normoxia occurred in 350 (50.9%) patients, and 300 (43.6%) had exposure to ED... Read More | Comment
Upvote Story 6
In a randomized trial, the routine use of bougies on every DL intubation led to a higher rate of first-pass intubation success. And even allowing for the two-step technique (bougie insertion followed by ET tube insertion), the bougie technique required less total time to intubate the patient, on average, by reducing the time spent guiding the ET tube into the airway. Read More | Comment
Upvote Story 5
A few years ago, I received report that a patient was ready to be weaned from the ventilator. He had no respiratory need for mechanical ventilation, and every time the medical team attempted to wean sedation to extubate, the patient “went crazy.” As I assumed care on the night shift, I looked into the eyes of this intubated 67-year-old male patient. I asked him gently... Read More | Comment
Upvote Story 5
High-flow nasal cannula oxygen therapy may be considered as an initial respiratory therapy for trauma patients with blunt chest injury. High-flow nasal cannula therapy could improve lung aeration as noted by the transthoracic lung ultrasound assessment, and LUS may help the attending physicians identify the usefulness of HFNC therapy and decide whether to continue the use of HFNC therapy or intubate the patient. During the... Read More | Comment
Upvote Story 8
This complex randomized, controlled trial failed to demonstrate that early extubation to non-invasive ventilation reduced the total time of mechanical ventilation. I will continue to extubate early and will use non-invasive mechanical ventilation or high-flow nasal oxygen therapy to support patients, with regular audit of re-intubation rates. The beneficial secondary outcomes demonstrated in this trial, such as reduced antibiotic use, reduced sedation requirement and reduced... Read More | Comment
Upvote Story 5
In this large observational series, there was no association between paralytic choice and first-pass rapid sequence intubation success or peri-intubation adverse events. There were 2,275 rapid sequence intubations facilitated by succinylcholine and 1,800 by rocuronium. Patients receiving succinylcholine were younger and more likely to undergo intubation with video laryngoscopy and by more experienced providers. First-pass intubation success rate was 87.0% with succinylcholine versus 87.5% with... Read More | Comment
Upvote Story 14
With a full-color design and concise, easy-to-read chapters, Critical Care Medicine: The Essentials and a Bit More covers the core elements of critical care, with a unique focus on the pathophysiology underlying clinical disorders and how pathophysiologic concerns affect treatment options. There is much here that’s new: brand-new content, expanded discussions, and more graphical elements than ever before. Chapters follow a consistent structural template, with... Read More | Comment
Upvote Story 9
Among critically ill immunocompromised patients with acute respiratory failure (ARF), high-flow oxygen therapy did not significantly decrease day-28 mortality compared with standard oxygen therapy. Of 778 randomized patients (median age, 64 [IQR, 54-71] years; 259 [33.3%] women), 776 (99.7%) completed the trial. The primary outcome was day-28 mortality. Secondary outcomes included intubation and mechanical ventilation by day 28, Pao2:Fio2 ratio over the 3 days after... Read More | Comment
Upvote Story 8
High-flow conditioned oxygen therapy delivered through nasal cannulae and noninvasive mechanical ventilation (NIV) may reduce the need for reintubation. Therefore, Hernández et al set out to test if high-flow conditioned oxygen therapy is noninferior to NIV for preventing postextubation respiratory failure and reintubation in patients at high risk of reintubation. Among high-risk adults who have undergone extubation, high-flow conditioned oxygen therapy was not inferior to... Read More | Comment