When to Withdraw Resuscitation in the ED

When can and should we withdraw from continuing resuscitation in the Emergency Department? We are here to save lives. I would argue the Emergency Medicine is a very pure expression of a Doctor's role: we meet a patient, we... read more

One-Year Outcomes in Patients With ARDS

One-Year Outcomes in Patients With ARDS

Poor functional recovery after invasive mechanical ventilation for acute respiratory distress syndrome is common. Helmet noninvasive ventilation may be the first intervention that mitigates the long-term complications that... read more

Papers of the Month March 2018

Gavin Denton and I get together again to review a couple of recent papers that have some bearing on our practice. Welcome to the Papers of the month. This month we cover Check Up- Position- “A Multicenter, Randomized Trial... read more

Apneic Oxygenation in the ICU

Apneic Oxygenation in the ICU

Hypoxemia is the most common complication of endotracheal intubation in the critically ill and the strongest risk factor for periprocedural cardiac arrest and death. The traditional approach to avoiding desaturation during... read more

Hemorrhagic Shock: Pearls and Pitfalls for the Resuscitation Room

Hemorrhagic Shock: Pearls and Pitfalls for the Resuscitation Room

Hemorrhagic shock is a state of systemic hypoperfusion secondary to acute blood loss which may have either traumatic or atraumatic etiologies. While gastrointestinal and traumatic etiologies are some of the most common causes... read more

Videographic Assessment of Pediatric Tracheal Intubation Technique During Emergency Airway Management

Videographic Assessment of Pediatric Tracheal Intubation Technique During Emergency Airway Management

Intubators commonly exhibited suboptimal technique during tracheal intubation such as bending deeply at the waist, having their eyes close to the patient's mouth, failing to widely open the patient's mouth, and not elevating... read more

Noninvasive Ventilation in Patients With Do-Not-Intubate and Comfort-Measures-Only Orders

Noninvasive Ventilation in Patients With Do-Not-Intubate and Comfort-Measures-Only Orders

A large proportion of patients with do-not-intubate orders who received noninvasive ventilation survived to hospital discharge and at 1 year, with limited data showing no decrease in quality of life in survivors. Provision... read more

Comparison of Etomidate and Ketamine for Induction During Rapid Sequence Intubation of Adult Trauma Patients

Comparison of Etomidate and Ketamine for Induction During Rapid Sequence Intubation of Adult Trauma Patients

Induction doses of etomidate during rapid sequence intubation cause transient adrenal dysfunction, but its clinical significance on trauma patients is uncertain. Ketamine has emerged as an alternative for rapid sequence intubation... read more

The effect of neuromuscular blockade on the efficiency of facemask ventilation in patients difficult to facemask ventilate

The effect of neuromuscular blockade on the efficiency of facemask ventilation in patients difficult to facemask ventilate

Facemask ventilation of the lungs can be an important rescue intervention in a "cannot intubate" scenario. We assessed the effect of neuromuscular blockade on expiratory tidal volumes in patients with expected difficulty... read more

Clinical Impact of External Laryngeal Manipulation During Laryngoscopy on Tracheal Intubation Success in Critically Ill Children

Clinical Impact of External Laryngeal Manipulation During Laryngoscopy on Tracheal Intubation Success in Critically Ill Children

External laryngeal manipulation during direct laryngoscopy was associated with lower initial tracheal intubation attempt success in critically ill children, even after adjusting for underlying differences in patient factors... read more

Tracheal Intubation During Adult In-Hospital Cardiac Arrest and Survival

Tracheal Intubation During Adult In-Hospital Cardiac Arrest and Survival

This cohort study uses data from the Get With The Guidelines-Resuscitation registry to investigate the association between tracheal intubation during adult in-hospital cardiac arrest and survival to hospital discharge. In... read more

Management of the Traumatized Airway

Management of the Traumatized Airway

There is a lack of evidence-based approach regarding the best practice for airway management in patients with a traumatized airway. Airway trauma may not be readily apparent, and its evaluation requires a high level of suspicion... read more

Guidelines for Tracheal Intubation in Critically Ill Adults

The Intensive Care Society, Faculty of Intensive Care Medicine, Difficult Airway Society and the Royal College of Anesthetists have combined to provide the "Guidelines for the management of tracheal intubation in critically... read more

Tracheal Intubation in Critically Ill Patients

Tracheal Intubation in Critically Ill Patients

We performed a systematic review of randomized controlled studies evaluating any drug, technique or device aimed at improving the success rate or safety of tracheal intubation in the critically ill. We identified 22 trials... read more

Predictors of Intubation in Patients With AHRF Treated With a Noninvasive Oxygenation Strategy

Predictors of Intubation in Patients With AHRF Treated With a Noninvasive Oxygenation Strategy

In patients with acute hypoxemic respiratory failure breathing spontaneously, the respiratory rate was a predictor of intubation under standard oxygen, but not under high-flow nasal cannula oxygen or noninvasive ventilation.... read more

Delayed Intubation Linked to Poor Outcome

Delayed Intubation Linked to Poor Outcome

The optimal timing of endotracheal intubation in critically ill patients requiring invasive mechanical ventilation remains undefined. A new analysis of the large, prospective Intensive Care Over Nations (ICON) database compares... read more

Effect of Standardized Handoff Curriculum on Improved Clinician Preparedness in the ICU

Effect of Standardized Handoff Curriculum on Improved Clinician Preparedness in the ICU

The UW-IPASS standardized handoff curriculum was perceived to improve intensive care provider preparedness and workflow. IPASS-based curricula represent an important step forward in communication standardization efforts and... read more