J C Hart, L N Goldstein
BACKGROUND: Airway management is an essential skill for doctors working in the emergency department (ED). Safety and efficacy are crucial to its success. Analysis of an airway registry can provide feedback that can be used for quality improvement purposes. OBJECTIVES: To examine the first airway registry from an ED in South Africa (SA), a low- to middle-income country (LMIC), and compare the findings with international data. METHODS: A retrospective analysis of 13 months' data from the airway registry of an academic ED with an annual census of 60 000 patients...
May 29, 2020: South African Medical Journal
Yong Hoon Lee, Keum-Ju Choi, Sun Ha Choi, Shin Yup Lee, Kyung Chan Kim, Eun Jin Kim, Jaehee Lee
The effect of intubation timing on the prognosis of critically ill patients with coronavirus 2019 (COVID-19) is not yet well understood. We investigated whether early intubation is associated with the survival of COVID-19 patients with acute respiratory distress syndrome (ARDS). This multicenter, retrospective, observational study was done on 47 adult COVID-19 patients with ARDS who were admitted to the intensive care unit (ICU) in Daegu, Korea between February 17 and April 23, 2020. Clinical characteristics and in-hospital mortality were compared between the early intubation and initially non-intubated groups, and between the early and late intubation groups, respectively...
September 2, 2020: Journal of Clinical Medicine
Hiroki Maeyama, Hiromichi Naito, Francis X Guyette, Takashi Yorifuji, Yuki Banshotani, Daisaku Matsui, Tetsuya Yumoto, Atsunori Nakao, Makoto Kobayashi
INTRODUCTION: The Helicopter Emergency Medical Service (HEMS) commonly intubates patients who require advanced airway support prior to takeoff. In-flight intubation (IFI) is avoided because it is considered difficult due to limited space, difficulty communicating, and vibration in flight. However, IFI may shorten the total prehospital time. We tested whether IFI can be performed safely by the HEMS. METHODS: We conducted a retrospective cohort study in adult patients transported from 2010 to 2017 who received prehospital, non-emergent intubation from a single HEMS...
September 7, 2020: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Shaimaa Fathy, Ahmed Hasanin, Maha Mostafa, Ezzat Ramzy, Khaled Sarhan, Tarek Almenesey, Ahmed G Safina, Osama Hosny, Ghada Adel Hamden, Ahmed A Gado, Ali Mokhtar
BACKGROUND: Patients with septic shock commonly require endotracheal intubation under general anaesthesia in the operating theatre, the emergency department, and the intensive care unit. Hypotension is a serious complication after induction of general anaesthesia especially in patients with circulatory failure. No randomised controlled trials had previously investigated protocols for induction of anaesthesia in septic shock patients. The aim of the current work is to compare two protocols, lidocaine-ketamine combination versus ketamine full-dose for rapid-sequence endotracheal intubation in patients with septic shock...
September 5, 2020: Anaesthesia, Critical Care & Pain Medicine
Lindie J M K Kuijpers, Mathijs Binkhorst, Nicole K Yamada, Romy N Bouwmeester, Arno F J van Heijst, Louis P Halamek, Marije Hogeveen
OBJECTIVE:  This study aimed to evaluate the construct validity and reliability of real-time assessment of a previously developed neonatal intubation scoring instrument (NISI). STUDY DESIGN:  We performed a randomized controlled simulation study at a simulation-based research and training facility. Twenty-four clinicians experienced in neonatal intubation ("experts") and 11 medical students ("novices") performed two identical elective intubations on a neonatal patient simulator...
September 8, 2020: American Journal of Perinatology
Jean-Damien Ricard, Oriol Roca, Virginie Lemiale, Amanda Corley, Jens Braunlich, Peter Jones, Byung Ju Kang, François Lellouche, Stefano Nava, Nuttapol Rittayamai, Giulia Spoletini, Samir Jaber, Gonzalo Hernandez
Nasal high flow (NHF) has gained popularity among intensivists to manage patients with acute respiratory failure. An important literature has accompanied this evolution. In this review, an international panel of experts assessed potential benefits of NHF in different areas of acute respiratory failure management. Analyses of the physiological effects of NHF indicate flow-dependent improvement in various respiratory function parameters. These beneficial effects allow some patients with severe acute hypoxemic respiratory failure to avoid intubation and improve their outcome...
September 8, 2020: Intensive Care Medicine
Dante A Suffredini, Michael G Allison
Infection with the novel 2019 coronavirus (SARS-CoV-2) is associated with the development of a viral pneumonia with severe hypoxemia and respiratory failure. In many cases these patients will require mechanical ventilation; but in others the severity of disease is significantly less and may not need invasive support. High flow nasal cannula (HFNC) is a widely used modality of delivering high concentrations of oxygen and airflow to patients with hypoxemic respiratory failure, but its use in patients with SARS-CoV-2 is poorly described...
September 10, 2020: Journal of Intensive Care Medicine
Andrew Norris, James Armstrong
No abstract text is available yet for this article.
September 8, 2020: British Journal of Anaesthesia
Daniel J Parks, Scott M Alter, Richard D Shih, Joshua J Solano, Patrick G Hughes, Lisa M Clayton
OBJECTIVE: Prehospital intramuscular (IM) ketamine is increasingly used for chemical restraint of agitated patients. However, few studies have assessed emergency department (ED) follow-up of patients receiving prehospital ketamine for this indication, with previous reports suggesting a high rate of post-administration intubation. This study examines the rate of and reasons for intubation and other airway interventions in agitated patients who received ketamine by Emergency Medical Services (EMS)...
September 14, 2020: Prehospital and Disaster Medicine
Giuseppe A Marraro, Yun-Feng Chen, Claudio Spada
No abstract text is available yet for this article.
October 2020: Critical Care Medicine
Thomas M Hemmerling, Cedrick Zaouter
No abstract text is available yet for this article.
October 2020: Anesthesia and Analgesia
Manuel Taboada, Mariana González, Antía Álvarez, Irene González, Javier García, María Eiras, María Diaz Vieito, Alberto Naveira, Pablo Otero, Olga Campaña, Ignacio Muniategui, Ana Tubio, Jose Costa, Salomé Selas, Agustín Cariñena, Adrián Martínez, Sonia Veiras, Francisco Aneiros, Valentín Caruezo, Aurora Baluja, Julian Alvarez
BACKGROUND: In the treatment for severe acute respiratory distress syndrome (ARDS) from Coronavirus Disease 2019 (COVID-19), the World Health Organization (WHO) recommends prone positioning (PP) during mechanical ventilation for periods of 12-16 hours per day to potentially improve oxygenation and survival. In this prospective observational study, we evaluated the ability of long PP sessions to improve oxygenation in awake ICU patients with moderate or severe ARDS due to COVID-19. METHODS: The study was approved by the ethics committee of Galicia (code No...
September 14, 2020: Anesthesia and Analgesia
Eric A Fried, George Zhou, Ronak Shah, Da Wi Shin, Anjan Shah, Daniel Katz, Garrett W Burnett
BACKGROUND: Numerous barrier devices have recently been developed and rapidly deployed worldwide in an effort to protect healthcare workers (HCWs) from exposure to COVID-19 during high-risk procedures. However, only a few studies have examined their impact on the dispersion of droplets and aerosols, which are both thought to be significant contributors to the spread of COVID-19. METHODS: Two commonly used barrier devices, an intubation box and a clear plastic intubation sheet, were evaluated using a physiologically accurate cough simulator...
September 15, 2020: Anesthesia and Analgesia
James Peyton, Raymond Park, Steven J Staffa, Stefano Sabato, Thomas W Templeton, Mary Lyn Stein, Annery G Garcia-Marcinkiewicz, Edgar Kiss, John Edem Fiadjoe, Britta von Ungern-Sternberg, Franklin Chiao, Patrick Olomu, David Zurakowski, Pete G Kovatsis
BACKGROUND: The design of a videolaryngoscope blade may affect its efficacy. We classified videolaryngoscope blades as standard and non-standard shapes to compare their efficacy performing tracheal intubation in children enrolled in the Paediatric Difficult Intubation Registry. METHODS: Cases entered in the Registry from March 2017 to January 2020 were analysed. We compared the success rates of initial and eventual tracheal intubation, complications, and technical difficulties between the two groups and by weight stratification...
September 16, 2020: British Journal of Anaesthesia
S J Phipps, A C Scott, C E Legge
No abstract text is available yet for this article.
July 2020: Anaesthesia reports
Tomohiro Chaki, Shunsuke Tachibana, Sho Kumita, Honami Sato, Kosuke Hamada, Yasuyuki Tokinaga, Michiaki Yamakage
BACKGROUND: Second-generation supraglottic airway (SGA) devices are useful for airway management during positive pressure ventilation in general anesthesia and emergency medicine. In some clinical settings, such as the anesthetic management of awake craniotomy, SGAs are used in the head-rotated position, which is required for exposure of the surgical field, although this position sometimes worsens the efficiency of mechanical ventilation with SGAs. In this study, we investigated and compared the influence of head rotation on oropharyngeal leak pressures (OPLP) of the i-gel and LMA® Supreme™ which are second-generation SGA devices...
September 1, 2020: Anesthesia and Analgesia
Jestin N Carlson, Henry E Wang
Airway management during cardiac arrest has undergone several advancements. Endotracheal intubation (ETI) often is considered the gold standard for airway management in cardiac arrest; however, other options exist. Recent prospective randomized trials have compared outcomes in bag-valve mask ventilation and supraglottic airways to ETI in out-of-hospital cardiac arrest. ETI, if performed early in resuscitation, is associated with worse patient outcomes and has been de-emphasized so as not to interfere with other aspects of the resuscitation...
October 2020: Critical Care Clinics
Stuart Winearls, Ema L Swingwood, Charlotte L Hardaker, Amy M Smith, Fraser M Easton, Katherine J Millington, Rebecca S Hall, Ann Smith, Katrina J Curtis
The global pandemic of COVID-19 has challenged the management of hypoxaemic respiratory failure and strained intensive care unit resources. While prone positioning (PP) is an established therapy in mechanically ventilated patients with acute respiratory distress syndrome (ARDS), its role in conscious patients is less well defined. We retrospectively reviewed our experience of implementing early PP in a cohort of 24 patients with acute hypoxaemic respiratory failure due to COVID-19 who required support with continuous positive airway pressure (CPAP)...
September 2020: BMJ Open Respiratory Research
Matteo Parotto, Richard M Cooper, Elizabeth C Behringer
Purpose of Review: This review explores relevant definitions, epidemiology, management, and potential future research directions in the extubation of the challenging/difficult airway. It provides guidance on identifying patients at risk and how to approach these clinical scenarios. Recent Findings: Based on recent literature, including large-scale audits and closed claims analysis, it is increasingly recognized that extubation of the difficult airway is a situation at risk of severe adverse events...
September 4, 2020: Current Anesthesiology Reports
Michael P Goldman, Ambika Bhatnagar, Joshua Nagler, Marc A Auerbach
Introduction: Advanced airway management in pediatrics is a rare, high stakes skillset. Developing proficiency in these skills is paramount, albeit challenging. Providers require innovative approaches to address initial training and maintenance of procedural competency. To address this, we developed a multimodality curriculum. Methods: Through an interactive problem-based learning session utilizing real intubation videos, hands-on skill stations, and two simulation-based scenarios, participants advanced through educational objectives towards the goal of improving perceived comfort, knowledge, skills, and attitudes in emergency pediatric advanced airway management...
September 4, 2020: MedEdPORTAL Publications
2020-09-23 15:37:28
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