Intubation and Obesity

R. Eleanor Anderson, MD, Calvin A. Brown, III, MD   Obesity and critical illness are dangerous in combination   Obesity affects all components of airway management, including oxygenation, bag-valve-mask ventilation, and choice of pharmacologic agents, intubation surgical airway, and rescue devices. In a prospective, multicenter, observational study, researchers in France assessed the incidence of... Read more..

Prehospital CPAP for Acute Respiratory Failure

R. Eleanor Anderson, MD, Calvin A. Brown, III, MD, FAAEM   A systematic review of controlled trials suggests that CPAP reduces need for intubation.   Continuous positive airway pressure (CPAP) and noninvasive ventilation (NIV) are commonly used in-hospital therapies for respiratory failure, predominantly in patients with chronic obstructive pulmonary disease and pulmonary edema. To... Read more..

Do Novices and Experts Hold a Laryngoscope Differently?

R. Eleanor Anderson, MD, Calvin A. Brown, III, MD, FAAEM   Yes, and it's all in the grip.   Direct laryngoscopy is a complex skill that requires both practice and proper instruction to master; however, specific teaching on handle grip and angle varies. A handle angle of 45° from horizontal is commonly taught as... Read more..

Prehospital Use of Ketamine for Agitated Patients?

Cheryl Lynn Horton, MD  : Although most patients were adequately sedated within 3 minutes, a few required ventilatory support.   Consensus is lacking regarding an optimal medication regimen to treat agitated and violent patients in the prehospital setting. Ketamine's rapid onset, short duration of action, and sedative properties may make it uniquely suited for... Read more..

Severe Hyperoxia in Cardiac Arrest Survivors is Associated with Worse Outcomes

Kristi L. Koenig, MD, FACEP, FIFEM   Severe, but not moderate, hyperoxia portended lower survival to hospital discharge.   Hyperoxia may result in increased oxidative stress and ischemia-reperfusion injury in patients resuscitated from cardiac arrest. To assess the effect of hyperoxia on outcomes, investigators retrospectively analyzed data for 184 ventilated post--cardiac arrest patients (mean... Read more..

2014 Airway Article of the Year

Dr. Cheryl Lynn Horton and Dr. Calvin A. Brown, III, present three nominees for “Airway Article of the Year.” The nominated articles were chosen from among those featured in the 2014 Quarterly Airway Research Updates. The panelists discuss the content and merits of each article and the audience votes to... Read more..

Does Nasal Cannula Design Affect Function?

R. Eleanor Anderson, MD, Calvin A. Brown, III, MD, FAAEM   A crossover comparison of four nasal cannulae shows differences in oxygen delivery and ETCO2   To assess whether the design of nasal cannulae influences O2 delivery and detection of end tidal carbon dioxide (ETCO2), researchers enrolled 45 healthy adults in a randomized, crossover... Read more..

3rd Annual Airway Article of the Year Winner Announced

The winner of the third annual “Airway Article of the Year” award was announced during a live webinar hosted by on December 5, 2014. Calvin Brown III, MD and Cheryl Lynn Horton, MD, hosts of the webinar, presented three articles as nominees. The nominees were chosen from among all... Read more..

December 2014 Quarterly Airway Management Research Update PowerPoint Slides

December 2014 Research Update Slides to Download Read more..

Complications During Physician-Performed Prehospital Intubation

Cheryl Lynn Horton, MD   Hypoxia occurred in 15% of patients and poor glottic view was the only predictor.   To determine the incidence of peri-intubation complications in a physician-staffed Scottish aeromedical transport system, researchers retrospectively analyzed emergent rapid-sequence intubations performed between 2009 and 2012.   Of 208 intubations, 75% were performed during interfacility transport and... Read more..

Transnasal High-Flow Humidified Oxygen for a Difficult Airway

R. Eleanor Anderson, MD, Ron M. Walls, MD, FRCPC, FAAEM   THRIVE Summary SidebarA physiologic pharyngeal oxygen reservoir extends the safe apnea window.   Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE) is a technique for providing high-flow, positive-pressure, humidified oxygen via nasal cannula. When compared... Read more..

Faster Learning Curve with the GlideScope Than the Direct Laryngoscope

Cheryl Lynn Horton   Over the course of training, emergency medicine residents showed improved first-pass success with the GlideScope video laryngoscope but no improvement with the direct laryngoscope.   To compare learning curves for the direct laryngoscope (DL) and GlideScope video laryngoscope, researchers retrospectively analyzed adult intubations performed by first-, second-, and third-year emergency... Read more..

Airway Management for Adults with Prehospital Cardiac Arrest: Is Intubation Passé

Cheryl Lynn Horton, MD   Patients who were intubated had similar outcomes to those who had a supraglottic airway device inserted.   To compare outcomes for prehospital cardiac arrest patients whose airways are managed with endotracheal intubation or insertion of a supraglottic airway device, researchers performed a literature review of studies published from 1980... Read more..

Are Propofol and Ketofol Interchangeable?

Daniel J. Pallin, MD, MPH   In a randomized trial, three drug regimens for procedural sedation were equivalent, but the analysis was flawed.   For procedural sedation, the advantage of propofol is its short duration; its disadvantage is dose-related respiratory suppression. The advantage of ketamine is absence of respiratory suppression; its disadvantage is longer... Read more..

A Dose of Ketamine Can Facilitate Preoxygenation Before Emergency Intubation

Daniel J. Pallin, MD, MPH In a new technique called "delayed sequence intubation," ketamine facilitated preoxygenation in patients with altered mental status.   Patients with altered mental status may not be able to undergo preoxygenation, which is required for optimal rapid sequence intubation. In a prospective observational study of 62 such patients, investigators... Read more..

TRUST: A Useful Tool for Assuring Correct Pediatric Endotracheal Tube Depth

Katherine Bakes, MD Ultrasound visualization of a saline-filled cuff at the level of the suprasternal notch was accurate for confirming correct tube depth.   Investigators evaluated the accuracy of the tracheal rapid ultrasound saline test (TRUST) to confirm proper endotracheal tube (ETT) depth in children ages 3 months to 18 years undergoing intubation... Read more..

ASA Issues Ebola Recommendations

Amid the growing concern over the Ebola virus, the American Society of Anesthesiologists Committee on Occupational Health released a statement on Ebola information and recommendations.  These guidelines make anesthesiologists aware of the risks and discuss adequate precautions to help ensure they do not become infected or transmit the Ebola virus. Read more..

September 2014 Quarterly Airway Management Research Update

Originally presented as a live webinar, Dr. Ron Walls, Dr. Ali Raja and Dr. Cheryl Lynn Horton use case discussions to introduce the latest published airway research and discuss their impact on clinical practice. Read more..

Macintosh or Miller Laryngoscope Blades for Infants?

R. Eleanor Anderson, MD Similar laryngeal views were achieved with both devices. The straight Miller laryngoscope blade is traditionally recommended for intubation in infants, due to the large size and flexibility of the infant epiglottis. However, the Miller and Macintosh blades have not been systematically compared in young children. In a prospective,... Read more..

Video vs. Direct Laryngoscopy in Patients with Cervical Spine Immobilization

R. Eleanor Anderson, MD, Daniel J. Pallin, MD, MPH Better laryngoscopic views with video laryngoscopy do not equal intubation success. Intubating a trauma patient with cervical spine immobilization can be difficult. Prior studies in this population have shown that video laryngoscopy improves laryngoscopic view and reduces intubation difficulty (NEJM JW Emerg Med... Read more..

The Congenital Difficult Airway in Pediatrics – Anesthesiology News Guide to Airway Management, August 2014

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Disposable Laryngoscope Blades and Reusable Handles: What Combination Maximizes Light Intensity?

R. Eleanor Anderson, MD, Ron M. Walls, MD, FRCPC, FAAEM Although all disposable blades delivered more than 500 lux with any handle, a reusable blade was best.   Disposable laryngoscope blades increasingly are used because of infection concerns and convenience. Clinical studies of light intensity through disposable blades have offered conflicting results and... Read more..

Comparing the i-gel to First- and Second-Generation LMAs

R. Eleanor Anderson, MD, Ron M. Walls, MD, FRCPC, FAAEM Rates of successful insertion did not differ, but the i-gel and second-generation LMAs performed best. Researchers compared performance of the i-gel and the laryngeal mask airway (LMA) in a meta-analysis of randomized, controlled trials involving patients undergoing elective surgery. The i-gel was... Read more..

Physician-Led Prehospital Airway Management in Trauma

R. Eleanor Anderson, MD, Ron M. Walls, MD, FRCPC, FAAEM   Intubation was successful in 99% of patients, and all surgical airways were successful in this large retrospective series.   To assess airway management of trauma patients in a physician-led prehospital system in England, researchers conducted a retrospective database review of 7256... Read more..

International Airway Faculty Formed by SAM and DAS

The Society for Airway Management (SAM) and the Difficult Airway Society (DAS) recently announced the creation of the International Airway Faculty. Independently, SAM and DAS recognized the need for an advisory body to serve as a clearinghouse, assist in the matching of research resources, facilitate multi-centered trials, assist in... Read more..

Do Not Use Cricoid Pressure with the i-gel Airway Device

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June 2014 Quarterly Airway Management Research Update

Originally presented as a live webinar, Dr. Ron Walls, Dr. Ali Raja and Dr. Cheryl Lynn Horton use case discussions to introduce the latest published airway research and discuss their impact on clinical practice. Read more..

Free-Hand vs. air-Q-Guided Fiber-Optic Intubation in Young Children

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Pentax Airway Scope vs. Macintosh Direct Laryngoscope

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Prehospital Noninvasive Positive Pressure Ventilation Saves Lives

Daniel J. Pallin, MD, MPH   Pooled data from seven trials demonstrate major benefits.   Several prior studies have suggested benefit from prehospital noninvasive positive pressure ventilation (NIPPV) for respiratory distress. To determine whether there was benefit across all of the prior studies, researchers pooled data from seven randomized trials in which NIPPV was... Read more.. 1 2 3