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With Oxygen, Could Less Be More?

Patricia Kritek, MD   Studies raise questions about delivering more oxygen than needed.   In 2016, two trials were published in which researchers examined established uses of supplemental oxygen. These results raise questions about our current practices.   A multicenter U.S. trial included 738 patients with chronic obstructive pulmonary disease (COPD) and mild-to-moderate resting hypoxemia (oxyhemoglobin... Read more..

With Oxygen, Could Less Be More?

Patricia Kritek, MD   Studies raise questions about delivering more oxygen than needed.   In 2016, two trials were published in which researchers examined established uses of supplemental oxygen. These results raise questions about our current practices.   A multicenter U.S. trial included 738 patients with chronic obstructive pulmonary disease (COPD) and mild-to-moderate resting hypoxemia (oxyhemoglobin... Read more..

2016 Airway Article of the Year Award

Dr. Calvin A. Brown, III, presents three nominees for “Airway Article of the Year.” The nominated articles were chosen from among those featured in the 2016 Quarterly Airway Research Updates. Dr. Brown discusses the content and merits of each article and the audience votes to select the 5th Annual “Airway... Read more..

2016 December Quarterly Airway Management Research Update

Dr. Calvin A. Brown, III uses a case discussion to introduce the latest published airway research and discusses its impact on clinical practice. This quarter Dr. Brown looks at studies around dosing in morbidly obese patients, apneic oxygenation and predicting NIPPV failure. Read more..

Does Patient Position Affect Administration of Intranasal Agents

Calvin A. Brown, III, MD   The volume of medication administered by an atomizer was 14 times greater when used on a mannequin in the supine versus upright position.   A concern with squeeze-bottle atomizers that administer intranasal medications is that they cannot ensure delivery of precise amounts of agents such as vasoconstrictors and... Read more..

Does Patient Position Affect Administration of Intranasal Agents

Calvin A. Brown, III, MD   The volume of medication administered by an atomizer was 14 times greater when used on a mannequin in the supine versus upright position.   A concern with squeeze-bottle atomizers that administer intranasal medications is that they cannot ensure delivery of precise amounts of agents such as vasoconstrictors and... Read more..

No Clear Right Choice for Postextubation Support

Patricia Kritek, MD   High-flow oxygen was noninferior to noninvasive positive pressure ventilation for preventing reintubation.   During the last 2 years, we have seen a rapid rise in use of high-flow oxygen. Although its use is supported during the immediate postextubation period for patients at low risk for reintubation (NEJM JW... Read more..

A New Score for Predicting Failure of Noninvasive Ventilation

Daniel M. Lindberg, MD   Five clinical criteria strongly predicted need for intubation in patients with respiratory failure.   Use of noninvasive ventilation (NIV) can avoid intubation in some patients with respiratory failure by temporarily supporting ventilation during initial treatment, but many patients fail NIV and ultimately need intubation. Patients at risk for NIV... Read more..

Oxygen in Critically Ill Patients: Too Much of a Good Thing Might Do Harm

Daniel D. Dressler, MD, MSc, SFHM, FACP   Outcomes were worse with a conventional high-oxygenation goal than with a conservative moderate-oxygenation goal.   Increasingly, excess oxygen administration is recognized as a risk factor for adverse outcomes when used perioperatively (NEJM JW Infect Dis Nov 2009 and JAMA 2009; 302:1543) or after myocardial... Read more..

High-Flow Nasal Cannula Therapy for Respiratory Distress in Preterm Babies?

Robin Steinhorn, MD   Treatment failure was more frequent with HFNC than with CPAP in babies with early respiratory failure.   Use of high-flow nasal cannula (HFNC) therapy as means of noninvasive respiratory support for preterm infants has increased over the last decade, largely because the devices are easy to use and well tolerated.... Read more..

Does Tracheal Intubation Improve In-Hospital Cardiac Arrest Outcomes for Children?

F. Bruder Stapleton, MD   Observational data support poorer survival outcomes with intubation in this setting.   For cardiopulmonary resuscitation (CPR) in hospitalized children, respiratory support is emphasized, as the predominant cause of cardiac arrest is respiratory failure. In the current observational study, researchers compared survival and neurological outcomes in 1555 children who were... Read more..

Buccal Oxygenation During Prolonged Laryngoscopy Prevents Desaturation in Obese Patients

Calvin A. Brown, III, MD   Compared with usual care, supplemental oxygen delivered to the buccal space through a modified tracheal tube reduced the risk of desaturation during prolonged laryngoscopy in obese patients undergoing elective surgery.   Obese patients can desaturate quickly during emergency airway management, placing them at risk for hypoxic injury. Apneic... Read more..

Dosing of Succinylcholine and Etomidate in Emergency Department Rapid Sequence Intubation

Daniel J. Pallin, MD, MPH   A single-center chart review shows that obese patients are at high risk for underdosing.   Current recommendations are that succinylcholine and etomidate be dosed according to total body weight (1–1.5 mg/kg and 0.2–0.4 mg/kg, respectively). Investigators reviewed records from a single emergency department (ED) to determine the frequency... Read more..

September 2016 Quarterly Airway Management Research Update

Orginally presented as a live webinar, Dr. Calvin A. Brown, III uses a case discussion to introduce the latest published airway research and discusses its impact on clinical practice. This quarter Dr. Brown looks at studies around preoxygenation, ketamine use, and maximizing techniques with hypercurved video laryngoscopy. Read more..

Fentanyl-Based Analgosedation Strategy for Intubated ICU Patients

Calvin A. Brown, III, MD   In this retrospective cohort study, an analgosedation strategy using fentanyl was associated with reductions in both ventilator time and the need for sedative infusions.   Complications from long-term deep sedation and the lack of adequate pain control for mechanically ventilated intensive care unit (ICU) patients has resulted in... Read more..

Early ECMO Improves Survival in Trauma Patients with Acute Respiratory Distress Syndrome

Calvin A. Brown, III, MD   In this retrospective cohort study, extracorporeal membrane oxygenation improved survival in trauma patients with severe ARDS.   Acute respiratory distress syndrome (ARDS) can complicate major trauma and is associated with high mortality. Case reports and small case series have reported improved survival when extracorporeal membrane oxygenation (ECMO) is... Read more..

A Partial Glottic View Improves GlideScope Intubation

Calvin A. Brown, III, MD   In this randomized clinical trial, GlideScope intubations were faster and easier when a restricted glottic view was used.   Intubation with hypercurved video laryngoscopes (VLs) often takes longer to complete because of the challenge of manipulating the endotracheal tube through the glottic opening. With direct laryngoscopy, a full... Read more..

Predictors of Prolonged Time to Intubation with Hypercurved Videolaryngoscopes

Calvin A. Brown, III, MD   In a study of operating room intubations with acute-angled videolaryngoscopes, “sniffing” head position, reduced mouth opening, and attending intubators were associated with prolonged intubation times.   To identify predictors of difficult or prolonged intubation with hypercurved video laryngoscopes, investigators conducted a secondary analysis of a randomized controlled trial... Read more..

June 30, 2016 Webinar Cancelled

We are sorry to have to cancel the June 30th Quarterly Airway Management Research Update.   The research from this quarter will be covered in the September 22nd webinar.  To register for the September session, visit https://attendee.gotowebinar.com/register/9015182081382477314.   If you have any pressing questions, please don't hesitate to contact Terry T. Steele at... Read more..

Helmets for Patients in the Intensive Care Unit?

Patricia Kritek, MD   Patients with hypoxemic respiratory failure avoided intubation when noninvasive ventilation was delivered via helmet.   Treating patients with acute respiratory distress syndrome (ARDS) usually requires intubation and mechanical ventilation. Although high-flow oxygen can limit these interventions, similar benefits have not been seen with noninvasive positive-pressure ventilation (NPPV; JW... Read more..

Extracorporeal Membrane Oxygenation (ECMO) for Critically Ill Adults in the Emergency Department: History, Current Applications, and Future Directions

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Shock Index Predicts Hypotension in Patients Induced with Ketamine

Daniel J. Pallin, MD, MPH   An observational study confirms that ketamine can cause hypotension in catecholamine-depleted patients.   Ketamine causes catecholamine release, but when used for rapid sequence intubation (RSI), it generally does not have hemodynamically consequential effects. In a prospective observational study, investigators in Australia evaluated the hemodynamic effects of ketamine in... Read more..

Dexmedetomidine Might Help Liberate Delirious Patients from the Ventilator

Patricia Kritek, MD   Treatment with dexmedetomidine for as long as 1 week shortened delirium duration and mechanical ventilation time by nearly 1 day.   Dexmedetomidine is a sedating α-2 agonist that doesn't impair respiratory drive. In this multicenter study, investigators randomized 74 intensive care unit (ICU) patients with agitated delirium to receive either... Read more..

SALAD Technique Set-Up

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Introduction to the SALAD Technique

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March 2016 Quarterly Airway Management Research Update

Originally presented as a live webinar, Dr. Calvin A. Brown, III uses a case discussion to introduce the latest published airway research and discusses its impact on clinical practice.  This quarter's theme is Oxygenation.  Dr. Brown looks at studies around preoxygenation outside the OR, use of nasal cannula during preoxygenation... Read more..

Two Approaches to Lessen Need for Reintubation

Patricia Kritek, MD   High-flow oxygen and noninvasive positive pressure ventilation lowered reintubation rates in selected patient populations.   During the past few years, interest has grown in using high-flow oxygen (HFO) and noninvasive positive pressure ventilation (NPPV) in lieu of intubation and mechanical ventilation (NEJM JW Gen Med Aug 1 2015... Read more..

Pediatric Intubations in Japan: Lower First-Pass Success Rate than in the U.S.

Cheryl Lynn Horton, MD   First-attempt intubation success rate was 60%, but only a quarter of patients received rapid sequence intubation and nearly all were intubated with direct laryngoscopy.   To determine predictors of first-pass intubation success in children, researchers analyzed data from the Japanese Emergency Airway Network for 293 pediatric intubations (median patient... Read more..

Patients Should Be Intubated in an Upright, Head-Forward Position

Calvin A. Brown, III, MD, FAAEM   In this retrospective study, patients intubated in a semi-erect, head-forward position had lower rates of peri-intubation adverse events than those in a supine position.   Desaturation and poor direct laryngeal views are two important factors leading to intubation failure. In the operating room (OR), direct laryngoscopy is... Read more..

How Are Prehospital King Laryngeal Tubes Managed in the ED?

Calvin A. Brown, III, MD, FAAEM   Most patients who arrived with a King LT-D in place underwent surgical tracheostomy for definitive airway placement.   King laryngeal tubes are commonly used prehospital rescue devices but do not provide a definitive airway. There is little information about how these tools are exchanged for endotracheal tubes... Read more.. 1 2