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..