Are Intubation and Extubation Aerosol-Generating Procedures?
Richard T. Ellison, III, MD
Quantitative analysis found that both tracheal intubation and extubation produce fewer aerosols than volitional coughs.
Epidemiologic studies performed during the severe acute respiratory syndrome (SARS) pandemic in 2003 noted an increased risk for transmission of the SARS coronavirus with tracheal intubation. The finding led to designating tracheal... Read more..
Can We Predict Which Children Will Arrest Soon After Intubation in the ED?
Carolyn K. Holland, MD, Med, FACEP, FAAP
Hypoxia prior to intubation strongly predicts post-intubation cardiac arrest in pediatric patients.
To identify risk factors for postintubation cardiac arrest in children, these authors retrospectively examined 543 endotracheal intubations performed at a single pediatric emergency department over 9 years. They conducted a nested case-control study... Read more..
Do Intubation Checklists Save Lives?
Lauren M. Westafer, MD, MPH, MS
A meta-analysis found no consistent association between use of endotracheal intubation checklists and either increased first-pass success or reduced mortality, peri-intubation arrest, or hypotension.
Intubation checklists have been widely adopted for use during endotracheal intubation in hopes of increasing the safety of this high-risk procedure, but... Read more..
Etomidate or Ketamine to Avoid Peri-Intubation Hypotension?
Benton R. Hunter, MD
In a large observational registry study, ketamine was associated with a higher risk for hypotensive events than etomidate.
Single-dose etomidate for emergency intubation is considered hemodynamically stable, but some authors have postulated that ketamine, which induces catecholamine release, may be safer for patients at risk for hypotension.
These authors... Read more..
Prone Positioning Can Help Oxygenation in Nonintubated Patients with COVID-19
Patricia Kritek, MD
But it's unclear whether proning ultimately prevents COVID-19–related deaths.
Prone positioning has been used for many years as an adjunct therapy for intubated patients with severe acute respiratory distress syndrome. Early in the COVID-19 pandemic, clinicians began using prone positioning for patients who were not yet intubated, with the... Read more..
Research Update: Out-of-Hospital Cardiac Arrest, Video Laryngoscopy, and Respiratory Failure due to COVID-19
Dr. Calvin Brown and special guests, Dr. Susan Wilcox (Mass General Hospital) and Dr. Darren Braude (Univ of New Mexico), discuss recent research on out-of-hospital cardiac arrest, standard-geometry v. hyperangulated video laryngoscopes, and respiratory failure due to COVID-19.
Noninvasive Ventilation and High-Flow Nasal Cannula Might Help Avoid Intubation for Hypoxemic Respiratory Failure
Patricia Kritek, MD
A meta-analysis showed lower mortality with noninvasive ventilation compared with standard oxygen therapy.
Comparisons of effectiveness among noninvasive ventilation (NIV), high-flow nasal cannula (HFNC), and standard oxygen therapy have yielded conflicting results in patients with respiratory failure who do not require immediate endotracheal intubation. Researchers performed a meta-analysis of... Read more..
Proning Nonintubated COVID-19 Patients with Acute Respiratory Distress Syndrome
Patricia Kritek, MD
Many patients showed improvement with noninvasive ventilation and prone positioning.
Prone positioning is used to treat mechanically ventilated patients with moderate-to-severe acute respiratory distress syndrome (ARDS). Numerous studies have demonstrated improved oxygenation in the prone position, and mortality benefit was shown in a large randomized, controlled trial (NEJM... Read more..
Self-Proning in COVID-19
Lauren M. Westafer, DO, MPH, MS
In this observational study, oxygen saturations in patients with COVID-19 increased after self-proning for 5 minutes.
Patients with severe COVID-19 often present with profound hypoxemia. Initial recommendations for their management included early intubation, but this was not predicated on evidence. Recently, many hospitals have initiated awake or... Read more..
Practical Guidance for Airway Management in the Coronavirus Patient
The four national directors of The Difficult Airway Course offer practical guidance for airway management of the coronavirus patient. Hosted by Calvin Brown III MD, this presentation includes perspectives from Emergency Medicine, Anesthesiology, Critical Care Medicine, and Pre-hospital Medicine. Panelists include J. Adam... Read more..
Video Laryngoscopy vs. Augmented Direct Laryngoscopy in the ED
Daniel M. Lindberg, MD
Video wins again.
Video laryngoscopy (VL) has been shown to make intubation easier and safer compared with traditional direct laryngoscopy (DL). These authors assessed intubation success for VL compared with several inexpensive and widely taught methods to augment DL (laryngeal manipulation, ramped positioning, bougie, and combinations of these).... Read more..
2019 Airway Article of the Year Announced
Airway Management Education Center, the creators of The Difficult Airway Course™, hosted the eighth annual “Airway Article of the Year” award show as a live webinar on December 12, 2019. Webinar host, Calvin Brown III, MD presented four articles as finalists. The nominees were selected from among all the articles... Read more..
2019 Article of the Year: Casey’s Bag-Mask Ventilation During Tracheal Intubation of Critically Ill Adults
Calvin Brown III, MD presents four nominees for the "2019 Airway Article of the Year." The nominated articles were chosen from among those featured in 2019 Quarterly Airway Research Updates. Dr. Brown discusses the content and merits of each article and the audience... Read more..
Research Update: DAS Guidelines on Awake Tracheal Intubation in Adults
Dr. Calvin Brown reviews the recently published Difficult Airway Society guidelines on awake tracheal intubation (ATI) in adults. The guidelines cover indication, set up, checklists, oxygenation, topicalization & sedation, and tube confirmation. General recommendations are also discussed. Read more..