Airway

How to Get Pediatric ETT First-Pass Success – VL For the Win!

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Previously, first-attempt success rates for pediatric intubations hovered around 50%. Video-assisted laryngoscopy significantly increased first-attempt success rates and also had fewer adverse outcomes.

Source
Video-Assisted Laryngoscopy for Pediatric Tracheal Intubation in the Emergency Department: A Multicenter Study of Clinical Outcomes. Ann Emerg Med. 2022 Oct 15:S0196-0644(22)00604-7. doi: 10.1016/j.annemergmed.2022.08.021. Epub ahead of print.

Mounting Evidence that Paralysis Awareness is a Big Problem

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In this single center cohort of 886 patients, 5 patients had definite awareness during paralysis. However, there were 61 patients determined to have possible awareness, meaning upwards of 7.4% of patients could have been aware.

Source
Recall of awareness during paralysis among emergency department patients undergoing tracheal intubation. Chest. 2022 Sep 08. Doi: https://doi.org/10.1016/j.chest.2022.08.2232

Mac 3 or Mac 4 for Intubation? | MacSize-ICU Results Surprising

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There was an association with increased first attempt intubation success during direct laryngoscopy when using a Macintosh 3 laryngoscope blade compared to a Macintosh 4 blade.

Source
Impact of Macintosh blade size on endotracheal intubation success in intensive care units: a retrospective multicenter observational MacSize-ICU study. Intensive Care Medicine. August 16, 2022. Doi: 10.1007/s00134-022-06832-9

Should We Stop Using Propofol for RSI? | The INTUBE Study

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Patients who suffer from peri-intubation cardiovascular instability and collapse have an increased risk of mortality. Propofol was significantly associated with increased risk of peri-intubation instability and collapse.

Source
Peri-intubation Cardiovascular Collapse in Patients Who Are Critically Ill: Insights from the INTUBE Study. Am J Respir Crit Care Med. 2022 Aug 15;206(4):449-458. doi: 10.1164/rccm.202111-2575OC.

Don’t Forget the Sedation – A Paralytic Nightmare

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The proportion of patients that experience awareness with paralysis is alarmingly high; 3.4% were aware of their surroundings but paralyzed, which 3.4% more than what should occur.

Source
Awareness With Paralysis Among Critically Ill Emergency Department Patients: A Prospective Cohort Study. Crit Care Med. 2022 Jul 22. doi: 10.1097/CCM.0000000000005626. Online ahead of print.

Upright Face-to-Face versus Supine Intubation – Which Is Better?

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Upright face-to-face intubation had minimal difference in time to intubation or laryngeal views obtained when compared to supine intubation on cadavers, but there were some limitations with this study and further investigation into this technique and its application are needed.

Source
Comparison of supine and upright face-to-face cadaver intubation. Am J Emerg Med. 2022 Jun;56:87-91. doi: 10.1016/j.ajem.2022.03.029. Epub 2022 Mar 18.

PREPARE II RCT – Does a Bolus Reduce Cardiovascular Collapse Post-Intubation?

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A 500mL fluid bolus does not reduce the incidence of cardiovascular collapse in critically ill patients undergoing endotracheal intubation.

Source
Effect of Fluid Bolus Administration on Cardiovascular Collapse Among Critically Ill Patients Undergoing Tracheal Intubation: A Randomized Clinical Trial. JAMA. 2022 Jun 16. doi: 10.1001/jama.2022.9792. Online ahead of print.

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