Best Tips for Bougie Use in Airway Management
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This comprehensive article on bougie use during emergency airway management covers all things bougie, with a lot of technical tips. We cover the highlights.
Source
Managing Emergency Endotracheal Intubation Utilizing a Bougie. Ann Emerg Med. 2024 2024 Jun 22:S0196-0644(24)00232-4. DOI: 10.1016/j.annemergmed.2024.04.021. PMID: 38912998.
Point | Counterpoint – DL Is Not the Building Block for Learning VL
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Yesterday we looked at an argument for learning DL prior to VL. Today, we are covering the counterpoint, where this group argues that DL is not the building block for learning VL.
Source
COUNTERPOINT: Direct Laryngoscopy: The Building Block to Airway Expertise? No. Chest. 2024 Jun;165(6):1297-1299. doi: 10.1016/j.chest.2024.01.027. PMID: 38852967
Point | Counterpoint – DL Should Be Learned Before VL
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Today we are looking at an opinion piece published in Chest where the authors provide an argument that DL should be learned prior to VL.
Source
POINT: Direct Laryngoscopy: The Building Block to Airway Expertise? Yes. Chest. 2024 Jun;165(6):1296-1297. doi: 10.1016/j.chest.2023.12.035. PMID: 38852966.
Anatomically vs Physiologically Difficult Airways
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An analysis of the NEAR database demonstrated a lower first-pass success rate of 89.2% for patients with anatomically difficult airways (ADA) compared to 93.7% in the control group. First-pass success for physiologic difficult airways (PDA) was 92.9% and fell to 87.4% for those with both ADA/PDA.
Source
First-Attempt Success Between Anatomically and Physiologically Difficult Airways in the National Emergency Airway Registry. Anesth Analg. 2024;138(6):1249-1259. doi:10.1213/ANE.0000000000006828
PREOXI RCT – Preoxygenation with Noninvasive Ventilation vs. Non-rebreather Mask
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Noninvasive ventilation (NIV) was superior to a standard non-rebreather (NRB) oxygen mask for preoxygenation of critically ill ED or ICU patients requiring intubation, with a NNT of 11 to prevent 1 episode of hypoxemia <85%.
Source
Noninvasive Ventilation for Preoxygenation during Emergency Intubation. NEJM. 2024 Jun 13.
How to Successfully Intubate a Neonate on the First Attempt
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In this RCT, successful intubation on the first attempt in critically ill neonates was much higher in patients when video laryngoscopy (VL) was used compared to direct laryngoscopy (DL).
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Video versus Direct Laryngoscopy for Urgent Intubation of Newborn Infants. NEJM. 2024 May 5. Online ahead of print. DOI: 10.1056/NEJMoa2402785
VL vs DL in the Operating Room
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This single site RCT found that for patients undergoing intubation for mainly elective surgeries, hyperangulated video-laryngoscopy (VL) had higher first-pass success and lower rates of intubation failure compared to Mac direct laryngoscopy (DL).
Source
Video Laryngoscopy vs Direct Laryngoscopy for Endotracheal Intubation in the Operating Room: A Cluster Randomized Clinical Trial. JAMA. 2024 Mar 18:e240762. doi: 10.1001/jama.2024.0762. Epub ahead of print. PMID: 38497992.
Timing of Airway Management in OHCA – Does It Matter?
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In a large retrospective review of patients with out-of-hospital-cardiac-arrest (OHCA) there was a very small, and probably clinically insignificant, association with favorable neurological outcome and survival in those who underwent early as opposed to late advanced airway management.
Source
Early versus late advanced airway management for adult patients with out-of-hospital cardiac arrest: A time-dependent propensity score matched analysis. Acad Emerg Med. 2024 Apr 8. Epub ahead of print. DOI: 10.111/acem.14907
New Meta-analysis – Should We Do Bougie-First Intubations?
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In this systematic review and meta-analysis to evaluate the use of a bougie versus non-bougie approach (ie. stylet) in intubations of adult patients, a bougie-first approach significantly increased the rate of first-attempt success compared to controls. But what does this say about your intubation strategy?
Source
Effect of Bougie Use on First-Attempt Success in Tracheal Intubations: A Systematic Review and Meta-Analysis. Ann Emerg Med. 2024 Feb;83(2):132-144. doi: 10.1016/j.annemergmed.2023.08.484. Epub 2023 Sep 19.
Do Extremes of Weight in Children Mean High-Risk Intubation?
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Underweight (less than 5th percentile) and obese (over 95th percentile) children are more likely to suffer hypoxemia and adverse events during tracheal intubation.
Source
Adverse Tracheal Intubation Events in Critically Ill Underweight and Obese Children: Retrospective Study of the National Emergency Airway for Children Registry (2013-2020). Pediatr Crit Care Med. 2024 Feb 1;25(2):147-158. Doi: 10.1097/PCC.0000000000003387.