POCUS for the Physiologically Difficult Airway
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Through the use of point-of-care ultrasound (POCUS) Emergency Medicine providers can optimize and tailor pre-intubation resuscitation in critically ill patients. See algorithm below.
Critical Care
CLOVERS RCT – Restrictive or Liberal Fluid Before Pressors?
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This unblinded superiority trial found no significant difference in mortality among patients who were randomized to a restrictive fluid strategy with earlier use of vasopressors or liberal fluid administration for treatment of sepsis-induced hypotension.
AHA Statement – Surgical Embolectomy and ECMO for High-Risk PE
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This is a scientific statement from the American Heart Association emphasizing the need for more research on surgical embolectomy and mechanical circulatory support in the treatment of high-risk pulmonary embolism.
Source
Surgical Management and Mechanical Circulatory Support in High-Risk Pulmonary Embolisms: Historical Context, Current Status, and Future Directions: A Scientific Statement From the American Heart Association. Circulation. 2023;10.1161/CIR.0000000000001117. doi:10.1161/CIR.0000000000001117
Angioedema – Who Needs Intubation?
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In patients presenting with angioedema, history of hypertension, shortness of breath, drooling, and anterior tongue or pharyngeal swelling were risk factors predicting eventual need for intubation.
Source
Clinical predictors of endotracheal intubation in patients presenting to the emergency department with angioedema. Am J Emerg Med. 2023 Jan;63:44-49. doi: 10.1016/j.ajem.2022.10.017. Epub 2022 Oct 19.
High-Dose Nitroglycerin Infusion in Sympathetic Crashing Acute Pulmonary Edema (SCAPE)
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This study suggests that high-dose nitroglycerin infusion may be a safe alternative to intermittent bolus dosing for SCAPE, but prospective trials are needed to determine optimal initial rates and titration strategies, as well as the proper use of other adjunct therapies.
Source
High-dose nitroglycerin infusion description of safety and efficacy in sympathetic crashing acute pulmonary edema: The HI-DOSE SCAPE study. Am J Emerg Med. 2022 Oct 18;63:74-78. doi: 10.1016/j.ajem.2022.10.018. Epub ahead of print.
PILOT RCT – Do Oxygen Targets Matter in Critically Ill Patients?
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Among adult patients receiving mechanical ventilation, there was no significant difference in ventilator-free days or 28-day mortality between groups in which a lower (88-92%), intermediate (92-96%), or higher SpO2 target (96-100%) was used.
Best Articles of 2022
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These are the top articles from 2022. Enjoy!
A Dark Side of Dexmedetomidine? Another Look at SPICE-III
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An increasing propofol dose, combined with a fixed dexmedetomidine infusion, was associated with decreased 90-day mortality in patients ≤ 65 years. An increasing dexmedetomidine dose, combined with a relatively fixed propofol dose, was associated with increased mortality in patients ≤65. Both associations were absent in patients > 65 years old.
Source
Dexmedetomidine and Propofol Sedation in Critically Ill Patients and Dose Associated 90-day Mortality: A Secondary Cohort Analysis of a Randomized Controlled Trial (SPICE-III). Am J Respir Crit Care Med. 2022 Oct 10. doi: 10.1164/rccm.202206-1208OC. Online ahead of print.
How Massive PE Kills – A Review of Right Heart Failure
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Decompensated right heart failure (RHF) increases morbidity and mortality, but it can be challenging to diagnose and treat. This review summarizes the unique physiology of RHF and treatment implications.
REFACED RCT – Is Fluid Restriction in Sepsis Feasible?
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IV crystalloid fluid restriction in the first 24-hours for ED sepsis patients without associated shock significantly reduced volumes when compared to standard of care. A larger trial investigating patient-centered outcomes is likely imminent.
Source
Restrictive fluids versus standard care in adults with sepsis in the emergency department (REFACED): A multicenter, randomized feasibility trial. Acad Emerg Med. 2022 Oct;29(10):1172-1184. doi: 10.1111/acem.14546. Epub 2022 Aug 5.