APRV for ARDS – What’s the Evidence?

Critical Care

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Evidence does not yet support airway pressure release ventilation (APRV) as an alternative to conventional lung-protective ventilation in acute respiratory distress syndrome (ARDS). However, this approach is plausible and warrants continued investigation.

Source
Caution-Do Not Attempt This at Home. Airway Pressure Release Ventilation Should Not Routinely Be Used in Patients With or at Risk of Acute Respiratory Distress Syndrome Outside of a Clinical Trial. Crit Care Med. 2023 Jan 20. doi: 10.1097/CCM.0000000000005776. Epub ahead of print.

Should We Pause Compressions to Intubate During CPR?

Airway, Resuscitation

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Routinely pausing chest compressions during cardiac arrest to intubate in the emergency department is not necessary; this is especially true if you have video laryngoscopy and a bougie.

Source
First Attempt Success with Continued versus Paused Chest Compressions During Cardiac Arrest in the Emergency Department. Resuscitation. 2023 Feb 8;109726. doi: 10.1016/j.resuscitation.2023.109726. Online ahead of print.

Not Just for Kids – RSV vs Flu Impact on Adults

Infectious Disease, Pulmonary/Allergy

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Respiratory syncytial virus (RSV) is prevalent in hospitalized adults and is associated with higher odds of prolonged hospitalization and mechanical ventilation, particularly in patients with CHF and COPD.

Source
Prevalence and Clinical Outcomes of Respiratory Syncytial Virus versus Influenza in Adults Hospitalized with Acute Respiratory Illness from a Prospective Multicenter Study. Clin Infect Dis. 2023 Jan 24;ciad031. doi: 10.1093/cid/ciad031. Online ahead of print.

Six Vital Signs? Should We Measure ETCO2 in Triage?

ED Operations

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ETCO2 measured during emergency department triage outperforms standard vital signs in predicting in-hospital mortality, ICU admission, and correlates with markers of metabolic acidosis.

Source
End-Tidal Carbon Dioxide Measured at Emergency Department Triage Outperforms Standard Triage Vital Signs in Predicting In-Hospital Mortality and ICU admission. Acad Emerg Med. 2023 Feb 21. doi: 10.1111/acem.14703. Epub ahead of print.

Epi for OHCA – ROSC, Survival…But Are We Saving the Brain?

EMS, Resuscitation

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In this systematic review and meta-analysis, researchers found the epinephrine in standard doses, high doses, and with vasopressin lead to an improvement in ROSC and survival to hospital admission in out of hospital cardiac arrest (OHCA) but did not improve survival to discharge or functional neurologic outcome.

Source
Epinephrine in Out-of-Hospital Cardiac Arrest: A Network Meta-analysis and Subgroup Analyses of Shockable and Nonshockable Rhythms. Chest. 2023 Jan 31:S0012-3692(23)00165-4. doi: 10.1016/j.chest.2023.01.033. Epub ahead of print.

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