Articles: intubation.
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Emerg Med Australas · Dec 2022
Observational StudyRocuronium ≤1.5 mg/kg versus >1.5 mg/kg and inadequate paralysis in prehospital and retrieval intubation: A retrospective study.
Greater Sydney Area Helicopter Emergency Medical Service encouraged an increased dose of rocuronium for rapid sequence intubations (RSIs) from 1.5 mg/kg to 2.0 mg/kg from the end of 2017 in response to a number of inadequately paralysed patients identified by our airway audit processes. Subsequent protocol change incorporated 2.0 mg/kg rocuronium. This retrospective observational study was undertaken to see if doses over 1.5 mg/kg rocuronium were associated with a reduction in the number of inadequately paralysed patients. ⋯ Although there were fewer inadequately paralysed patients with rocuronium doses >1.5 mg/kg, this did not reach statistical significance, presumably because of the low event rate. Further investigation into rocuronium dose for RSI is warranted.
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Pediatr Crit Care Me · Dec 2022
Pediatric Acute Lung Injury and Sepsis Investigators (PALISI): Evolution of an Investigator-Initiated Research Network.
The Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network originated over 20 years ago to foster research to optimize the care of critically ill infants and children. Over this period, PALISI has seen two major evolutions: formalization of our network infrastructure and a broadening of our clinical research focus. First, the network is unique in that its activities and meetings are funded by subscriptions from members who now comprise a multidisciplinary group of investigators from over 90 PICUs all over the United States (US) and Canada, with collaborations across the globe. ⋯ Second, our research investigations have expanded beyond the original focus on sepsis and acute lung injury, to incorporate the whole field of pediatric critical care, for example, efficient liberation from mechanical ventilator support, prudent use of blood products, improved safety of intubation practices, optimal sedation practices and glucose control, and pandemic research on influenza and COVID-19. Our network approach in each field follows, where necessary, the full spectrum of clinical and translational research, including: immunobiology studies for understanding basic pathologic mechanisms; surveys to explore contemporary clinical practice; consensus conferences to establish agreement about literature evidence; observational prevalence and incidence studies to measure scale of a clinical issue or question; case control studies as preliminary best evidence for design of definitive prospective studies; and, randomized controlled trials for informing clinical care. As a research network, PALISI and its related subgroups have published over 350 peer-reviewed publications from 2002 through September 2022.
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Randomized Controlled Trial
Standard and flexible tip bougie for tracheal intubation using a non-channelled hyperangulated videolaryngoscope: a randomised comparison.
Bougie impingement during tracheal intubation can increases the likelihood of prolonged intubation time, failed intubation and airway trauma. A flexible tip bougie may overcome this problem, which can occur when using a non-channelled, hyperangulated videolaryngoscope with a standard bougie. This randomised controlled study compared standard and flexible tip bougies using a non-channelled videolaryngoscope (C-MAC® D-blade) in 160 patients. ⋯ There was no significant differences in laryngoscopy time, total tracheal intubation time, first attempt success rate and postoperative sore throat between the two groups. Both the flexible tip and standard bougies can be used with a high first attempt success rate for tracheal intubation using a C-MAC D-blade videolaryngoscope. The flexible tip bougie demonstrated a significantly better modified intubation difficulty scale score and lower incidence of bougie impingement.
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Journal of anesthesia · Dec 2022
ReviewPreoxygenation: from hardcore physiology to the operating room.
If we define the human body by the mass of the elements that compose it, we could say that we are oxygen and other elements. Oxygen, in addition to being fundamental in our composition, is an element that we constantly need to support cellular respiration and, therefore, life. ⋯ Accordingly, the ability to induce the cessation of ventilation in a patient must be accompanied by different technical and non-technical skills that allow the patient's safety to be maintained in this highly vulnerable state. Through the use of basic mathematical tools and comparative physiology, we hereby propose to review the physiological foundations of preoxygenation to understand the reasons behind the clinical recommendations in this field.